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Abou-Alfa GK, Geyer SM, Nixon AB, Innocenti F, Shi Q, Kumthekar P, Jacobson S, El Dika I, Yaqubie A, Lopez J, Huang B, Tang YW, Wen Y, Schwartz LH, El-Khoueiry AB, Knox JJ, Rajdev L, Bertagnolli MM, Meyerhardt JA, O'Reilly EM, Venook AP. CALGB 80802 (Alliance): Impact of Sorafenib with and without Doxorubicin on Hepatitis C Infection in Patients with Advanced Hepatocellular Carcinoma. Cancer Res Commun 2024; 4:682-690. [PMID: 38363156 PMCID: PMC10919207 DOI: 10.1158/2767-9764.crc-22-0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/28/2023] [Accepted: 02/13/2024] [Indexed: 02/17/2024]
Abstract
Sorafenib blocks nonstructural protein 5A (NS5A)-recruited c-Raf-mediated hepatitis C virus (HCV) replication and gene expression. Release of Raf-1-Ask-1 dimer and inhibition of Raf-1 via sorafenib putatively differ in the presence or absence of doxorubicin. Cancer and Leukemia Group B (CALGB) 80802 (Alliance) randomized phase III trial of doxorubicin plus sorafenib versus sorafenib in patients with advanced hepatocellular carcinoma (HCC), showed no improvement in median overall survival (OS). Whether HCV viral load impacts therapy and whether any correlation between HCV titers and outcome based on HCV was studied. In patients with HCV, HCV titer levels were evaluated at baseline and at multiple postbaseline timepoints until disease progression or treatment discontinuation. HCV titer levels were evaluated in relation to OS and progression-free survival (PFS). Among 53 patients with baseline HCV data, 12 patients had undetectable HCV (HCV-UN). Postbaseline HCV titer levels did not significantly differ between treatment arms. One patient in each arm went from detectable to HCV-UN with greater than 2 log-fold titer levels reduction. Aside from these 2 HCV-UN patients, HCV titers remained stable on treatment. Patients who had HCV-UN at baseline were 3.5 times more likely to progress and/or die from HCC compared with HCV detectable (HR = 3.51; 95% confidence interval: 1.58-7.78; P = 0.002). HCV titer levels remained unchanged, negating any sorafenib impact onto HCV titer levels. Although an overall negative phase III study, patients treated with doxorubicin plus sorafenib and sorafenib only, on CALGB 80802 had worse PFS if HCV-UN. Higher levels of HCV titers at baseline were associated with significantly improved PFS. SIGNIFICANCE Sorafenib therapy for HCC may impact HCV replication and viral gene expression. In HCV-positive patients accrued to CLAGB 80802 phase III study evaluating the addition of doxorubicin to sorafenib, HCV titer levels were evaluated at baseline and different timepoints. Sorafenib did not impact HCV titer levels. Despite an improved PFS in patients with detectable higher level HCV titers at baseline, no difference in OS was noted.
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Affiliation(s)
- Ghassan K. Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Medical College of Cornell University, New York, New York
| | - Susan M. Geyer
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Andrew B. Nixon
- Duke Cancer Institute, Duke University Health System, Durham, North Carolina
| | | | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Priya Kumthekar
- Alliance for Clinical Trials in Oncology Protocol Office, Chicago, Illinois
| | - Sawyer Jacobson
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Imane El Dika
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Medical College of Cornell University, New York, New York
| | - Amin Yaqubie
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juan Lopez
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Binhui Huang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yi-Wei Tang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yujia Wen
- University of Chicago, Chicago, Illinois
| | - Lawrence H. Schwartz
- Columbia University Medical Center, New York, New York
- New York-Presbyterian Hospital, New York, New York
| | | | | | | | | | | | - Eileen M. O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Medical College of Cornell University, New York, New York
| | - Alan P. Venook
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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2
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Cowzer D, White JB, Chou JF, Chen PJ, Kim TH, Khalil DN, El Dika IH, Columna K, Yaqubie A, Light JS, Shia J, Yarmohammadi H, Erinjeri JP, Wei AC, Jarnagin W, Do RK, Solit DB, Capanu M, Shah RH, Berger MF, Abou-Alfa GK, Harding JJ. Targeted Molecular Profiling of Circulating Cell-Free DNA in Patients With Advanced Hepatocellular Carcinoma. JCO Precis Oncol 2023; 7:e2300272. [PMID: 37769223 PMCID: PMC10581608 DOI: 10.1200/po.23.00272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/29/2023] [Accepted: 08/08/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE Next-generation sequencing (NGS) of tumor-derived, circulating cell-free DNA (cfDNA) may aid in diagnosis, prognostication, and treatment of patients with hepatocellular carcinoma (HCC). The operating characteristics of cfDNA mutational profiling must be determined before routine clinical implementation. METHODS This was a single-center, retrospective study with the primary objective of defining genomic alterations in circulating cfDNA along with plasma-tissue genotype agreement between NGS of matched tumor samples in patients with advanced HCC. cfDNA was analyzed using a clinically validated 129-gene NGS assay; matched tissue-based NGS was analyzed with a US Food and Drug Administration-authorized NGS tumor assay. RESULTS Fifty-three plasma samples from 51 patients with histologically confirmed HCC underwent NGS-based cfDNA analysis. Genomic alterations were detected in 92.2% of patients, with the most commonly mutated genes including TERT promoter (57%), TP53 (47%), CTNNB1 (37%), ARID1A (18%), and TSC2 (14%). In total, 37 (73%) patients underwent paired tumor NGS, and concordance was high for mutations observed in patient-matched plasma samples: TERT (83%), TP53 (94%), CTNNB1 (92%), ARID1A (100%), and TSC2 (71%). In 10 (27%) of 37 tumor-plasma samples, alterations were detected by cfDNA analysis that were not detected in the patient-matched tumors. Potentially actionable mutations were identified in 37% of all cases including oncogenic/likely oncogenic alterations in TSC1/2 (18%), BRCA1/2 (8%), and PIK3CA (8%). Higher average variant allele fraction was associated with elevated alpha-fetoprotein, increased tumor volume, and no previous systemic therapy, but did not correlate with overall survival in treatment-naïve patients. CONCLUSION Tumor mutation profiling of cfDNA in HCC represents an alternative to tissue-based genomic profiling, given the high degree of tumor-plasma NGS concordance; however, genotyping of both blood and tumor may be required to detect all clinically actionable genomic alterations.
