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Mehra T, Lupatsch JE, Kössler T, Dedes K, Siebenhüner AR, von Moos R, Wicki A, Schwenkglenks ME. Olaparib not cost-effective as maintenance therapy for platinum-sensitive, BRCA1/2 germline-mutated metastatic pancreatic cancer. PLoS One 2024; 19:e0301271. [PMID: 38573891 PMCID: PMC10994352 DOI: 10.1371/journal.pone.0301271] [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: 12/07/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE To assess the cost-effectiveness and budget impact of olaparib as a maintenance therapy in platinum-responsive, metastatic pancreatic cancer patients harboring a germline BRCA1/2 mutation, using the Swiss context as a model. METHODS Based on data from the POLO trial, published literature and local cost data, we developed a partitioned survival model of olaparib maintenance including full costs for BRCA1/2 germline testing compared to FOLFIRI maintenance chemotherapy and watch-and-wait. We calculated the incremental cost-effectiveness ratio (ICER) for the base case and several scenario analyses and estimated 5-year budget impact. RESULTS Comparing olaparib with watch-and wait and maintenance chemotherapy resulted in incremental cost-effectiveness ratios of CHF 2,711,716 and CHF 2,217,083 per QALY gained, respectively. The 5-year costs for the olaparib strategy in Switzerland would be CHF 22.4 million, of which CHF 11.4 million would be accounted for by germline BRCA1/2 screening of the potentially eligible population. This would amount to a budget impact of CHF 15.4 million (USD 16.9 million) versus watch-and-wait. CONCLUSIONS Olaparib is not a cost-effective maintenance treatment option. Companion diagnostics are an equally important cost driver as the drug itself.
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Affiliation(s)
- Tarun Mehra
- Department of Medical Oncology and Hematology, University Hospital of Zurich, Zurich, Switzerland
| | - Judith E. Lupatsch
- Department of Public Health, Institute of Pharmaceutical Medicine (ECPM) and Health Economics Facility, University of Basel, Basel, Switzerland
| | - Thibaud Kössler
- Service d’oncologie, Hôpitaux Universitaires Genève, Genève, Switzerland
| | | | | | - Roger von Moos
- Department of Medical Oncology and Hematology, Cantonal Hospital of Graubünden, Chur, Switzerland
| | - Andreas Wicki
- Department of Medical Oncology and Hematology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - Matthias E. Schwenkglenks
- Department of Public Health and Head of Research, Health Economics Facility, Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
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2
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Pavic M, Wolfer A, Li Q, Gircys A, Juritz S, Wicki A, Cerny T, Rohr UP. Regulatory Challenges: Is a Surrogate End Point Instead of Overall Survival Enough for Regulatory Approval of (Neo)Adjuvant Cancer Treatment? The Swissmedic Perspective. J Clin Oncol 2023; 41:4973-4975. [PMID: 37733978 DOI: 10.1200/jco.23.01442] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 09/23/2023] Open
Abstract
Surrogate end point only is not enough—the Swiss regulator`s perspective on (neo)adjuvant trials.
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Affiliation(s)
- Matea Pavic
- Division Clinical Assessment, Authorisation Sector, Swissmedic Swiss Agency for Therapeutic Products, Bern, Switzerland
| | - Anita Wolfer
- Division Clinical Assessment, Authorisation Sector, Swissmedic Swiss Agency for Therapeutic Products, Bern, Switzerland
| | - Qiyu Li
- Division Clinical Assessment, Authorisation Sector, Swissmedic Swiss Agency for Therapeutic Products, Bern, Switzerland
| | - Arunas Gircys
- Division Clinical Assessment, Authorisation Sector, Swissmedic Swiss Agency for Therapeutic Products, Bern, Switzerland
| | - Stephanie Juritz
- Division Clinical Assessment, Authorisation Sector, Swissmedic Swiss Agency for Therapeutic Products, Bern, Switzerland
| | - Andreas Wicki
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Human Medicines Expert Committee (HMEC), Swissmedic, Bern, Switzerland
| | - Thomas Cerny
- Human Medicines Expert Committee (HMEC), Swissmedic, Bern, Switzerland
| | - Ulrich-Peter Rohr
- Division Clinical Assessment, Authorisation Sector, Swissmedic Swiss Agency for Therapeutic Products, Bern, Switzerland
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3
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Stricker HM, Wicki A. [Long-term side effects of immune checkpoint inhibition]. Ther Umsch 2023; 80:367-372. [PMID: 37971528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The use of immune checkpoint inhibitors has fundamentally changed the treatment landscape of solid tumors in recent years. Even in advanced stages or in tumors with historically poor prognosis, such as triple-negative breast cancer, progression-free survival, as well as overall survival of affected individuals, have considerably improved. As a result, the side effects and consequences of therapy, their detection, and treatment are becoming an increasingly important part of patient follow-up.
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Affiliation(s)
- Helena Marie Stricker
- Klinik für Medizinische Onkologie und Hämatologie, Universität Zürich und Universitätsspital Zürich, Zürich
| | - Andreas Wicki
- Klinik für Medizinische Onkologie und Hämatologie, Universität Zürich und Universitätsspital Zürich, Zürich
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4
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Rieger MJ, Schenkel X, Dedic I, Brunn T, Gnannt R, Hofmann M, de Rougemont O, Stolz SM, Rösler W, Studt JD, Balabanov S, Wicki A, Lorch A, Manz MG, Schwotzer R. Complication rates of peripherally inserted central catheters vs implanted ports in patients receiving systemic anticancer therapy: A retrospective cohort study. Int J Cancer 2023; 153:1397-1405. [PMID: 37254629 DOI: 10.1002/ijc.34612] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/22/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023]
Abstract
While implanted port catheters ("PORTs") have historically been the standard device for intravenous systemic anticancer therapy, the use of peripherally inserted central catheters (PICCs) has increased continuously and reliable catheter selection guidelines are lacking. We compare complication rates of PORTs and PICCs in cancer treatment in a retrospective study of 3365 patients with both solid organ (n = 2612) and hematologic (n = 753) malignancies, between 2001 and 2021. 26.4% (n = 890) of all patients were treated via PICCs and 73.6% (2475) via PORTs. 20.7% (578) experienced a major catheter-related complication with a higher rate in PICCs than in PORTs (23.5% vs 14.9%, P < .001). Among major complications, infections and mechanical complications were more common in PICCs than in PORTs (11.9% vs 6.4%, P = .001, 7.3% vs 4.2%, P = .002), whereas the rate of thrombosis was similar (3.4% vs 3.0%, P = .9). While PORTs had a higher rate of periprocedural complications (2.7% vs 1.1%, P < .05), PICCs overall complication rate exceeded PORTs within 3 days from implantation. Median follow-up was 49 (PICC) and 60 weeks (PORT). PORTs are safer and therefore should be preferred in this setting regardless of catheter dwell time.
