1
|
Heslop E, Cammish P, McNiff M, Pegg K, Irvin A, Reuben E, Johnson A, Gaeta A, Turner C, Fischer R, Peay H, Muntoni F, Childs A, Straub V, Guglieri M. P.125 DMD Hub: A UK network enabling trials in Duchenne muscular dystrophy. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.241] [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: 11/05/2022]
|
2
|
Vesely C, Wong YNS, Childs A, Akarca AU, Dhami P, Vaikkinen H, Conde L, Herrero J, Ogunbiyi O, Gander A, Luong TV, Thirlwell C, Caplin M, Toumpanakis C, Peggs K, Quezada SA, Marafioti T, Meyer T. Systematic Evaluation of the Immune Environment of Small Intestinal Neuroendocrine Tumors. Clin Cancer Res 2022; 28:2657-2668. [PMID: 35320356 PMCID: PMC9359734 DOI: 10.1158/1078-0432.ccr-21-4203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The immune tumor microenvironment and the potential therapeutic opportunities for immunotherapy in small intestinal neuroendocrine tumors (siNET) have not been fully defined. EXPERIMENTAL DESIGN Herein, we studied 40 patients with primary and synchronous metastatic siNETs, and matched blood and normal tissue obtained during surgery. We interrogated the immune checkpoint landscape using multi-parametric flow cytometry. In addition, matched FFPE tissue was obtained for multi-parametric IHC to determine the relative abundance and distribution of T-cell infiltrate. Tumor mutational burden (TMB) was also assessed and correlated with immune infiltration. RESULTS Effector tumor-infiltrating lymphocytes (TIL) had a higher expression of PD-1 in the tumor microenvironment compared with the periphery. In addition, CD8+ TILs had a significantly higher co-expression of PD-1/ICOS and PD-1/CTLA-4 (cytotoxic T lymphocyte antigen-4) and higher levels of PD-1 expression compared with normal tissue. IHC revealed that the majority of cases have ≤10% intra-tumoral T cells but a higher number of peri-tumoral T cells, demonstrating an "exclusion" phenotype. Finally, we confirmed that siNETs have a low TMB compared with other tumor types in the TCGA database but did not find a correlation between TMB and CD8/Treg ratio. CONCLUSIONS Taken together, these results suggest that a combination therapy approach will be required to enhance the immune response, using PD-1 as a checkpoint immunomodulator backbone in combination with other checkpoint targeting molecules (CTLA-4 or ICOS), or with drugs targeting other pathways to recruit "excluded" T cells into the tumor microenvironment to treat patients with siNETs.
Collapse
Affiliation(s)
- Clare Vesely
- UCL Cancer Institute, UCL, London, United Kingdom
| | - Yien Ning Sophia Wong
- UCL Cancer Institute, UCL, London, United Kingdom.,Cancer Immunology Unit, Research Department of Hematology, UCL Cancer Institute, UCL, London, United Kingdom
| | - Alexa Childs
- UCL Cancer Institute, UCL, London, United Kingdom.,Royal Free Hospital, Pond Street, London, United Kingdom
| | | | - Pawan Dhami
- UCL Cancer Institute, UCL, London, United Kingdom
| | | | - Lucia Conde
- UCL Cancer Institute, UCL, London, United Kingdom
| | | | | | - Amir Gander
- Royal Free Hospital, Pond Street, London, United Kingdom
| | - Tu Vinh Luong
- Royal Free Hospital, Pond Street, London, United Kingdom
| | - Chrissie Thirlwell
- UCL Cancer Institute, UCL, London, United Kingdom.,The University of Exeter Medical School, Exeter, United Kingdom
| | - Martyn Caplin
- Royal Free Hospital, Pond Street, London, United Kingdom
| | | | - Karl Peggs
- UCL Cancer Institute, UCL, London, United Kingdom.,Cancer Immunology Unit, Research Department of Hematology, UCL Cancer Institute, UCL, London, United Kingdom
| | - Sergio A. Quezada
- UCL Cancer Institute, UCL, London, United Kingdom.,Cancer Immunology Unit, Research Department of Hematology, UCL Cancer Institute, UCL, London, United Kingdom
| | | | - Tim Meyer
- UCL Cancer Institute, UCL, London, United Kingdom.,Royal Free Hospital, Pond Street, London, United Kingdom.,Corresponding Author: Tim Meyer, UCL Cancer Institute, University College London, 72 Huntley Street, London WC1E 6DD. Phone: 44-207-679-6731; E-mail;
| |
Collapse
|
3
|
Childs A, Zakeri N, Ma YT, O’Rourke J, Ross P, Hashem E, Hubner RA, Hockenhull K, Iwuji C, Khan S, Palmer DH, Connor J, Swinson D, Darby S, Braconi C, Roques T, Yu D, Luong TV, Meyer T. Biopsy for advanced hepatocellular carcinoma: results of a multicentre UK audit. Br J Cancer 2021; 125:1350-1355. [PMID: 34526664 PMCID: PMC8575957 DOI: 10.1038/s41416-021-01535-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/04/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Advanced hepatocellular carcinoma (HCC) is commonly diagnosed using non-invasive radiological criteria (NIRC) defined by the European Association for the Study of the Liver or the American Association for the Study of Liver Diseases. In 2017, The National Institute for Clinical Excellence mandated histological confirmation of disease to authorise the use of sorafenib in the UK. METHODS This was a prospective multicentre audit in which patients suitable for sorafenib were identified at multidisciplinary meetings. The primary analysis cohort (PAC) was defined by the presence of Child-Pugh class A liver disease and performance status 0-2. Clinical, radiological and histological data were reported locally and collected on a standardised case report form. RESULTS Eleven centres reported 418 cases, of which 361 comprised the PAC. Overall, 76% had chronic liver disease and 66% were cirrhotic. The diagnostic imaging was computed tomography in 71%, magnetic resonance imaging in 27% and 2% had both. Pre-existing histology was available in 45 patients and 270 underwent a new biopsy, which confirmed HCC in 93.4%. Alternative histological diagnoses included cholangiocarcinoma (CC) and combined HCC-CC. In cirrhotic patients, NIRC criteria had a sensitivity of 65.4% and a positive predictive value of 91.4% to detect HCC. Two patients (0.7%) experienced mild post-biopsy bleeding. CONCLUSION The diagnostic biopsy is safe and feasible for most patients eligible for systemic therapy.
Collapse
Affiliation(s)
- Alexa Childs
- grid.437485.90000 0001 0439 3380Department of Oncology, Royal Free London NHS Foundation Trust, London, UK
| | - Nekisa Zakeri
- grid.437485.90000 0001 0439 3380Department of Oncology, Royal Free London NHS Foundation Trust, London, UK
| | - Yuk Ting Ma
- grid.412563.70000 0004 0376 6589University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joanne O’Rourke
- grid.412563.70000 0004 0376 6589University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Ross
- grid.429705.d0000 0004 0489 4320King’s College Hospital NHS Foundation Trust, London, UK
| | - Essam Hashem
- grid.429705.d0000 0004 0489 4320King’s College Hospital NHS Foundation Trust, London, UK
| | - Richard A. Hubner
- grid.412917.80000 0004 0430 9259Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Kimberley Hockenhull
- grid.412917.80000 0004 0430 9259Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Chinenye Iwuji
- grid.269014.80000 0001 0435 9078Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sam Khan
- grid.269014.80000 0001 0435 9078Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel H. Palmer
- grid.418624.d0000 0004 0614 6369University of Liverpool and The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Joanna Connor
- grid.418624.d0000 0004 0614 6369University of Liverpool and The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Daniel Swinson
- grid.415967.80000 0000 9965 1030Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Suzanne Darby
- grid.31410.370000 0000 9422 8284Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Chiara Braconi
- grid.5072.00000 0001 0304 893XThe Royal Marsden NHS Foundation Trust, London, UK
| | - Tom Roques
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Dominic Yu
- grid.437485.90000 0001 0439 3380Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Tu Vinh Luong
- grid.437485.90000 0001 0439 3380Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Tim Meyer
- grid.437485.90000 0001 0439 3380Department of Oncology, Royal Free London NHS Foundation Trust, London, UK ,grid.83440.3b0000000121901201UCL Cancer Institute, University College London, London, UK
| |
Collapse
|
4
|
Turner C, Childs A, Johnson A, Manzur A, Quinlivan R, Sarkozy A, Wong J, Guglieri M. DMD – CLINICAL CARE. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
5
|
Childs A, Steele CD, Vesely C, Rizzo FM, Ensell L, Lowe H, Dhami P, Vaikkinen H, Luong TV, Conde L, Herrero J, Caplin M, Toumpanakis C, Thirlwell C, Hartley JA, Pillay N, Meyer T. Whole-genome sequencing of single circulating tumor cells from neuroendocrine neoplasms. Endocr Relat Cancer 2021; 28:631-644. [PMID: 34280125 PMCID: PMC8428071 DOI: 10.1530/erc-21-0179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 11/20/2022]
Abstract
Single-cell profiling of circulating tumor cells (CTCs) as part of a minimally invasive liquid biopsy presents an opportunity to characterize and monitor tumor heterogeneity and evolution in individual patients. In this study, we aimed to compare single-cell copy number variation (CNV) data with tissue and define the degree of intra- and inter-patient genomic heterogeneity. We performed next-generation sequencing (NGS) whole-genome CNV analysis of 125 single CTCs derived from seven patients with neuroendocrine neoplasms (NEN) alongside matched white blood cells (WBC), formalin-fixed paraffin-embedded (FFPE), and fresh frozen (FF) samples. CTC CNV profiling demonstrated recurrent chromosomal alterations in previously reported NEN copy number hotspots, including the prognostically relevant loss of chromosome 18. Unsupervised hierarchical clustering revealed CTCs with distinct clonal lineages as well as significant intra- and inter-patient genomic heterogeneity, including subclonal alterations not detectable by bulk analysis and previously unreported in NEN. Notably, we also demonstrated the presence of genomically distinct CTCs according to the enrichment strategy utilized (EpCAM-dependent vs size-based). This work has significant implications for the identification of therapeutic targets, tracking of evolutionary change, and the implementation of CTC-biomarkers in cancer.