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Affiliation(s)
- Darren Cowzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica B. White
- Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joanne F. Chou
- Weill Medical College of Cornell University, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pin-Jung Chen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tae-Hyung Kim
- Weill Medical College of Cornell University, New York, NY
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danny N. Khalil
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Medical College of Cornell University, New York, NY
| | - Imane H. El Dika
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Medical College of Cornell University, New York, NY
| | - Katrina Columna
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amin Yaqubie
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph S. Light
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jinru Shia
- Weill Medical College of Cornell University, New York, NY
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hooman Yarmohammadi
- Weill Medical College of Cornell University, New York, NY
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph Patrick Erinjeri
- Weill Medical College of Cornell University, New York, NY
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alice C. Wei
- Weill Medical College of Cornell University, New York, NY
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William Jarnagin
- Weill Medical College of Cornell University, New York, NY
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard K.G. Do
- Weill Medical College of Cornell University, New York, NY
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David B. Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Medical College of Cornell University, New York, NY
| | - Marinela Capanu
- Weill Medical College of Cornell University, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ronak H. Shah
- Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael F. Berger
- Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Medical College of Cornell University, New York, NY
| | - Ghassan K. Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Medical College of Cornell University, New York, NY
| | - James J. Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Medical College of Cornell University, New York, NY
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3
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Zack T, Losert KP, Maisel SM, Wild J, Yaqubie A, Herman M, Knox JJ, Mayer RJ, Venook AP, Butte A, O'Neill AF, Abou-Alfa GK, Gordan JD. Defining incidence and complications of fibrolamellar liver cancer through tiered computational analysis of clinical data. NPJ Precis Oncol 2023; 7:29. [PMID: 36959495 PMCID: PMC10034241 DOI: 10.1038/s41698-023-00371-2] [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] [Received: 09/19/2022] [Accepted: 03/03/2023] [Indexed: 03/25/2023] Open
Abstract
The incidence and biochemical consequences of rare tumor subtypes are often hard to study. Fibrolamellar liver cancer (FLC) is a rare malignancy affecting adolescents and young adults. To better characterize the incidence and biochemical consequences of this disease, we combined a comprehensive analysis of the electronic medical record and national payer data and found that FLC incidence is likely five to eight times higher than previous estimates. By employing unsupervised learning on clinical laboratory data from patients with hyperammonemia, we find that FLC-associated hyperammonemia mirrors metabolic dysregulation in urea cycle disorders. Our findings demonstrate that advanced computational analysis of rich clinical datasets can provide key clinical and biochemical insights into rare cancers.
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Affiliation(s)
- Travis Zack
- Helen Diller Family Comprehensive Cancer Center (HDFCCC), University of California, San Francisco (UCSF), San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | | | | | - Jennifer Wild
- Helen Diller Family Comprehensive Cancer Center (HDFCCC), University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Amin Yaqubie
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Herman
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jennifer J Knox
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Robert J Mayer
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Alan P Venook
- Helen Diller Family Comprehensive Cancer Center (HDFCCC), University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Atul Butte
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | - Allison F O'Neill
- Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Department of Pediatric Oncology, Boston, MA, USA
| | - Ghassan K Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Weill Medical College at Cornell University, New York, NY, USA.
| | - John D Gordan
- Helen Diller Family Comprehensive Cancer Center (HDFCCC), University of California, San Francisco (UCSF), San Francisco, CA, USA.
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA.