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Affiliation(s)
- Max J Rieger
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Xenia Schenkel
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Ivona Dedic
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Tadeusz Brunn
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ralph Gnannt
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Hofmann
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Olivier de Rougemont
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian M Stolz
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Wiebke Rösler
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Jan-Dirk Studt
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Balabanov
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Wicki
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Markus G Manz
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Schwotzer
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
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5
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Mehra T, Dongre K, Boesing M, Frei P, Suenderhauf C, Zippelius A, Leuppi JD, Wicki A, Leuppi-Taegtmeyer AB. Pre-treatment comorbidities, C-reactive protein and eosinophil count, and immune-related adverse events as predictors of survival with checkpoint inhibition for multiple tumour entities. Cancer Med 2023. [PMID: 37084178 DOI: 10.1002/cam4.5919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The development of immune-related adverse events (irAEs) may be associated with clinical efficacy of checkpoint inhibitors (CPIs) in patients with cancer. We therefore investigated the effect of irAEs and pre-treatment parameters on outcome in a large, real-life patient cohort. METHODS We performed a single-centre, retrospective, observational study including patients who received CPIs from 2011 to 2018 and followed until 2021. The primary outcome was overall survival, and the secondary outcome was the development of irAEs. RESULTS In total, 229 patients with different tumour entities (41% non-small cell lung cancer [NSCLC], 29% melanoma) received a total of 282 CPI treatment courses (ipilimumab, nivolumab, pembrolizumab or atezolizumab). Thirty-four percent of patients developed irAEs (of these 17% had CTCAE Grade ≥3). Factors independently associated with mortality were pre-treatment CRP ≥10 mg/L (hazard ratio [HR] 2.064, p = 0.0003), comorbidity measured by Charlson comorbidity index (HR 1.149, p = 0.014) and irAEs (HR 0.644, p = 0.036) (age-adjusted, n = 216). Baseline eosinophil count ≤0.2 × 109 /L was a further independent predictor of mortality (age-, CRP-, CCI- and irAE-adjusted HR = 2.252, p = 0.002, n = 166). Anti-CTLA-4 use (p < 0.001), and pre-treatment CRP <10 mg/L were independently associated with irAE occurrence (p = 0.037). CONCLUSIONS We found an independent association between irAE occurrence and improved overall survival in a real-life cohort spanning multiple tumour entities and treatment regimens. Pre-treatment comorbidities, CRP and eosinophil count represent potential markers for predicting treatment response.
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Affiliation(s)
- Tarun Mehra
- Department of Oncology, Medical University Clinic, Kantonsspital Baselland, Liestal, Switzerland
- Department of Oncology & Hematology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - Kanchan Dongre
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Patient Safety, University Hospital Basel, Basel, Switzerland
| | - Maria Boesing
- Medical University Clinic, Kantonsspital Baselland, Liestal, Switzerland
| | - Patricia Frei
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Claudia Suenderhauf
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alfred Zippelius
- Department of Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Joerg D Leuppi
- Medical University Clinic, Kantonsspital Baselland, Liestal, Switzerland
| | - Andreas Wicki
- Department of Oncology, Medical University Clinic, Kantonsspital Baselland, Liestal, Switzerland
- Department of Oncology & Hematology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - Anne B Leuppi-Taegtmeyer
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Patient Safety, University Hospital Basel, Basel, Switzerland
- Medical University Clinic, Kantonsspital Baselland, Liestal, Switzerland
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6
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Eichhoff OM, Stoffel CI, Käsler J, Briker L, Turko P, Karsai G, Zila N, Paulitschke V, Cheng PF, Leitner A, Bileck A, Zamboni N, Irmisch A, Balazs Z, Tastanova A, Pascoal S, Johansen P, Wegmann R, Mena J, Othman A, Viswanathan VS, Wenzina J, Aloia A, Saltari A, Dzung A, Aebersold R, Ak M, Al-Quaddoomi FS, Albert SI, Albinus J, Alborelli I, Andani S, Attinger PO, Bacac M, Baumhoer D, Beck-Schimmer B, Beerenwinkel N, Beisel C, Bernasconi L, Bertolini A, Bodenmiller B, Bonilla X, Bosshard L, Calgua B, Casanova R, Chevrier S, Chicherova N, Coelho R, D'Costa M, Danenberg E, Davidson N, Drãgan MA, Dummer R, Engler S, Erkens M, Eschbach K, Esposito C, Fedier A, Ferreira P, Ficek J, Frei AL, Frey B, Goetze S, Grob L, Gut G, Günther D, Haberecker M, Haeuptle P, Heinzelmann-Schwarz V, Herter S, Holtackers R, Huesser T, Immer A, Irmisch A, Jacob F, Jacobs A, Jaeger TM, Jahn K, James AR, Jermann PM, Kahles A, Kahraman A, Koelzer VH, Kuebler W, Kuipers J, Kunze CP, Kurzeder C, Lehmann KV, Levesque M, Lischetti U, Lugert S, Maass G, Manz MG, Markolin P, Mehnert M, Mena J, Metzler JM, Miglino N, Milani ES, Moch H, Muenst S, Murri R, Ng CK, Nicolet S, Nowak M, Lopez MN, Pedrioli PG, Pelkmans L, Piscuoglio S, Prummer M, Rimmer N, Ritter M, Rommel C, Rosano-González ML, Rätsch G, Santacroce N, Del Castillo JS, Schlenker R, Schwalie PC, Schwan S, Schär T, Senti G, Shao W, Singer F, Sivapatham S, Snijder B, Sobottka B, Sreedharan VT, Stark S, Stekhoven DJ, Tanna T, Theocharides AP, Thomas TM, Tolnay M, Tosevski V, Toussaint NC, Tuncel MA, Tusup M, Van Drogen A, Vetter M, Vlajnic T, Weber S, Weber WP, Wegmann R, Weller M, Wendt F, Wey N, Wicki A, Wildschut MH, Wollscheid B, Yu S, Ziegler J, Zimmermann M, Zoche M, Zuend G, Krauthammer M, Schreiber SL, Hornemann T, Distel M, Snijder B, Dummer R, Levesque MP. ROS Induction Targets Persister Cancer Cells with Low Metabolic Activity in NRAS-Mutated Melanoma. Cancer Res 2023; 83:1128-1146. [PMID: 36946761 DOI: 10.1158/0008-5472.can-22-1826] [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: 06/03/2022] [Revised: 10/04/2022] [Accepted: 01/24/2023] [Indexed: 03/23/2023]
Abstract
Clinical management of melanomas with NRAS mutations is challenging. Targeting MAPK signaling is only beneficial to a small subset of patients due to resistance that arises through genetic, transcriptional, and metabolic adaptation. Identification of targetable vulnerabilities in NRAS-mutated melanoma could help improve patient treatment. Here, we used multiomics analyses to reveal that NRAS-mutated melanoma cells adopt a mesenchymal phenotype with a quiescent metabolic program to resist cellular stress induced by MEK inhibition. The metabolic alterations elevated baseline reactive oxygen species (ROS) levels, leading these cells to become highly sensitive to ROS induction. In vivo xenograft experiments and single-cell RNA sequencing demonstrated that intratumor heterogeneity necessitates the combination of a ROS inducer and a MEK inhibitor to inhibit both tumor growth and metastasis. Ex vivo pharmacoscopy of 62 human metastatic melanomas confirmed that MEK inhibitor-resistant tumors significantly benefited from the combination therapy. Finally, oxidative stress response and translational suppression corresponded with ROS-inducer sensitivity in 486 cancer cell lines, independent of cancer type. These findings link transcriptional plasticity to a metabolic phenotype that can be inhibited by ROS inducers in melanoma and other cancers. SIGNIFICANCE Metabolic reprogramming in drug-resistant NRAS-mutated melanoma cells confers sensitivity to ROS induction, which suppresses tumor growth and metastasis in combination with MAPK pathway inhibitors.
