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Zhao B, Chen S, Hong Y, Jia L, Zhou Y, He X, Wang Y, Tian Z, Yang Z, Gao D. Research Progress of Conjugated Nanomedicine for Cancer Treatment. Pharmaceutics 2022; 14:1522. [PMID: 35890416 PMCID: PMC9315807 DOI: 10.3390/pharmaceutics14071522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 12/05/2022] Open
Abstract
The conventional cancer therapeutic modalities include surgery, chemotherapy and radiotherapy. Although immunotherapy and targeted therapy are also widely used in cancer treatment, chemotherapy remains the cornerstone of tumor treatment. With the rapid development of nanotechnology, nanomedicine is believed to be an emerging field to further improve the efficacy of chemotherapy. Until now, there are more than 17 kinds of nanomedicine for cancer therapy approved globally. Thereinto, conjugated nanomedicine, as an important type of nanomedicine, can not only possess the targeted delivery of chemotherapeutics with great precision but also achieve controlled drug release to avoid adverse effects. Meanwhile, conjugated nanomedicine provides the platform for combining several different therapeutic approaches (chemotherapy, photothermal therapy, photodynamic therapy, thermodynamic therapy, immunotherapy, etc.) with the purpose of achieving synergistic effects during cancer treatment. Therefore, this review focuses on conjugated nanomedicine and its various applications in synergistic chemotherapy. Additionally, the further perspectives and challenges of the conjugated nanomedicine are also addressed, which clarifies the design direction of a new generation of conjugated nanomedicine and facilitates the translation of them from the bench to the bedside.
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Mehrabian A, Mashreghi M, Dadpour S, Badiee A, Arabi L, Hoda Alavizadeh S, Alia Moosavian S, Reza Jaafari M. Nanocarriers Call the Last Shot in the Treatment of Brain Cancers. Technol Cancer Res Treat 2022; 21:15330338221080974. [PMID: 35253549 PMCID: PMC8905056 DOI: 10.1177/15330338221080974] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Indexed: 12/12/2022] Open
Abstract
Our brain is protected by physio-biological barriers. The blood–brain barrier (BBB) main mechanism of protection relates to the abundance of tight junctions (TJs) and efflux pumps. Although BBB is crucial for healthy brain protection against toxins, it also leads to failure in a devastating disease like brain cancer. Recently, nanocarriers have been shown to pass through the BBB and improve patients’ survival rates, thus becoming promising treatment strategies. Among nanocarriers, inorganic nanocarriers, solid lipid nanoparticles, liposomes, polymers, micelles, and dendrimers have reached clinical trials after delivering promising results in preclinical investigations. The size of these nanocarriers is between 10 and 1000 nm and is modified by surface attachment of proteins, peptides, antibodies, or surfactants. Multiple research groups have reported transcellular entrance as the main mechanism allowing for these nanocarriers to cross BBB. Transport proteins and transcellular lipophilic pathways exist in BBB for small and lipophilic molecules. Nanocarriers cannot enter via the paracellular route, which is limited to water-soluble agents due to the TJs and their small pore size. There are currently several nanocarriers in clinical trials for the treatment of brain cancer. This article reviews challenges as well as fitting attributes of nanocarriers for brain tumor treatment in preclinical and clinical studies.
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Affiliation(s)
- Amin Mehrabian
- School of Pharmacy, Biotechnology Research Center, 37552Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, 37552Mashhad University of Medical Sciences, Mashhad, Iran.,Nanotechnology Research Center, Pharmaceutical Technology Institute, 37552Mashhad University of Medical Sciences, Mashhad, Iran.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Mohammad Mashreghi
- School of Pharmacy, 37552Mashhad University of Medical Sciences, Mashhad, Iran.,Nanotechnology Research Center, Pharmaceutical Technology Institute, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saba Dadpour
- School of Pharmacy, 37552Mashhad University of Medical Sciences, Mashhad, Iran.,Nanotechnology Research Center, Student Research Committee, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Badiee
- School of Pharmacy, 37552Mashhad University of Medical Sciences, Mashhad, Iran.,Nanotechnology Research Center, Pharmaceutical Technology Institute, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Arabi
- School of Pharmacy, 37552Mashhad University of Medical Sciences, Mashhad, Iran.,Nanotechnology Research Center, Pharmaceutical Technology Institute, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Hoda Alavizadeh
- School of Pharmacy, 37552Mashhad University of Medical Sciences, Mashhad, Iran.,Nanotechnology Research Center, Pharmaceutical Technology Institute, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Alia Moosavian
- School of Pharmacy, 37552Mashhad University of Medical Sciences, Mashhad, Iran.,Nanotechnology Research Center, Pharmaceutical Technology Institute, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Reza Jaafari
- School of Pharmacy, Biotechnology Research Center, 37552Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, 37552Mashhad University of Medical Sciences, Mashhad, Iran.,Nanotechnology Research Center, Pharmaceutical Technology Institute, 37552Mashhad University of Medical Sciences, Mashhad, Iran
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3
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Samare-Najaf M, Samareh A, Jamali N, Abbasi A, Clark CC, Khorchani MJ, Zal F. Adverse Effects and Safety of Etirinotecan Pegol, a Novel Topoisomerase Inhibitor, in Cancer Treatment: A Systematic Review. CCTR 2021. [DOI: 10.2174/1573394717666210202103502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Due to the increasing prevalence of cancer and the inadequacy of current
therapies, the development of novel antitumor pharmaceutics with higher efficacies and lower adverse
effects is considered a fundamental tenet of contemporary cancer management.
Poly-Ethylene-Glycol (PEG) attachment is a novel pharmaceutical technology to improve the efficacy
and safety of chemotherapies. Etirinotecan Pegol (EP), also known as NKTR-102, is the PEGylated
form of Irinotecan (CPT-11), which causes cancer cell apoptosis by inhibiting the
topoisomerase I enzyme.
Objectives:
The present study reviews and evaluates various reports of the EP’s anti-tumor activity
in various cancers.
Data Sources:
Studies were identified using the Scopus database, with no exclusions. The search
terms included Etirinotecan Pegol and NKTR-102, which yielded 125 articles (66 and 59 articles,
respectively). In addition, the clinicaltrials.gov website was used to find ongoing studies, which resulted
in the addition of two studies.
Study Eligibility Criteria:
Subsequently, we excluded studies that were published in languages
other than English, duplicate articles, and studies with no data.
Results:
This systematic review clarifies that EP possesses numerous advantages over many other
medications, such as safety, efficacy, increased half-life, increased health-related quality of life, increased
overall survival, increased progression-free survival, and decreasing the adverse events in
the treatment of various cancers.
Conclusion:
Therefore, Etirinotecan Pegol may represent a major contribution to the treatment of
various cancers in the future.
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Affiliation(s)
- Mohammad Samare-Najaf
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Samareh
- Department of Biochemistry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Navid Jamali
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Abbasi
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Cain C.T. Clark
- Centre for Intelligent Healthcare, Coventry University, CV1 5FB, United Kingdom
| | - Majid J. Khorchani
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Zal
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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4
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Affiliation(s)
- Marianne B. Ashford
- Advanced Drug Delivery Pharmaceutical Sciences, R&D, AstraZeneca Macclesfield SK10 2NA UK
| | - Richard M. England
- Advanced Drug Delivery Pharmaceutical Sciences, R&D, AstraZeneca Macclesfield SK10 2NA UK
| | - Nadim Akhtar
- New Modalities & Parenteral Development Pharmaceutical Technology & Development, Operations, AstraZeneca Macclesfield SK10 2NA UK
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5
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Norouzi M, Hardy P. Clinical applications of nanomedicines in lung cancer treatment. Acta Biomater 2021; 121:134-142. [PMID: 33301981 DOI: 10.1016/j.actbio.2020.12.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/21/2020] [Accepted: 12/03/2020] [Indexed: 12/22/2022]
Abstract
Lung cancer is the leading cause of cancer mortality worldwide. Owing to a lack of early-stage diagnosis, most lung cancers are detected in advanced stages, limiting the available therapeutic options. Moreover, extensive systemic chemotherapy of lung tumors is often associated with severe off-target toxicity and drug resistance of cancer cells, thus diminishing the outcomes of chemotherapy modalities. In this light, nanomedicines have opened an alternative avenue to develop more efficacious therapeutic platforms while addressing several current challenges. Clinical findings have revealed that nanomedicines improve the pharmacokinetics and biodistribution of the therapeutic agents while decreasing their systemic toxicity. This review provides an update on nanomedicines that have been clinically approved or are undergoing clinical trials for treatment of lung cancer. By discussing the clinical findings of the current nanoformulations, this review provides prospects for the development of more efficacious nanomedicines to improve the clinical outcomes of lung cancer treatment.