Collapse
Affiliation(s)
- Alexa Childs
- UCL Cancer Institute, University College London, London, UK
| | | | - Clare Vesely
- UCL Cancer Institute, University College London, London, UK
| | | | - Leah Ensell
- UCL Cancer Institute, University College London, London, UK
| | - Helen Lowe
- UCL Cancer Institute, University College London, London, UK
| | - Pawan Dhami
- UCL Cancer Institute, University College London, London, UK
| | - Heli Vaikkinen
- UCL Cancer Institute, University College London, London, UK
| | - Tu Vinh Luong
- Department of Histopathology, Royal Free London NHS Foundation Trust, London, UK
| | - Lucia Conde
- UCL Cancer Institute, University College London, London, UK
| | - Javier Herrero
- UCL Cancer Institute, University College London, London, UK
| | - Martyn Caplin
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
| | - Christos Toumpanakis
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
| | - Christina Thirlwell
- UCL Cancer Institute, University College London, London, UK
- Department of Oncology, Royal Free London NHS Foundation Trust, London, UK
| | - John A Hartley
- UCL Cancer Institute, University College London, London, UK
| | - Nischalan Pillay
- Research Department of Pathology, Cancer Institute, University College London, London, UK
- Department of Cellular and Molecular Pathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, UK
| | - Tim Meyer
- UCL Cancer Institute, University College London, London, UK
- Department of Oncology, Royal Free London NHS Foundation Trust, London, UK
- Correspondence should be addressed to T Meyer:
| |
Collapse
|
6
|
Frizziero M, Wang X, Chakrabarty B, Childs A, Luong TV, Walter T, Khan MS, Morgan M, Christian A, Elshafie M, Shah T, Minicozzi A, Mansoor W, Meyer T, Lamarca A, Hubner RA, Valle JW, McNamara MG. Retrospective study on mixed neuroendocrine non-neuroendocrine neoplasms from five European centres. World J Gastroenterol 2019; 25:5991-6005. [PMID: 31660035 PMCID: PMC6815794 DOI: 10.3748/wjg.v25.i39.5991] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/15/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) is a rare diagnosis, mainly encountered in the gastro-entero-pancreatic tract. There is limited knowledge of its epidemiology, prognosis and biology, and the best management for affected patients is still to be defined.
AIM To investigate clinical-pathological characteristics, treatment modalities and survival outcomes of a retrospective cohort of patients with a diagnosis of MiNEN.
METHODS Consecutive patients with a histologically proven diagnosis of MiNEN were identified at 5 European centres. Patient data were retrospectively collected from medical records. Pathological samples were reviewed to ascertain compliance with the 2017 World Health Organisation definition of MiNEN. Tumour responses to systemic treatment were assessed according to the Response Evaluation Criteria in Solid Tumours 1.1. Kaplan-Meier analysis was applied to estimate survival outcomes. Associations between clinical-pathological characteristics and survival outcomes were explored using Log-rank test for equality of survivors functions (univariate) and Cox-regression analysis (multivariable).
RESULTS Sixty-nine consecutive patients identified; Median age at diagnosis: 64 years. Males: 63.8%. Localised disease (curable): 53.6%. Commonest sites of origin: colon-rectum (43.5%) and oesophagus/oesophagogastric junction (15.9%). The neuroendocrine component was; predominant in 58.6%, poorly differentiated in 86.3%, and large cell in 81.25%, of cases analysed. Most distant metastases analysed (73.4%) were occupied only by a poorly differentiated neuroendocrine component. Ninety-four percent of patients with localised disease underwent curative surgery; 53% also received perioperative treatment, most often in line with protocols for adenocarcinomas from the same sites of origin. Chemotherapy was offered to most patients (68.1%) with advanced disease, and followed protocols for pure neuroendocrine carcinomas or adenocarcinomas in equal proportion. In localised cases, median recurrence free survival (RFS); 14.0 months (95%CI: 9.2-24.4), and median overall survival (OS): 28.6 months (95%CI: 18.3-41.1). On univariate analysis, receipt of perioperative treatment (vs surgery alone) did not improve RFS (P = 0.375), or OS (P = 0.240). In advanced cases, median progression free survival (PFS); 5.6 months (95%CI: 4.4-7.4), and median OS; 9.0 months (95%CI: 5.2-13.4). On univariate analysis, receipt of palliative active treatment (vs best supportive care) prolonged PFS and OS (both, P < 0.001).
CONCLUSION MiNEN is most commonly driven by a poorly differentiated neuroendocrine component, and has poor prognosis. Advances in its biological understanding are needed to identify effective treatments and improve patient outcomes.
Collapse
Affiliation(s)
- Melissa Frizziero
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Xin Wang
- Department of Analytics and Development, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Bipasha Chakrabarty
- Department of Pathology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Alexa Childs
- Department of Medical Oncology, Royal Free London NHS Foundation Trust, London NW3 2QG, United Kingdom
- UCL Cancer Institute, University College London, London WC1E 6AG, United Kingdom
| | - Tu V Luong
- Department of Histopathology, Royal Free London NHS Foundation Trust, London NW3 2QG, United Kingdom
| | - Thomas Walter
- Department of Gastroenterology and Medical Oncology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon 69003, France
| | - Mohid S Khan
- Department of Gastroenterology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Meleri Morgan
- Department of Cellular Pathology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Adam Christian
- Department of Cellular Pathology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Mona Elshafie
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Tahir Shah
- Department of Hepatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Annamaria Minicozzi
- Department of Surgical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Wasat Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Tim Meyer
- Department of Medical Oncology, Royal Free London NHS Foundation Trust, London NW3 2QG, United Kingdom
- UCL Cancer Institute, University College London, London WC1E 6AG, United Kingdom
| | - Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Richard A Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, United Kingdom
| |
Collapse
|
7
|
Guglieri M, Clemens P, Haberlova J, Horrocks I, Selby K, Webster R, Smith E, Straub V, McMillan H, Yang M, Harper A, Tulinius M, Mah J, Childs A, Finkel R, Nevo Y, McDonald C, Morgenroth L, Bendixon R, Hoffman E. P.336Vision DMD: a phase IIb randomized, double-blind, parallel group, placebo- and active-controlled study to assess the efficacy and safety of vamorolone in boys with Duchenne muscular dystrophy. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.450] [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: 11/28/2022]
|
8
|
Specht S, Scoto M, Childs A, Eglon G, Hastings L, Pysden K, Manning S, Jimenez C, Munot P, Brusa C, Turner M, Guglieri M, Manzur A, Muntoni F, Straub V, Marini-Bettolo C. P.212Mortality in patients with spinal muscular atrophy over the last 10 years: the UK experience. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.326] [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: 11/25/2022]
|
9
|
Rizzo FM, Vesely C, Childs A, Marafioti T, Khan MS, Mandair D, Cives M, Ensell L, Lowe H, Akarca AU, Luong T, Caplin M, Toumpanakis C, Krell D, Thirlwell C, Silvestris F, Hartley JA, Meyer T. Circulating tumour cells and their association with bone metastases in patients with neuroendocrine tumours. Br J Cancer 2019; 120:294-300. [PMID: 30636773 PMCID: PMC6353867 DOI: 10.1038/s41416-018-0367-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 07/18/2018] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 02/03/2023] Open
Abstract
Background Bone metastases are associated with a worse outcome in patients with neuroendocrine tumours (NETs). Tumour overexpression of C-X-C chemokine receptor 4 (CXCR4) appears predictive of skeletal involvement. We investigated the role of circulating tumour cells (CTCs) and CXCR4 expression on CTCs as potential predictors of skeleton invasion. Methods Blood from patients with metastatic bronchial, midgut or pancreatic NET (pNET) was analysed by CellSearch. CXCR4 immunohistochemistry was performed on matched formalin-fixed paraffin-embedded (FFPE) samples. Results Two hundred and fifty-four patients were recruited with 121 midgut and 119 pNETs, of which 51 and 36% had detectable CTCs, respectively. Bone metastases were reported in 30% of midgut and 23% of pNET patients and were significantly associated with CTC presence (p = 0.003 and p < 0.0001). In a subgroup of 40 patients, 85% patients with CTCs had CTCs positive for CXCR4 expression. The proportion of CXCR4-positive CTCs in patients with bone metastases was 56% compared to 35% in those without (p = 0.18) it. Staining for CXCR4 on matched FFPE tissue showed a trend towards a correlation with CXCR4 expression on CTCs (p = 0.08). Conclusions CTC presence is associated with bone metastases in NETs. CXCR4 may be involved in CTC osteotropism and present a therapeutic target to reduce skeletal morbidity.