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Affiliation(s)
- Ossia M Eichhoff
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Corinne I Stoffel
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Jan Käsler
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Luzia Briker
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Turko
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Gergely Karsai
- Institute for Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Nina Zila
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Verena Paulitschke
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Phil F Cheng
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | | | - Andrea Bileck
- Joint Metabolome Facility, Faculty of Chemistry, University of Vienna, Vienna, Austria
- Department of Analytical Chemistry, University of Vienna, Vienna, Austria
| | - Nicola Zamboni
- Institute for Molecular Systems Biology, ETH Zurich, Switzerland
| | - Anja Irmisch
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Zsolt Balazs
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- Biomedical Informatics, University Hospital of Zurich, Zurich, Switzerland
| | - Aizhan Tastanova
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Susana Pascoal
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Pål Johansen
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Rebekka Wegmann
- Institute for Molecular Systems Biology, ETH Zurich, Switzerland
| | - Julien Mena
- Institute for Molecular Systems Biology, ETH Zurich, Switzerland
| | - Alaa Othman
- Institute for Molecular Systems Biology, ETH Zurich, Switzerland
| | | | - Judith Wenzina
- Skin and Endothelium Research Division, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Andrea Aloia
- Institute for Molecular Systems Biology, ETH Zurich, Switzerland
| | - Annalisa Saltari
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Dzung
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
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- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- Biomedical Informatics, University Hospital of Zurich, Zurich, Switzerland
| | | | - Thorsten Hornemann
- Institute for Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Martin Distel
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Berend Snijder
- Institute for Molecular Systems Biology, ETH Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Mitchell P Levesque
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
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7
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Mamot C, Wicki A, Hasler-Strub U, Riniker S, Li Q, Holer L, Bärtschi D, Zaman K, von Moos R, Dedes KJ, Boos LA, Novak U, Bodmer A, Ritschard R, Obermann EC, Tzankov A, Ackermann C, Membrez-Antonioli V, Zürrer-Härdi U, Caspar CB, Deuster S, Senn M, Winterhalder R, Rochlitz C. A multicenter phase II trial of anti-EGFR-immunoliposomes loaded with doxorubicin in patients with advanced triple negative breast cancer. Sci Rep 2023; 13:3705. [PMID: 36879012 PMCID: PMC9988854 DOI: 10.1038/s41598-023-30950-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Advanced triple negative breast cancer (TNBC) is an aggressive, but initially chemo-sensitive disease. The prognosis is poor and more than three quarters of patients experience progression 12 months after the initiation of conventional first-line chemotherapy. Approximately two thirds of TNBC express epidermal growth factor receptor 1 (EGFR). We have developed an anti-EGFR targeted nanocontainer drug by inserting anti-EGFR antibody fragments into the membrane of pegylated liposomes (anti-EGFR-ILs-dox). The payload consists of doxorubicin, a standard drug for TNBC. In a first-in-human phase I trial in 26 patients with various advanced solid malignancies, anti-EGFR-ILs-dox has shown little toxicity and encouraging efficacy. In this single-arm phase II trial, we assessed the efficacy of anti-EGFR-ILs-dox as first-line therapy in patients with advanced, EGFR + TNBC. The primary endpoint was progression-free survival at 12 months (PFS12m). Secondary endpoints included overall response rate (ORR), duration of response (DOR), time to progression (TTP), overall survival (OS) and adverse events (AEs). 48 patients received anti-EGFR-ILs-dox 50 mg/m2 iv, on day one of a 28 days-cycle until progression. The Kaplan-Meier estimate for PFS12m was 13% (one-sided 90% CI 7%, 95% CI [5%, 25%]), median PFS was 3.5 months (95% CI 1.9, 5.4). The trial has not reached its primary endpoint. There were no new toxicity signals. Based on these results, anti-EGFR-ILs-dox should not be further developed for TNBC. It remains an open question whether anti-EGFR-ILs-dox would offer more opportunities in other EGFR-expressing malignancies, where targeting this receptor has already shown anticancer effects.Trial registration: This trial was registered at clinicaltrials.gov: NCT02833766. Registered 14/07/2016.
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Affiliation(s)
- Christoph Mamot
- Cantonal Hospital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Andreas Wicki
- University and University Hospital Zurich, Rämistrasse 100, 8091, Zürich, Switzerland.
| | | | | | - Qiyu Li
- Competence Center of the Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Lisa Holer
- Competence Center of the Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Daniela Bärtschi
- Competence Center of the Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Khalil Zaman
- University Hospital Lausanne, Lausanne, Switzerland
| | | | | | - Laura A Boos
- University and University Hospital Zurich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Urban Novak
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | | | | | | | | | | | - Martin Senn
- University Hospital Basel, Basel, Switzerland
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8
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Abstract
In recent years, exceptional technological advances have enabled the identification and interrogation of rare circulating tumour cells (CTCs) from blood samples of patients, leading to new fields of research and fostering the promise for paradigm-changing, liquid biopsy-based clinical applications. Analysis of CTCs has revealed distinct biological phenotypes, including the presence of CTC clusters and the interaction between CTCs and immune or stromal cells, impacting metastasis formation and providing new insights into cancer vulnerabilities. Here we review the progress made in understanding biological features of CTCs and provide insight into exploiting these developments to design future clinical tools for improving the diagnosis and treatment of cancer.
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Affiliation(s)
- Alexander Ring
- Department of Biology, Institute for Molecular Health Sciences, ETH Zurich, Zurich, Switzerland
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Bich Doan Nguyen-Sträuli
- Department of Biology, Institute for Molecular Health Sciences, ETH Zurich, Zurich, Switzerland
- Department of Gynecology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andreas Wicki
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Nicola Aceto
- Department of Biology, Institute for Molecular Health Sciences, ETH Zurich, Zurich, Switzerland.
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9
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Schwab FD, Scheidmann MC, Ozimski LL, Kling A, Armbrecht L, Ryser T, Krol I, Strittmatter K, Nguyen-Sträuli BD, Jacob F, Fedier A, Heinzelmann-Schwarz V, Wicki A, Dittrich PS, Aceto N. MyCTC chip: microfluidic-based drug screen with patient-derived tumour cells from liquid biopsies. Microsyst Nanoeng 2022; 8:130. [PMID: 36561926 PMCID: PMC9763115 DOI: 10.1038/s41378-022-00467-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 06/17/2023]
Abstract
Cancer patients with advanced disease are characterized by intrinsic challenges in predicting drug response patterns, often leading to ineffective treatment. Current clinical practice for treatment decision-making is commonly based on primary or secondary tumour biopsies, yet when disease progression accelerates, tissue biopsies are not performed on a regular basis. It is in this context that liquid biopsies may offer a unique window to uncover key vulnerabilities, providing valuable information about previously underappreciated treatment opportunities. Here, we present MyCTC chip, a novel microfluidic device enabling the isolation, culture and drug susceptibility testing of cancer cells derived from liquid biopsies. Cancer cell capture is achieved through a label-free, antigen-agnostic enrichment method, and it is followed by cultivation in dedicated conditions, allowing on-chip expansion of captured cells. Upon growth, cancer cells are then transferred to drug screen chambers located within the same device, where multiple compounds can be tested simultaneously. We demonstrate MyCTC chip performance by means of spike-in experiments with patient-derived breast circulating tumour cells, enabling >95% capture rates, as well as prospective processing of blood from breast cancer patients and ascites fluid from patients with ovarian, tubal and endometrial cancer, where sensitivity to specific chemotherapeutic agents was identified. Together, we provide evidence that MyCTC chip may be used to identify personalized drug response patterns in patients with advanced metastatic disease and with limited treatment opportunities.
