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Pardo Aranda N, Remon J, Martinez Marti A, Martinez de Castro AM, Cedres Perez S, Navarro A, Scheenaard E, Piera A, Carbonell LL, Vivancos A, Felip E, Gámez Córdoba E. Outcome of EGFR mutant patirnts included in a clinical trial after progression on EGFR TKI. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20555] [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: 11/20/2022] Open
Abstract
e20555 Background: EGFR mutant(EGFRm) NSCLC patients develop adquired resistance after 12 months on EGFR TKI. Acquired T790mutation(T790M) is the most common mechanism of resistance in around 60% of patients, followed by MET amplification in 20% of cases. Inclusion in a clinical trials at progression may have an impact in patients’ outcome. Methods: We retrospectively assessed the overall survival in EGFRm patients according to post-progression treatment on 1st/2nd generation EGFR TKI: standard vs. experimental (clinical trial). Also, we assessed the survival in the cohort of acquired T790M NSCLC patients(p). X2 test and long rank test P values are described. OS was defined since progression 1st/2nd generation EGFR TKI to death or last follow up Results: 42p EGFRm were enrolled. According to EGFRm subtype (24 p EGFR del19, 14p EGFR L858R, 1p EGFR exon18, 1 EGFR exon20 ,2p unknown). Median age was 58 (33-83) and 27 (64%) females. First-line EGFR TKI was 30% gefitinib / 58 % erlotinib /10 % afatinib/2% dacotinib At PD, in 51 biopsies (b) were performed,11p were biopsy twice.Tumor tissue for molecular determinations was available in in 86% of cases. Druggable molecular alterations were detected in 57% of cases: 20 acquired T790M and 4 MET amplification. According to these results all 24 p were enrolled in a clinical trial (NCT02108964,NCT01802632,NCT02147990,NCT02335944, NCT02151981), and 18p were screening failure; 8p (45%) of them due to abscense of adquired resistance mechanisms. 10 received platinum-based chemotherapy and 6 only received best supportive care. OS metastatic disease was 51 months for patients included in a clinical trial vs 22 months for those on standard treatment (p < 0.001; 95%CI: 14.4-47). OS was: 34 months vs 10 months for those included in a clinical trial vs standard, respectively (p < 0.001; 95%CI: 8.88-25). For T790M tumours, OS post-progression was 25 months Conclusions: Enrolling patients in clinical trials may allow personalised treatment according to mechanisms of resistance improving survival after 1st/2nd generation EGFR TK progression disease.
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Affiliation(s)
- Nuria Pardo Aranda
- Medical Oncology Department Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Alex Martinez Marti
- Medical Oncology Department Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | - Alejandro Navarro
- Medical Oncology Department Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Eulalia Scheenaard
- Vall d’Hebron University Hospital Institute of Oncology (VHIO), Barcelona, Spain
| | - Adelaida Piera
- Medical Oncology Department Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - LLuisa Carbonell
- Medical Oncology Department Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Enriqueta Felip
- Vall d’Hebron University Hospital Institute of Oncology (VHIO), Barcelona, Spain
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Cedres S, Aranda NP, de Castro AM, Mendivil AN, Marti AM, Ortiz C, Racca F, Vilaro M, Carbonell L, Piera A, fuente I, Felip E. Analysis of outcomes and brain metastases (BM) of molecular selected non-small cell lung cancer (NSCLC) patients included in clinical trials. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cedres Perez S, Pardo Aranda N, Navarro A, Martinez Marti A, Martinez de Castro AM, Cabrera G, Vilaro M, Carbonell LL, de la Fuente I, Piera A, Martinez L, Hernandez-Losa J, Sansano I, Felip E. Analysis of clinical characteristics and outcomes of ALK positive (ALK+) patients treated with ALK inhibitors (ALKi). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e20550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Nuria Pardo Aranda
- Medical Oncology Department Vall d'Hebron Institute of Oncology-Vall d´Hebron University Hospital, Barcelona, Spain
| | - Alejandro Navarro
- Medical Oncology Department Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Alex Martinez Marti
- Medical Oncology Department Vall d´Hebron Institute of Oncology-Vall D'Hebron University Hospital, Barcelona, Spain