Collapse
Affiliation(s)
- Francesca M Rizzo
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - Clare Vesely
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - Alexa Childs
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - Teresa Marafioti
- Department of Pathology, UCL Cancer Institute, University College London, London, UK
| | - Mohid S Khan
- Wales Neuroendocrine Tumour Service, Department of Gastroenterology, University Hospital of Wales, Cardiff, UK
| | - Dalvinder Mandair
- Neuroendocrine Tumour Unit, Department of Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Mauro Cives
- Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Bari, Italy
| | - Leah Ensell
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - Helen Lowe
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - Ayse U Akarca
- Department of Pathology, UCL Cancer Institute, University College London, London, UK
| | - TuVinh Luong
- Department of Histopathology, Royal Free London NHS Foundation Trust, London, UK
| | - Martyn Caplin
- Neuroendocrine Tumour Unit, Department of Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, Department of Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Daniel Krell
- Neuroendocrine Tumour Unit, Department of Oncology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Christina Thirlwell
- Department of Oncology, UCL Cancer Institute, University College London, London, UK.,Neuroendocrine Tumour Unit, Department of Oncology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Franco Silvestris
- Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Bari, Italy
| | - John A Hartley
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - Tim Meyer
- Department of Oncology, UCL Cancer Institute, University College London, London, UK. .,Neuroendocrine Tumour Unit, Department of Oncology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK.
| |
Collapse
|
10
|
Wicki A, Brown N, Xyrafas A, Bize V, Hawle H, Berardi S, Cmiljanović N, Cmiljanović V, Stumm M, Dimitrijević S, Herrmann R, Prêtre V, Ritschard R, Tzankov A, Hess V, Childs A, Hierro C, Rodon J, Hess D, Joerger M, von Moos R, Sessa C, Kristeleit R. First-in human, phase 1, dose-escalation pharmacokinetic and pharmacodynamic study of the oral dual PI3K and mTORC1/2 inhibitor PQR309 in patients with advanced solid tumors (SAKK 67/13). Eur J Cancer 2018; 96:6-16. [PMID: 29660598 DOI: 10.1016/j.ejca.2018.03.012] [Citation(s) in RCA: 40] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND PQR309 is an orally bioavailable, balanced pan-phosphatidylinositol-3-kinase (PI3K), mammalian target of rapamycin (mTOR) C1 and mTORC2 inhibitor. PATIENTS AND METHODS This is an accelerated titration, 3 + 3 dose-escalation, open-label phase I trial of continuous once-daily (OD) PQR309 administration to evaluate the safety, pharmacokinetics (PK) and pharmacodynamics in patients with advanced solid tumours. Primary objectives were to determine the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D). RESULTS Twenty-eight patients were included in six dosing cohorts and treated at a daily PQR309 dose ranging from 10 to 150 mg. Common adverse events (AEs; ≥30% patients) included fatigue, hyperglycaemia, nausea, diarrhoea, constipation, rash, anorexia and vomiting. Grade (G) 3 or 4 drug-related AEs were seen in 13 (46%) and three (11%) patients, respectively. Dose-limiting toxicity (DLT) was observed in two patients at 100 mg OD (>14-d interruption in PQR309 due to G3 rash, G2 hyperbilirubinaemia, G4 suicide attempt; dose reduction due to G3 fatigue, G2 diarrhoea, G4 transaminitis) and one patient at 80 mg (G3 hyperglycaemia >7 d). PK shows fast absorption (Tmax 1-2 h) and dose proportionality for Cmax and area under the curve. A partial response in a patient with metastatic thymus cancer, 24% disease volume reduction in a patient with sinonasal cancer and stable disease for more than 16 weeks in a patient with clear cell Bartholin's gland cancer were observed. CONCLUSION The MTD and RP2D of PQR309 is 80 mg of orally OD. PK is dose-proportional. PD shows PI3K pathway phosphoprotein downregulation in paired tumour biopsies. Clinical activity was observed in patients with and without PI3K pathway dysregulation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov # NCT01940133.
Collapse
Affiliation(s)
- Andreas Wicki
- University Hospital Basel, Division of Oncology, Dept. of Biomedicine, Petersgraben 4, 4031 Basel, Switzerland.
| | - Nicholas Brown
- University College London Hospitals NHS Trust, Gynecological Oncology Team, 235 Euston Road, London NW1 2BU, United Kingdom
| | | | - Vincent Bize
- SAKK Coordinating Center, Effingerstrasse 33, 3008 Bern, Switzerland
| | - Hanne Hawle
- SAKK Coordinating Center, Effingerstrasse 33, 3008 Bern, Switzerland
| | - Simona Berardi
- SAKK Coordinating Center, Effingerstrasse 33, 3008 Bern, Switzerland
| | | | | | - Michael Stumm
- Piqur Therapeutics AG, Hochbergstrasse 60C, 4057 Basel, Switzerland
| | | | - Richard Herrmann
- Piqur Therapeutics AG, Hochbergstrasse 60C, 4057 Basel, Switzerland
| | - Vincent Prêtre
- University Hospital Basel, Dept. of Biomedicine, Petersgraben 4, 4031 Basel, Switzerland
| | - Reto Ritschard
- University Hospital Basel, Dept. of Biomedicine, Petersgraben 4, 4031 Basel, Switzerland
| | - Alexandar Tzankov
- University Hospital Basel, Dept. of Pathology, Schönbeinstrasse 40, 4056 Basel, Switzerland
| | - Viviane Hess
- University Hospital Basel, Division of Oncology, Dept. of Biomedicine, Petersgraben 4, 4031 Basel, Switzerland
| | - Alexa Childs
- University College London Hospitals NHS Trust, Gynecological Oncology Team, 235 Euston Road, London NW1 2BU, United Kingdom
| | - Cinta Hierro
- Vall d'Hebron Institut d'Oncologia, Universitat Autonoma of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jordi Rodon
- Vall d'Hebron Institut d'Oncologia, Universitat Autonoma of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Dagmar Hess
- Cantonal Hospital St. Gallen, Dept. of Oncology and Hematology, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Markus Joerger
- Cantonal Hospital St. Gallen, Dept. of Oncology and Hematology, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Roger von Moos
- Cantonal Hospital Graubünden, Dept. of Oncology and Hematology, Loestrasse 170, 7000 Chur, Switzerland
| | - Cristiana Sessa
- Istituto Oncologico della Svizzera Italiana, Ospedale San Giovanni, 6500 Bellinzona, Switzerland
| | - Rebecca Kristeleit
- University College London Hospitals NHS Trust, Gynecological Oncology Team, 235 Euston Road, London NW1 2BU, United Kingdom
| |
Collapse
|
11
|
Vesely C, Childs A, Wong Y, Ogunbiyi O, Luong T, Thirlwell C, Caplin M, Marafioti T, Quezada S, Meyer T. Systematic evaluation of the immune microenvironment of neuroendocrine tumours (NET). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx361.061] [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: 11/13/2022] Open
|
12
|
Frizziero M, Wang X, Chakrabarty B, Childs A, Luong T, Walter T, Elshafie M, Shah T, Fulford P, Minicozzi A, Mansoor W, Meyer T, Hubner R, Valle J, McNamara M. Mixed adeno-neuroendocrine carcinoma (MANEC) of the gastroenteropancreatic (GEP) tract: A multicentre retrospective study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx368.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
13
|
Lamarca A, Walter T, Pavel M, Borbath I, Freis P, Nuñez B, Childs A, McNamara MG, Hubner RA, Garcia-Carbonero R, Meyer T, Valle JW, Barriuso J. Design and Validation of the GI-NEC Score to Prognosticate Overall Survival in Patients With High-Grade Gastrointestinal Neuroendocrine Carcinomas. J Natl Cancer Inst 2017; 109:2960706. [PMID: 28130474 DOI: 10.1093/jnci/djw277] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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] [Received: 07/15/2016] [Revised: 10/06/2016] [Accepted: 10/19/2016] [Indexed: 08/30/2023] Open
Abstract
Background Prognostic markers for risk stratification of patients with gastrointestinal high-grade neuroendocrine carcinomas (GI-NECs) are lacking; we designed and validated a prognostic score for overall survival (OS). Methods Consecutive patients diagnosed in five neuroendocrine specialist European centers were included. Patients were divided into three cohorts: a training cohort (TC), an external validation cohort (EVC), and a prospective validation cohort (PVC). Prognostic factors were identified by log-rank test, Cox-regression, and logistic regression analyses. The derived score was internally and externally validated. All statistical tests were two-sided. Results Of 395 patients screened, 313 were eligible (TC = 109 patients, EVC = 184 patients, and PVC = 20 patients). The derived prognostic score included five variables: presence of liver metastases, alkaline phosphatase (ALK), lactate dehydrogenase (LDH), Eastern Cooperative Oncology Group performance status (ECOG PS), and Ki67. In multivariable analysis, the score was prognostic for OS (hazard ratio [HR] = 1.86, 95% confidence interval [CI] = 1.47 to 2.35, P < .001) and had good discrimination (C-index = 0.76) and calibration (mean error = 0.021, 90th percentile = 0.037) in the TC. These results were validated in the EVC and PVC, in which our score was able to prognosticate for OS when adjusted for other prognostic variables in the multivariable analysis (HR = 1.85, 95% CI = 1.27 to 2.71, P = .001; and HR = 4.51, 95% CI = 1.87 to 10.87, P = .001, respectively). The score classified patients into two groups with incremental risk of death: group A (0-2 points, 181 patients [63.9%], median OS = 19.4 months, 95% CI = 16.1 to 25.1) and group B (3-6 points, 102 patients [36.1%], median OS = 5.2 months, 95% CI = 3.6 to 6.9). Conclusions The GI-NEC score identifies two distinct patient cohorts; it provides a tool for clinicians when making treatment decisions and may be used as a stratification factor in future clinical trials.