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Affiliation(s)
- Fabienne D. Schwab
- Department of Biomedicine, Cancer Metastasis Laboratory, University of Basel, Basel, Switzerland
- Department of Gynaecologic Oncology, University Hospital Basel, Basel, Switzerland
| | - Manuel C. Scheidmann
- Department of Biomedicine, Cancer Metastasis Laboratory, University of Basel, Basel, Switzerland
| | - Lauren L. Ozimski
- Department of Biomedicine, Cancer Metastasis Laboratory, University of Basel, Basel, Switzerland
- Department of Biology, Swiss Federal Institute of Technology Zurich (ETH Zurich), Zurich, Switzerland
| | - André Kling
- Department of Biosystems Science and Engineering, Swiss Federal Institute of Technology Zurich (ETH Zurich), Basel, Switzerland
| | - Lucas Armbrecht
- Department of Biosystems Science and Engineering, Swiss Federal Institute of Technology Zurich (ETH Zurich), Basel, Switzerland
| | - Till Ryser
- Department of Biomedicine, Cancer Metastasis Laboratory, University of Basel, Basel, Switzerland
| | - Ilona Krol
- Department of Biomedicine, Cancer Metastasis Laboratory, University of Basel, Basel, Switzerland
- Department of Biology, Swiss Federal Institute of Technology Zurich (ETH Zurich), Zurich, Switzerland
| | - Karin Strittmatter
- Department of Biomedicine, Cancer Metastasis Laboratory, University of Basel, Basel, Switzerland
- Department of Biology, Swiss Federal Institute of Technology Zurich (ETH Zurich), Zurich, Switzerland
| | - Bich Doan Nguyen-Sträuli
- Department of Biology, Swiss Federal Institute of Technology Zurich (ETH Zurich), Zurich, Switzerland
- Department of Gynaecology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Francis Jacob
- Department of Biomedicine, Ovarian Cancer Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - André Fedier
- Department of Biomedicine, Ovarian Cancer Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- Department of Gynaecologic Oncology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, Ovarian Cancer Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andreas Wicki
- University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Petra S. Dittrich
- Department of Biosystems Science and Engineering, Swiss Federal Institute of Technology Zurich (ETH Zurich), Basel, Switzerland
| | - Nicola Aceto
- Department of Biology, Swiss Federal Institute of Technology Zurich (ETH Zurich), Zurich, Switzerland
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10
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Kleber M, Wicki A, Cheetham M. Strategien zur gemeinsamen Entscheidungsfindung in der Therapie bei Patient_innen mit onkologischen Erkrankungen. Therapeutische Umschau 2022; 79:401-408. [DOI: 10.1024/0040-5930/a001381] [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: 11/19/2022]
Abstract
Zusammenfassung. In der Onkologie ist die gemeinsame Entscheidungsfindung (Shared decision-Making, SDM) bei therapeutischen Fragen ein komplexer Prozess, bei dem zahlreiche personen-, behandlungs- und kontextbezogene Faktoren die Auswahl geeigneter Behandlungsoptionen und die endgültigen Behandlungsentscheidungen beeinflussen können. SDM spielt eine entscheidende Rolle, indem es die Patient_innen in das Arzt-Patienten-Gespräch und in die anstehenden Behandlungsentscheidungen gezielt einbezieht. Bei präferenzsensitiven Entscheidungen kann der SDM-Prozess für Patient_innen besonders belastend sein und sowohl Ärzt_innen als auch Patient_innen sehen in der unzureichenden Vorbereitung des Patienten respektive der Patientin ein Hindernis für SDM. Elektronische oder webbasierte Entscheidungshilfen könnten dazu beitragen, onkologische Patient_innen bereits im Vorfeld des Arzt-Patienten-Gespräches auf den SDM-Prozess vorzubereiten. Ziel dieses Beitrags ist es, einen aktuellen Überblick über die Rolle des SDM und seine zukünftige Entwicklung in der Onkologie zu geben. Bei dieser Entwicklung wird der Einsatz von Entscheidungshilfen im Rahmen eines Phasen-Models des SDM für die Onkologie beleuchtet. Dabei liegt der Schwerpunkt auf der potenziellen Nutzung der Chatbot-Technologie zur Vorbereitung der Patient_innen auf die Teilnahme am SDM und Optimierung der Arzt-Patienten-Kommunikation. Dieser Artikel beleuchtet auch einige wichtige Forschungslücken für die künftige Entwicklung von Chatbots als Entscheidungshilfen in der Onkologie.
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Affiliation(s)
- Martina Kleber
- Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich, Schweiz
| | - Andreas Wicki
- Klinik für Medizinische Onkologie und Hämatologie, Universitätsspital Zürich, Schweiz
| | - Marcus Cheetham
- Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich, Schweiz
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11
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Bastian S, Joerger M, Baertschi D, Holer L, Guckenberger M, Jochum W, Koeberle D, Siebenhüner A, Berger M, Winterhalder R, Largiadèr C, Löffler-Baumann M, Mosna- Firlejczyk K, Wicki A, Fischer Maranta A, von Moos R. 431P Neoadjuvant treatment with regorafenib and capecitabine combined with radiotherapy in locally advanced rectal cancer: A multicenter phase Ib trial (RECAP) SAKK 41/16. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.569] [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: 11/01/2022] Open
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12
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Ring A, Spataro M, Wicki A, Aceto N. Clinical and Biological Aspects of Disseminated Tumor Cells and Dormancy in Breast Cancer. Front Cell Dev Biol 2022; 10:929893. [PMID: 35837334 PMCID: PMC9274007 DOI: 10.3389/fcell.2022.929893] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Progress in detection and treatment have drastically improved survival for early breast cancer patients. However, distant recurrence causes high mortality and is typically considered incurable. Cancer dissemination occurs via circulating tumor cells (CTCs) and up to 75% of breast cancer patients could harbor micrometastatses at time of diagnosis, while metastatic recurrence often occurs years to decades after treatment. During clinical latency, disseminated tumor cells (DTCs) can enter a state of cell cycle arrest or dormancy at distant sites, and are likely shielded from immune detection and treatment. While this is a challenge, it can also be seen as an outstanding opportunity to target dormant DTCs on time, before their transformation into lethal macrometastatic lesions. Here, we review and discuss progress made in our understanding of DTC and dormancy biology in breast cancer. Strides in our mechanistic insights of these features has led to the identification of possible targeting strategies, yet, their integration into clinical trial design is still uncertain. Incorporating minimally invasive liquid biopsies and rationally designed adjuvant therapies, targeting both proliferating and dormant tumor cells, may help to address current challenges and improve precision cancer care.
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Affiliation(s)
- Alexander Ring
- Department of Biology, Institute for Molecular Health Sciences, ETH Zurich, Zurich, Switzerland
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maria Spataro
- Department of Biology, Institute for Molecular Health Sciences, ETH Zurich, Zurich, Switzerland
| | - Andreas Wicki
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicola Aceto
- Department of Biology, Institute for Molecular Health Sciences, ETH Zurich, Zurich, Switzerland
- *Correspondence: Nicola Aceto,
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13
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Schulze JB, Günther MP, Riemenschnitter C, Wicki A, von Känel R, Euler S. Distinct psycho-oncological support inclinations and needs in patients with cancer: A large sample latent class analysis approach. Gen Hosp Psychiatry 2022; 75:17-22. [PMID: 35093622 DOI: 10.1016/j.genhosppsych.2021.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 09/20/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND In patients with cancer, the routine recording of distress symptoms has been widely established in recent years. Psycho-oncological support has proven to reduce distress and increase quality of life. Despite high levels of distress as well as physical and emotional challenges in patients with cancer, a significant proportion forgoes psycho-oncological services. METHODS A cross-sectional retrospective evaluation was carried out. Latent class analysis was used to examine the relationship between distress, physical and emotional challenges, and desire for psycho-oncological services in 2191 patients with cancer. RESULTS Latent class analysis revealed four homogeneous subgroups: a) patients with high distress, high physical and low emotional challenges and no desire for psycho-oncology, b) patients with high distress, low physical and high emotional challenges and no desire for psycho-oncology, c) patients with high distress, high physical and emotional challenges and a desire for psycho-oncology, d) patients with low distress, low physical and emotional challenges and no desire for psycho-oncology. CONCLUSION The identification of these subgroups of patients with cancer is useful for health care providers in order to focus their efforts in patients with cancer. It might contribute to a more tailored treatment offer for specific subgroups whose needs have so far been insufficiently met.