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Zhong W, Zhang X, Zeng Y, Lin D, Wu J. Recent applications and strategies in nanotechnology for lung diseases. Nano Res 2021; 14:2067-2089. [PMID: 33456721 PMCID: PMC7796694 DOI: 10.1007/s12274-020-3180-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/11/2020] [Accepted: 10/11/2020] [Indexed: 05/14/2023]
Abstract
Lung diseases, including COVID-19 and lung cancers, is a huge threat to human health. However, for the treatment and diagnosis of various lung diseases, such as pneumonia, asthma, cancer, and pulmonary tuberculosis, are becoming increasingly challenging. Currently, several types of treatments and/or diagnostic methods are used to treat lung diseases; however, the occurrence of adverse reactions to chemotherapy, drug-resistant bacteria, side effects that can be significantly toxic, and poor drug delivery necessitates the development of more promising treatments. Nanotechnology, as an emerging technology, has been extensively studied in medicine. Several studies have shown that nano-delivery systems can significantly enhance the targeting of drug delivery. When compared to traditional delivery methods, several nanoparticle delivery strategies are used to improve the detection methods and drug treatment efficacy. Transporting nanoparticles to the lungs, loading appropriate therapeutic drugs, and the incorporation of intelligent functions to overcome various lung barriers have broad prospects as they can aid in locating target tissues and can enhance the therapeutic effect while minimizing systemic side effects. In addition, as a new and highly contagious respiratory infection disease, COVID-19 is spreading worldwide. However, there is no specific drug for COVID-19. Clinical trials are being conducted in several countries to develop antiviral drugs or vaccines. In recent years, nanotechnology has provided a feasible platform for improving the diagnosis and treatment of diseases, nanotechnology-based strategies may have broad prospects in the diagnosis and treatment of COVID-19. This article reviews the latest developments in nanotechnology drug delivery strategies in the lungs in recent years and studies the clinical application value of nanomedicine in the drug delivery strategy pertaining to the lung.
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Affiliation(s)
- Wenhao Zhong
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107 China
| | - Xinyu Zhang
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107 China
| | - Yunxin Zeng
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107 China
| | - Dongjun Lin
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107 China
| | - Jun Wu
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107 China
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, 510006 China
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Si J, Zhao X, Gao S, Huang D, Sui M. Advances in delivery of Irinotecan (CPT-11) active metabolite 7-ethyl-10-hydroxycamptothecin. Int J Pharm 2019; 568:118499. [DOI: 10.1016/j.ijpharm.2019.118499] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/19/2022]
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Abstract
Polymer therapeutics encompasses polymer-drug conjugates that are nano-sized, multicomponent constructs already in the clinic as antitumor compounds, either as single agents or in combination with other organic drug scaffolds. Nanoparticle-based polymer-conjugated therapeutics are poised to become a leading delivery strategy for cancer treatments as they exhibit prolonged half-life, higher stability and selectivity, water solubility, longer clearance time, lower immunogenicity and antigenicity and often also specific targeting to tissues or cells. Compared to free drugs, polymer-tethered drugs preferentially accumulate in the tumor sites unlike conventional chemotherapy which does not discriminate between the cancer cells and healthy cells, thereby causing severe side-effects. It is also desirable that the drug reaches its site of action at a particular concentration and the therapeutic dose remains constant over a sufficiently long period of time. This can be achieved by opting for new formulations possessing polymeric systems of drug carriers. However, many challenges still remain unanswered in polymeric drug conjugates which need to be readdressed and therefore, can broaden the scope of this field. This review highlights some of the antitumor polymer therapeutics including polymer-drug conjugates, polymeric micelles, polymeric liposomes and other polymeric nanoparticles that are currently under investigation.
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Affiliation(s)
- Shazia Parveen
- Chemistry Department, Faculty of Science, Taibah University Yanbu Branch 46423 Yanbu Saudi Arabia +966 504522069
| | - Farukh Arjmand
- Department of Chemistry, Aligarh Muslim University Aligarh-202002 India
| | - Sartaj Tabassum
- Department of Chemistry, Aligarh Muslim University Aligarh-202002 India
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Wang S, Zimmermann S, Parikh K, Mansfield AS, Adjei AA. Current Diagnosis and Management of Small-Cell Lung Cancer. Mayo Clin Proc 2019; 94:1599-1622. [PMID: 31378235 DOI: 10.1016/j.mayocp.2019.01.034] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/05/2019] [Accepted: 01/31/2019] [Indexed: 12/25/2022]
Abstract
Small-cell lung cancer (SCLC) is an aggressive disease with distinct pathological, clinical, and molecular characteristics from non-small-cell lung cancer. SCLC has high metastatic potential, resulting in a clinically poor prognosis. Early concurrent chemo-radiation is the standard of care for limited-stage SCLC (LS-SCLC). Prophylactic cranial irradiation (PCI) is recommended for patients with LS-SCLC without progression of disease after initial therapy. A combination of etoposide and cisplatin or carboplatin remains the mainstay of first-line treatment for ES-SCLC, with the addition of atezolizumab, now becoming standard. Most SCLCs initially respond to therapy but almost invariably recur. Topotecan and amrubicin (in Japan) remain the primary chemotherapy options for relapsed SCLC. Immunotherapy, including nivolumab with or without ipilimumab, is now available for refractory disease. In general, the poor prognosis of SCLC has not improved significantly for more than 3 decades. Recently, next-generation molecular profiling studies have identified new therapeutic targets for SCLC. A variety of proapoptotic agents, compounds capitalizing on DNA-repair defects, immunotherapy agents, and antibody-drug conjugates are being evaluated in SCLC, with a number of them showing early promise.
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Affiliation(s)
- Shuhang Wang
- Peking University Cancer Hospital, Beijing, China
| | - Stefan Zimmermann
- Département d'Oncologie, service d'Immuno-Oncologie, CHUV, Lausanne, Switzerland
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Bardhi E, Marchetti C, Scopelliti A, Musacchio L, Tomao F, Schiavi M, Carraro C, Palaia I, Monti M, Muzii L, Benedetti Panici P. Etirinotecan pegol in women with recurrent platinum-resistant or refractory ovarian cancer. Expert Opin Investig Drugs 2019; 28:667-673. [PMID: 31353973 DOI: 10.1080/13543784.2019.1648430] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: A PEGylated form of irinotecan, a topoisomerase I inhibitor, is now available in commerce; its safety and efficacy have been tested in platinum resistant/refractory ovarian cancer (PROC) patients. This novel agent is known as Etirinotecan Pegol (EP). EP, like irinotecan, exerts its action through its principal metabolite SN-38. Areas covered: This drug evaluation article focuses on the most recent investigations and clinical progress regarding EP, a long-acting polymer conjugate of irinotecan for the treatment of PROC. Expert opinion: EP provides prolonged and continuous exposure of SN-38 in tumors, when compared to its parent drug irinotecan. Results from phase II studies are comparable in terms of efficacy to other agents of proven use in PROC. A limitation of the use of EP is the schedule-dependent toxicities (mainly diarrhea and dehydration). In the future, EP could be investigated in association with other agents, even in attempts to restore sensitivity to other treatments. PROC remains a very difficult setting and EP might be a valid agent for patients with good performance status that have exhausted therapeutic options. In such a setting, participation in clinical trials is strongly encouraged.
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Affiliation(s)
- Erlisa Bardhi
- a Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome , Policlinico Umberto I, Rome , Italy
| | - Claudia Marchetti
- a Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome , Policlinico Umberto I, Rome , Italy.,b Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS , Rome , Italy
| | - Annalisa Scopelliti
- a Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome , Policlinico Umberto I, Rome , Italy
| | - Lucia Musacchio
- a Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome , Policlinico Umberto I, Rome , Italy
| | - Federica Tomao
- a Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome , Policlinico Umberto I, Rome , Italy
| | - Michele Schiavi
- a Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome , Policlinico Umberto I, Rome , Italy
| | - Carlo Carraro
- a Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome , Policlinico Umberto I, Rome , Italy
| | - Innocenza Palaia
- a Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome , Policlinico Umberto I, Rome , Italy
| | - Marco Monti
- a Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome , Policlinico Umberto I, Rome , Italy
| | - Ludovico Muzii
- a Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome , Policlinico Umberto I, Rome , Italy
| | - Pierluigi Benedetti Panici
- a Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome , Policlinico Umberto I, Rome , Italy
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11
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Fontaine SD, Hann B, Reid R, Ashley GW, Santi DV. Species-specific optimization of PEG~SN-38 prodrug pharmacokinetics and antitumor effects in a triple-negative BRCA1-deficient xenograft. Cancer Chemother Pharmacol 2019; 84:729-738. [PMID: 31321449 DOI: 10.1007/s00280-019-03903-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/27/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Optimal efficacy of a macromolecular prodrug requires balancing the rate of drug release with the rate of prodrug elimination. Since circulating macromolecules have different elimination rates in different species, a prodrug optimal for one species will likely not be for another. The objectives of this work were (a) to develop an approach to optimize pharmacokinetics of a PEG~SN-38 prodrug in a particular species, (b) to use the approach to predict the pharmacokinetics of various prodrugs of SN-38 in the mouse and human, and (c) to develop a PEG~SN-38 conjugate that is optimized for mouse tumor models. METHODS We developed models that describe the pharmacokinetics of a drug released from a prodrug by the relationship between the rates of drug release and elimination of the prodrug. We tested the model by varying the release rate of SN-38 from PEG~SN-38 conjugates in the setting of a constant prodrug elimination rate in the mouse. Finally, we tested the antitumor efficacy of a PEG~SN-38 optimized for the mouse. RESULTS Optimization of a PEG~SN-38 prodrug was achieved by adjusting the rate of SN-38 release such that the ratio of t1/2,β of released SN-38 to the t1/2 of prodrug elimination was 0.2-0.8. Using this approach, we could rationalize the efficacy of previous PEGylated SN-38 prodrugs in the mouse and human. Finally, a mouse-optimized PEG~SN-38 showed remarkable antitumor activity in BRCA1-deficient MX-1 xenografts; a single dose gave tumor regression, suppression, and shrinkage of massive tumors. CONCLUSIONS The efficacy of a macromolecular prodrug can be optimized for a given species by balancing the rate of drug release from the carrier with the rate of prodrug elimination.