Collapse
Affiliation(s)
- Angela Lamarca
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| | - Thomas Walter
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| | - Marianne Pavel
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| | - Ivan Borbath
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| | - Patricia Freis
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| | - Barbara Nuñez
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| | - Alexa Childs
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| | - Mairéad G McNamara
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| | - Richard A Hubner
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| | - Rocio Garcia-Carbonero
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| | - Tim Meyer
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| | - Juan W Valle
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| | - Jorge Barriuso
- Affiliations of authors: Department of Medical Oncology, The Christie NHS Foundation Trust (ENETS Centre of Excellence), Manchester, UK (AL, MGM, RAH, JWV, JB); Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France (TW, PF); Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany (MP); Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (IB); Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain (BN, RGC); Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, UK (AC, TM); Institute of Cancer Sciences (MGM, JWV) and Faculty of Biology, Medicine and Health (JB), University of Manchester, Manchester, UK
| |
Collapse
|
14
|
Childs A, Vesely C, Ensell L, Lowe H, Luong TV, Caplin ME, Toumpanakis C, Thirlwell C, Hartley JA, Meyer T. Expression of somatostatin receptors 2 and 5 in circulating tumour cells from patients with neuroendocrine tumours. Br J Cancer 2016; 115:1540-1547. [PMID: 27875519 PMCID: PMC5155369 DOI: 10.1038/bjc.2016.377] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/12/2016] [Accepted: 10/17/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Neuroendocrine tumours (NET) overexpress somatostatin receptors (SSTR) that can be targeted for therapy. Somatostatin receptor expression is routinely measured by molecular imaging but the resolution is insufficient to define heterogeneity. We hypothesised that SSTR expression could be measured on circulating tumour cells (CTCs) and used to investigate heterogeneity of expression and track changes during therapy. METHODS MCF-7 cells were transfected with SSTR2 or 5 and spiked into donor blood for analysis by CellSearch. Optimum anti-SSTR antibody concentration and exposure time were determined, and flow cytometry was used to evaluate assay sensitivity. For clinical evaluation, blood was analysed by CellSearch, and SSTR2/5 immunohistochemistry was performed on matched tissue samples. RESULTS Flow cytometry confirmed CellSearch was sensitive and that detection of SSTR was unaffected by the presence of somatostatin analogue up to a concentration of 100 ng ml-l. Thirty-one NET patients were recruited: grade; G1 (29%), G2 (45%), G3 (13%), primary site; midgut (58%), pancreatic (39%). Overall, 87% had SSTR-positive tumours according to somatostatin receptor scintigraphy or 68-Ga-DOTATE PET/CT. Circulating tumour cells were detected in 21 out of 31 patients (68%), of which 33% had evidence of heterogeneous expression of either SSTR2 (n=5) or SSTR5 (n=2). CONCLUSIONS Somatostatin receptors 2 and 5 are detectable on CTCs from NET patients and may be a useful biomarker for evaluating SSTR-targeted therapies and this is being prospectively evaluated in the Phase IV CALMNET trial (NCT02075606).
Collapse
Affiliation(s)
- Alexa Childs
- UCL Cancer Institute, University College London, London WC1E 6DD, UK
| | - Clare Vesely
- UCL Cancer Institute, University College London, London WC1E 6DD, UK
| | - Leah Ensell
- UCL Cancer Institute, University College London, London WC1E 6DD, UK
| | - Helen Lowe
- UCL Cancer Institute, University College London, London WC1E 6DD, UK
| | - Tu Vinh Luong
- Department of Histopathology, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - Martyn E Caplin
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - Christos Toumpanakis
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - Christina Thirlwell
- UCL Cancer Institute, University College London, London WC1E 6DD, UK
- Department of Oncology, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - John A Hartley
- UCL Cancer Institute, University College London, London WC1E 6DD, UK
| | - Tim Meyer
- UCL Cancer Institute, University College London, London WC1E 6DD, UK
- Department of Oncology, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| |
Collapse
|
15
|
Childs A, Kirkwood A, Edeline J, Luong TV, Watkins J, Lamarca A, Alrifai D, Nsiah-Sarbeng P, Gillmore R, Mayer A, Thirlwell C, Sarker D, Valle JW, Meyer T. Ki-67 index and response to chemotherapy in patients with neuroendocrine tumours. Endocr Relat Cancer 2016; 23:563-70. [PMID: 27412968 DOI: 10.1530/erc-16-0099] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/15/2016] [Indexed: 01/23/2023]
Abstract
Chemotherapy (CT) is widely used for neuroendocrine tumours (NETs), but there are no validated biomarkers to predict response. The Ki-67 proliferation index has been proposed as a means of selecting patients for CT, but robust data are lacking. The aim of this study was to investigate the relationship between response to chemotherapy and Ki-67 in NET. We reviewed data from 222 NET patients treated with CT. Tumours were graded according to Ki-67 index: G1 ≤2%, G2 3-20% and G3 >20%. Response was assessed according to RECIST and survival calculated from start of chemotherapy to death. To explore Ki-67 as a marker of response, we calculated the likelihood ratio and performed receiver operating characteristic analysis. Overall, 193 patients had a documented Ki-67 index, of which 173 were also evaluable for radiological response: 10% were G1, 46% G2 and 43% G3; 46% were pancreatic NET (PNET). Median overall survival was 22.1 months. Overall response rate was 30% (39% in PNET vs 22% in non-PNET) and 43% of patients had stable disease. Response rate increased with grade: 6% in G1 tumours, 24% in G2 and 43% in G3. However, maximum likelihood ratio was 2.3 at Ki-67=35%, and the area under the ROC curve was 0.60. As reported previously, a high Ki-67 was an adverse prognostic factor for overall survival. In conclusion, response to CT increases with Ki-67 index, but Ki-67 alone is an unreliable means to select patients for CT. Improved methods to stratify patients for systemic therapy are required.
Collapse
Affiliation(s)
- Alexa Childs
- Department of OncologyRoyal Free London NHS Foundation Trust, London, UK
| | - Amy Kirkwood
- Cancer Research UK & UCL Cancer Trials CentreLondon, UK
| | | | - Tu Vinh Luong
- Department of PathologyRoyal Free London NHS Foundation Trust, London, UK
| | - Jennifer Watkins
- Department of PathologyRoyal Free London NHS Foundation Trust, London, UK
| | - Angela Lamarca
- Institute of Cancer SciencesUniversity of Manchester/The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Roopinder Gillmore
- Department of OncologyRoyal Free London NHS Foundation Trust, London, UK
| | - Astrid Mayer
- Department of OncologyRoyal Free London NHS Foundation Trust, London, UK
| | - Christina Thirlwell
- Department of OncologyRoyal Free London NHS Foundation Trust, London, UK UCL Cancer InstituteUCL, London, UK
| | | | - Juan W Valle
- Institute of Cancer SciencesUniversity of Manchester/The Christie NHS Foundation Trust, Manchester, UK
| | - Tim Meyer
- Department of OncologyRoyal Free London NHS Foundation Trust, London, UK UCL Cancer InstituteUCL, London, UK
| |
Collapse
|
16
|
Lamarca A, Walter T, Pavel ME, Borbath I, Freis P, Nuñez B, Childs A, McNamara MG, Hubner R, Garcia-Carbonero R, Meyer T, Barriuso J, Valle JW. External validation of a prognostic score in patients (pts) with high-grade gastrointestinal neuroendocrine carcinomas (GI-NECs). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4089] [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)
- Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Thomas Walter
- Department of Medical Oncology, Hospices Civils de Lyon, Edouard Herriot Hospital, University of Lyon, Lyon, France
| | | | - Ivan Borbath
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Patricia Freis
- Department of Medical Oncology, Hospices Civils de Lyon Edouard Herriot Hospital, University of Lyon, Lyon, France
| | - Barbara Nuñez
- Department of Medical Oncology, Doce de Octubre University Hospital, Madrid, Spain
| | - Alexa Childs
- Department of Medical Oncology, Royal Free London NHS Foundation Trust (ENETS Centre of Excellence), London, United Kingdom
| | - Mairead G McNamara
- Institute of Cancer Sciences, University of Manchester; Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Richard Hubner
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - Tim Meyer
- UCL Cancer Institute, University College London,, London, United Kingdom
| | - Jorge Barriuso
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Juan W. Valle
- Institute of Cancer Sciences, University of Manchester; Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
17
|
Wicki A, Sessa C, Childs A, Stathis A, Hess D, Joerger M, von Moos R, Rodon J, Hierro C, Cmiljanovic N, Bize V, Berardi S, Xyrafas A, Kristeleit R. Abstract CT310: First-in-man (FIM) pharmacodynamic (PD) and pharmacokinetic (PK) phase I trial of PQR309 in advanced solid tumors. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-ct310] [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: 11/16/2022]
Abstract
Abstract
Background: PQR309 is a novel, oral, balanced pan-PI3K, mTORC1 and mTORC2 inhibitor. Preclinical experiments show promising anti-cancer activity. The primary objectives of this FIM trial of PQR309 were definition of maximal tolerated dose (MTD), and safety.
Methods: The trial was designed as an accelerated 3+3 study. Patients with advanced solid tumors with no standard management options were eligible. Dose-limiting toxicity (DLT) was defined as either grade 4 neutropenia >7 days, febrile neutropenia, grade 4 thrombocytopenia, non-hematological toxicity of either grade 4, uncontrolled grade 3 >7 days or dose-limiting grade 2, or treatment delay >14 days. The DLT period was 21 days. Starting dose of PQR-309 was 10mg once daily (OD) continuously, based on preclinical data and a No observed adverse effect level (NOAEL) of 4 mg/kg in non-rodent species. The predefined dose levels were 10, 20, 40, 80, 120mg adjusted by dose banding method to the patient weight. Additional flat doses at 80 and 100 mg were investigated. The highest dose reached with this schedule was 150mg OD. Toxicities were assessed throughout dose escalation. 21 patients were included in the trial.