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4
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Cowzer D, White JB, Chen PJ, Kim TH, Khalil D, El Dika IH, Chou JF, Yaqubie A, Light JS, Shia J, Yarmohammadi H, Erinjeri JP, Capanu M, Do RKG, Solit DB, Shah RH, Berger MF, Abou-Alfa GK, Harding JJ. Next-generation sequencing (NGS) of circulating cell-free DNA (cfDNA) in patients (pts) with advanced hepatocellular carcinoma (HCC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4110 Background: HCC is often diagnosed based on high-quality cross-sectional imaging, and when a biopsy is pursued, acquisition of tissue may be of limited quantity and quality or complicated by underlying medical comorbidities. NGS of tumor derived circulating cfDNA represents an investigational tool for non-invasive molecular profiling, that has the potential to aid in diagnosis, prognosis, and in monitoring disease status. Although prior reports have evaluated such technologies, few studies have included tumor tissues to confirm histology and to explore plasma-tissue gene concordance. Methods: The primary objective of this retrospective cohort study was to define genomic alterations in circulating cfDNA and to explore plasma-tissue genotype concordance in HCC pts. HCC pts underwent collection of cfDNA for NGS using the MSK-ACCESS 129-gene assay between August 2019 and February 2021. Matched tissue-based NGS with the FDA authorized MSK-IMPACT gene assay was completed when tumor tissue was available. Clinical actionability of sequence variants was annotated by OncoKB, an FDA recognized knowledge base. Clinicopathologic characteristics were extracted, and all data were reported with descriptive statistics. Results: 51 unique patients with 53 plasma samples had an HCC histological diagnosis. Pts were male (39, 76%), median age 69 (42-87), viral hepatitis-related (24, 47%), and advanced stage (Stage III:9, 18%; Stage IV:38, 74.5%). Extrahepatic disease and macrovascular involvement were observed in 28 (55%) and 19 (38%) pts, respectively. 22 (43%) pts had AFP ≥400 ng/mL. 49 (92.5%) of 53 plasma samples had detectable genomic alterations. Median cfDNA yield after extraction was 39.43 ng (range: 7.93-287.68). The most frequently mutated genes occurring in > 10% of patients were TERT (57%), TP53 (47%), CTNNB1 (37%), ARID1A (18%) and TSC2 (14%). The most common oncogenic pathways that contained alterations were WNT-β-Catenin (45%) and PIK3-AKT-TOR (25%). 37 (73%) pts underwent tissue sequencing with MSK-IMPACT with a median time of 9.0 months to the time cfDNA testing. MSK-ACCESS identified mutations observed in tumor in most cases: TERT (20/22; 91%), TP53 (16/17; 94%), CTNNB1 (11/12; 92%), ARID1A (6/6; 100%) and TSC2 (6/7; 86%). In 18 (49%) of 37 paired samples, additional mutations in cfDNA not seen in tumor were detected and included KRAS, EGFR, and TP53 alterations. Potentially actionable mutations were identified through cfDNA in 37% of cases including TSC1/2 (18%), BRCA1/ 2 (8%) and PIK3CA (8%). Conclusions: Circulating cfDNA genotyping with MSK-ACCESS identifies previously reported HCC tumor genomic profiles and revealed tumor-associated mutations in 92.5% of plasma samples. Ongoing efforts will explore predictive and prognostic implications of NGS at different HCC stages as well as kinetics of treatment response.
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Affiliation(s)
- Darren Cowzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Pin-Jung Chen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tae-Hyung Kim
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danny Khalil
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Joanne F. Chou
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering, New York, NY
| | - Amin Yaqubie
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jinru Shia
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Marinela Capanu
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering, New York, NY
| | | | - David B. Solit
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, Kravis Center for Molecular Oncology, Sloan Kettering Institute, New York, NY
| | - Ronak H. Shah
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ghassan K. Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Medical College, Cornell University, New York, NY
| | - James J. Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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5
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Mondaca S, Schultz N, Roa JC, Walch HS, Sepulveda S, Harding JJ, Yaqubie A, Garcia P, Aguayo G, Nervi B, Li BT, Abou-Alfa GK. Clinical and genomic characterization of ERBB2-altered gallbladder cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4114 Background: Gallbladder cancer (GBC) is a molecularly distinct entity among biliary tract tumors. ERBB2 amplification and mutation have been described in GBC, however, clinical and genomic characterization of the ERBB2-altered subgroup has been limited. Methods: Patients with GBC treated at Memorial Sloan Kettering and Pontificia Universidad Católica de Chile with genomic tumor profiling between 2014 and 2021 were included. Clinical information was retrieved from electronic medical records. Categorical data were analyzed by Fisher exact test and time-to-event data were analyzed by Cox proportional hazards models. Results: During the study period 260 GBC patients underwent genomic profiling. The prevalence of ERBB2 alterations was 14% including 8% with ERBB2 gene amplification, 4.2% with ERBB2 mutation, 1.5% with concurrent amplification and mutation and 0.4% with ERBB2 fusion. There was no age difference between GBC patients with and without ERBB2 alterations (63.6 vs. 65.4; p = 0.36) and in both subgroups there was a majority of female patients (75% vs. 84%; p = 0.44). Patients with ERBB2-altered tumors had a different genomic profile with lower concurrent KRAS alterations (2% vs. 12%; p = 0.14) and higher prevalence of TP53 alterations (81% vs. 59%; p = 0.01). There was no difference in the prevalence of PIK3CA mutations (13% vs. 9%; p = 0.38). GBC patients with ERBB2 alterations had a longer overall survival (22.3 vs. 12.1 months; HR 0.54 95% CI 0.3 to 0.98). Conclusions: ERBB2 amplification and mutation are the most frequent potentially targetable alterations in GBC (14%). ERBB2-driven GBC has higher concurrent alterations of TP53, while KRAS alterations appear to be less frequent. While no particular clinical feature was associated with this subgroup, overall survival was longer.