| | | | | | - Marta Vilaro
- Oncology Data Science (OdysSey) Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - LLuisa Carbonell
- Medical Oncology Department Vall d'Hebron Institute of OncologyVall d´Hebron University Hospital, Barcelona, Spain
| | - Iris de la Fuente
- Medical Oncology Department Vall d'Hebron Institute of OncologyVall d´Hebron University Hospital, Barcelona, Spain
| | - Adelaida Piera
- Medical Oncology Department Vall d'Hebron Institute of OncologyVall d´Hebron University Hospital, Barcelona, Spain
| | - Lidia Martinez
- Medical Oncology Department Vall d'Hebron Institute of OncologyVall d´Hebron University Hospital, Barcelona, Spain
| | | | - Irene Sansano
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Martinez Marti A, Cabrera G, Ortiz C, Vilaro M, Miquel JM, Cedres Perez S, Navarro A, Pardo Aranda N, Martinez P, Piera A, Carbonell LL, De la Fuente I, Garcia S, Sansano I, Felip E. Results of patients with thoracic cancers older than 70 years included in clinical trials: A center experience. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e20582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alex Martinez Marti
- Medical Oncology Department Vall d´Hebron Institute of Oncology-Vall D'Hebron University Hospital, Barcelona, Spain
| | | | | | - Marta Vilaro
- Oncology Data Science (OdysSey) Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | - Alejandro Navarro
- Medical Oncology Department Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Nuria Pardo Aranda
- Medical Oncology Department Vall d'Hebron Institute of Oncology-Vall d´Hebron University Hospital, Barcelona, Spain
| | - Pablo Martinez
- Medical Oncology Department, Clinica Diagonal, Barcelona, Spain
| | - Adelaida Piera
- Medical Oncology Department Vall d'Hebron Institute of OncologyVall d´Hebron University Hospital, Barcelona, Spain
| | - LLuisa Carbonell
- Medical Oncology Department Vall d'Hebron Institute of OncologyVall d´Hebron University Hospital, Barcelona, Spain
| | - Iris De la Fuente
- Study Coordinator, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Silvia Garcia
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Irene Sansano
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Eskens FALM, Ramos FJ, Burger H, O'Brien JP, Piera A, de Jonge MJA, Mizui Y, Wiemer EAC, Carreras MJ, Baselga J, Tabernero J. Phase I pharmacokinetic and pharmacodynamic study of the first-in-class spliceosome inhibitor E7107 in patients with advanced solid tumors. Clin Cancer Res 2013; 19:6296-304. [PMID: 23983259 DOI: 10.1158/1078-0432.ccr-13-0485] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the safety, tolerability, pharmacokinetics, pharmacodynamics, and clinical activity of E7107 administered as 5-minute bolus infusions on days 1, 8, and 15 in a 28-day schedule. EXPERIMENTAL DESIGN Patients with solid tumors refractory to standard therapies or with no standard treatment available were enrolled. Dose levels of 0.6 to 4.5 mg/m(2) were explored. RESULTS Forty patients [24M/16F, median age 61 years (45-79)] were enrolled. At 4.5 mg/m(2), dose-limiting toxicity (DLT) consisted of grade 3 diarrhea, nausea, and vomiting and grade 4 diarrhea, respectively, in two patients. At 4.0 mg/m(2), DLT (grade 3 nausea, vomiting, and abdominal cramps) was observed in one patient. Frequently occurring side effects were mainly gastrointestinal. After drug discontinuation at 4.0 mg/m(2), one patient experienced reversible grade 4 blurred vision. The maximum tolerated dose (MTD) is 4.0 mg/m(2). No complete or partial responses during treatment were observed; one patient at 4.0 mg/m(2) had a confirmed partial response after drug discontinuation. Pharmacokinetic analysis revealed a large volume of distribution, high systemic clearance, and a plasma elimination half-life of 5.3 to 15.1 hours. Overall drug exposure increased in a dose-dependent manner. At the MTD, mRNA levels of selected target genes monitored in peripheral blood mononuclear cells showed a reversible 15- to 25-fold decrease, whereas unspliced pre-mRNA levels of DNAJB1 and EIF4A1 showed a reversible 10- to 25-fold increase. CONCLUSION The MTD for E7107 using this schedule is 4.0 mg/m(2). Pharmacokinetics is dose-dependent and reproducible within patients. Pharmacodynamic analysis revealed dose-dependent reversible inhibition of pre-mRNA processing of target genes, confirming proof-of-principle activity of E7107.