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Affiliation(s)
- Shaun D Fontaine
- ProLynx, 455 Mission Bay Boulevard South, Suite 341, San Francisco, CA, 94158, USA
| | - Byron Hann
- University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA
| | - Ralph Reid
- ProLynx, 455 Mission Bay Boulevard South, Suite 341, San Francisco, CA, 94158, USA
| | - Gary W Ashley
- ProLynx, 455 Mission Bay Boulevard South, Suite 341, San Francisco, CA, 94158, USA
| | - Daniel V Santi
- ProLynx, 455 Mission Bay Boulevard South, Suite 341, San Francisco, CA, 94158, USA.
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12
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Jeibouei S, Akbari ME, Kalbasi A, Aref AR, Ajoudanian M, Rezvani A, Zali H. Personalized medicine in breast cancer: pharmacogenomics approaches. Pharmgenomics Pers Med 2019; 12:59-73. [PMID: 31213877 PMCID: PMC6549747 DOI: 10.2147/pgpm.s167886] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/27/2019] [Indexed: 12/14/2022]
Abstract
Abstract: Breast cancer is the fifth cause of cancer death among women worldwide and represents a global health concern due to the lack of effective therapeutic regimens that could be applied to all disease groups. Nowadays, strategies based on pharmacogenomics constitute novel approaches that minimize toxicity while maximizing drug efficacy; this being of high importance in the oncology setting. Besides, genetic profiling of malignant tumors can lead to the development of targeted therapies to be included in effective drug regimens. Advances in molecular diagnostics have revealed that breast cancer is a multifaceted disease, characterized by inter-tumoral and intra-tumoral heterogeneity and, unlike the past, molecular classifications based on the expression of individual biomarkers have led to devising novel therapeutic strategies that improve patient survival. In this review, we report and discuss the molecular classification of breast cancer subtypes, the heterogeneity resource, and the advantages and disadvantages of current drug regimens with consideration of pharmacogenomics in response and resistance to treatment.
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Affiliation(s)
- Shabnam Jeibouei
- Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Alireza Kalbasi
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Amir Reza Aref
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mohammad Ajoudanian
- Department of Tissue Engineering and Applied Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Rezvani
- Department of Hematology, Medical Oncology and Stem Cell Transplantation, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hakimeh Zali
- Proteomics Research Centre, Department of Tissue Engineering and Applied Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim N, Rugo HS, Twelves C, Dieras V, Müller V, Tagliaferri M, Hannah AL, Cortés J. ATTAIN: Phase III study of etirinotecan pegol versus treatment of physician's choice in patients with metastatic breast cancer and brain metastases. Future Oncol 2019; 15:2211-2225. [PMID: 31074641 DOI: 10.2217/fon-2019-0180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/14/2022] Open
Abstract
The increasing incidence of breast cancer brain metastases is a major clinical problem with its associated poor prognosis and limited treatment options. The long-acting topoisomerase-1 inhibitor, etirinotecan pegol, was designed to preferentially accumulate in tumor tissue including brain metastases, providing sustained cytotoxic SN38 levels. Motivated by improved survival findings from subgroup analyses from the Phase III BEACON trial, this ongoing randomized, Phase III trial compares etirinotecan pegol to drugs commonly used for advanced breast cancer in patients with stable, treated breast cancer brain metastases who have been previously treated with an anthracycline, taxane and capecitabine. The primary end point is overall survival. Secondary end points include objective response rate, progression-free survival and time to CNS disease progression or recurrence in patients with/without CNS lesions present at study entry. Trial registration number: NCT02915744.
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Affiliation(s)
- Debu Tripathy
- The University of Texas MD Anderson Cancer Center, Department of Breast Medical Oncology, Houston, TX 77030, USA
| | - Sara M Tolaney
- Dana-Farber Cancer Institute, Center for Women's Cancers, Boston, MA 02215, USA
| | - Andrew D Seidman
- Memorial Sloan-Kettering Cancer Center, Bobst International Center, New York, NY 10065, USA
| | - Carey K Anders
- University of North Carolina School of Medicine, Duke Cancer Center, Chapel Hill, NC 27710, USA
| | - Nuhad Ibrahim
- The University of Texas MD Anderson Cancer Center, Department of Breast Medical Oncology, Houston, TX 77030, USA
| | - Hope S Rugo
- University of California San Francisco, Department of Medicine (Hematology/Oncology), San Francisco, CA 94115, USA
| | - Chris Twelves
- University of Leeds, Leeds Institute of Cancer and Pathology (LICAP), Leeds, LS2 9JT, UK.,St James' University Hospital, Institute of Oncology, Leeds, LS9 7BE, UK
| | - Veronique Dieras
- Institut Curie, Oncological Medicine Department, 75248, Paris, France
| | - Volkmar Müller
- University Medical Center Hamburg-Eppendorf, Department of Obstetrics and Gynecology, 20246 Hamburg, Germany
| | | | | | - Javier Cortés
- IOB Institute of Oncology, Quironsalud Group, 28034 Madrid & 08023 Barcelona, Spain.,Vall d'Hebron Institute of Oncology (VHIO), Breast Cancer and Melanoma Group, 08035 Barcelona, Spain
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14
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Abstract
Introduction: PEGylation is a well-established technology for improving the therapeutic value of drugs by attaching polyethylene glycol (PEG). The first PEGylated enzyme products appeared on the market in the early 1990s; currently, more than 18 PEGylated products have been approved by Food and Drug Administration, which encompass various classes of drug molecules, such as enzymes, interferons, granulocyte colony-stimulating factors, hormones, antibody fragments, coagulation factors, oligonucleotide aptamers, synthetic peptides, and small organic molecules. Areas covered: While PEGylated products mainly comprise biologic drugs, such as recombinant proteins and enzymes, non-biologic drugs have recently emerged as a target for PEGylation. This review focuses on the recent development of PEGylated non-biologic drugs, such as small organic molecules, synthetic peptides, and aptamers. Expert opinion: Several PEGylated versions of anti-cancer drugs, opioid agonists, glucagon-like peptide-1 receptor agonists, and oligonucleotide aptamers are in active development stage, and it is likely that they will have a dramatic impact on the market. Although some safety concerns about PEG in clinical trials have been recently issued, PEGylation is still a commercially attractive proposition as a half-life extension technology for long-acting drug development.
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Affiliation(s)
- Eun Ji Park
- a College of Pharmacy , Chung-Ang University , Seoul , Republic of Korea.,b D&D Pharmatech , Seongnam , Republic of Korea
| | - Jiyoung Choi
- a College of Pharmacy , Chung-Ang University , Seoul , Republic of Korea
| | - Kang Choon Lee
- b D&D Pharmatech , Seongnam , Republic of Korea.,c College of Pharmacy , SungKyunKwan University , Suwon , Republic of Korea
| | - Dong Hee Na
- a College of Pharmacy , Chung-Ang University , Seoul , Republic of Korea
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Abstract
Lung cancer is an umbrella term for a subset of heterogeneous diseases that are collectively responsible for the most cancer-related deaths worldwide. Despite the tremendous progress made in understanding lung tumour biology, advances in early diagnosis, multimodal therapy and deciphering molecular mechanisms of drug resistance, overall curative outcomes remain low, especially in metastatic disease. Nanotechnology, in particular nanoparticles (NPs), continue to progressively impact the way by which tumours are diagnosed and treated. The unique physicochemical properties of materials at the nanoscale grant access to a diverse molecular toolkit that can be manipulated for use in respiratory oncology. This realisation has resulted in several clinically approved NP formulations and many more in clinical trials. However, NPs are not a panacea and have yet to be utilised to maximal effect in lung cancer, and medicine in a wider context. This review serves to: describe the complexity of lung cancer, the current diagnostic and therapeutic environment, and highlight the recent advancements of nanotechnology based approaches in diagnosis and treatment of respiratory malignancies. Finally, a brief outlook on the future directions of nanomedicine is provided; presently the full potential of the field is yet to be realised. By gleaning lessons and integrating advancements from neighbouring disciplines, nanomedicine can be elevated to a position where the current barriers that stymie full clinical impact are lifted.
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Kotecki N, Lefranc F, Devriendt D, Awada A. Therapy of breast cancer brain metastases: challenges, emerging treatments and perspectives. Ther Adv Med Oncol 2018; 10:1758835918780312. [PMID: 29977353 PMCID: PMC6024336 DOI: 10.1177/1758835918780312] [Citation(s) in RCA: 29] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 04/25/2018] [Indexed: 02/06/2023] Open
Abstract
Brain metastases are the most common central nervous system tumors in adults, and incidence of brain metastases is increasing due to both improved diagnostic techniques (e.g. magnetic resonance imaging) and increased cancer patient survival through advanced systemic treatments. Outcomes of patients remain disappointing and treatment options are limited, usually involving multimodality approaches. Brain metastases represent an unmet medical need in solid tumor care, especially in breast cancer, where brain metastases are frequent and result in impaired quality of life and death. Challenges in the management of brain metastases have been highlighted in this review. Innovative research and treatment strategies, including prevention approaches and emerging systemic treatment options for brain metastases of breast cancer, are further discussed.
