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Fracasso PM, Duska LR, Thaker PH, Gao F, Zoberi I, Dehdashti F, Siegel BA, Uliel L, Menias CO, Rehm PK, Goodner SA, Creekmore AN, Lothamer HL, Rader JS. An Exploratory Study of Neoadjuvant Cetuximab Followed by Cetuximab and Chemoradiotherapy in Women With Newly Diagnosed Locally Advanced Cervical Cancer. Am J Clin Oncol 2022; 45:286-293. [PMID: 35696702 PMCID: PMC9233135 DOI: 10.1097/coc.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study explored the feasibility of cetuximab with chemoradiation in women with cervical carcinoma and evaluated fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) to assess early response to cetuximab (NCT00292955). PATIENTS AND METHODS Eligible patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IVB invasive carcinoma of the uterine cervix were treated on 1 of 3 dose levels (DL). DL1 consisted of neoadjuvant cetuximab, then concurrent radiotherapy with cetuximab 250 mg/m2/cisplatin 40 mg/m2, followed by weekly cetuximab. DL2 consisted of radiotherapy with cetuximab 200 mg/m2 and cisplatin 30 mg/m2. DL3 consisted of radiotherapy with cetuximab 250 mg/m2 and cisplatin 30 mg/m2. Patients underwent 18F-FDG-PET/CT before treatment, after neoadjuvant cetuximab, and at the end of treatment. RESULTS Of the 21 patients enrolled, 9, 3, and 9 were treated in DL1, DL2, and DL3, respectively. DL1 required dose reductions due to gastrointestinal toxicities. DL2 and 3 were tolerated with 1 dose-limiting toxicity (grade 4 renal failure) at DL3. Following 3 weekly treatments of neoadjuvant cetuximab in DL1, 7 patients had maximum standardized uptake value changes on 18F-FDG-PET/CT consistent with response to cetuximab. Of the 12 patients with locally advanced disease, eleven evaluable patients had no evidence of disease on 18F-FDG-PET/CT at treatment end. Five-year progression-free survival and overall survival rates for all patients were 57.5% and 58.5%, respectively. CONCLUSIONS Cetuximab with cisplatin 30 mg/m2 and radiotherapy was tolerated. 18F-FDG-PET/CT demonstrated early evidence of response to neoadjuvant cetuximab. With advances in precision oncology and the recent approval of pembrolizumab in metastatic cervical cancer, dual-target inhibition with an epidermal growth factor receptor inhibitor may be a promising treatment in the future.
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Affiliation(s)
- Paula M. Fracasso
- UVA Cancer Center, University of Virginia, Charlottesville,
VA, 22908
- Department of Medicine, University of Virginia,
Charlottesville, VA 22908
| | - Linda R. Duska
- UVA Cancer Center, University of Virginia, Charlottesville,
VA, 22908
- Department of Obstetrics and Gynecology, University of
Virginia, Charlottesville, VA 22908
| | - Premal H. Thaker
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Obstetrics and Gynecology, Washington
University School of Medicine, St. Louis, MO, 63110
| | - Feng Gao
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Surgery and the Division of Public Health
Sciences, Washington University School of Medicine, St. Louis, MO, 63110
| | - Imran Zoberi
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Radiation Oncology, Washington University
School of Medicine, St. Louis, MO, 63110
| | - Farrokh Dehdashti
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Division of Nuclear Medicine, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Barry A. Siegel
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Division of Nuclear Medicine, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Livnat Uliel
- Division of Nuclear Medicine, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Christine O. Menias
- Division of Diagnostic Radiology, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Patrice K. Rehm
- Division of Nuclear Medicine, University of Virginia,
Charlottesville, VA 22908
| | - Sherry A. Goodner
- UVA Cancer Center, University of Virginia, Charlottesville,
VA, 22908
| | - Allison N. Creekmore
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
| | - Heather L. Lothamer
- Department of Obstetrics and Gynecology, University of
Virginia, Charlottesville, VA 22908
| | - Janet S. Rader
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Obstetrics and Gynecology, Washington
University School of Medicine, St. Louis, MO, 63110
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Ma CX, Gao F, Naughton M, Pluard TJ, Sorscher S, Creekmore AN, Guo Z, Dehdashti F, Park BH, Lockhart AC, Doyle LA, Ellis MJ, Erlanger B. A phase I study of the AKT inhibitor MK-2206 plus hormonal therapy in postmenopausal women with estrogen receptor positive (ER+) metastatic breast cancer (MBC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.553] [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)
- Cynthia X. Ma
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Feng Gao
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Michael Naughton
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Timothy J. Pluard
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Steven Sorscher
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Allison N Creekmore
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Zhanfang Guo
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Farrokh Dehdashti
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Ben Ho Park
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | - Matthew J. Ellis
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Bracha Erlanger