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Affiliation(s)
- Jan Ben Schulze
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Moritz Philipp Günther
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Cosima Riemenschnitter
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas Wicki
- Department of Medical Oncology and Hematology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Euler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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14
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Rentsch CA, Thalmann GN, Lucca I, Kwiatkowski M, Wirth GJ, Strebel RT, Engeler D, Pedrazzini A, Hüttenbrink C, Schultze-Seemann W, Torpai R, Bubendorf L, Wicki A, Roth B, Bosshard P, Püschel H, Boll DT, Hefermehl L, Roghmann F, Gierth M, Ribi K, Schäfer S, Hayoz S. A Phase 1/2 Single-arm Clinical Trial of Recombinant Bacillus Calmette-Guérin (BCG) VPM1002BC Immunotherapy in Non-muscle-invasive Bladder Cancer Recurrence After Conventional BCG Therapy: SAKK 06/14. Eur Urol Oncol 2022; 5:195-202. [PMID: 35012889 DOI: 10.1016/j.euo.2021.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/27/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND VPM1002BC is a genetically modified Mycobacterium bovis bacillus Calmette-Guérin (BCG) strain with potentially improved immunogenicity and attenuation. OBJECTIVE To report on the efficacy, safety, tolerability and quality of life of intravesical VPM1002BC for the treatment of non-muscle-invasive bladder cancer (NMIBC) recurrence after conventional BCG therapy. DESIGN, SETTING, AND PARTICIPANTS We designed a phase 1/2 single-arm trial (NCT02371447). Patients with recurrent NMIBC after BCG induction ± BCG maintenance therapy and intermediate to high risk for cancer progression were eligible. INTERVENTION Patients were scheduled for standard treatment of six weekly instillations with VPM1002BC followed by maintenance for 1 yr. Treatment was stopped in cases of recurrence. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was defined as the recurrence-free rate (RFR) in the bladder 60 wk after trial registration. The sample size was calculated based on the assumption that ≥30% of the patients would be without recurrence at 60 wk after registration. RESULTS AND LIMITATIONS After exclusion of two ineligible patients, 40 patients remained in the full analysis set. All treated tumours were of high grade and 27 patients (67.5%) presented with carcinoma in situ. The recurrence-free rate in the bladder at 60 wk after trial registration was 49.3% (95% confidence interval [CI] 32.1-64.4%) and remained at 47.4% (95% CI 30.4-62.6%] at 2 yr and 43.7% (95% CI 26.9-59.4%) at 3 yr after trial registration. At the same time, progression to muscle-invasive disease had occurred in three patients and metastatic disease in four patients. Treatment-related grade 1, 2, and 3 adverse events (AEs) were observed in 14.3%, 54.8%, and 4.8% of the patients, respectively. No grade ≥4 AEs occurred. Two of the 42 patients did not tolerate five or more instillations during induction. Limitations include the single-arm trial design and the low number of patients for subgroup analysis. CONCLUSIONS At 1 yr after treatment start, almost half of the patients remained recurrence-free after therapy with VPM100BC. The primary endpoint of the study was met and the therapy is safe and well tolerated. PATIENT SUMMARY We conducted a trial of VPM100BC, a genetically modified bacillus Calmette-Guérin (BCG) strain for treatment of bladder cancer not invading the bladder muscle. At 1 year after the start of treatment, almost half of the patients with a recurrence after previous conventional BCG were free from non-muscle-invasive bladder cancer (NMIBC). The results are encouraging and VPM1002BC merits further evaluation in randomised studies for patients with NMIBC.
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Affiliation(s)
- Cyrill A Rentsch
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - George N Thalmann
- Department of Urology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ilaria Lucca
- Department of Urology, University Hospital Lausanne, Lausanne, Switzerland
| | - Maciej Kwiatkowski
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland; Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Grégory J Wirth
- Division of Urology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Räto T Strebel
- Department of Urology, Cantonal Hospital Chur, Chur, Switzerland
| | - Daniel Engeler
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Augusto Pedrazzini
- Department of Internal Medicine, Fondazione Oncologia Lago Maggiore, Locarno, Switzerland
| | - Clemens Hüttenbrink
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Wolfgang Schultze-Seemann
- Department of Urology, University Hospital Freiburg im Breisgau., University of Freiburg im Bresigau, Freiburg im Breisgau, Germany
| | - Raimund Torpai
- Department of Urology, Katholische Hospitalvereinigung Ostwestfalen gem. GmbH, Franziskus Hospital, Bielefeld, Germany
| | - Lukas Bubendorf
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Wicki
- Department of Oncology, University Hospital, University of Basel, Basel, Switzerland
| | - Beat Roth
- Department of Urology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Piet Bosshard
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Heike Püschel
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel T Boll
- Department of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lukas Hefermehl
- Department of Urology, Cantonal Hospital Baden, Baden, Switzerland
| | - Florian Roghmann
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Michael Gierth
- Department of Urology, University Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Karin Ribi
- International Breast Cancer Study Group Coordinating Center, Bern, Switzerland; SAKK Coordinating Center, Bern, Switzerland
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15
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Kasenda B, König D, Manni M, Ritschard R, Duthaler U, Bartoszek E, Bärenwaldt A, Deuster S, Hutter G, Cordier D, Mariani L, Hench J, Frank S, Krähenbühl S, Zippelius A, Rochlitz C, Mamot C, Wicki A, Läubli H. Targeting immunoliposomes to EGFR-positive glioblastoma. ESMO Open 2022; 7:100365. [PMID: 34998092 PMCID: PMC8741448 DOI: 10.1016/j.esmoop.2021.100365] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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: 09/05/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022] Open
Abstract
Background We assessed the capacity of epidermal growth factor receptor (EGFR)-targeted immunoliposomes to deliver cargo to brain tumor tissue in patients with relapsed glioblastoma harboring an EGFR amplification. We aimed to assess the tolerability and effectiveness of anti-EGFR immunoliposomes loaded with doxorubicin (anti-EGFR ILs-dox) in glioblastoma multiforme patients. Patients and methods Patients with EGFR-amplified, relapsed glioblastoma were included in this phase I pharmacokinetic trial. Patients received up to four cycles of anti-EGFR ILs-dox. Twenty-four hours later, plasma and cerebrospinal fluid (CSF) samples were obtained. In addition, we also treated three patients with anti-EGFR ILs-dox before resection of their relapsed glioblastoma. Doxorubicin concentrations were measured in plasma, CSF, and tumor tissue. Safety and efficacy parameters were also obtained. Results There were no or negligible levels of doxorubicin found in the CSF demonstrating that anti-EGFR ILs-dox are not able to cross the blood–brain barrier (BBB). However, significant levels were detected in glioblastoma tissue 24 h after the application, indicating that the disruption of BBB integrity present in high-grade gliomas might enable liposome delivery into tumor tissue. No new safety issues were observed. The median progression-free survival was 1.5 months and the median overall survival was 8 months. One patient undergoing surgery had a very long remission suggesting that neoadjuvant administration may have a positive effect on outcome. Conclusions We clearly demonstrate that anti-EGFR-immunoliposomes can be targeted to EGFR-amplified glioblastoma and cargo—in this case doxorubicin—can be delivered, although these immunoliposomes do not cross the intact BBB. (The GBM-LIPO trial was registered as NCT03603379). Human pharmacokinetic and pharmacodynamic data for EGFR-targeted immunoliposomes. Demonstration of delivery of immunoliposomes to glioblastoma tissue. EGFR as a target to deliver drug-containing nanoparticles to glioma tissue.