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Affiliation(s)
- Nuria Kotecki
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Florence Lefranc
- Department of Neurosurgery, Hopital Erasme, Université Libre de Bruxelles, Belgium
| | - Daniel Devriendt
- Department of Radiotherapy, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Ahmad Awada
- Medical Oncology Clinic, Institut Jules Bordet, 1 rue Heger Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Prasad Tharanga Jayasooriya RG, Dilshara MG, Neelaka Molagoda IM, Park C, Park SR, Lee S, Choi YH, Kim GY. Camptothecin induces G 2/M phase arrest through the ATM-Chk2-Cdc25C axis as a result of autophagy-induced cytoprotection: Implications of reactive oxygen species. Oncotarget 2018; 9:21744-57. [PMID: 29774099 DOI: 10.18632/oncotarget.24934] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 02/28/2018] [Indexed: 11/25/2022] Open
Abstract
In the present study, we report that camptothecin (CPT) caused irreversible cell cycle arrest at the G2/M phase, and was associated with decreased levels of cell division cycle 25C (Cdc25C) and increased levels of cyclin B1, p21, and phospho-H3. Interestingly, the reactive oxygen species (ROS) inhibitor, glutathione, decreased CPT-induced G2/M phase arrest and moderately induced S phase arrest, indicating that the ROS is required for the regulation of CPT-induced G2/M phase arrest. Furthermore, transient knockdown of nuclear factor-erythroid 2-related factor 2 (Nrf2), in the presence of CPT, increased the ROS’ level and further shifted the cell cycle from early S phase to the G2/M phase, indicating that Nrf2 delayed the S phase in response to CPT. We also found that CPT-induced G2/M phase arrest increased, along with the ataxia telangiectasia-mutated (ATM)-checkpoint kinase 2 (Chk2)-Cdc25C axis. Additionally, the proteasome inhibitor, MG132, restored the decrease in Cdc25C levels in response to CPT, and significantly downregulated CPT-induced G2/M phase arrest, suggesting that CPT enhances G2/M phase arrest through proteasome-mediated Cdc25C degradation. Our data also indicated that inhibition of extracellular signal-regulated kinase (ERK) and c-Jun N-terminal kinase (JNK) inhibited CPT-induced p21 and cyclin B1 levels; however, inhibition of ERK blocked CPT-induced G2/M phase arrest, and inhibition of JNK enhanced apoptosis in response to CPT. Finally, we found that CPT-induced G2/M phase arrest circumvented apoptosis by activating autophagy through ATM activation. These findings suggest that CPT-induced G2/M phase arrest through the ROS-ATM-Chk2-Cdc25C axis is accompanied by the activation of autophagy.
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Rugo HS, Cortes J, Awada A, O'Shaughnessy J, Twelves C, Im SA, Hannah A, Lu L, Sy S, Caygill K, Zajchowski DA, Davis DW, Tagliaferri M, Hoch U, Perez EA. Change in Topoisomerase 1-Positive Circulating Tumor Cells Affects Overall Survival in Patients with Advanced Breast Cancer after Treatment with Etirinotecan Pegol. Clin Cancer Res 2018; 24:3348-3357. [PMID: 29618616 DOI: 10.1158/1078-0432.ccr-17-3059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/10/2018] [Accepted: 03/26/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Preplanned exploratory analyses were performed to identify biomarkers in circulating tumor cells (CTC) predictive of response to the topoisomerase 1 inhibitor etirinotecan pegol (EP).Experimental Design: The BEACON trial treated patients with metastatic breast cancer (MBC) with EP or treatment of physician's choice (TPC). Blood from 656 of 852 patients (77%) was processed with ApoStream to enrich for CTCs. A multiplex immunofluorescence assay measured expression of candidate response biomarkers [topoisomerase 1 (Top1), topoisomerase 2 (Top2), Ki67, RAD51, ABCG2, γH2AX, and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL)] in CTCs. Patients were classified as Top1 low (Top1Lo) or Top1 high (Top1Hi) based on median CTC Top1 expression. Correlation of CTC biomarker expression at baseline, cycle 2 day 1 (C2D1), and cycle 4 day 1 with overall survival (OS) was investigated using Cox regression and Kaplan-Meier analyses.Results: Overall, 98% of samples were successfully processed, of which 97% had detectable CTCs (median, 47-63 CTCs/mL; range, 0-2,020 CTCs/mL). Top1, Top2, and TUNEL expression was detected in 52% to 90% of samples; no significant associations with OS were observed in pretreatment samples for either group. EP-treated patients with low C2D1Top1+ CTCs had improved OS compared with those with higher positivity (14.1 months vs. 11.0 months, respectively; HR, 0.7; P = 0.02); this difference was not seen in TPC-treated patients (HR, 1.12; P = 0.48). Patients whose CTCs decreased from Top1Hi to Top1Lo at C2D1 had the greatest OS benefit from EP (HR, 0.57; P = 0.01).Conclusions: CTC Top1 expression following EP treatment may identify patients with MBC most likely to have an OS benefit. Clin Cancer Res; 24(14); 3348-57. ©2018 AACR.
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Affiliation(s)
- Hope S Rugo
- University of California, San Francisco, San Francisco, California
| | - Javier Cortes
- Ramon y Cajal University Hospital, Madrid, and Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Ahmad Awada
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Joyce O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, Texas
| | - Chris Twelves
- University of Leeds and Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | | | - Lin Lu
- Nektar Therapeutics, San Francisco, California
| | - Sherwin Sy
- Nektar Therapeutics, San Francisco, California
| | | | | | | | | | - Ute Hoch
- Nektar Therapeutics, San Francisco, California.
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Sy SKB, Chia YL, Gordi T, Hoch U, Eldon MA. Integrated population pharmacokinetics of etirinotecan pegol and its four metabolites in cancer patients with solid tumors. Cancer Chemother Pharmacol 2018; 81:897-909. [PMID: 29564497 DOI: 10.1007/s00280-018-3562-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/13/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Etirinotecan pegol (EP), a long-acting topoisomerase-1 inhibitor, is a polyethylene glycol conjugate of irinotecan, with an intended indication for treatment of breast cancer with brain metastases. The objective of this study was to develop a population pharmacokinetic (popPK) model of EP and four of its metabolites (irinotecan, SN38, SN38-glucuronide, and APC) and determine covariates affecting their pharmacokinetics. METHODS Data from 83 cancer patients enrolled in phase 1 studies were used. The model was developed in two stages: (1) concentration-time data were analyzed with a 3-analyte model for EP, irinotecan, and SN38; and (2) a 5-analyte model developed based on expansion of 3-analyte model to include concentration-time data for SN38 glucuronide and APC with parameter values from 3-analyte model fixed. Covariate relationships with parameters were selected based on Wald's test within the Wald's Approximation Method approach, first for the 3-analyte model then the 5-analyte model. RESULTS The final integrated popPK model for the five analytes was a two-compartment per analyte model that followed the metabolic cascade of EP to irinotecan, followed by metabolism of irinotecan to the previously known metabolites, but with altered exposures as compared to administration of irinotecan. With the model developed based on total dose of EP, the population estimates of EP clearance and central volume were 0.237 L/h and 5.5 L, respectively. Patient age, body surface area (BSA), and estimated glomerular filtration rate were found to correlate with EP clearance and BSA with EP central volume. Individuals who were homozygous for UGT1A1*28 genotype had modestly reduced elimination capacity of SN38 compared to heterozygous and wild-type genotypes. Simulations evaluating the clinical importance of significant covariates indicated minimal change in areas under the curve and peak concentrations of EP and SN38. CONCLUSIONS The pharmacokinetics of EP and four metabolites including the active metabolite SN38 were described by an integrated popPK model. Other than BSA, which was already accounted by a BSA-based dosing scheme, no other covariates were deemed to have clinical implications. No EP starting dose adjustment based on patient demographics and other covariates was deemed necessary.
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Lenz HJ, Philip P, Saunders M, Kolevska T, Mukherjee K, Samuel L, Bondarde S, Dobbs T, Tagliaferri M, Hoch U, Hannah AL, Berkowitz M. Randomized study of etirinotecan pegol versus irinotecan as second-line treatment for metastatic colorectal cancer. Cancer Chemother Pharmacol 2017; 80:1161-1169. [PMID: 29043412 DOI: 10.1007/s00280-017-3438-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/19/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Etirinotecan pegol (EP) is a long-acting topoisomerase-I inhibitor designed to provide sustained exposure to SN-38 (active metabolite of irinotecan). This phase II study compared EP versus irinotecan as second-line treatment for KRAS-mutant, irinotecan-naïve, metastatic colorectal cancer (mCRC). METHODS Patients were randomized to EP 145 mg/m2 or irinotecan 350 mg/m2 Q21d until disease progression/unacceptable toxicity. The primary endpoint was progression-free survival (PFS) with response determined by central radiologic review (RECIST version 1.1). RESULTS The study was terminated before completing accrual due to evolving standards of care. Eighty-three patients were randomized. Median PFS was longer with EP versus irinotecan (4.0 versus 2.8 months, respectively; HR 0.65; 95% CI 0.40-1.04; P = 0.07). Six-month PFS rates were 32.8 and 15.4%, respectively. Median OS was 9.6 and 8.4 months in EP and irinotecan arms, respectively (HR 0.91; 95% CI 0.56-1.49). ORRs were 10 and 5%, respectively (P = 0.676); median DOR was significantly longer in EP arm (7.9 versus 1.4 months; P = 0.018). The most common grade-3/4 adverse events for EP and irinotecan were diarrhea (21 vs 20%), neutropenia (10 vs 22%), abdominal pain (14 vs 5%), nausea (14 vs 2%), and vomiting (12 vs 7%), respectively. CONCLUSION EP is active and safe for second-line treatment of KRAS-mutant, irinotecan-naïve mCRC.