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Affiliation(s)
- Sebastian Mondaca
- Department of Hematology and Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Juan Carlos Roa
- Department of Pathology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - James J. Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amin Yaqubie
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Patricia Garcia
- Department of Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gloria Aguayo
- Department of Pathology, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Bruno Nervi
- Department of Hematology and Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bob T. Li
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ghassan K. Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Medical College, Cornell University, New York, NY
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6
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Zou C, El Dika I, Vercauteren KOA, Capanu M, Chou J, Shia J, Pilet J, Quirk C, Lalazar G, Andrus L, Kabbani M, Yaqubie A, Khalil D, Mergoub T, Chiriboga L, Rice CM, Abou‐Alfa GK, de Jong YP. Mouse characteristics that affect establishing xenografts from hepatocellular carcinoma patient biopsies in the United States. Cancer Med 2021; 11:602-617. [PMID: 34951132 PMCID: PMC8817074 DOI: 10.1002/cam4.4375] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Chenhui Zou
- Division of Gastroenterology and Hepatology Weill Medical College at Cornell University New York New York USA
- Laboratory of Virology and Infectious Disease The Rockefeller University New York New York USA
| | - Imane El Dika
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine Weill Medical College at Cornell University New York New York USA
| | - Koen O. A. Vercauteren
- Laboratory of Virology and Infectious Disease The Rockefeller University New York New York USA
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center New York New York USA
| | - Joanne Chou
- Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center New York New York USA
| | - Jinru Shia
- Department of Pathology Memorial Sloan Kettering Cancer Center New York New York USA
| | - Jill Pilet
- Laboratory of Virology and Infectious Disease The Rockefeller University New York New York USA
| | - Corrine Quirk
- Laboratory of Virology and Infectious Disease The Rockefeller University New York New York USA
| | - Gadi Lalazar
- Division of Gastroenterology and Hepatology Weill Medical College at Cornell University New York New York USA
- Laboratory of Cellular Biophysics The Rockefeller University New York New York USA
| | - Linda Andrus
- Laboratory of Virology and Infectious Disease The Rockefeller University New York New York USA
| | - Mohammad Kabbani
- Laboratory of Virology and Infectious Disease The Rockefeller University New York New York USA
- Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany
| | - Amin Yaqubie
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Danny Khalil
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine Weill Medical College at Cornell University New York New York USA
| | - Taha Mergoub
- Memorial Sloan Kettering Cancer Center Sloan Kettering Institute New York New York USA
| | - Luis Chiriboga
- Department of Pathology Center for Biospecimen Research and Development NYU Langone Health New York New York USA
| | - Charles M. Rice
- Laboratory of Virology and Infectious Disease The Rockefeller University New York New York USA
| | - Ghassan K. Abou‐Alfa
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
- Department of Medicine Weill Medical College at Cornell University New York New York USA
| | - Ype P. de Jong
- Division of Gastroenterology and Hepatology Weill Medical College at Cornell University New York New York USA
- Laboratory of Virology and Infectious Disease The Rockefeller University New York New York USA
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7
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Zack T, Maisel S, O'Neill AF, La Quaglia MP, Herman M, Knox JJ, Yaqubie A, Venook AP, Mayer RJ, Gordan JD, Abou-Alfa GK. Computational extraction and analysis of de-identified medical records to characterize hyperammonemia in patients with fibrolamellar carcinoma (FLC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16169 Background: Rare cancers including FLC make up 25% of adult tumors, but are difficult to study due to low incidence and incomplete case identification. FLC occurs in adolescents and young adults without liver dysfunction. Hyperammonemia has been frequently reported in FLC patients, but is poorly understood. Methods: Data from three clinical trials allowed us to establish the incidence of hyperammonemia (serum ammonia value > 75 µmol/L) in FLC. In these studies, FLC patients received everolimus, estrogen deprivation therapy (EDT) with leuprolide + letrozole or everolimus + EDT (Oncologist. 2020 25(11):925-e1603), ENMD-2076 (Oncologist. 2020 25(12):e1837-e1845), or neratinib (J Clin Oncol 39, 2021 (suppl 3; abstr 310); ammonia was tested prospectively in the latter two studies. To assess impacts of cancer therapy or liver dysfunction, we studied hyperammonemia in FLC and non-FLC patients at UCSF in parallel. Using Natural Language Processing (NLP) of pathology reports and oncology notes from > 2300 liver cancer patients from the last 12 years of UCSF records, we identified a cohort of patients with FLC, contrasting their laboratory data to all UCSF patients with ammonia testing for the last 10 years. We used leiden clustering and umap dimensionality reduction to contrast FLC and other patients to assess the clinical context of hyperammonemia. Results: Data from the 3 trials showed hyperammonemia in 10 of 32 (31.3%) FLC patients during study participation, independent of the therapy received. These patients exhibited hyperammonemia with varying levels, and at different points in their treatment. NLP identified 37 patients with FLC ( < 0.1% of liver cancer patients), with 33% showing hyperammonemia. Across all UCSF patients, we found 24,000 independent visits where ammonia was tested, with > 2400 demonstrating hyperammonemia. Using leidan clustering on all encounters with ammonia > 75 µmol/L, we found distinct subsets of hyperammonemia corresponding to known metabolic and physiologic processes (e.g., fulminant liver failure, tumor lysis syndrome, etc). FLC patients clustered separately from hepatocellular carcinoma patients with hyperammonemic encephalopathy due to cirrhosis. Conclusions: NLP of large EMRs is a valuable tool to study FLC, a rare cancer. Herein, we have defined hyperammonemia as a frequent event in FLC, not directly linked to hepatic dysfunction or individual therapies. Further investigation may determine whether hyperammonemia is related to FLC tumor biology.