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Affiliation(s)
- Ferry A L M Eskens
- Authors' Affiliations: Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, the Netherlands; Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain; Eisai Inc., Woodcliff Lake, New Jersey; Eisai Inc., Tsukuba, Japan; and Memorial Sloan-Kettering Cancer Center, New York, New York
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Cervantes A, Elez E, Roda D, Ecsedy J, Macarulla T, Venkatakrishnan K, Roselló S, Andreu J, Jung J, Sanchis-Garcia JM, Piera A, Blasco I, Maños L, Pérez-Fidalgo JA, Fingert H, Baselga J, Tabernero J. Phase I pharmacokinetic/pharmacodynamic study of MLN8237, an investigational, oral, selective aurora a kinase inhibitor, in patients with advanced solid tumors. Clin Cancer Res 2012; 18:4764-74. [PMID: 22753585 DOI: 10.1158/1078-0432.ccr-12-0571] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Aurora A kinase (AAK) is a key regulator of mitosis and a target for anticancer drug development. This phase I study investigated the safety, pharmacokinetics, and pharmacodynamics of MLN8237 (alisertib), an investigational, oral, selective AAK inhibitor, in 59 adults with advanced solid tumors. EXPERIMENTAL DESIGN Patients received MLN8237 once daily or twice daily for 7, 14, or 21 consecutive days, followed by 14 days recovery, in 21-, 28-, or 35-day cycles. Dose-limiting toxicities (DLT) and the maximum-tolerated dose (MTD) for the 7- and 21-day schedules were determined. Pharmacokinetic parameters were derived from plasma concentration-time profiles. AAK inhibition in skin and tumor biopsies was evaluated and antitumor activity assessed. RESULTS Neutropenia and stomatitis were the most common DLTs. The MTD for the 7- and 21-day schedules was 50 mg twice daily and 50 mg once daily, respectively. MLN8237 absorption was fast (median time to maximum concentration, 2 hours). Mean terminal half-life was approximately 19 hours. At steady state, pharmacodynamic effects were shown by accumulation of mitotic and apoptotic cells in skin, and exposure-related increases in numbers of mitotic cells with characteristic spindle and chromosomal abnormalities in tumor specimens, supporting AAK inhibition by MLN8237. Stable disease was observed and was durable with repeat treatment cycles, administered over 6 months, in 6 patients, without notable cumulative toxicity. CONCLUSIONS The recommended phase II dose of MLN8237 is 50 mg twice daily on the 7-day schedule, which is being evaluated further in a variety of malignancies, including in a phase III trial in peripheral T-cell lymphoma.