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Affiliation(s)
- Heinz-Josef Lenz
- USC Norris Comprehensive Cancer Center, 1441 Eastlake Ave Rm 3456, Los Angeles, CA, 90089-9173, USA.
| | - Philip Philip
- Barbara Ann Karmanos Cancer Institute, 4th Fl, HWCRC 4100 John R Detroit, Detroit, MI, 48201, USA.,Wayne State University, Detroit, MI, USA
| | - Mark Saunders
- Christie Hospital NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Tatjana Kolevska
- Kaiser Permanente Medical Center, 2nd Floor, Hallway C, 975 Sereno Drive, Vallejo, CA, 94589, USA
| | - Kalyan Mukherjee
- Chittaranjan National Cancer Institute, 37 Shyama Prasad Mukherjee Road, Bhawanipur, Kolkata, West Bengal, 700026, India
| | - Leslie Samuel
- ANCHOR Unit Clinic D, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK
| | - Shailesh Bondarde
- Shatabdi Super Specialty Hospital, Suyojit City Center, Mumbai Naka, Nashik, 422 005, India
| | - Tracy Dobbs
- Tennessee Cancer Specialists, 1415 Old Weisgarser Road, Knoxville, TN, 37909-1292, USA
| | - Mary Tagliaferri
- Nektar Therapeutics, 455 Mission Bay Boulevard South, San Francisco, CA, 94158, USA
| | - Ute Hoch
- Nektar Therapeutics, 455 Mission Bay Boulevard South, San Francisco, CA, 94158, USA
| | - Alison L Hannah
- Nektar Therapeutics, 455 Mission Bay Boulevard South, San Francisco, CA, 94158, USA
| | - Maurice Berkowitz
- UCLA Geffen School of Medicine, 201 S. Buena Vista Street, Suite 200, Burbank, CA, 91505, USA
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Aggarwal C, Cohen RB, Yu E, Hwang WT, Bauml JM, Alley E, Evans TL, Langer CJ. Etirinotecan Pegol (NKTR-102) in Third-line Treatment of Patients With Metastatic or Recurrent Non-Small-cell Lung Cancer: Results of a Phase II Study. Clin Lung Cancer 2018; 19:157-62. [PMID: 29129435 DOI: 10.1016/j.cllc.2017.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Third-line treatment options are limited for patients with metastatic non-small-cell lung cancer (NSCLC). Etirinotecan pegol (NKTR-102) is a long-acting topoisomerase-I inhibitor. We conducted a single-arm phase II trial to evaluate its efficacy in third-line treatment. PATIENTS AND METHODS Patients aged ≥ 18 years with histologically proven NSCLC who had received 2 previous systemic therapy regimens, measurable disease, Eastern Cooperative Oncology Group (ECOG) performance status ≤ 1, and adequate end-organ function were eligible. Etirinotecan pegol was administered at a dose of 145 mg/m2 intravenously once every 3 weeks until progression. The response was assessed every 6 weeks using Response Evaluation Criteria In Solid Tumors, version 1.1. The primary endpoint was the overall objective response rate. The secondary endpoints included progression-free survival (PFS), overall survival (OS) and safety. A Simon 2-stage design was implemented for futility. RESULTS From January 2013 to January 2015, 40 patients were enrolled. Their median age was 66 years (range, 19-85 years), 45% were female, 30% had an ECOG performance status of 0, 96% were current and former smokers, and 31 had adenocarcinoma. Patients received a median of 3 cycles (range, 2-15) of protocol therapy. The best response was a partial response in 2 patients. The treatment was well tolerated; 3 patients had grade 3 gastrointestinal toxicity attributable to therapy. The median PFS was 2.3 months (95% confidence interval [CI], 1.3-4.4 months), and the median OS was 7.1 months (95% CI 4.2-11.4 months). CONCLUSIONS Etirinotecan pegol was well tolerated and led to 2 partial responses and disease stabilization with this third-line treatment of metastatic NSCLC. However, the study failed to meet its prespecified response rate endpoint.
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Rustin G, Vergote I, Micha JP, Duska LR, Reed N, Bendell J, Spitz D, Dark G, Hoch U, Tagliaferri M, Hannah AL, Garcia AA. A multicenter, open-label, expanded phase 2 study to evaluate the safety and efficacy of etirinotecan pegol, a polymer conjugate of irinotecan, in women with recurrent platinum-resistant or refractory ovarian cancer. Gynecol Oncol 2017; 147:276-282. [PMID: 28935273 DOI: 10.1016/j.ygyno.2017.08.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/22/2017] [Revised: 08/15/2017] [Accepted: 08/24/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Etirinotecan pegol (EP) is a novel polyethylene glycol conjugated form of irinotecan with documented activity in platinum-resistant ovarian cancer (PROC). We report the results of the expanded portion of a phase II study of EP in patients with PROC who received prior pegylated liposomal doxorubicin (PLD) or who were unable to receive it. METHODS This multicenter, open-label, phase II study evaluated EP q21d for PROC. The primary endpoint was objective response rate (ORR) by Response Evaluation Criteria in Solid Tumors version 1.0. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and safety. Patient populations evaluated included a modified intent-to-treat (mITT) group consisting of all patients who received at least one dose and with measurable disease and a primary efficacy (pEFF) group (subset of the mITT population who received prior PLD). RESULTS One hundred thirty-nine patients were enrolled. Of the 132 patients in the mITT group, 20 achieved an ORR (15.2%; 95% CI 9.5-22.4); median PFS and OS were 4.4 months and 10.2 months, respectively. In the pEFF group (n=104), 15 patients (14.4%; 95% CI 8.3-22.7) achieved an ORR; median PFS and OS were 4.4 months and 10.9 months, respectively. The most common grade 3/4 toxicities were diarrhea (20%), abdominal pain (17%), vomiting (14%), dehydration (13%), and nausea (13%). Severe diarrhea was reduced to 15% with strict adherence to screening and management guidelines. CONCLUSIONS This study confirms the activity and safety of single-agent EP in patients with PROC, including patients who received prior PLD. Further evaluation earlier in the disease course and in combination is warranted.
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Affiliation(s)
- G Rustin
- Mount Vernon Hospital, Middlesex, United Kingdom
| | - I Vergote
- Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - J P Micha
- Gynecologic Oncology Associates, Newport Beach, CA, USA
| | - L R Duska
- University of Virginia Health System, Division of Gynecologic Oncology, Charlottesville, VA, USA
| | - N Reed
- Beatson West of Scotland Cancer Centre, Gartnavel General Hospital, Glasgow, United Kingdom
| | - J Bendell
- Tennessee Oncology, PLLC, Sarah Cannon Research Institute, Nashville, TN, USA
| | - D Spitz
- Palm Beach Cancer Institute, West Palm Beach, FL, USA
| | - G Dark
- Freemen Hospital, High Heaton, Newcastle-upon-Tyne, United Kingdom
| | - U Hoch
- Nektar Therapeutics, San Francisco, CA, USA
| | | | - A L Hannah
- Nektar Therapeutics, San Francisco, CA, USA
| | - A A Garcia
- USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, CA, USA; LSU Stanley S. Scott Cancer Center, New Orleans, LA, USA.
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Twelves C, Cortés J, O'Shaughnessy J, Awada A, Perez EA, Im S, Gómez-Pardo P, Schwartzberg LS, Diéras V, Yardley DA, Potter DA, Mailliez A, Moreno-Aspitia A, Ahn JS, Zhao C, Hoch U, Tagliaferri M, Hannah AL, Rugo HS. Health-related quality of life in patients with locally recurrent or metastatic breast cancer treated with etirinotecan pegol versus treatment of physician's choice: Results from the randomised phase III BEACON trial. Eur J Cancer 2017; 76:205-215. [DOI: 10.1016/j.ejca.2017.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 01/10/2017] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
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England RM, Hare JI, Barnes J, Wilson J, Smith A, Strittmatter N, Kemmitt PD, Waring MJ, Barry ST, Alexander C, Ashford MB. Tumour regression and improved gastrointestinal tolerability from controlled release of SN-38 from novel polyoxazoline-modified dendrimers. J Control Release 2017; 247:73-85. [DOI: 10.1016/j.jconrel.2016.12.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/20/2016] [Accepted: 12/29/2016] [Indexed: 12/11/2022]
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Sy SK, Sweeney TD, Ji C, Hoch U, Eldon MA. Etirinotecan pegol administration is associated with lower incidences of neutropenia compared to irinotecan administration. Cancer Chemother Pharmacol 2016; 79:57-67. [PMID: 27904955 PMCID: PMC5225190 DOI: 10.1007/s00280-016-3192-6] [Citation(s) in RCA: 5] [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: 10/06/2016] [Accepted: 11/04/2016] [Indexed: 11/30/2022]
Abstract
Purpose The relationship between incidences of neutropenia and 10-hydroxy-7-ethyl camptothecin (SN38) exposure was explored using SN38 pharmacokinetic and neutrophil count data from toxicology studies of etirinotecan pegol (EP) and irinotecan in beagle dogs. Methods Dogs received four weekly intravenous infusions of either vehicle control (n = 22), EP (6, 15, 20, 25, 40/25 mg/kg; n = 3–9 dogs/dose group/sex; n = 48), or irinotecan (20 or 25 mg/kg n = 3–4 dogs/dose group/sex; n = 14). Blood samples were collected up to 50 days post-dose for characterization of SN38 pharmacokinetics. Two separate models were created describing SN38 concentration time profiles after either irinotecan or EP administrations to project the AUC0–168h after Day 1 and Day 22 doses. The relationship between incidence of neutropenia and SN38 exposure was explored using logistic regression. Results The incidence of neutropenia in dogs receiving weekly doses of irinotecan or EP was strongly correlated with maximum plasma SN38 concentration (Cmax), but not SN38 area under the concentration–time curve (AUC). Neutropenia occurred in approximately 80% of dogs receiving irinotecan (mean SN38 Cmax of 13.5 and 26.3 ng/mL for 20 and 25 mg/kg, respectively). No neutropenia occurred in dogs receiving EP at doses up to and including 25 mg/kg (mean SN38 Cmax of 3.4 and 4.9 ng/mL for 20 and 25 mg/kg, respectively), despite 2.5–3.6 times greater SN38 AUC after EP compared to irinotecan at equivalent doses. Conclusions EP administration avoids both high SN38 Cmax values and development of dose-limiting neutropenia observed after irinotecan, while maintaining greater and sustained SN38 exposure between doses. Electronic supplementary material The online version of this article (doi:10.1007/s00280-016-3192-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Kenneth Sy
- Department of Clinical Pharmacology, Nektar Therapeutics, 455 Mission Bay Boulevard South, San Francisco, CA, 94158, USA
| | - Theresa D Sweeney
- Department of Toxicology, Nektar Therapeutics, San Francisco, CA, USA
| | - Chunmei Ji
- Department of Toxicology, Nektar Therapeutics, San Francisco, CA, USA
| | - Ute Hoch
- Department of Clinical Pharmacology, Nektar Therapeutics, 455 Mission Bay Boulevard South, San Francisco, CA, 94158, USA.