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Affiliation(s)
- Travis Zack
- University of California San Francisco Medical Center, San Francisco, CA
| | | | | | | | | | - Jennifer J. Knox
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Amin Yaqubie
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Alan P. Venook
- University of California San Francisco, San Francisco, CA
| | | | | | - Ghassan K. Abou-Alfa
- Memorial Sloan Kettering Cancer Center, Weill Medical College at Cornell University, New York, NY
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8
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Harding JJ, Do RK, Yaqubie A, Cleverly A, Zhao Y, Gueorguieva I, Lahn M, Benhadji KA, Kelley RK, Abou‐Alfa GK. Phase 1b study of galunisertib and ramucirumab in patients with advanced hepatocellular carcinoma. Cancer Med 2021; 10:3059-3067. [PMID: 33811482 PMCID: PMC8085979 DOI: 10.1002/cam4.3880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/29/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Preclinical data suggest that vascular endothelial growth factor (VEGF) and transforming growth factor (TGF)-β signaling interact to stimulate angiogenesis and suppress antitumor immune responses. Thus, combined inhibition of both pathways may offer greater antitumor activity compared with VEGF-targeted antiangiogenic monotherapy against hepatocellular carcinoma (HCC). METHODS This is a multicenter, open-label, phase 1b study of galunisertib, an inhibitor of TGF-β receptor 1, and ramucirumab, an anti-VEGF receptor 2 antibody, in patients with advanced HCC aiming to define the maximum tolerated dose (MTD). Secondary objectives included safety, pharmacokinetics (PK), antitumor efficacy, and plasma alpha-fetoprotein and TGF-β kinetics. Dose escalation employed a 3 + 3 design. Patients received galunisertib at 80 mg (cohort 1) or 150 mg (cohort 2) orally twice a day on days 1-14 of a 28-day cycle combined with ramucirumab 8 mg/kg intravenously every 2 weeks. RESULTS Eight patients were enrolled: three in cohort 1 and five in cohort 2 (two patients were unevaluable due to rapid disease progression and replaced). No dose-limiting toxicities were observed. Treatment-related adverse events (AEs) of any grade in ≥2 patients included nausea (25%) and vomiting (25%). There was one Grade 3 treatment-related AE, a cerebrovascular accident possibly related to ramucirumab. Galunisertib exposure was dose-proportional and not affected by ramucirumab. The RECIST version 1.1 objective response rate and disease control rate were 0% and 12.5%, respectively. CONCLUSION Combination therapy was safe and tolerable and displayed favorable PK. The MTD was established at galunisertib at 150 mg orally twice a day and ramucirumab 8 mg/kg intravenously every 2 weeks. The results do not support the preclinical hypothesis that blocking TGFβ signaling enhances efficacy of VEGF-targeted therapy; thus further clinical development was halted for the combination of galunisertib and ramucirumab.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/pharmacokinetics
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/metabolism
- Carcinoma, Hepatocellular/pathology
- Female
- Humans
- Liver Neoplasms/drug therapy
- Liver Neoplasms/metabolism
- Liver Neoplasms/pathology
- Male
- Maximum Tolerated Dose
- Middle Aged
- Nausea/chemically induced
- Prospective Studies
- Pyrazoles/administration & dosage
- Pyrazoles/adverse effects
- Pyrazoles/pharmacokinetics
- Quinolines/administration & dosage
- Quinolines/adverse effects
- Quinolines/pharmacokinetics
- Receptor, Transforming Growth Factor-beta Type I/antagonists & inhibitors
- Response Evaluation Criteria in Solid Tumors
- Vascular Endothelial Growth Factor A/metabolism
- Vascular Endothelial Growth Factor Receptor-2/antagonists & inhibitors
- Vomiting/chemically induced
- alpha-Fetoproteins/analysis
- Ramucirumab
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Affiliation(s)
- James J. Harding
- Memorial Sloan Kettering Cancer CenterNew YorkNYUSA
- Weill Cornell Medical CollegeNew YorkNYUSA
| | - Richard K. Do
- Memorial Sloan Kettering Cancer CenterNew YorkNYUSA
- Weill Cornell Medical CollegeNew YorkNYUSA
| | - Amin Yaqubie
- Memorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | | | | | | | | | | | - Robin K. Kelley
- Helen Diller Cancer CenterUniversity of California San FranciscoSan FranciscoCAUSA
| | - Ghassan K. Abou‐Alfa
- Memorial Sloan Kettering Cancer CenterNew YorkNYUSA
- Weill Cornell Medical CollegeNew YorkNYUSA
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9
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Abou-Alfa GK, Bibeau K, Schultz N, Yaqubie A, Millang BM, Ren H, Féliz L. Effect of FGFR2 alterations on survival in patients receiving systemic chemotherapy for intrahepatic cholangiocarcinoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.303] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
303 Background: Most patients (pts) with cholangiocarcinoma (CCA) are diagnosed with advanced disease and are ineligible for surgery. FGFR2 fusions/rearrangements are oncogenic drivers and are present almost exclusively in pts with intrahepatic CCA (iCCA; 10–16% of pts); however, little is known about the effects of FGFR2 status on response to systemic chemotherapy. Memorial Sloan Kettering (MSK) obtains genomic sequencing data from almost all iCCA pts treated at the institution. This provides a unique, rich database from which genomic profiling data can be overlaid with clinical data to facilitate a meaningful understanding of pt outcomes, and to suggest potential therapeutic options. This retrospective analysis evaluated progression free survival (PFS) and overall survival (OS) in pts receiving standard systemic chemotherapy (CXT) for iCCA harboring FGFR2 fusions/rearrangements ( FGFR2 +), or harboring wild-type FGFR2 ( FGFR2wt). Methods: Clinical and genomic data were obtained from the MSK database for all iCCA pts to determine disease history and exposure to prior lines (PL) of CXT in the advanced setting. Only pts with complete data for PL of CXT were analyzed. Median PFS and OS were calculated using the Kaplan-Meier method. OS was calculated from diagnosis until death; PFS was calculated from first dose of first line of CXT until progression, death, last visit, relevant dates of later CXT lines; pts with unconfirmed outcomes were censored at last known follow-up date. Results: One-hundred-thirty-two pts were included in this analysis (median age at diagnosis: 62.0 y; 54.5% female; FGFR2+, n = 15; FGFR2wt, n = 115; other FGFR2 alterations, n = 2). Among pts receiving first-line CXT, median PFS was 7.1 months (95% CI: 5.0–8.3) for all pts (n = 124), 6.2 months (2.0–16.8) for FGFR2+ pts (n = 15), and 7.2 months (5.0–8.3) for FGFR2wt pts (n = 107). Among pts with ≥2 PL of CXT (n = 90), median PFS on second-line chemotherapy was 5.6 months (95% CI: 2.8–10.3) for FGFR2+ pts, and 3.7 months (2.6–5.6) for FGFR2wt pts. Median OS was numerically longer in FGFR2+ pts compared with FGFR2wt pts (31.3 months [95% CI: 5.8–not estimable] vs 21.8 months [16.7–26.6]). Conclusions: Among pts receiving standard systemic chemotherapy for iCCA, median PFS was similar in pts harboring FGFR2+ vs FGFR2wt receiving first-line chemotherapy, and relatively longer in pts harboring FGFR2+ receiving second-line chemotherapy. Median OS was longer in FGFR2+ vs FGFR2wt pts. Compared with recently published data in molecularly unselected CCA pts (Lowery. Cancer. 2019; 125: 4426), PFS was similar in pts receiving first-line chemotherapy, and slightly longer for second-line chemotherapy. Data interpretation is limited by the retrospective nature of this analysis of investigator-reported data, the study size, and by the possibility that the analysis population may not reflect the general population of pts with CCA.