Results: No DLT has been observed to date. Drug-related adverse events (AE) included hyperglycemia, rash, loss of appetite, weight loss, nausea, diarrhea, and fatigue. The most common AE ≥ grade 3 was hyperglycemia in 5 patients. Blood sugar levels were manageable with oral antidiabetic drugs or insulin. Preliminary PK evaluation estimates a half-life of about 20 hours. Cmax and AUC show dose proportionality. Preliminary PD assessment of 16 phospho-proteins involved in PI3K and MAPK signaling in fresh-frozen tumor biopsies, indicates downregulation of p-Akt, pS6 and p4EPB from 40mg OD. In addition, moderate inhibition of p-Erk was also observed. This correlates with preclinical data. Preliminary signs of clinical anti-cancer activity include 1 patient with clear cell cancer of the Bartholin's gland experiencing stable disease for over 16 weeks. No DLT has been observed up to doses of 150mg OD. Based on these data, further dose escalation in this study will continue with intermittent dosing schedules. Trials of PQR309 in combination with other anti-cancer agents are planned.
Citation Format: Andreas Wicki, Cristiana Sessa, Alexa Childs, Anastasios Stathis, Dagmar Hess, Markus Joerger, Roger von Moos, Jordi Rodon, Cinta Hierro, Natasa Cmiljanovic, Vincent Bize, Simona Berardi, Alexandros Xyrafas, Rebecca Kristeleit. First-in-man (FIM) pharmacodynamic (PD) and pharmacokinetic (PK) phase I trial of PQR309 in advanced solid tumors. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr CT310. doi:10.1158/1538-7445.AM2015-CT310
Collapse
Affiliation(s)
| | | | - Alexa Childs
- 3University College Hospital, London, United Kingdom
| | | | - Dagmar Hess
- 4Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | | | - Jordi Rodon
- 6Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cinta Hierro
- 6Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Vincent Bize
- 8Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Simona Berardi
- 8Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | | | | |
Collapse
|
18
|
Kristeleit RS, Brown NF, Hess D, Joerger M, Von Moos R, Rodón J, Hierro C, Childs A, Stathis A, Dimitrijevic S, Stumm M, Herrmann R, Sessa C, Bize V, Hess V, Wicki A. A phase 1 first-in-human (FIH) dose-escalation (DE) study of the oral dual PI3K/mTOR inhibitor PQR309 in patients (pts) with advanced solid tumors: Final DE results. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.2592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
| | | | - Dagmar Hess
- Kantonsspital St Gallen, Eggersriet, Switzerland
| | | | | | - Jordi Rodón
- Vall d'Hebron Institute of Oncology, VHIO, Barcelona, Spain
| | - Cinta Hierro
- Vall d'Hebron Institute of Oncology, VHIO, Barcelona, Spain
| | - Alexa Childs
- University College London Cancer Institute, London, United Kingdom
| | - Anastasios Stathis
- IOSI - Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | | | | | | | - Vincent Bize
- SAKK - Swiss Group for Clinical Cancer Research, Coordinating Center, Bern, Switzerland
| | | | | |
Collapse
|
19
|
Abstract
Hepatocellular cancer (HCC) accounts for 47,000 deaths per year in Europe and the incidence is expected to increase over the next 10-15 years. The highest incidence is found in Southern Europe, mainly attributable to chronic hepatitis C infection. The most widely used staging system used is the Barcelona-Clinic Liver Cancer (BCLC) classification according to which, 30-40% patients are suitable for potentially curative therapies including transplantation, resection or ablative therapy while the remainder are offered palliative therapy with transarterial therapy, systemic therapy or supportive care. Here we review the indications and outcomes of these interventions as applied to the European population.
Collapse
Affiliation(s)
- Alexa Childs
- Department of Oncology, UCL Medical School, Royal Free Hospital, London, NW3 2QG, UK
| | - James O'Beirne
- The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London, NW3 2QG, UK
| | - Tim Meyer
- Department of Oncology, UCL Medical School, Royal Free Hospital, London, NW3 2QG, UCL Cancer Institute, London, WC1E 6BT, UK
| |
Collapse
|
20
|
Ricotti V, Ridout DA, Scott E, Quinlivan R, Robb SA, Manzur AY, Muntoni F, Muntoni F, Robb S, Quinlivan R, Ricotti V, Main M, Bushby K, Straub V, Sarkozy A, Guglieri M, Strehle E, Eagle M, Mayhew A, Roper H, McMurchie H, Childs A, Pysden K, Pallant L, Spinty S, Peachey G, Shillington A, Wraige E, Jungbluth H, Sheehan J, Spahr R, Hughes I, Bateman E, Cammiss C, Willis T, Groves L, Emery N, Baxter P, Senior M, Hartley L, Parsons B, Majumdar A, Jenkins L, Naismith K, Keddie A, Horrocks I, Di Marco M, Chow G, Miah A, de Goede C, Thomas N, Geary M, Palmer J, White C, Greenfield K, Scott E. Long-term benefits and adverse effects of intermittent versus daily glucocorticoids in boys with Duchenne muscular dystrophy. J Neurol Neurosurg Psychiatry 2013; 84:698-705. [PMID: 23250964 DOI: 10.1136/jnnp-2012-303902] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the current use of glucocorticoids (GCs) in Duchenne muscular dystrophy in the UK, and compare the benefits and the adverse events of daily versus intermittent prednisolone regimens. DESIGN A prospective longitudinal observational study across 17 neuromuscular centres in the UK of 360 boys aged 3-15 years with confirmed Duchenne muscular dystrophy who were treated with daily or intermittent (10 days on/10 days off) prednisolone for a mean duration of treatment of 4 years. RESULTS The median loss of ambulation was 12 years in intermittent and 14.5 years in daily treatment; the HR for intermittent treatment was 1.57 (95% CI 0.87 to 2.82). A fitted multilevel model comparing the intermittent and daily regiments for the NorthStar Ambulatory Assessment demonstrated a divergence after 7 years of age, with boys on an intermittent regimen declining faster (p<0.001). Moderate to severe side effects were more commonly reported and observed in the daily regimen, including Cushingoid features, adverse behavioural events and hypertension. Body mass index mean z score was higher in the daily regimen (1.99, 95% CI 1.79 to 2.19) than in the intermittent regimen (1.51, 95% CI 1.27 to 1.75). Height restriction was more severe in the daily regimen (mean z score -1.77, 95% CI -1.79 to -2.19) than in the intermittent regimen (mean z score -0.70, 95% CI -0.90 to -0.49). CONCLUSIONS Our study provides a framework for providing information to patients with Duchenne muscular dystrophy and their families when introducing GC therapy. The study also highlights the importance of collecting longitudinal natural history data on patients treated according to standardised protocols, and clearly identifies the benefits and the side-effect profile of two treatment regimens, which will help with informed choices and implementation of targeted surveillance.