| | - Michael A Eldon
- Department of Clinical Pharmacology, Nektar Therapeutics, 455 Mission Bay Boulevard South, San Francisco, CA, 94158, USA
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Cortés J, Rugo HS, Twelves C, Awada A, Perez EA, Im SA, Zhao C, Hoch U, Tomkinson D, Buchanan J, Tagliaferri M, Hannah A, O'Shaughnessy J. Safety and tolerability of etirinotecan pegol in advanced breast cancer: analysis of the randomized, phase 3 BEACON trial. Springerplus 2016; 5:1033. [PMID: 27441152 PMCID: PMC4938835 DOI: 10.1186/s40064-016-2446-4] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/27/2016] [Indexed: 11/29/2022]
Abstract
Purpose New treatments with novel mechanisms of action and non-overlapping toxicities are needed for patients with metastatic breast cancer. Etirinotecan pegol (EP) is a long-acting topoisomerase-I inhibitor with a unique toxicity profile. The randomized phase 3 BEACON study that compared EP to treatment of physician’s choice (TPC) demonstrated its clinical activity. We now present detailed safety data from the BEACON trial. Methods Patients with locally recurrent or metastatic breast cancer who had received at least two prior cytotoxic regimens for advanced disease were randomized to EP or TPC. Prior treatment with an anthracycline, a taxane and capecitabine was required. The frequencies of treatment-emergent AEs (TEAEs) and serious TEAEs were evaluated for the safety population, comprising all patients who received at least one dose of assigned treatment. Results A total of 831 patients were evaluated (n = 425, EP; n = 406, TPC). Compared with TPC, EP was associated with a slightly higher median relative dose intensity (98.3 vs. 92.8 %, respectively) and significantly fewer grade ≥3 toxicities (48.0 vs. 63.1 %, P < 0.0001). The most commonly reported grade ≥3 toxicities in the EP arm were diarrhea (9.6 %) and neutropenia (9.6 %) and in the TPC arm, neutropenia (30.8 %). Median time to onset of grade ≥3 diarrhea was delayed with EP relative to TPC (43 vs. 7 days, respectively). Conclusions The differentiated mechanism of action of EP resulted in a safety profile that is substantially distinguished from that of current widely used therapies for the treatment of women with advanced breast cancer.
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Affiliation(s)
- Javier Cortés
- Ramon y Cajal University Hospital, Madrid, Spain ; Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron 119-129, Barcelona, Spain
| | - Hope S Rugo
- University of California, San Francisco, CA USA
| | - Chris Twelves
- St. James's University Hospital, University of Leeds, Leeds, UK
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | | | - Seock-Ah Im
- Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Carol Zhao
- Nektar Therapeutics, San Francisco, CA USA
| | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA USA
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Twelves C, Jove M, Gombos A, Awada A. Cytotoxic chemotherapy: Still the mainstay of clinical practice for all subtypes metastatic breast cancer. Crit Rev Oncol Hematol 2016; 100:74-87. [DOI: 10.1016/j.critrevonc.2016.01.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/24/2015] [Accepted: 01/20/2016] [Indexed: 01/15/2023] Open
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Abstract
The identification of additional chemotherapy agents for anthracycline- and taxane-pretreated advanced breast cancer (ABC) is an urgent medical need. Single agent chemotherapy is most times administered because combined therapy is only associated with modest, if any, improvement in median progression-free survival. Randomized trials failed to show overall survival benefit compared with single agent chemotherapy. We hope to modify the natural history of ABC by the consecutive use of treatments with documented activity in heavily pretreated patients. Quality of life remains an important end point as cure is in general not possible. We first review the activity of the approved and the most frequently used agents in heavily pretreated ABC. Thereafter, the potential role and safety profile of etirinotecan pegol is discussed given the results recently released of a Phase III trial comparing this agent to Treatment of Physician's Choice.
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Affiliation(s)
- Guy Jerusalem
- Medical Oncology CHU Sart Tilman Liege & Liege University, Domaine Universitaire du Sart Tilman, B35, 4000 Liege, Belgium
| | - Andrée Rorive
- Medical Oncology CHU Sart Tilman Liege, Domaine Universitaire du Sart Tilman, B35, 4000 Liege, Belgium
| | - Joëlle Collignon
- Medical Oncology CHU Sart Tilman Liege, Domaine Universitaire du Sart Tilman, B35, 4000 Liege, Belgium
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Perez EA, Awada A, O'Shaughnessy J, Rugo HS, Twelves C, Im SA, Gómez-Pardo P, Schwartzberg LS, Diéras V, Yardley DA, Potter DA, Mailliez A, Moreno-Aspitia A, Ahn JS, Zhao C, Hoch U, Tagliaferri M, Hannah AL, Cortes J. Etirinotecan pegol (NKTR-102) versus treatment of physician's choice in women with advanced breast cancer previously treated with an anthracycline, a taxane, and capecitabine (BEACON): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol 2015; 16:1556-1568. [PMID: 26482278 DOI: 10.1016/s1470-2045(15)00332-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND New options are needed for patients with heavily pretreated breast cancer. Etirinotecan pegol is a long-acting topoisomerase-I inhibitor that prolongs exposure to, but reduces the toxicity of, SN38 (the active metabolite of irinotecan). We assessed whether etirinotecan pegol is superior to currently available treatments for patients with previously treated, locally recurrent or metastatic breast cancer. METHODS In this open-label, multicentre, randomised phase 3 study (BEACON; BrEAst Cancer Outcomes with NKTR-102), conducted at 135 sites in 11 countries, patients with locally recurrent or metastatic breast cancer previously treated with an anthracycline, a taxane, and capecitabine (and two to five previous regimens for advanced disease) were randomly assigned (1:1) centrally via an interactive response system to etirinotecan pegol (145 mg/m(2) as a 90-min intravenous infusion every 3 weeks) or single-drug treatment of physician's choice. Patients with stable brain metastases and an Eastern Cooperative Oncology Group performance status of 0-1 were eligible. Randomisation was stratified with a permuted block scheme by region, previous eribulin, and receptor status. After randomisation, patients and investigators were aware of treatment assignments. The primary endpoint was overall survival in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01492101. FINDINGS Between Dec 19, 2011, and Aug 20, 2013, 852 patients were randomly assigned; 429 to etirinotecan pegol and 423 to treatment of physician's choice. There was no significant difference in overall survival between groups (median 12·4 months [95% CI 11·0-13·6] for the etirinotecan pegol group vs 10·3 months [9·0-11·3] for the treatment of physician's choice group; hazard ratio 0·87 [95% CI 0·75-1·02]; p=0·084). The safety population includes the 831 patients who received at least one dose of assigned treatment (425 assigned to etirinotecan pegol and 406 to treatment of physician's choice). Serious adverse events were recorded for 128 (30%) patients treated with etirinotecan pegol and 129 (32%) treated with treatment of physician's choice. Fewer patients in the etirinotecan pegol group had grade 3 or worse toxicity than those in the treatment of physician's choice group (204 [48%] vs 256 [63%]; p<0·0001). The most common grade 3 or worse adverse events were diarrhoea (41 [10%] in the experimental group vs five [1%] in the control group), neutropenia (41 [10%] vs 125 [31%]), and peripheral neuropathy (two [<1%] vs 15 [4%]). Three patients in the etirinotecan pegol group died of treatment-related adverse events (pneumonia, myelodysplastic syndrome, and acute renal failure) and two in the treatment of physician's choice group (neutropenic sepsis and septic shock). INTERPRETATION This trial did not demonstrate an improvement in overall survival for etirinotecan pegol compared to treatment of physician's choice in patients with heavily pre-treated advanced breast cancer. The toxicity profile noted in the etirinotecan pegol group differed from that in the control group. In view of the frequency of cross-resistance and overlapping toxicities noted with many available drugs and the need for effective drugs in highly refractory disease, etirinotecan pegol may warrant further research in some subgroups of patients. FUNDING Nektar Therapeutics.