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Affiliation(s)
- Ghassan K. Abou-Alfa
- Memorial Sloan Kettering Cancer Center & Weill Medical College at Cornell University, New York, NY
| | | | | | - Amin Yaqubie
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Luis Féliz
- Incyte Biosciences International Sàrl, Geneva, DE, Switzerland
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10
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El Dika IH, Geyer SM, Nixon AB, Innocenti F, Shi Q, Jacobson SB, Yaqubie A, Lopez JC, Huang B, Tang YW, Wen Y, Schwartz LH, Bertagnolli MM, Meyerhardt JA, O'Reilly EM, Venook AP, Abou-Alfa GK. Alliance/CALGB 80802: Impact of hepatitis C (HCV) on doxorubicin (DO) + sorafenib (S) versus S in patients (pts) with advanced hepatocellular carcinoma (aHCC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.325] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
325 Background: Alliance/CALGB 80802 randomized phase III trial evaluated DO+S vs. S in pts with aHCC, and showed no improvement in median OS. Multi-drug resistant pathway mitigation by the Ras/Raf/MEK/ERK pathway and bFGF-mediated activation of Raf-1 promotes the formation of antiapoptotic Raf-1 and ASK1 complex, induced by anthracyclines. S efficiently blocks NS5A-recruited c-Raf mediated HCV replication and viral gene expression. Once inhibited by S, VEGF expression of HepG2 may limit HCV cellular entry. Release of Raf-1-Ask-1 dimer and inhibition of Raf-1 via S putatively differ in the presence or absence of DO. We hypothesize treatment with S reduces HCV titer levels (TL) and influence pts’ outcome. Methods: In 80802 HCV pts, TL were evaluated in both arms at baseline and post-baseline at Day 1 of Cycles 2, 3, and every 2 cycles and at progression or discontinuation of therapy. HCV undetectable (HCV-UN) levels were defined as < 50 copies/mL. TL were evaluated in relation to OS and PFS. HCV RNA levels were measured by TaqMan PCR and by genotype. Results: Of 356 pts, 83 were HCV+ with more Black/African American (25/50 = 50%) vs. White (54/239 = 23%) or other race groups (4/67 = 6%) (p < 0.0001). HCV titer data were available on 54 pts (S: 28, DO+S: 26). At baseline, 12 pts (S: 7, DO+S: 5) were HCV-UN, and post-baseline HCV TL did not significantly differ between treatment arms; one patient in each arm went from detectable (HCV-D) to HCV-UN. Post-baseline, 40 pts were HCV-D vs. 14 who were HCV-UN (S+DO: 8, S: 6 pts). Except for the two pts who became HCV-UN, baseline HCV-D vs. HCV-UN titers was similar to that status post-baseline. PFS and OS between HCV-D and HCV-UN both at baseline and post-baseline are delineated in the table. Conclusions: We observed that S did not influence HCV TL. Pts treated with DO+S vs. S had worse PFS if they had HCV-UN, and further that higher levels of HCV titers at baseline were associated with significantly improved PFS. Given the small sample size, these findings warrant further prospective evaluation. Support: U10CA180821, U10CA180882, U24CA196171; Bayer, Bristol-Myers-Squibb, and Sanofi. https://acknowledgments.alliancefound.org . Clinical trial information: NCT01015833. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - Amin Yaqubie
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Juan C. Lopez
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Binhui Huang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yi-Wei Tang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Monica M. Bertagnolli
- Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Jeffrey A. Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute/Partners Cancer Care, Boston, MA
| | | | - Alan P. Venook
- University of California San Francisco, San Francisco, CA
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11
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Abou-Alfa GK, Meyer T, Zhang J, Sherrin S, Yaqubie A, Clemens O’Neill A, Xu F, Eli LD, Harding JJ, O'Reilly EM, Lalani AS, Bryce R, Gordan JD. Evaluation of neratinib (N), pembrolizumab (P), everolimus (E), and nivolumab (V) in patients (pts) with fibrolamellar carcinoma (FLC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
310 Background: FLC, a rare liver cancer of young adults, has no effective systemic therapies. Surgical resection is used extensively with non-curative intent. FLC is associated with a DNAJB1- PRKACA chimeric transcript that produces a fusion protein with retained kinase activity and increased expression of several oncogenic signaling pathways including, but not limited to, HER2 ( ERBB2). Methods: N (240 mg oral daily) was studied in FLC pts in the SUMMIT study (NCT01953926); and later under compassionate use for N-based combinations (combo): P (2 mg/kg q3w), E (7.5 mg daily), and V (240 mg q2w) in doublet or triplet regimens. Eligible pts: ≥12y; histologically confirmed FLC; adequate organ function; any number of prior therapies. Primary endpoint: objective response rate (ORR; RECIST v1.1). Secondary endpoints: duration of