Collapse
Affiliation(s)
- Valeria Ricotti
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Childs A, Balakrishnan N, Chandrasekar B. Exact distribution of the MLEs of the parameters and of the quantiles of two-parameter exponential distribution under hybrid censoring. STATISTICS-ABINGDON 2011. [DOI: 10.1080/02331888.2010.538476] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A. Childs
- a Department of Mathematics and Statistics , McMaster University , Hamilton , ON , Canada , L8S 4K1
| | - N. Balakrishnan
- a Department of Mathematics and Statistics , McMaster University , Hamilton , ON , Canada , L8S 4K1
| | - B. Chandrasekar
- b Department of Statistics , Loyola College , Chennai , 600 034 , India
| |
Collapse
|
22
|
|
23
|
Read JA, Beale PJ, Horvath LG, Volker D, Childs A, Smith N, Clarke SJ. Impact of fish-oil supplement on nutritional parameters, inflammation and chemotherapy induced toxicity in colorectal cancer (CRC) patients receiving FOLFIRI- a pilot study. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8243] [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)
- J. A. Read
- Royal Prince Alfred Hosp, Camperdown, NSW, Australia; Concord Hosp, Concord, NSW, Australia; Royal Prince Alfred Hosp, Camperdown, Australia; Sydney Univ, Sydney, Australia; Univ of Technology, Sydney, Australia
| | - P. J. Beale
- Royal Prince Alfred Hosp, Camperdown, NSW, Australia; Concord Hosp, Concord, NSW, Australia; Royal Prince Alfred Hosp, Camperdown, Australia; Sydney Univ, Sydney, Australia; Univ of Technology, Sydney, Australia
| | - L. G. Horvath
- Royal Prince Alfred Hosp, Camperdown, NSW, Australia; Concord Hosp, Concord, NSW, Australia; Royal Prince Alfred Hosp, Camperdown, Australia; Sydney Univ, Sydney, Australia; Univ of Technology, Sydney, Australia
| | - D. Volker
- Royal Prince Alfred Hosp, Camperdown, NSW, Australia; Concord Hosp, Concord, NSW, Australia; Royal Prince Alfred Hosp, Camperdown, Australia; Sydney Univ, Sydney, Australia; Univ of Technology, Sydney, Australia
| | - A. Childs
- Royal Prince Alfred Hosp, Camperdown, NSW, Australia; Concord Hosp, Concord, NSW, Australia; Royal Prince Alfred Hosp, Camperdown, Australia; Sydney Univ, Sydney, Australia; Univ of Technology, Sydney, Australia
| | - N. Smith
- Royal Prince Alfred Hosp, Camperdown, NSW, Australia; Concord Hosp, Concord, NSW, Australia; Royal Prince Alfred Hosp, Camperdown, Australia; Sydney Univ, Sydney, Australia; Univ of Technology, Sydney, Australia
| | - S. J. Clarke
- Royal Prince Alfred Hosp, Camperdown, NSW, Australia; Concord Hosp, Concord, NSW, Australia; Royal Prince Alfred Hosp, Camperdown, Australia; Sydney Univ, Sydney, Australia; Univ of Technology, Sydney, Australia
| |
Collapse
|
24
|
Childs A, Chandrasekar B, Balakrishnan N, Kundu D. Exact likelihood inference based on Type-I and Type-II hybrid censored samples from the exponential distribution. ANN I STAT MATH 2003. [DOI: 10.1007/bf02530502] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
25
|
|
26
|
Childs A, Jacobs C, Kaminski T, Halliwell B, Leeuwenburgh C. Supplementation with vitamin C and N-acetyl-cysteine increases oxidative stress in humans after an acute muscle injury induced by eccentric exercise. Free Radic Biol Med 2001; 31:745-53. [PMID: 11557312 DOI: 10.1016/s0891-5849(01)00640-2] [Citation(s) in RCA: 208] [Impact Index Per Article: 9.0] [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] [Indexed: 10/27/2022]
Abstract
There has been no investigation to determine if the widely used over-the-counter, water-soluble antioxidants vitamin C and N-acetyl-cysteine (NAC) could act as pro-oxidants in humans during inflammatory conditions. We induced an acute-phase inflammatory response by an eccentric arm muscle injury. The inflammation was characterized by edema, swelling, pain, and increases in plasma inflammatory indicators, myeloperoxidase and interleukin-6. Immediately following the injury, subjects consumed a placebo or vitamin C (12.5 mg/kg body weight) and NAC (10 mg/kg body weight) for 7 d. The resulting muscle injury caused increased levels of serum bleomycin-detectable iron and the amount of iron was higher in the vitamin C and NAC group. The concentrations of lactate dehydrogenase (LDH), creatine kinase (CK), and myoglobin were significantly elevated 2, 3, and 4 d postinjury and returned to baseline levels by day 7. In addition, LDH and CK activities were elevated to a greater extent in the vitamin C and NAC group. Levels of markers for oxidative stress (lipid hydroperoxides and 8-iso prostaglandin F2alpha; 8-Iso-PGF2alpha) and antioxidant enzyme activities were also elevated post-injury. The subjects receiving vitamin C and NAC had higher levels of lipid hydroperoxides and 8-Iso-PGF2alpha 2 d after the exercise. This acute human inflammatory model strongly suggests that vitamin C and NAC supplementation immediately post-injury, transiently increases tissue damage and oxidative stress.
Collapse
Affiliation(s)
- A Childs
- Biochemistry of Aging Laboratory, Center for Exercice Science, College of Human Performance, University of Florida, Gainesville, FL 32611, USA
| | | | | | | | | |
Collapse
|
27
|
Kemme MJ, Burggraaf J, Schoemaker RC, Paulson S, Karim A, Lentjes EG, Childs A, Braeckman RA, Cohen AF. The influence of reduced liver blood flow on the pharmacokinetics and pharmacodynamics of recombinant tissue factor pathway inhibitor. Clin Pharmacol Ther 2000; 67:504-11. [PMID: 10824629 DOI: 10.1067/mcp.2000.106796] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Recombinant tissue factor pathway inhibitor (rTFPI) has been shown to be an effective treatment in animal models of sepsis and is under investigation for human use. Reduced liver blood flow during septic shock may substantially alter the pharmacokinetics of rTFPI because clearance of rTFPI approaches liver blood flow. The aim of this study was to examine the effect of exercise-induced reduction in liver blood flow on the pharmacokinetics and pharmacodynamics of rTFPI. METHODS This was a two-way, open-label, randomized crossover study in eight healthy male volunteers. The subjects in both treatment groups received a continuous intravenous infusion of rTFPI (0.2 mg/kg/h) concurrently with intravenous sorbitol (50 mg/min) for 4 hours. Sorbitol was used as a biomarker for liver blood flow. The subjects were randomized to remain supine or to exercise on a bicycle ergometer for 30 minutes starting at the beginning of the third hour of the infusion. RESULTS Exercise reduced liver blood flow (mean +/- SEM) from 1.44 +/- 0.06 L/min to 0.40 +/- 0.03 L/min. The average clearance of rTFPI decreased from 0.73 +/- 0.04 L/min in the supine position to 0.25 +/- 0.02 L/min during exercise. This decrease in rTFPI clearance resulted in an 80% (95% confidence interval [CI], 60% to 102%) increase in plasma rTFPI levels during exercise. The average maximal prothrombin time and activated partial thromboplastin time values during exercise were 1.4 (95% CI, 0.4 to 2.5) and 4.4 (95% CI, 2.7 to 6.1) seconds higher compared with the supine steady-state level. CONCLUSIONS Reduction in liver blood flow by exercise markedly increased rTFPI concentrations and induced a slight but variable prothrombin time and activated partial thromboplastin time increase at the rTFPI dose studied.
Collapse
Affiliation(s)
- M J Kemme
- Centre for Human Drug Research, Department of Clinical Chemistry, Leiden University Medical Center, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
The objective of this study was to compare the effectiveness and safety of intramuscular droperidol to other intramuscularly administered agents used in the management of acutely agitated patients. Twenty-seven inpatients with a history of brain injury were prospectively monitored over a period of 2 months. Data collected for each episode of agitation include: dose, number of doses, time to achieve an adequate response or calming effect, post-episodic functioning, treatment-emergent side effects, and other patient demographics. A retrospective medical records review was also performed on the same cohort, to compare clinical outcomes associated with other intramuscular agents previously used for acute agitation. Time to achieve calming was significantly shorter with intramuscular droperidol (mean = 27.0 minutes) compared to intramuscular haloperidol, lorazepam, or diphenhydramine (group mean = 36.2 minutes, p = 0.02). Of the three comparative agents, the time to achieve calming was the fastest with lorazepam (mean = 35.0 minutes), and slower with diphenhydramine (mean = 42.6 minutes) and haloperidol (mean = 43.0 minutes). Single doses of droperidol controlled agitation more frequently than did single doses of comparative agents, and there was less post-episodic sedation with droperidol following release from seclusion or restraints. Both groups were similar in regard to the incidence of treatment-emergent events. This data represents the first published experience supporting the effectiveness of droperidol in reducing acute agitation in persons with brain injury. Follow-up studies with prospective, double-blind, parallel treatment groups should be performed to validate these preliminary findings.
Collapse
Affiliation(s)
- S W Stanislav
- College of Pharmacy, The University of Texas at Austin, 78712, USA.
| | | |
Collapse
|
29
|
McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database. Arch Phys Med Rehabil 1999; 80:941-4. [PMID: 10453772 DOI: 10.1016/s0003-9993(99)90087-4] [Citation(s) in RCA: 383] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To establish isometric endurance holding times, as well as ratios between torso extensors, flexors, and lateral flexors (stabilizers), for clinical assessment and rehabilitation targets. DESIGN Simple measurement of endurance times in four tests performed in random order by a healthy cohort. To measure reliability, a subsample also performed the tests again 8 weeks later. SETTING University laboratory. PARTICIPANTS Seventy-five young healthy subjects (31 men, 44 women). RESULTS Women had longer endurance times than men for torso extension, but not for torso flexion or for the "side bridge" exercise, which challenges the lateral flexors (stabilizers). Men could sustain the "side bridge" for 65% of their extensor time and 99% of their flexion time, whereas women could sustain the "side bridge" for only 39% of their extensor time and 79% of their flexion time. The tests proved reliable, with reliability coefficients of >.97 for the repeated tests on 5 consecutive days and again 8 weeks later. CONCLUSION Healthy young men and women possess different endurance profiles for the spine stabilizing musculature. Given the growing support for quantification of endurance, these data of endurance times and their ratios between extensor, flexor, and lateral flexor groups in healthy normal subjects are useful for patient evaluation and for providing clinical training targets.
Collapse
Affiliation(s)
- S M McGill
- Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Ontario, Canada
| | | | | |
Collapse
|
30
|
Liauw C, Childs A, Allen N, Edge M, Franklin K, Collopy D. Effect of interactions between stabilisers and silica used for anti-blocking applications on UV and thermal stability of polyolefin film 2. Degradation studies. Polym Degrad Stab 1999. [DOI: 10.1016/s0141-3910(99)00006-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
31
|
Miller M, Boyer MJ, Butow PN, Gattellari M, Dunn SM, Childs A. The use of unproven methods of treatment by cancer patients. Frequency, expectations and cost. Support Care Cancer 1998; 6:337-47. [PMID: 9695201 DOI: 10.1007/s005200050175] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The use of unproven therapies is of concern for a number of reasons, including the lack of scientific evidence of support them, their potential financial costs and the possibility of interference with conventional treatment. This study explored the prevalence, predictors and experiences of unproven therapy use by cancer patients attending an oncology clinic at an Australian teaching hospital. A questionnaire was administered to patients whilst they were waiting for a consultation with their oncologist. A total of 173 patients were invited to participate, and 156 consented to complete the survey (90%). Over half the patients (81, 52%) had used at least one unproven therapy since their diagnosis, and 28% had used three or more. Patients most commonly practised mediation/relaxation, changed their diet and used multi-vitamins. Most expected that the therapies would aid their conventional treatments and make them feel more in control of their situation. Benefits reported were largely psychological, such as an increased sense of control or a reduction in anxiety. Younger patients, those with early stage or advanced metastatic disease and those who had used unproven therapies prior to developing cancer were more likely to use unproven therapies. Health professionals involved in the care of cancer patients should be prepared to discuss the use of unproven therapies and try to identify and deal with unmet needs to help patients to cope with their illness.