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Affiliation(s)
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | | | - Hope S Rugo
- University of California, San Francisco, CA, USA
| | - Chris Twelves
- University of Leeds and St James's University Hospital, Leeds, UK
| | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | | | - David A Potter
- University of Minnesota Department of Medicine and Masonic Cancer Center, Minneapolis, MN, USA
| | | | | | - Jin-Seok Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Carol Zhao
- Nektar Therapeutics, San Francisco, CA, USA
| | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA, USA
| | | | | | - Javier Cortes
- Vall d'Hebron Institute of Oncology, Barcelona, Spain; Ramon y Cajal University Hospital, Madrid, Spain
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Adkins CE, Nounou MI, Hye T, Mohammad AS, Terrell-Hall T, Mohan NK, Eldon MA, Hoch U, Lockman PR. NKTR-102 Efficacy versus irinotecan in a mouse model of brain metastases of breast cancer. BMC Cancer 2015; 15:685. [PMID: 26463521 PMCID: PMC4604629 DOI: 10.1186/s12885-015-1672-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 10/01/2015] [Indexed: 02/07/2023] Open
Abstract
Background Brain metastases are an increasing problem in women with invasive breast cancer. Strategies designed to treat brain metastases of breast cancer, particularly chemotherapeutics such as irinotecan, demonstrate limited efficacy. Conventional irinotecan distributes poorly to brain metastases; therefore, NKTR-102, a PEGylated irinotecan conjugate should enhance irinotecan and its active metabolite SN38 exposure in brain metastases leading to brain tumor cytotoxicity. Methods Female nude mice were intracranially or intracardially implanted with human brain seeking breast cancer cells (MDA-MB-231Br) and dosed with irinotecan or NKTR-102 to determine plasma and tumor pharmacokinetics of irinotecan and SN38. Tumor burden and survival were evaluated in mice treated with vehicle, irinotecan (50 mg/kg), or NKTR-102 low and high doses (10 mg/kg, 50 mg/kg respectively). Results NKTR-102 penetrates the blood-tumor barrier and distributes to brain metastases. NKTR-102 increased and prolonged SN38 exposure (>20 ng/g for 168 h) versus conventional irinotecan (>1 ng/g for 4 h). Treatment with NKTR-102 extended survival time (from 35 days to 74 days) and increased overall survival for NKTR-102 low dose (30 % mice) and NKTR-102 high dose (50 % mice). Tumor burden decreased (37 % with 10 mg/kg NKTR-102 and 96 % with 50 mg/kg) and lesion sizes decreased (33 % with 10 mg/kg NKTR-102 and 83 % with 50 mg/kg NKTR-102) compared to conventional irinotecan treated animals. Conclusions Elevated and prolonged tumor SN38 exposure after NKTR-102 administration appears responsible for increased survival in this model of breast cancer brain metastasis. Further, SN38 concentrations observed in this study are clinically achieved with 145 mg/m2 NKTR-102, such as those used in the BEACON trial, underlining translational relevance of these results. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1672-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chris E Adkins
- Department of Basic Pharmaceutical Sciences, West Virginia University Health Sciences Center, 1 Medical Center Drive, Morgantown, WV, 26506-905, USA. .,School of Pharmacy, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, 79106, USA.
| | - Mohamed I Nounou
- School of Pharmacy, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, 79106, USA. .,Faculty of Pharmacy, Department of Pharmaceutics, Alexandria University, Alexandria, Egypt.
| | - Tanvirul Hye
- School of Pharmacy, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, 79106, USA.
| | - Afroz S Mohammad
- Department of Basic Pharmaceutical Sciences, West Virginia University Health Sciences Center, 1 Medical Center Drive, Morgantown, WV, 26506-905, USA. .,School of Pharmacy, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, 79106, USA.
| | - Tori Terrell-Hall
- Department of Basic Pharmaceutical Sciences, West Virginia University Health Sciences Center, 1 Medical Center Drive, Morgantown, WV, 26506-905, USA. .,School of Pharmacy, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, 79106, USA.
| | - Neel K Mohan
- Nektar Therapeutics, San Francisco, CA, 94158, USA.
| | | | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA, 94158, USA.
| | - Paul R Lockman
- Department of Basic Pharmaceutical Sciences, West Virginia University Health Sciences Center, 1 Medical Center Drive, Morgantown, WV, 26506-905, USA. .,School of Pharmacy, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, 79106, USA.
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Vera R, Alonso V, Gállego J, González E, Guillén-ponce C, Pericay C, Rivera F, Safont MJ, Valladares-ayerbes M. Current controversies in the management of metastatic colorectal cancer. Cancer Chemother Pharmacol 2015; 76:659-77. [DOI: 10.1007/s00280-015-2808-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/12/2015] [Indexed: 12/16/2022]
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Nagpal S, Recht CK, Bertrand S, Thomas RP, Ajlan A, Pena J, Gershon M, Coffey G, Kunz PL, Li G, Recht LD. Phase II pilot study of single-agent etirinotecan pegol (NKTR-102) in bevacizumab-resistant high grade glioma. J Neurooncol 2015; 123:277-82. [PMID: 25935109 PMCID: PMC4452613 DOI: 10.1007/s11060-015-1795-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/20/2015] [Indexed: 11/24/2022]
Abstract
Patients with recurrence of high-grade glioma (HGG) after bevacizumab (BEV) have an extremely poor prognosis. Etirinotecan pegol (EP) is the first long-acting topoisomerase-I inhibitor designed to concentrate in and provide continuous tumor exposure throughout the entire chemotherapy cycle. Here we report results of a Phase 2, single arm, open-label trial evaluating EP in HGG patients who progressed after BEV. Patients age >18 with histologically proven anaplastic astrocytoma or glioblastoma (GB) who previously received standard chemo-radiation and recurred after BEV were eligible. A predicted life expectancy >6 weeks and KPS ≥ 50 were required. The primary endpoint was PFS at 6-weeks. Secondary endpoint was overall survival from first EP infusion. Response was assessed by RANO criteria. Single agent EP was administered IV every 3 weeks at 145 mg/m2. Patients did not receive BEV while on EP. 20 patients (90 % GB) were enrolled with a median age of 50 and median KPS of 70. Three patients with GB (16.7 % of GB) had partial MRI responses. 6-week PFS was 55 %. Median and 6-month PFS were 2.2 months (95 % CI 1.4–3.4 months) and 11.2 % (95 % CI 1.9–28.9 %) respectively. Median overall survival from first EP infusion was 4.5 months (95 % CI 2.4–5.9). Only one patient had grade 3 toxicity (diarrhea with dehydration) attributable to EP. Hematologic toxicity was mild. Three patients had confirmed partial responses according to RANO criteria. These clinical data combined with a favorable safety profile warrant further clinical investigation of this agent in HGG.
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Affiliation(s)
- Seema Nagpal
- Division of Neuro-Oncology, Department of Neurology, Stanford University, 875 Blake Wilbur Drive CC2221, Stanford, CA, 94305, USA,
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Amzerin M, Mokrim M, Errihani H, Piccart MJ. Iterative and prolonged remission in metastatic breast cancer using pegylated irinotecan: a case report. J Med Case Rep 2015; 9:5. [PMID: 25971303 PMCID: PMC4429498 DOI: 10.1186/1752-1947-9-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/25/2014] [Indexed: 11/13/2022] Open
Abstract
Introduction Pegylated irinotecan NKTR-102 is a topoisomerase I inhibitor-polymer conjugate. This new formulation of irinotecan has been evaluated in a phase II clinical trial and is showing remarkable activity. To the best of our knowledge, this is the first case report of an impressive iterative response to pegylated irinotecan NKTR-102 in metastatic breast cancer. Case presentation We report the case of a 49-year-old Caucasian woman diagnosed with metastatic luminal A breast cancer with initial bone followed by liver and bone marrow metastases, treated with three lines of hormonal therapy, targeted therapy and six lines of chemotherapy. She showed no major response to conventional treatment, whereas, the tumor shrinkage under pegylated irinotecan NKTR-102 was impressive, durable and iterative. Conclusions Reintroduction of an active drug is a valid approach as illustrated by our case. The results of the current phase III trials of pegylated irinotecan NKTR-102 are eagerly awaited.
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Affiliation(s)
- Mounia Amzerin
- Department of Medical Oncology, National Institute of Oncology, Université Mohammed V de Rabat, Avenue Allal El Fassi, 10100, Rabat, Morocco.
| | - Maha Mokrim
- Department of Medical Oncology, Jules Bordet Institute, Université Libre de Bruxelles, Boulevard de Waterloo 125, B-1000, Brussels, Belgium.
| | - Hassan Errihani
- Department of Medical Oncology, National Institute of Oncology, Université Mohammed V de Rabat, Avenue Allal El Fassi, 10100, Rabat, Morocco.
| | - Martine J Piccart
- Department of Medical Oncology, Jules Bordet Institute, Université Libre de Bruxelles, Boulevard de Waterloo 125, B-1000, Brussels, Belgium.
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Abstract
Irinotecan is a very active chemotherapeutic agent used for the treatment of several malignancies, including colorectal cancer, gastroesophageal tumors, lung cancer, breast cancer, ovarian cancer, and primary brain tumors. Irinotecan exerts its antineoplastic effects through its active metabolite 7-ethyl-10-hydroxycamptothecin. This metabolite is also responsible for the classic side effects associated with irinotecan that include diarrhea and neutropenia. A pegylated form of this agent, etirinotecan pegol, is undergoing clinical development with the main goal of increasing its therapeutic efficacy and its safety. This agent decreases the maximal exposure to 7-ethyl-10-hydroxycamptothecin while providing continuous exposure to the treated tumor. The half-life of etirinotecan pegol is 50 days and it has been studied in different schedules: weekly, every other week, and once every 3 weeks. The maximum tolerated dose of etirinotecan pegol was found to be 145 mg/m(2). There have already been two phase II clinical trials published showing the efficacy of this novel agent in the treatment of metastatic ovarian and breast cancer. The side effect profile was acceptable for most patients, with a number of patients experiencing diarrhea and even neutropenia.