response; clinical benefit rate (CBR); safety (CTCAE v4.0); somatic and germline sequencing (MSK IMPACT). Results: As of 03-Sep-2020, 15 pretreated pts received N in SUMMIT (confirmed ORR 0%; CBR 13%). Efficacy data for 5 pts from SUMMIT and 2 more pts receiving combo under compassionate use (4 male, 3 female, median age 26 years, median 0 [range 0–4] prior systemic therapies) are in shown in the table. The most common adverse events (AE) with single-agent N (n = 5) were diarrhea (grade 1 80%; grade 2 20%) and nausea (grade 1 60%); other AEs were grade ≤1 in ≤20% of pts. Conclusions: N monotherapy had limited benefit as a single agent in FLC pts. Several case studies evaluating N-based combo with checkpoint inhibitors administered under compassionate use demonstrated that NP led to 1 PR, and the triplet of NPE to prolonged SD. These are case-limited observations but are critical and worth evaluating further in upcoming clinical trials given the continued lack of a standard of care therapy for pts with FLC. Clinical trial information: NCT01953926. [Table: see text]
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Affiliation(s)
| | - Tim Meyer
- Royal Free Hospital, London, United Kingdom
| | - Jie Zhang
- Puma Biotechnology Inc., Los Angeles, CA
| | - Scott Sherrin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amin Yaqubie
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Feng Xu
- Puma Biotechnology Inc., Los Angeles, CA
| | - Lisa D Eli
- Puma Biotechnology Inc., Los Angeles, CA
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12
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Harding JJ, Catalanotti F, Munhoz RR, Cheng DT, Yaqubie A, Kelly N, McDermott GC, Kersellius R, Merghoub T, Lacouture ME, Carvajal RD, Panageas KS, Berger MF, Rosen N, Solit DB, Chapman PB. A Retrospective Evaluation of Vemurafenib as Treatment for BRAF-Mutant Melanoma Brain Metastases. Oncologist 2015; 20:789-97. [PMID: 25956405 DOI: 10.1634/theoncologist.2014-0012] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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] [Received: 01/11/2014] [Accepted: 02/04/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND RAF inhibitors are an effective therapy for patients with BRAF-mutant melanoma and brain metastasis. Efficacy data are derived from clinical studies enriched with physiologically fit patients; therefore, it is of interest to assess the real-world experience of vemurafenib in this population. Tumor-specific genetic variants that influence sensitivity to RAF kinase inhibitors also require investigation. METHODS Records of patients with BRAF-mutant melanoma and brain metastases who were treated with vemurafenib were reviewed. Clinical data were extracted to determine extracranial and intracranial objective response rates, progression-free survival (PFS), overall survival (OS), and safety. A bait-capture, next-generation sequencing assay was used to identify mutations in pretreatment tumors that could explain primary resistance to vemurafenib. RESULTS Among patients with intracranial disease treated with vemurafenib, 27 were included in survival analyses and 22 patients were assessable for response. The extracranial and intracranial objective response rates were 71% and 50%, respectively. Discordant responses were observed between extracranial and intracranial metastatic sites in 4 of 19 evaluable patients. Median PFS was 4.1 months (95% confidence interval [CI]: 2.6-7.9); median intracranial PFS was 4.6 months (95% CI: 2.7-7.9), median OS was 7.5 months (95% CI: 4.3-not reached), with a 30.4% 1-year OS rate. Outcomes were influenced by performance status. Vemurafenib was tolerable, although radiation-induced dermatitis occurred in some patients who received whole-brain radiotherapy. Adequate samples for next-generation sequencing analysis were available for seven patients. Melanomas categorized as "poorly sensitive" (≥20% tumor growth, new lesions, or ≤50% shrinkage for <4 months) harbored co-occurring mutations in genes predicted to activate the phosphatidylinositol 3-kinase-AKT (PI3K-AKT) pathway. CONCLUSION Vemurafenib is highly active in BRAF-mutant melanoma brain metastases but has limited activity in patients with poor performance status. The safety and efficacy of concurrent radiotherapy and RAF inhibition requires careful clinical evaluation. Combination strategies blocking the MAPK and PI3K-AKT pathway may be warranted in a subset of patients. IMPLICATIONS FOR PRACTICE Vemurafenib is active for BRAF-mutant intracranial melanoma metastases in an unselected patient population typical of routine oncologic practice. Patients with poor performance status appear to have poor outcomes despite vemurafenib therapy. Preliminary data indicate that co-occurring or secondary alterations in the phosphatidylinositol 3-kinase-AKT (PI3K-AKT) pathway are involved in resistance to RAF inhibition, thus providing a rationale for dual MAPK and PI3K-AKT pathway inhibition in this patient population.