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Affiliation(s)
- B Kasenda
- Division of Oncology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - D König
- Division of Oncology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - M Manni
- Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland
| | - R Ritschard
- Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland
| | - U Duthaler
- Division of Clinical Pharmacology, University Hospital Basel, Basel, Switzerland
| | - E Bartoszek
- Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland
| | - A Bärenwaldt
- Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland
| | - S Deuster
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - G Hutter
- Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - D Cordier
- Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - L Mariani
- Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - J Hench
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - S Frank
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - S Krähenbühl
- Division of Clinical Pharmacology, University Hospital Basel, Basel, Switzerland
| | - A Zippelius
- Division of Oncology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland
| | - C Rochlitz
- Division of Oncology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland
| | - C Mamot
- Division of Medical Oncology, Cantonal Hospital, Aarau, Switzerland
| | - A Wicki
- Division of Oncology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - H Läubli
- Division of Oncology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland.
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16
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Ludwig S, Schmid L, Kahraman A, Rechsteiner M, Zoche M, Curioni-Fontecedro A, Siebenhüner A, Dedes K, Kiessling M, Fritsch R, Wicki A, Moch H, Weber A, Britschgi C. 1834P Impact of comprehensive genomic profiling and molecular tumor board decision on clinical outcome of patients with solid tumors: A single center, retrospective analysis. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.722] [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] Open
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17
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Wicki A, Mamot C, Hasler-Strub U, Riniker S, Li Q, Holer L, Baertschi D, Zaman K, von Moos R, Dedes K, Novak U, Bodmer A, Ritschard R, Obermann E, Ackermann C, Membrez-Antonioli V, Zuerrer U, Caspar C, Rochlitz C, Winterhalder R. 268P Anti-EGFR-immunoliposomes loaded with doxorubicin in patients with advanced triple-negative, EGFR positive breast cancer: A multicenter single arm phase II trial [SAKK 24/14]. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.551] [Citation(s) in RCA: 1] [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: 10/20/2022] Open
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18
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Irmisch A, Bonilla X, Chevrier S, Lehmann KV, Singer F, Toussaint NC, Esposito C, Mena J, Milani ES, Casanova R, Stekhoven DJ, Wegmann R, Jacob F, Sobottka B, Goetze S, Kuipers J, Sarabia Del Castillo J, Prummer M, Tuncel MA, Menzel U, Jacobs A, Engler S, Sivapatham S, Frei AL, Gut G, Ficek J, Miglino N, Aebersold R, Bacac M, Beerenwinkel N, Beisel C, Bodenmiller B, Dummer R, Heinzelmann-Schwarz V, Koelzer VH, Manz MG, Moch H, Pelkmans L, Snijder B, Theocharides APA, Tolnay M, Wicki A, Wollscheid B, Rätsch G, Levesque MP. The Tumor Profiler Study: integrated, multi-omic, functional tumor profiling for clinical decision support. Cancer Cell 2021; 39:288-293. [PMID: 33482122 DOI: 10.1016/j.ccell.2021.01.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [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: 01/02/2023]
Abstract
The application and integration of molecular profiling technologies create novel opportunities for personalized medicine. Here, we introduce the Tumor Profiler Study, an observational trial combining a prospective diagnostic approach to assess the relevance of in-depth tumor profiling to support clinical decision-making with an exploratory approach to improve the biological understanding of the disease.
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Affiliation(s)
- Anja Irmisch
- University Hospital Zurich, Department of Dermatology, University of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
| | - Ximena Bonilla
- ETH Zurich, Department of Computer Science, Institute of Machine Learning, Universitätstrasse 6, 8092 Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; University Hospital Zurich, Biomedical Informatics, Schmelzbergstrasse 26, 8006 Zurich, Switzerland
| | - Stéphane Chevrier
- University of Zurich, Department of Quantitative Biomedicine, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Kjong-Van Lehmann
- ETH Zurich, Department of Computer Science, Institute of Machine Learning, Universitätstrasse 6, 8092 Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; University Hospital Zurich, Biomedical Informatics, Schmelzbergstrasse 26, 8006 Zurich, Switzerland
| | - Franziska Singer
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, NEXUS Personalized Health Technologies, John-von-Neumann-Weg 9, 8093 Zurich, Switzerland
| | - Nora C Toussaint
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, NEXUS Personalized Health Technologies, John-von-Neumann-Weg 9, 8093 Zurich, Switzerland
| | - Cinzia Esposito
- University of Zurich, Department of Molecular Life Sciences, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Julien Mena
- ETH Zurich, Department of Biology, Institute of Molecular Systems Biology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Emanuela S Milani
- ETH Zurich, Department of Health Sciences and Technology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Ruben Casanova
- University of Zurich, Department of Quantitative Biomedicine, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Daniel J Stekhoven
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, NEXUS Personalized Health Technologies, John-von-Neumann-Weg 9, 8093 Zurich, Switzerland
| | - Rebekka Wegmann
- ETH Zurich, Department of Biology, Institute of Molecular Systems Biology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Francis Jacob
- University Hospital Basel and University of Basel, Department of Biomedicine, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Bettina Sobottka
- University Hospital Zurich, Department of Pathology and Molecular Pathology, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Sandra Goetze
- ETH Zurich, Department of Health Sciences and Technology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Jack Kuipers
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, Department of Biosystems Science and Engineering, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Jacobo Sarabia Del Castillo
- University of Zurich, Department of Molecular Life Sciences, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Michael Prummer
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, NEXUS Personalized Health Technologies, John-von-Neumann-Weg 9, 8093 Zurich, Switzerland
| | - Mustafa A Tuncel
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, Department of Biosystems Science and Engineering, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Ulrike Menzel
- ETH Zurich, Department of Biosystems Science and Engineering, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Andrea Jacobs
- University of Zurich, Department of Quantitative Biomedicine, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Stefanie Engler
- University of Zurich, Department of Quantitative Biomedicine, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Sujana Sivapatham
- University of Zurich, Department of Quantitative Biomedicine, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Anja L Frei
- University Hospital Zurich, Department of Pathology and Molecular Pathology, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Gabriele Gut
- University of Zurich, Department of Molecular Life Sciences, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Joanna Ficek
- ETH Zurich, Department of Computer Science, Institute of Machine Learning, Universitätstrasse 6, 8092 Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; University Hospital Zurich, Biomedical Informatics, Schmelzbergstrasse 26, 8006 Zurich, Switzerland
| | - Nicola Miglino
- University Hospital Zurich, Department of Medical Oncology and Hematology, Rämistrasse 100, 8091 Zurich, Switzerland
| | | | - Rudolf Aebersold
- ETH Zurich, Department of Biology, Institute of Molecular Systems Biology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Marina Bacac
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Zurich, Wagistrasse 10, 8952 Schlieren, Switzerland
| | - Niko Beerenwinkel
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, Department of Biosystems Science and Engineering, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Christian Beisel
- ETH Zurich, Department of Biosystems Science and Engineering, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Bernd Bodenmiller
- University of Zurich, Department of Quantitative Biomedicine, Winterthurerstrasse 190, 8057 Zurich, Switzerland; ETH Zurich, Institute of Molecular Health Sciences, Otto-Stern-Weg 7, 8093 Zurich, Switzerland
| | - Reinhard Dummer
- University Hospital Zurich, Department of Dermatology, University of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
| | - Viola Heinzelmann-Schwarz
- University Hospital Basel and University of Basel, Department of Biomedicine, Hebelstrasse 20, 4031 Basel, Switzerland; University Hospital Basel, Gynecological Cancer Center, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Viktor H Koelzer
- University Hospital Zurich, Department of Pathology and Molecular Pathology, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Markus G Manz
- University Hospital Zurich, Department of Medical Oncology and Hematology, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Holger Moch
- University Hospital Zurich, Department of Pathology and Molecular Pathology, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Lucas Pelkmans
- University of Zurich, Department of Molecular Life Sciences, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Berend Snijder
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, Department of Biology, Institute of Molecular Systems Biology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Alexandre P A Theocharides
- University Hospital Zurich, Department of Medical Oncology and Hematology, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Markus Tolnay
- University Hospital Basel, Institute of Medical Genetics and Pathology, Schönbeinstrasse 40, 4031 Basel, Switzerland
| | - Andreas Wicki
- University Hospital Zurich, Department of Medical Oncology and Hematology, Rämistrasse 100, 8091 Zurich, Switzerland; University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Bernd Wollscheid
- ETH Zurich, Department of Health Sciences and Technology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Gunnar Rätsch
- ETH Zurich, Department of Computer Science, Institute of Machine Learning, Universitätstrasse 6, 8092 Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; University Hospital Zurich, Biomedical Informatics, Schmelzbergstrasse 26, 8006 Zurich, Switzerland; ETH Zurich, Department of Biology, Wolfgang-Pauli-Strasse 27, 8093 Zurich, Switzerland.