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Affiliation(s)
- Carlos Alemany
- Department of Hematology and Oncology, Florida Hospital Cancer Institute, 2501 N. Orange Avenue, Suite 689, Orlando, FL, 32804, USA,
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Hoch U, Staschen CM, Johnson RK, Eldon MA. Nonclinical pharmacokinetics and activity of etirinotecan pegol (NKTR-102), a long-acting topoisomerase 1 inhibitor, in multiple cancer models. Cancer Chemother Pharmacol 2014; 74:1125-37. [PMID: 25228368 DOI: 10.1007/s00280-014-2577-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/27/2014] [Indexed: 12/20/2022]
Abstract
Purpose The aim of the study was to demonstrate the activity of etirinotecan pegol, a polymer conjugate of irinotecan, in multiple human tumor models and to establish both the pharmacokinetic/pharmacodynamics (PK/PD) relationship and clinical relevance of the findings. Experimental design Anti-tumor activity was evaluated in mouse models of human lung, colorectal, breast, ovarian, and gastric cancers. Etirinotecan pegol was administered intravenously (once or every 3–7 days) to animals with established tumors. Activity was assessed by tumor growth delay (TGD) and regression. Mice bearing established colorectal and lung tumors were treated with etirinotecan pegol or irinotecan, and serial blood and tumor samples were collected at planned times between 0 and 60 days post-treatment for quantitation of etirinotecan pegol and SN38. For PK analysis, analyte concentration–time data were fit with compartmental models; PK/PD analysis was based on an inhibitory Emax response model. Results Etirinotecan pegol was active in all tumor models. TGD was sustained for 2–10 weeks after last dose, while conventional irinotecan resulted in little suppression of tumor growth. Etirinotecan pegol was eliminated very slowly from the tumor (t1/2 = 17 days), achieving higher and more sustained tumor exposure when compared with conventional irinotecan. The increased tumor exposure following etirinotecan pegol correlated with strong and prolonged suppression of tumor growth. Sustained plasma exposure to active SN38 was consistently observed across nonclinical species (including mouse, rat, and dog) and translated to cancer patients. Conclusions Etirinotecan pegol is the first long-acting topoisomerase 1 inhibitor that provides sustained exposure, which results in prolonged anti-tumor activity in a wide variety of cancer models. Electronic supplementary material The online version of this article (doi:10.1007/s00280-014-2577-7) contains supplementary material, which is available to authorized users.
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Stenvang J, Kümler I, Nygård SB, Smith DH, Nielsen D, Brünner N, Moreira JMA. Biomarker-guided repurposing of chemotherapeutic drugs for cancer therapy: a novel strategy in drug development. Front Oncol 2013; 3:313. [PMID: 24400218 PMCID: PMC3872326 DOI: 10.3389/fonc.2013.00313] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 10/12/2013] [Accepted: 12/10/2013] [Indexed: 12/29/2022] Open
Abstract
Cancer is a leading cause of mortality worldwide and matters are only set to worsen as its incidence continues to rise. Traditional approaches to combat cancer include improved prevention, early diagnosis, optimized surgery, development of novel drugs, and honing regimens of existing anti-cancer drugs. Although discovery and development of novel and effective anti-cancer drugs is a major research area, it is well known that oncology drug development is a lengthy process, extremely costly and with high attrition rates. Furthermore, those drugs that do make it through the drug development mill are often quite expensive, laden with severe side-effects and unfortunately, to date, have only demonstrated minimal increases in overall survival. Therefore, a strong interest has emerged to identify approved non-cancer drugs that possess anti-cancer activity, thus shortcutting the development process. This research strategy is commonly known as drug repurposing or drug repositioning and provides a faster path to the clinics. We have developed and implemented a modification of the standard drug repurposing strategy that we review here; rather than investigating target-promiscuous non-cancer drugs for possible anti-cancer activity, we focus on the discovery of novel cancer indications for already approved chemotherapeutic anti-cancer drugs. Clinical implementation of this strategy is normally commenced at clinical phase II trials and includes pre-treated patients. As the response rates to any non-standard chemotherapeutic drug will be relatively low in such a patient cohort it is a pre-requisite that such testing is based on predictive biomarkers. This review describes our strategy of biomarker-guided repurposing of chemotherapeutic drugs for cancer therapy, taking the repurposing of topoisomerase I (Top1) inhibitors and Top1 as a potential predictive biomarker as case in point.
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Affiliation(s)
- Jan Stenvang
- Faculty of Health and Medical Sciences, Department of Veterinary Disease Biology, Section for Molecular Disease Biology and Sino-Danish Breast Cancer Research Centre, University of Copenhagen , Copenhagen , Denmark ; Danish Centre for Translational Breast Cancer Research , Copenhagen , Denmark
| | - Iben Kümler
- Department of Oncology, Center for Cancer Research, Herlev Hospital, University of Copenhagen , Copenhagen , Denmark
| | - Sune Boris Nygård
- Faculty of Health and Medical Sciences, Department of Veterinary Disease Biology, Section for Molecular Disease Biology and Sino-Danish Breast Cancer Research Centre, University of Copenhagen , Copenhagen , Denmark
| | - David Hersi Smith
- Faculty of Health and Medical Sciences, Department of Veterinary Disease Biology, Section for Molecular Disease Biology and Sino-Danish Breast Cancer Research Centre, University of Copenhagen , Copenhagen , Denmark ; DAKO A/S , Glostrup , Denmark
| | - Dorte Nielsen
- Department of Oncology, Center for Cancer Research, Herlev Hospital, University of Copenhagen , Copenhagen , Denmark
| | - Nils Brünner
- Faculty of Health and Medical Sciences, Department of Veterinary Disease Biology, Section for Molecular Disease Biology and Sino-Danish Breast Cancer Research Centre, University of Copenhagen , Copenhagen , Denmark ; Danish Centre for Translational Breast Cancer Research , Copenhagen , Denmark
| | - José M A Moreira
- Faculty of Health and Medical Sciences, Department of Veterinary Disease Biology, Section for Molecular Disease Biology and Sino-Danish Breast Cancer Research Centre, University of Copenhagen , Copenhagen , Denmark ; Danish Centre for Translational Breast Cancer Research , Copenhagen , Denmark
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Vergote IB, Garcia A, Micha J, Pippitt C, Bendell J, Spitz D, Reed N, Dark G, Fracasso PM, Ibrahim EN, Armenio VA, Duska L, Poole C, Gennigens C, Dirix LY, Leung AC, Zhao C, Soufi-Mahjoubi R, Rustin G. Randomized multicenter phase II trial comparing two schedules of etirinotecan pegol (NKTR-102) in women with recurrent platinum-resistant/refractory epithelial ovarian cancer. J Clin Oncol 2013; 31:4060-6. [PMID: 24081946 PMCID: PMC4878105 DOI: 10.1200/jco.2012.45.1278] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Etirinotecan pegol (NKTR-102) is a unique, long-acting topoisomerase-I inhibitor with prolonged systemic exposure to SN38 (7-ethyl-10-hydroxycamptothecin), the active metabolite of irinotecan. This randomized phase II trial investigated two dosing schedules of etirinotecan pegol in patients with platinum-resistant/refractory ovarian carcinoma. PATIENTS AND METHODS A total of 71 eligible patients were randomly assigned to receive etirinotecan pegol 145 mg/m(2) every 14 or 21 days until progression or unacceptable adverse events (AEs). The primary end point was objective response rate (ORR) by RECIST (version 1.0). Secondary end points included response by Gynecologic Cancer Intergroup criteria, duration of ORR, progression-free survival (PFS), and overall survival (OS). RESULTS The overall confirmed ORR was 20% (95% CI, 10% to 30%): 20% for once every 14 days, and 19% for once every 21 days. Median response duration was 4.1 months for once every 14 days and 4.0 months for once every 21 days. Median PFS for every 14 and every 21 days was 4.1 and 5.3 months, respectively, and median OS was 10.0 and 11.7 months, respectively. Etirinotecan pegol was well tolerated, with the most common grade 3 to 4 AEs being dehydration (24%) and diarrhea (23%). Diarrhea, dehydration, nausea, and neutropenia were less frequent with the schedule of once every 21 days than with that of once every 14 days. CONCLUSION Both schedules of etirinotecan pegol showed activity in patients with heavily pretreated ovarian cancer, with encouraging ORR and PFS rates. The schedule of once every 21 days was better tolerated and had slightly longer PFS and OS rates. The treatment schedule of etirinotecan pegol 145 mg/m(2) once every 21 days was selected for the expanded phase II study and is preferred for future phase III studies. These findings provide support to directly compare etirinotecan pegol versus one of the approved drugs (eg, pegylated liposomal doxorubicin or topotecan) in platinum-resistant ovarian cancer.
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Affiliation(s)
- Ignace B. Vergote
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Agustin Garcia
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - John Micha
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Charles Pippitt
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Johanna Bendell
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Daniel Spitz
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Nicholas Reed
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Graham Dark
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Paula M. Fracasso
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Emad N. Ibrahim
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Vincent A. Armenio
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Linda Duska
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Chris Poole
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Christine Gennigens
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Luc Y. Dirix
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Abraham C.F. Leung
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Carol Zhao
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Raoudha Soufi-Mahjoubi
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Gordon Rustin
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
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Awada A, Garcia AA, Chan S, Jerusalem GHM, Coleman RE, Huizing MT, Mehdi A, O'reilly SM, Hamm JT, Barrett-lee PJ, Cocquyt V, Sideras K, Young DE, Zhao C, Chia YL, Hoch U, Hannah AL, Perez EA. Two schedules of etirinotecan pegol (NKTR-102) in patients with previously treated metastatic breast cancer: a randomised phase 2 study. Lancet Oncol 2013; 14:1216-25. [DOI: 10.1016/s1470-2045(13)70429-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kümler I, Brünner N, Stenvang J, Balslev E, Nielsen DL. A systematic review on topoisomerase 1 inhibition in the treatment of metastatic breast cancer. Breast Cancer Res Treat 2013; 138:347-58. [DOI: 10.1007/s10549-013-2476-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/05/2013] [Indexed: 01/26/2023]
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