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Affiliation(s)
- Andres Cervantes
- Hematology and Medical Oncology Department, Hospital Clinico, INCLIVA, University of Valencia, Valencia, Spain
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Dienstmann R, Tolcher AW, Papadopoulos KP, Rasco DW, Tabernero J, Brana I, Piera A, Skartved NJ, Aladdin H, Petersen J, Patnaik A. Phase I trial of the first-in-class EGFR antibody mixture, Sym004, in patients with advanced solid tumors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Capdevila J, Clive S, Tabernero J, Lardelli P, Soto-Matos A, Baselga J, Piera A, Pardos I, Rye R, Smyth JF. Phase I study of the novel anticancer drug PM00104 as a 24-hour IV infusion every 3 weeks (q3w) in patients (pts) with advanced solid tumors or lymphoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2568 Background: PM00104 is a novel synthetic alkaloid related to the marine compounds jorumycin and renieramycins. Preliminary preclinical studies suggest changes in cell cycle and DNA binding properties and transcriptional inhibition as main mechanisms of action. PM00104 has shown broad in vitro and in vivo anti-tumor activity (IC50 ≤ 10-8 M) with an acceptable toxicology profile. Methods: The aim of this phase I study was to assess the safety profile, dose-limiting toxicities (DLT), maximum tolerated dose (MTD), recommended dose (RD), pharmacokinetics (PK), relationship between PK and pharmacodynamics (PD) and anti-tumor activity of PM00104 administered as a 24-hour i.v. infusion q3w. Sequential cohorts of 3–6 pts were treated at 133, 266, 400, 800, 900, 1600, 3200, 4000 and 5000 μg/m2. Results: Twenty nine pts have been treated (18 male, 11 female; median age: 59, range: 44–78; ECOG PS ≤2). Five pts developed DLTs: 2 pts at 5000 μg/m2 (grade 4 thrombocytopenia/neutropenia and grade 3 nausea/vomiting in 1 pt; and grade 3 nausea in 1 pt); 1 at 4000 μg/m2 (grade 4 neutropenia/thrombocytopenia and grade 3 asthenia); 1 at 3200 μg/m2 (grade 3 tumor pain) and 1 at 266 μg/m2 (grade 3 transaminase increase). The MTD was reached at 5000 μg/m2 and the RD at 4000 μg/m2. At the RD 6 more pts have been included in order to further evaluate the safety profile and anti-tumor activity. Other adverse events included nausea and vomiting (more frequent at doses ≥800 μg/m2), fatigue, anorexia and diarrhea; most of them being of ≤grade 2 severity. No objective responses were seen but 3 pts with pancreatic adenocarcinoma, hepatocarcinoma and lower esophagus adenocarcinoma presented stable disease lasting >3 months. PM00104 shows a dose-proportional PK profile, the half-life being 20–30 hours and the volume of distribution around 1000 L. Conclusions: PM00104 has shown an acceptable safety profile with signs of anti-tumor activity in pts with advanced malignancies when administered as a 24-hour i.v. infusion q3w. PM00104 is also being evaluated with other administration schedules as monotherapy and in combination with other anti-tumor agents. [Table: see text]
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Affiliation(s)
- J. Capdevila
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - S. Clive
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - J. Tabernero
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - P. Lardelli
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - A. Soto-Matos
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - J. Baselga
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - A. Piera
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - I. Pardos
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - R. Rye
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - J. F. Smyth
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
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Badia MC, Chamarro R, Làinez JM, Piera A. [Proteus syndrome with cerebral vascular malformations]. Neurologia 2006; 21:88-91. [PMID: 16525914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
INTRODUCTION Proteus syndrome is a congenital hamartomatous dysplasia. This sporadic disorder involves the skeletal system, soft tissues, skin and vascular system. The most likely pathogenesis involves somatic mosaicism. Main manifestations included soft-tissue and epidermal nevi, partial gigantism, hemihypertrophy, exostoses, lipomas and vascular anomalies. The most common brain abnormalities are hemimegencephaly and migrational disorders. We present a case of Proteus syndrome with cerebral vascular anomalies which are not described previously. CLINICAL CASE Our patient is a 61 year-old male who has hypertrophy of the four limbs, macrodactyly and hypertrophy of chest and abdomen asymmetric with mild facial asymmetry. Prominent and abundant of the four extremities and trunk, also asymmetric. Vascular tumors in the skin of trunk and left limb. Cerebral MRI shows venous angiomas and multiple cavernous malformations. CONCLUSION Clinical diagnostic criteria of Proteus syndrome are documented in our patient. He also has brain vascular malformations which are not described previously in the literature. We consider that both findings are not a product of causality due to the high prevalence of systemic vascular hamartomatous malformations in these patients. We hypothesize that a single mutation, probably involving genes in relation with apoptotic control will be responsible of Proteus syndrome and cerebral vascular anomalies in our patient, due to a defect of angiogenesis.
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Affiliation(s)
- M C Badia
- Hospital Clínico Universitario, Valencia.
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