| | - Mitchell P Levesque
- University Hospital Zurich, Department of Dermatology, University of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland.
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19
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Koessler T, Paradiso V, Piscuoglio S, Nienhold R, Ho L, Christinat Y, Terracciano LM, Cathomas G, Wicki A, McKee TA, Nouspikel T. Reliability of liquid biopsy analysis: an inter-laboratory comparison of circulating tumor DNA extraction and sequencing with different platforms. J Transl Med 2020; 100:1475-1484. [PMID: 32616816 DOI: 10.1038/s41374-020-0459-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 01/11/2023] Open
Abstract
Liquid biopsy, the analysis of circulating tumor DNA (ctDNA), is a promising tool in oncology, especially in personalized medicine. Although its main applications currently focus on selection and adjustment of therapy, ctDNA may also be used to monitor residual disease, establish prognosis, detect relapses, and possibly screen at-risk individuals. CtDNA represents a small and variable proportion of circulating cell-free DNA (ccfDNA) which is itself present at a low concentration in normal individuals and so analyzing ctDNA is technically challenging. Various commercial systems have recently appeared on the market, but it remains difficult for practitioners to compare their performance and to determine whether they yield comparable results. As a first step toward establishing national guidelines for ctDNA analyses, four laboratories in Switzerland joined a comparative exercise to assess ccfDNA extraction and ctDNA analysis by sequencing. Extraction was performed using six distinct methods and yielded ccfDNA of equally high quality, suitable for sequencing. Sequencing of synthetic samples containing predefined amounts of eight mutations was performed on three different systems, with similar results. In all four laboratories, mutations were easily identified down to 1% allele frequency, whereas detection at 0.1% proved challenging. Linearity was excellent in all cases and while molecular yield was superior with one system this did not impact on sensitivity. This study also led to several additional conclusions: First, national guidelines should concentrate on principles of good laboratory practice rather than recommend a particular system. Second, it is essential that laboratories thoroughly validate every aspect of extraction and sequencing, in particular with respect to initial amount of DNA and average sequencing depth. Finally, as software proved critical for mutation detection, laboratories should validate the performance of variant callers and underlying algorithms with respect to various types of mutations.
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Affiliation(s)
- Thibaud Koessler
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Viola Paradiso
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Salvatore Piscuoglio
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland.,Visceral surgery research laboratory, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Ronny Nienhold
- Institute of Pathology, Cantonal Hospital Basel-Land, Liestal, Switzerland
| | - Liza Ho
- Clinical Pathology Service, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - Yann Christinat
- Clinical Pathology Service, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - Luigi M Terracciano
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Gieri Cathomas
- Visceral surgery research laboratory, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Andreas Wicki
- Department of Oncology & Hematology, Medical University Clinic, Cantonal Hospital Basel-Land, Liestal, and University of Basel, Basel, Switzerland
| | - Thomas A McKee
- Clinical Pathology Service, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
| | - Thierry Nouspikel
- Medical Genetics, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland.
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20
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Rentsch C, Thalmann G, Lucca I, Kwiatkowski M, Wirth G, Strebel R, Engeler D, Pedrazzini A, Hüttenbrink C, Schultze-Seemann W, Bubendorf L, Wicki A, Roth B, Bosshard P, Püschel H, Boll D, Hefermehl L, Roghmann F, Gierth M, Schäfer S, Hayoz S. Results of a phase II single arm clinical trial assessing efficacy, safety and tolerability of the recombinant Bacillus Calmette Guérin (BCG) VPM1002BC in patients with BCG failure - SAKK 06/14. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33377-2] [Citation(s) in RCA: 1] [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: 11/17/2022] Open
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21
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Homann N, Lorenzen S, Schenk M, Thuss-Patience PC, Goekkurt E, Hofheinz RD, Kretzschmar A, Bolling C, Angermeier S, Wicki A, Siebenhuener AR, Lindig U, Pink D, Ettrich TJ, Schmalenberg H, Waberer L, Talbot J, Pauligk C, Goetze TO, Al-Batran SE. Interim safety analysis of the DANTE trial: Perioperative atezolizumab in combination with FLOT versus FLOT alone in patients with resectable esophagogastric adenocarcinoma—A randomized, open-label phase II trial of the German Gastric Group at the AIO and SAKK. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4549] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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
4549 Background: The DANTE study evaluates atezolizumab in the perioperative treatment of locally advanced, potentially resectable gastric or GEJ adenocarcinoma in combination with perioperative FLOT. Here, we report the protocol-defined interim safety analysis. Methods: DANTE is a multinational, prospective, multicenter, randomized, investigator-initiated, open label phase II trial. Patients (pts) with locally advanced, potentially resectable adenocarcinoma of the stomach and GEJ (≥cT2 and/or N-positive) without distant metastases are enrolled. Pts are randomized 1:1 to 4 pre-operative 2-week cycles of FLOT followed by surgery and 4 additional cycles of FLOT plus atezolizumab at 840 mg every 2 weeks, followed by a total of 8 additional cycles of atezolizumab at 1200 mg every 3 weeks as monotherapy (arm A) or FLOT alone (arm B). Primary endpoint is time to disease progression or relapse after surgery (PFS/DFS). Results: Recruitment started in Sep 2018; by Feb 2020, a total of 175 pts have been randomized. This analysis is based on the first 40 pts (20 pts in each arm). The pts had a median age of 62 y and 75% of pts had an ECOG PS of 0 in both arms. The cohort was well balanced in terms of tumor location and clinical stage. 5% of the 40 patients (overall 7.4% of 175 pts enrolled) showed microsatellite instability. 90% of pts enrolled completed all pre-operative cycles in each arm. Total number of adverse events with relation to study treatment was 154 in arm A and 148 in arm B. Total number of serious adverse events (SAE; related or not) was 16 in Arm A and 14 in arm B. 20% of pts in each arm had an SAE due to perioperative morbidity. No surgical mortality was observed. 18 and 19 pts proceeded to operation in arms A and B, respectively. Premature treatment discontinuation occurred in 2 pts in each arm: disease progression (1) and deterioration of general health condition (1) in arm A; and pts’ wish (1) and death (1) in arm B. Median hospitalization time was 15 days in arm A and 16 days in arm B. Conclusions: Perioperative atezolizumab plus FLOT is feasible and safe. The study continues recruitment. Clinical trial information: NCT03421288 .