Collapse
Affiliation(s)
- M Miller
- Department of Medicine, University of Sydney, Australia
| | | | | | | | | | | |
Collapse
|
32
|
Cox K, Visintin L, Kovac S, Childs A, Kelleher H, Murray B, White G, Storey D, Findlay M. Establishing a programme for continuous ambulatory infusion chemotherapy. Aust N Z J Med 1997; 27:680-4. [PMID: 9483236 DOI: 10.1111/j.1445-5994.1997.tb00998.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The development of venous access devices (VADs) and portable infusion pumps has enabled chemotherapy to be administered continuously within the home environment. AIM The objective of this study was to describe the experience of establishing an ambulatory chemotherapy programme for patients receiving protracted infusions (PVIs) of 5-fluorouracil (5-FU). METHODS The files of all patients receiving PVI 5-FU as a component of their treatment for gastrointestinal malignancy were reviewed. The types of VADs, infusion pump systems and their management were documented. Information packages and education programmes were developed for patients. RESULTS Seventy-four patients with gastrointestinal cancer were studies. At the end of the period the Portacath was the preferred VAD, while both pumps used were found to have advantages and disadvantages. The choice of pump was decided more by patient preference than systematic differences in performance of the pumps. CONCLUSIONS The findings in this review confirm that, with close attention to the potential pitfalls of ambulatory chemotherapy, an acceptable service can be provided.
Collapse
Affiliation(s)
- K Cox
- Department of Medical Oncology, Royal Prince Alfred Hospital, Sydney, NSW
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Allen N, Edge M, Corrales T, Childs A, Liauw C, Catalina F, Peinado C, Minihan A. Entrapment of stabilisers in silica: I. Controlled release of additives during polypropylene degradation. Polym Degrad Stab 1997. [DOI: 10.1016/s0141-3910(96)00161-9] [Citation(s) in RCA: 12] [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: 10/17/2022]
|
34
|
Stanislav SW, Fabre T, Crismon ML, Childs A. Buspirone's efficacy in organic-induced aggression. J Clin Psychopharmacol 1994; 14:126-30. [PMID: 8195453] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The objectives of this study were to (1) identify and characterize hospitalized patients with an organic-related psychiatric diagnosis who had received buspirone therapy and (2) assess the effect of buspirone on aggressive behaviors. A retrospective medical records review was conducted on all patients who were admitted to our psychiatric/rehabilitation facility over a 36-month period and who had received buspirone therapy. Monthly behavioral therapy records were used to determine the quality and quantity of aggressive-related behaviors. Study endpoint was reached in each subject when buspirone was discontinued or when records were unavailable. Twenty subjects, ranging in age from 15 to 55 years old (mu = 26.1 +/- 9.8), were identified for study. Nine (90%) of 10 subjects for whom data were available for at least 3 months showed an improvement in behavior by study endpoint, and 6 (60%) showed at least a 50% reduction in behavioral symptoms by study endpoint. Results from this study suggest that buspirone is well tolerated and may be effective in the treatment of aggressive and other maladaptive behaviors in individuals with an organic component to their psychiatric illness, particularly traumatic brain injury. Prospective, controlled trials are needed to validate these findings.
Collapse
Affiliation(s)
- S W Stanislav
- College of Pharmacy, University of Texas at Austin 78712
| | | | | | | |
Collapse
|
35
|
Stanislav SW, Barker K, Crismon ML, Childs A. Effect of a clinical psychopharmacy consultation service on patient outcomes. Am J Hosp Pharm 1994; 51:778-81. [PMID: 8010316] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The effect of a psychopharmacy consultation service on outcomes in patients with psychiatric disorders was studied. The medical records of 30 randomly selected patients who had been hospitalized between August 1990 and July 1992 at a private psychiatric institution and who had been seen by the psychopharmacy consultation service during that period were reviewed. Data obtained included (1) patient demographics, (2) patient information generated by the psychopharmacy consultation, (3) the types of recommendations made by the psychopharmacy specialist and whether the recommendations were accepted by the physician, and (4) the clinical outcome. Forty-three psychopharmacy consultations for the 30 patients were evaluated. A total of 125 recommendations were made by the consultation service; of these, 75 (60%) were accepted. The consultations were divided into consultations for which at least a majority of the resulting recommendations were accepted by the physician (n = 29) and consultations for which less than a majority of the recommendations were accepted (n = 14). For the majority group, 23 (79%) of the 29 consultations were associated with a positive outcome, compared with 2 (14%) of the 14 consultations in the less-than-majority group. Similarly, positive outcomes were significantly more frequent in the majority-group patients (16/21 [76%]) than in the less-than-majority-group patients (2/9 [22%]). The frequency of positive outcomes was higher among patients for whom most of the recommendations of a clinical psychopharmacy consultation service were accepted than among patients for whom most recommendations were not accepted.
Collapse
Affiliation(s)
- S W Stanislav
- College of Pharmacy, University of Texas at Austin 78712
| | | | | | | |
Collapse
|
36
|
Childs A, Thomas B, Tibbles P. Self-harm. Specialist needs. Nurs Times 1994; 90:32-3. [PMID: 8115253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
37
|
Bukowski RM, Budd GT, Gibbons JA, Bauer RJ, Childs A, Antal J, Finke J, Tuason L, Lorenzi V, McLain D. Phase I trial of subcutaneous recombinant macrophage colony-stimulating factor: clinical and immunomodulatory effects. J Clin Oncol 1994; 12:97-106. [PMID: 8270990 DOI: 10.1200/jco.1994.12.1.97] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [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: 01/29/2023] Open
Abstract
PURPOSE Recombinant human macrophage colony-stimulating factor (rM-CSF) has been demonstrated to control the growth, differentiation, and function of mononuclear phagocytes. Preclinical studies have indicated antitumor effects, and therefore a phase I trial of rM-CSF in patients with malignancy was initiated. The toxicity and hematologic and immunologic effects were investigated. PATIENTS AND METHODS rM-CSF was administered as a subcutaneous injection on days 1 through 5 and 8 through 12. Cycles were repeated every 28 days. Cohorts of four to seven patients received rM-CSF at dose levels from 0.1 to 25.6 mg/m2/d. Forty-two patients received 88 cycles of rM-CSF. All patients had metastatic solid tumors refractory to standard therapy. RESULTS The toxicity of rM-CSF was mild. Dose-limiting toxicity included thrombocytopenia (two patients) and iritis (one patient) occurring at a dose of 25.6 mg/m2/d. Hematologic studies demonstrated dose-related monocytosis occurring routinely at doses > or = 3.2 mg/m2/d, and thrombocytopenia. Immunologic studies demonstrated enhanced secretion of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1-beta (IL-1 beta) by monocytes after in vitro stimulation with lipopolysaccharide, and increased expression of TNF-alpha mRNA at higher rM-CSF dose levels. Pharmacokinetic studies demonstrated that the systemic clearance rate of M-CSF increases during week 1 of therapy, resulting in lower blood levels of M-CSF during the second week of therapy. CONCLUSION rM-CSF can be safely administered to patients, and has biologic activity on peripheral-blood monocytes.
Collapse
Affiliation(s)
- R M Bukowski
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, OH
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Michals ML, Crismon ML, Roberts S, Childs A. Clozapine response and adverse effects in nine brain-injured patients. J Clin Psychopharmacol 1993; 13:198-203. [PMID: 8354736] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Clozapine was used to treat nine brain-injured patients with psychotic symptoms or outbursts of rage and aggression refractory to other medications. Verbal and physical aggression decreased markedly in two patients, and one additional patient had a dramatic decrease in bizarre behaviors. Mild improvement occurred in three patients with a decrease in agitation and frequency of auditory hallucinations. Response was indeterminate in three patients because of inadequate length of treatment. The incidence of side effects appeared to be higher than expected, with seizures occurring in two of nine patients. These case reports illustrate that clozapine may be useful in the treatment of psychosis and aggressive behavior after brain injury, despite the occurrence of adverse effects.
Collapse
Affiliation(s)
- M L Michals
- College of Pharmacy, University of Texas, Austin 78712
| | | | | | | |
Collapse
|
39
|
Childs NL, Childs A. Coma and vegetative states. Arch Phys Med Rehabil 1993; 74:333. [PMID: 8439268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
40
|
Abstract
Severe post-anoxic spasticity in a 25-year-old female was significantly improved during an open trial of 15 cycle per second CES. The bipolar LISS device with suboccipital electrode placement was used for 40 minutes three times a day. A synergism appeared when dantrolene 50 mg twice a day was combined with the CES, these additive effects being greater than either modality used alone.