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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Fracasso PM, Goodner SA, Creekmore AN, Morgan HP, Foster DM, Hardmon AA, Engel SJ, Springer BC, Mathews KJ, Fisher EB, Walker MS. Coaching intervention as a strategy for minority recruitment to cancer clinical trials. J Oncol Pract 2013; 9:294-9. [PMID: 24130255 PMCID: PMC3825290 DOI: 10.1200/jop.2013.000982] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 11/20/2022] Open
Abstract
PURPOSE Lack of trust and rapport with health care providers has been identified in the under-representation of racial/ethnic minorities within clinical trials. Our study used a coach to promote trust among minority patients with advanced cancer. PATIENTS AND METHODS Minority patients with advanced breast, colorectal, lung, or prostate carcinoma were randomly assigned to receive a coach Intervention (CI) or usual care (UC). All patients completed baseline and 6-month telephone interviews to assess demographics, trust in health care providers, attitudes toward clinical trials, and quality of life. Patients randomly assigned to CI were assigned a coach, who made biweekly contacts for 6 months to address general issues, progress or development in cancer care, and available resources. Patients randomly assigned to UC received the standard of care, without this intervention. Clinical trial enrollment was assessed. RESULTS Over 21 months, we screened 268 patients and enrolled 73 African Americans and two Asian Americans. Patients were randomly assigned to CI (n = 38) or to UC (n = 37). Longitudinal analyses were conducted on 69 patients who completed the 6-month follow-up assessment. Trial enrollment was 16 and 13 patients for the CI and UC groups, respectively. This difference was not significant (P = .351). Higher quality of life (1-point odds ratio on Functional Assessment of Cancer Treatment-General = 1.033, P = .036) and positive attitudes toward trials predicted enrollment. There was no significant difference between these groups in quality of life, attitudes toward clinical trials, perceptions of racism, trust in doctors, or depression. CONCLUSIONS Quality of life and positive attitude toward trials predicted trial enrollment, regardless of assignment to CI or UC.
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Affiliation(s)
- Paula M. Fracasso
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Sherry A. Goodner
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Allison N. Creekmore
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Helen P. Morgan
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Denise M. Foster
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Angela A. Hardmon
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Seth J. Engel
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Brian C. Springer
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Katherine J. Mathews
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Edwin B. Fisher
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Mark S. Walker
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
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Ma CX, Ellis MJC, Petroni GR, Guo Z, Cai SR, Ryan CE, Craig Lockhart A, Naughton MJ, Pluard TJ, Brenin CM, Picus J, Creekmore AN, Mwandoro T, Yarde ER, Reed J, Ebbert M, Bernard PS, Watson M, Doyle LA, Dancey J, Piwnica-Worms H, Fracasso PM. A phase II study of UCN-01 in combination with irinotecan in patients with metastatic triple negative breast cancer. Breast Cancer Res Treat 2012; 137:483-92. [PMID: 23242585 PMCID: PMC3539064 DOI: 10.1007/s10549-012-2378-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 12/04/2012] [Indexed: 12/20/2022]
Abstract
Mutations in TP53 lead to a defective G1 checkpoint and the dependence on checkpoint kinase 1 (Chk1) for G2 or S phase arrest in response to DNA damage. In preclinical studies, Chk1 inhibition resulted in enhanced cytotoxicity of several chemotherapeutic agents. The high frequency of TP53 mutations in triple negative breast cancer (TNBC: negative for estrogen receptor, progesterone receptor, and HER2) make Chk1 an attractive therapeutic target. UCN-01, a non-selective Chk1 inhibitor, combined with irinotecan demonstrated activity in advanced TNBC in our Phase I study. The goal of this trial was to further evaluate this treatment in women with TNBC. Patients with metastatic TNBC previously treated with anthracyclines and taxanes received irinotecan (100–125 mg/m2 IV days 1, 8, 15, 22) and UCN-01 (70 mg/m2 IV day 2, 35 mg/m2 day 23 and subsequent doses) every 42-day cycle. Peripheral blood mononuclear cells (PBMC) and tumor specimens were collected. Twenty five patients were enrolled. The overall response (complete response (CR) + partial response (PR)) rate was 4 %. The clinical benefit rate (CR + PR + stable disease ≥6 months) was 12 %. Since UCN-01 inhibits PDK1, phosphorylated ribosomal protein S6 (pS6) in PBMC was assessed. Although reduced 24 h post UCN-01, pS6 levels rose to baseline by day 8, indicating loss of UCN-01 bioavailability. Immunostains of γH2AX and pChk1S296 on serial tumor biopsies from four patients demonstrated an induction of DNA damage and Chk1 activation following irinotecan. However, Chk1 inhibition by UCN-01 was not observed in all tumors. Most tumors were basal-like (69 %), and carried mutations in TP53 (53 %). Median overall survival in patients with TP53 mutant tumors was poor compared to wild type (5.5 vs. 20.3 months, p = 0.004). This regimen had limited activity in TNBC. Inconsistent Chk1 inhibition was likely due to the pharmacokinetics of UCN-01. TP53 mutations were associated with a poor prognosis in metastatic TNBC.