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Affiliation(s)
- James J Harding
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Federica Catalanotti
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Rodrigo R Munhoz
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Donavan T Cheng
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Amin Yaqubie
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Nicole Kelly
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Gregory C McDermott
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Romona Kersellius
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Taha Merghoub
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Mario E Lacouture
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Richard D Carvajal
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Katherine S Panageas
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Michael F Berger
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Neal Rosen
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - David B Solit
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
| | - Paul B Chapman
- Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Human Oncology and Pathogenesis Program, Memorial Hospital Research Laboratories, New York, New York, USA; Immunology and Molecular and Pharmacology and Chemistry Programs, Sloan Kettering Institute, New York, New York, USA
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13
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Bozic I, Reiter JG, Allen B, Antal T, Chatterjee K, Shah P, Moon YS, Yaqubie A, Kelly N, Le DT, Lipson EJ, Chapman PB, Diaz LA, Vogelstein B, Nowak MA. Evolutionary dynamics of cancer in response to targeted combination therapy. eLife 2013; 2:e00747. [PMID: 23805382 PMCID: PMC3691570 DOI: 10.7554/elife.00747] [Citation(s) in RCA: 416] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/20/2013] [Indexed: 12/16/2022] Open
Abstract
In solid tumors, targeted treatments can lead to dramatic regressions, but responses are often short-lived because resistant cancer cells arise. The major strategy proposed for overcoming resistance is combination therapy. We present a mathematical model describing the evolutionary dynamics of lesions in response to treatment. We first studied 20 melanoma patients receiving vemurafenib. We then applied our model to an independent set of pancreatic, colorectal, and melanoma cancer patients with metastatic disease. We find that dual therapy results in long-term disease control for most patients, if there are no single mutations that cause cross-resistance to both drugs; in patients with large disease burden, triple therapy is needed. We also find that simultaneous therapy with two drugs is much more effective than sequential therapy. Our results provide realistic expectations for the efficacy of new drug combinations and inform the design of trials for new cancer therapeutics. DOI:http://dx.doi.org/10.7554/eLife.00747.001 As medicine becomes increasingly personalized, more and more emphasis is being placed on the development of therapies that target specific cancer-causing mutations. But while many of these drugs are effective in the short term, and do extend patient lives, tumors tend to evolve resistance to them within a few months. The key problem is that large tumors are genetically diverse. This means that for any given treatment, there is likely to be a small population of cells within the tumor that is resistant to the effects of the drug. When the drug is given to a patient, these cells will survive and multiply and this will lead ultimately to treatment failure. Given that a single drug is therefore highly unlikely to eradicate a tumor, combinations of two or more drugs may offer a higher chance of cure. This approach has been effective in the treatment of HIV as well as certain forms of leukemia. Here, Bozic et al. present a mathematical model designed to predict the effects of combination targeted therapies on tumors, based on the data obtained from 20 melanoma (skin cancer) patients. Their model revealed that if even 1 of the 6.6 billion base pairs of DNA present in a human diploid cell has undergone a mutation that confers resistance to each of two drugs, treatment with those drugs will not lead to sustained improvement for the majority of patients. This confirms the need to develop drugs that target distinct pathways. The model also reveals that combination therapy with two drugs given simultaneously is far more effective than sequential therapy where the drugs are used one after the other. Indeed, the model of Bozic et al. indicates that sequential treatment offers no chance of a cure, even when there are no cross-resistance mutations present, whereas combination therapy offers some hope of a cure, even in the presence of cross-resistance mutations. By emphasizing the need to develop drugs that target distinct pathways, and to administer them in combination rather than sequentially, the study by Bozic et al. offers valuable advice for drug development and the design of clinical trials, as well as for clinical practice. DOI:http://dx.doi.org/10.7554/eLife.00747.002
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Affiliation(s)
- Ivana Bozic
- Program for Evolutionary Dynamics , Harvard University , Cambridge , United States ; Department of Mathematics , Harvard University , Cambridge , United States
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14
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Harding JJ, Catalanotti F, Yaqubie A, McDermott GC, Kersellius R, Merghoub T, Carvajal RD, D'Angelo SP, Dickson MA, Schwartz GK, Wolchok JD, Berger MF, Solit DB, Chapman PB. Vemurafenib (VEM) in patients (pts) with BRAF-mutant melanoma and brain metastases (mets). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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
9060 Background: Emerging data suggest that RAF inhibitors are an effective therapy for pts with BRAF-mutant melanoma and brain mets. Although reported efficacy is encouraging, these data are derived from case reports or early stage trials enriched with physiologically fit pts. It is therefore of interest to assess the “real world” experience of VEM in this population. Methods: Records of all BRAF-mutant melanoma pts treated with RAF inhibitors at our center from 2007 to 2012 were reviewed retrospectively. We determined the best overall response rate (BORR) and, when applicable, the overrall intracranial response rate (OIRR) by RECIST v1.1, progression-free survival (PFS), and overall survival (OS) to RAF inhibition. Pretreatment formalin-fixed, paraffin-embedded tumor was assessed using an exon capture assay able to sequence coding exons of 279 cancer-associated genes. Results: 21 (18%) of 119 pts with BRAF-mutant melanoma treated with VEM had active brain mets (age range: 25-86, sex: 52% men, median ECOG PS: 1, proportion with extracranial mets: 90%, BRAF mutation: 86% V600E and 14% V600K). 10/21 pts had no prior intracranial (IC) therapy; 11/21 pts received whole brain radiotherapy (WBRT, 7/21), stereotactic radiosurgery (1/21), metastasectomy (2/21) or multimodality therapy (1/21) prior to VEM. 12/21 pts received ipilimumab sometime during their disease course. For radiographically evaluable pts (N=17), the BORR was 65% (95% CI: 43-88) and the OIRR was 40% (95% CI: 15-65). For 4 pts, the BORR and OIRR were discordant−3 pts had IC progression but visceral tumor shrinkage, 1 pt had IC disease control but visceral progression. VEM was effective in pts whether or not they had received prior local brain therapy. The estimated median PFS and OS for all brain mets pts (N=21) were 4 and 8 months, respectively. Pretreatment tumor is available for exon sequencing in approximately half of these patients. This analysis is ongoing. Conclusions: In routine clinical practice, the OIRR to VEM was 40% which is higher than historical response rates to WBRT. VEM may be preferable to WBRT as a first-line therapy for pts with BRAF-mutant melanoma and brain mets. Whether RAF inhibitor treatment improves OS in this population will require further study.
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Affiliation(s)
| | | | - Amin Yaqubie
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Taha Merghoub
- Memorial Sloan-Kettering Cancer Center, New York, NY
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