Collapse
Affiliation(s)
- A Childs
- Health Care Rehabilitation Center, Austin, TX 78745
| |
Collapse
|
41
|
Coates A, Childs A, Cox K, Forsyth C, Joshua D, McNeil E, Grygiel J. The above letter was referred to the authors, who respond as follows:. Ann Oncol 1992. [DOI: 10.1093/oxfordjournals.annonc.a058341] [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
|
42
|
Coates AS, Childs A, Cox K, Forsyth C, Joshua DE, McNeil E, Grygiel JJ. Severe vascular adverse effects with thrombocytopenia and renal failure following emetogenic chemotherapy and ondansetron. Ann Oncol 1992; 3:719-22. [PMID: 1450061 DOI: 10.1093/oxfordjournals.annonc.a058326] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
During late 1991, a series of severe adverse events involving thrombocytopenia, renal insufficiency and thrombotic episodes was observed in patients receiving emetogenic chemotherapy. Two patients died, one of renal failure and one of cerebral haemorrhage in the presence of thrombocytopenia. Other severe side effects included thrombosis of the aorta causing paraplegia and multifocal cerebral infarctions. Common exposure features included the use of ondansetron and dexamethasone as antiemetics, and in most of the cases high dose (100 mg/M2 or more) cisplatin. Retrospective review of a series of patients treated with similar cytotoxic regimens for similar diseases before the use of ondansetron revealed no similar adverse effects, but no substantial differences were observed in renal function or haematologic toxicity in the two groups overall. Sporadic adverse vascular events have been observed before the use of ondansetron. The mechanism remains unknown, and it is not clear whether ondansetron was a factor in the unusual incidence of such events in the present series.
Collapse
Affiliation(s)
- A S Coates
- Department of Medical Oncology, Royal Prince Alfred Hospital, Camperdown NSW, Australia
| | | | | | | | | | | | | |
Collapse
|
43
|
Sanda MG, Yang JC, Topalian SL, Groves ES, Childs A, Belfort R, de Smet MD, Schwartzentruber DJ, White DE, Lotze MT. Intravenous administration of recombinant human macrophage colony-stimulating factor to patients with metastatic cancer: a phase I study. J Clin Oncol 1992; 10:1643-9. [PMID: 1403042 DOI: 10.1200/jco.1992.10.10.1643] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Recombinant human macrophage colony-stimulating factor (M-CSF) has been shown to stimulate specifically macrophage lineage differentiation in vitro and to induce cells capable of antitumor activity alone or in combination with an antibody. The administration of M-CSF to mice has demonstrated antitumor therapeutic effects in vivo. Therefore, a phase I trial of M-CSF administration to patients with metastatic cancer was undertaken. PATIENTS AND METHODS M-CSF was given by intermittent intravenous bolus infusion every 8 hours for 7 days; the treatment cycle was repeated once after a week of rest. Cohorts of three patients underwent dose escalation from 10 to 100,000 micrograms/m2/d; 23 patients received 27 courses of M-CSF administration. All patients had metastatic solid tumors refractory to conventional therapy, including renal cell carcinoma (RCC) (nine), melanoma (seven), and colorectal carcinoma (seven). RESULTS Treatment-related toxicity was minimal; five patients developed transient signs of ocular or periorbital inflammation, with iridocyclitis as the most severe manifestation. At the highest doses, platelet counts decreased with therapy (but remained > 100,000/mm3) and the absolute monocyte count increased during the course of therapy. Only at 30,000 and 100,000 micrograms/m2/d was treatment limited because of toxicity (iritis and malaise). Pharmacokinetic studies demonstrated up to a 1,000-fold increase in circulating serum M-CSF after bolus infusion; half-life varied from 1 to 6 hours. Complete regression of mediastinal adenopathy and multiple pulmonary metastases were observed in one patient with RCC. CONCLUSION Recombinant M-CSF can be administered safely to patients with metastatic cancer at doses that demonstrate biologic activity.
Collapse
Affiliation(s)
- M G Sanda
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
PURPOSE The study was designed to determine prospectively the prevalence of fasting serum lipid abnormalities in patients who were treated with cisplatin-based chemotherapy for germ cell tumors. We unexpectedly had demonstrated hypercholesterolemia in 20 of 30 nonfasting patients in a prior study of long-term toxicity of chemotherapy for germ cell tumors. The present study was designed to explore this phenomenon further. PATIENTS AND METHODS Seventeen unselected patients with biopsy-proven germ cell tumors, who underwent cisplatin-based chemotherapy and who had no prior history of cardiac disease nor known hypercholesterolemia, were studied. In addition to the standard staging tests, blood was drawn for a pretreatment fasting lipid screen, which included cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and apolipoproteins A1, B, and (a). Repeat samples were drawn 24 hours after the administration of cisplatin and at intervals of 6 to 24 months after the completion of treatment. RESULTS Seven of 17 patients (41%) had higher than desirable levels of total serum cholesterol and low-density lipoprotein cholesterol. Two of them had normal levels before treatment, four had preexisting hypercholesterolemia that increased further, and one patient had an elevated pretreatment level that did not alter. Absolute increases in serum cholesterol were noted in 14 of 17 patients. No consistent patterns of change beyond the reference ranges were found for other serum lipids. CONCLUSIONS We have confirmed our initial observation that serum cholesterol increases in patients who received cisplatin-containing chemotherapy regimens for germ cell tumors. Further studies will be necessary to define whether other lipid abnormalities occur and the biologic significance of these findings.
Collapse
Affiliation(s)
- D Raghavan
- Department of Nursing, Royal Prince Alfred Hospital, Camperdown, Australia
| | | | | | | | | |
Collapse
|
45
|
Shih Y, Konrad MW, Warren MK, Childs A, Paradise C, Meyers FJ, Groves ES. Suppression and transient induction of lymphokines in cancer patients after administration of polyethylene glycolated interleukin-2. Eur J Immunol 1992; 22:727-33. [PMID: 1547819 DOI: 10.1002/eji.1830220316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Polyethylene glycolated (pegylated) interleukin-2 (PEG IL-2) was administered as a weekly i.v. bolus to patients with metastatic cancer in a phase-I trial. Efficacy, toxicity and pharmacokinetics have been described previously. To explore mechanism of IL-2 action and discover predictors of efficacy, the levels of several lymphokines were measured in pharmacokinetic serum samples. IL-1 beta and IL-6 were elevated in many patients before PEG IL-2 administration, forming a continuous, log-normal distribution among patients. The levels of the two lymphokines were strongly correlated. However, no significant correlation could be found between these levels, clinical chemistry, or tumor regression seen after PEG IL-2 administration. Three hours after PEG IL-2 administration, IL-1 beta and IL-6 levels, if elevated, fell to normal. In all patients, independent of initial levels, IL-6 and IFN-gamma, but not IL-1 beta, increased 4 to 6 h after the injection and then fell rapidly, even though PEG IL-2 levels were high and often changed only slightly during this period. This suggests an active shut down of lymphokine synthesis, or an increase in elimination rate. After the fourth administration of PEG IL-2, the peak level of IFN-gamma was 2 to 20 times higher than after the first, while the peak level of IL-6 did not change in a consistent direction. Responding patients had typical peak levels of IL-6 and IFN-gamma. Low levels of TNF and IL-4 were occasionally seen before and after PEG IL-2 administration, but no consistent pattern was evident.
Collapse
Affiliation(s)
- Y Shih
- Cetus Corporation, Emeryville
| | | | | | | | | | | | | |
Collapse
|
46
|
Zamkoff KW, Hudson J, Groves ES, Childs A, Konrad M, Rudolph AR. A phase I trial of recombinant human macrophage colony-stimulating factor by rapid intravenous infusion in patients with refractory malignancy. J Immunother 1992; 11:103-10. [PMID: 1571332 DOI: 10.1097/00002371-199202000-00004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [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: 12/27/2022]
Abstract
Twenty patients with advanced cancer for which there was no effective standard therapy or whose disease was refractory to standard therapy were treated with recombinant macrophage colony-stimulating factor (rM-CSF). The rM-CSF was administered by intravenous bolus infusion for 5 consecutive days every other week for 2 treatment weeks. The doses administered ranged from 30 to 33,000 micrograms/m2/day. There was no intrapatient dose escalation. There were minimal to no systemic side effects seen, except for acute dyspnea noted in three patients. The dyspnea was felt to be related to the rate of infusion and did not recur in one patient given additional rM-CSF at a slower infusion rate. The major hematologic effect seen was a mild decrease in platelet count, which began to recover while the patients continued to receive the rM-CSF. The clearance of rM-CSF was dose dependent. Lower doses resulted in a saturable mechanism felt to represent cellular uptake. Clearance at higher doses demonstrated both a first-order mechanism at high serum rM-CSF concentrations, representing renal clearance, as well as a saturable mechanism at low serum concentrations. The maximum mean serum half-life was reached at dose levels of greater than or equal to 3,690 micrograms/m2 and was in the range of 234-258 min. By this route of administration, rises in absolute monocyte count were slight and seen only at doses of greater than or equal to 450 micrograms/m2 during the second therapy week. The maximum tolerated dose was not reached in this study because of lack of availability of rM-CSF.
Collapse
Affiliation(s)
- K W Zamkoff
- Department of Medicine, State University of New York Health Science Center, Syracuse, New York 13210
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
Presentations by experts at an international conference on coma and persistent vegetative state (PVS) identified 32 parameters of varying prognostic significance that can be determined in this patient population. These parameters are tabulated for heuristic purposes and to summarize a portion of the information exchanged at this conference.
Collapse
Affiliation(s)
- A Childs
- Healthcare Rehabilitation Center, Austin, Texas 78745
| |
Collapse
|
48
|
Childs A. Seasonal affective disorder. A sad situation. Nurs Times 1990; 86:46-7. [PMID: 2235576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
49
|
Crismon ML, Childs A, Wilcox RE, Barrow N. The effect of bromocriptine on speech dysfunction in patients with diffuse brain injury (akinetic mutism). Clin Neuropharmacol 1988; 11:462-6. [PMID: 3219678 DOI: 10.1097/00002826-198810000-00007] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- M L Crismon
- College of Pharmacy, University of Texas, Austin 78712
| | | | | | | |
Collapse
|
50
|
Affiliation(s)
- A Childs
- College of Pharmacy, University of Texas, Austin 78712
| | | |
Collapse
|