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Affiliation(s)
- Cynthia X Ma
- Section of Breast Oncology, Division of Oncology, Department of Medicine, Washington University School of Medicine, Campus Box 8056, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
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Ma CX, Ellis MJ, Petroni GR, Lockhart AC, Naughton M, Pluard TJ, Brenin C, Picus J, Creekmore AN, Mwandoro TN, Guo Z, Cai S, Ryan C, Yarde E, Hoog J, Dancey J, Watson M, Piwnica-Worms H, Fracasso PM. Clinical and correlative science results in a phase II study of UCN-01in combination with irinotecan in recurrent triple-negative breast cancer (TNBC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3047 Background: Chk1 inhibitors enhance chemotherapy efficacy by inducing “mitotic catastrophe” in p53 deficient TNBC preclinical models. Irinotecan (I) combined with UCN-01, a nonselective Chk1 inhibitor, showed promising activity in TNBC in our phase I study. The primary objective of the phase II trial was to determine the efficacy and toxicity. Correlatives included assessing tumor molecular subtype, TP53, PTEN and pathways targeted by UCN-01. Methods: Pts with measurable, metastatic (met) TNBC, prior anthracycline (A) and taxane (T), received I (100-125 mg/m2 IV on days (d) 1, 8, 15, 22) and UCN-01 (70 mg/m2 IV on d2 and 35 mg/m2 on d23 and later doses) on a 42-d cycle (C). Archival tumors and serial peripheral blood mononuclear cells (PBMC) and optional tumor biopsies were collected. Results: Twenty five pts were enrolled. All had prior A and T. The median no. of prior regimens for met disease was 3 (range 1-4). Toxicities included neutropenia, diarrhea, nausea, vomiting, and hyperglycemia. Best responses included 1 PR, 8 SD (range 2.3-8.6 mos) for a clinical benefit rate (CR+PR+SD>6 mos) of 3/25 (12%), 95% CI (3, 31%). The median PFS and OS were 2.3 and 11.3 mos, respectively. pS6 was examined since UCN-01 inhibits PDK1. pS6 was reduced in PBMC 24h post UCN-01, but close to baseline by d8. Immunostain of cleaved caspase 3 (CC3), pHistone H3 (pHH3), γH2AX, and pS6 were done on serial biopsies from 4 pts with adequate biopsy materials. In all cases, pS6 was reduced 24h post UCN-01. Results for other markers were variable. One case with TP53 deletion showed an induction of CC3, with an increase in pHH3 and γH2AX, suggesting abrogation of cell cycle arrest and enhanced DNA damage. Among 15 with sufficient specimen for analysis, most were basal-like (basal 10, basal/HER2-E 1, HER2-E 2, Luminal B 2) by PAM50, low in PTEN level (11) and carried mutations in TP53 (8). Median OS was 5.5 (95% CI: 2, 11.3) mos in TP53 mutant and 20.3 (95% CI: 2.9, - ) mos in wild type populations (p=0.004). Conclusions: This regimen had limited activity in TNBC. Despite the long half-life, drug activity is not detectable by d8 based on PBMC analysis. Our data indicates that future trials in TNBC should consider p53 status.
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Affiliation(s)
- Cynthia X. Ma
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | | | | | | | - Joel Picus
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Zhanfang Guo
- Washington University School of Medicine, St. Louis, MO
| | - Shirong Cai
- Washington University School of Medicine, St. Louis, MO
| | | | - Erin Yarde
- University of Virginia Health System, Charlottesville, VA
| | - Jeremy Hoog
- Washington University School of Medicine, St. Louis, MO
| | - Janet Dancey
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Mark Watson
- Washington University School of Medicine, St. Louis, MO
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Fracasso PM, Picus J, Wildi JD, Goodner SA, Creekmore AN, Gao F, Govindan R, Ellis MJ, Tan BR, Linette GP, Fu CJ, Pentikis HS, Zumbrun SC, Egorin MJ, Bellet RE. Phase 1 and pharmacokinetic study of weekly docosahexaenoic acid-paclitaxel, Taxoprexin®, in resistant solid tumor malignancies. Cancer Chemother Pharmacol 2008; 63:451-8. [DOI: 10.1007/s00280-008-0756-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Accepted: 04/01/2008] [Indexed: 11/30/2022]
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