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Affiliation(s)
- Nils Homann
- Klinikum Wolfsburg, Med. Klinik II, Wolfsburg, Germany
| | - Sylvie Lorenzen
- Third Department of Internal Medicine (Hematology/Medical Oncology), Klinikum Rechts der Isar, Technische Universitat Munchen, Munich, Germany
| | - Michael Schenk
- Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Peter C. Thuss-Patience
- Charité–University Medicine Berlin, Department of Haematology, Oncology and Tumorimmunology, Campus Virchow-Klinikum, Berlin, Germany
| | - Eray Goekkurt
- Haematologisch-Onkologische Praxis Eppendorf, Hamburg, Germany
| | - Ralf Dieter Hofheinz
- University Medical Center Mannheim, Tagestherapiezentrum am ITM, Mannheim, Germany
| | | | | | | | | | | | | | - Daniel Pink
- Helios Klinikum Bad Saarow-Sarcoma Center Berlin-Brandenburg and University Medicine Greifswald, Germany, Bad Saarow, Germany
| | | | - Harald Schmalenberg
- Krankenhaus Dresden-Friedrichstadt, IV. Medizinische Klinik, Dresden, Germany
| | - Lisa Waberer
- IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | | | - Claudia Pauligk
- University Cancer Center Frankfurt, Institut für Klinisch-Onkologische Forschung and IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Thorsten Oliver Goetze
- University Cancer Center Frankfurt, Institut für Klinisch-Onkologische Forschung and IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Salah-Eddin Al-Batran
- University Cancer Center Frankfurt, Institut für Klinisch-Onkologische Forschung and IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany
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22
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Rentsch CA, Bosshard P, Mayor G, Rieken M, Püschel H, Wirth G, Cathomas R, Parzmair GP, Grode L, Eisele B, Sharma H, Gupta M, Gairola S, Shaligram U, Goldenberger D, Spertini F, Audran R, Enoiu M, Berardi S, Hayoz S, Wicki A. Results of the phase I open label clinical trial SAKK 06/14 assessing safety of intravesical instillation of VPM1002BC, a recombinant mycobacterium Bacillus Calmette Guérin (BCG), in patients with non-muscle invasive bladder cancer and previous failure of conventional BCG therapy. Oncoimmunology 2020; 9:1748981. [PMID: 32363120 PMCID: PMC7185202 DOI: 10.1080/2162402x.2020.1748981] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/09/2019] [Revised: 11/08/2019] [Accepted: 01/18/2020] [Indexed: 01/10/2023] Open
Abstract
Background: VPM1002BC is a modified mycobacterium Bacillus Calmette Guérin (BCG) for the treatment of non-muscle invasive bladder cancer (NMIBC). The genetic modifications are expected to result in better immunogenicity and less side effects. We report on patient safety and immunology of the first intravesical application of VPM1002BC in human. Methods: Six patients with BCG failure received a treatment of 6 weekly instillations with VPM1002BC. Patients were monitored for adverse events (AE), excretion of VPM1002BC and cytokines, respectively. Results: No DLT (dose limiting toxicity) occurred during the DLT-period. No grade ≥3 AEs occurred. Excretion of VPM1002BC in the urine was limited to less than 24 hours. Plasma levels of TNFα significantly increased after treatment and blood-derived CD4+ T cells stimulated with PPD demonstrated significantly increased intracellular GM-CSF and IFN expression. Conclusion: The intravesical application of VPM1002BC is safe and well tolerated by patients and results in a potential Th1 weighted immune response.
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Affiliation(s)
- Cyrill A Rentsch
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Piet Bosshard
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Urology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Grégoire Mayor
- Department of Urology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Malte Rieken
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Heike Püschel
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Grégory Wirth
- Department of Urology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Richard Cathomas
- Department of Oncology, Cantonal Hospital Chur, Chur, Switzerland
| | | | | | - Bernd Eisele
- Vakzine Projekt Management GmbH, Hannover, Germany
| | - Hitt Sharma
- Serum Institute of India Pvt. Ltd., Pune, India
| | | | | | | | - Daniel Goldenberger
- Department of Clinical Bacteriology & Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - François Spertini
- Division of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
| | - Régine Audran
- Division of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | | | - Andreas Wicki
- Department of Oncology, University Hospital Basel, University of Basel, Switzerland
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23
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Al-Batran SE, Lorenzen S, Schenk M, Thuss-Patience PC, Goekkurt E, Hofheinz R, Kretzschmar A, Bolling C, Angermeier S, Wicki A, Siebenhuener AR, Eigendorff E, Pink C, Ettrich TJ, Schmalenberg H, Waberer L, Talbot J, Pauligk C, Goetze TO, Homann N. Safety of perioperative atezolizumab in combination with FLOT versus FLOT alone in patients with resectable esophagogastric adenocarcinoma: An interim safety analysis of the DANTE, a randomized, open-label phase II trial of the German Gastric Group at the AIO and the SAKK. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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
398 Background: The DANTE study evaluates atezolizumab in the perioperative treatment of locally advanced, potentially resectable gastric or GEJ adenocarcinoma in combination with perioperative FLOT. Here, we report the protocol-defined interim safety analysis. Methods: DANTE is a large, multinational, prospective, multicenter, randomized, investigator-initiated, open label phase II trial. Patients (pts) with locally advanced, potentially resectable adenocarcinoma of the stomach and GEJ (≥cT2 and/or N-positive) without distant metastases are enrolled. Pts are randomized 1:1 to 4 pre-operative 2-week cycles (8 weeks) of FLOT followed by surgery and 4 additional cycles of FLOT plus atezolizumab at 840 mg every 2 weeks, followed by a total of 8 additional cycles of atezolizumab at 1200 mg every 3 weeks as monotherapy (arm A) or FLOT alone (arm B). Primary endpoint is time to disease progression or relapse after surgery (PFS/DFS). Results: Recruitment started in Sept 2018; by September 2019, a total of 122 pts have been randomized. This analysis is based on the first 40 pts (20 pts in each arm). The pts had a median age of 62 y and 75% of pts had an ECOG PS of 0 in both arms. The cohort was well balanced in terms of tumor location and clinical stage. 90% of pts enrolled completed all pre-operative cycles in each arm. Total number of adverse events with relation to study treatment was 154 in arm A and 148 in arm B. Total number of serious adverse events (SAE; related or not) was 16 in Arm A and 14 in arm B. 20% of pts in each arm had an SAE due to perioperative morbidity. No surgical mortality was observed. 18 and 19 pts proceeded to operation in arms A and B, respectively. Premature treatment discontinuation occurred in 2 pts in each arm: disease progression (1) and deterioration of general health condition (1) in arm A; and pts’ wish (1) and death (1) in arm B. Median hospitalization time was 15 days in arm A and 16 days in arm B. Conclusions: perioperative atezolizumab plus FLOT is feasible and safe. The study continued recruitment. Clinical trial information: NCT03421288.
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Affiliation(s)
- Salah-Eddin Al-Batran
- Institute of Clinical Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Sylvie Lorenzen
- Third Department of Internal Medicine (Hematology/Medical Oncology), Klinikum Rechts der Isar, Technische Universitat Munchen, Munich, Germany
| | - Michael Schenk
- Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Peter C. Thuss-Patience
- Charité–University Medicine Berlin, Department of Haematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Eray Goekkurt
- Haematologisch-Onkologische Praxis Eppendorf, Hamburg, Germany
| | - Ralf Hofheinz
- University Medical Center Mannheim, Tagestherapiezentrum am ITM, Mannheim, Germany
| | | | | | | | | | | | | | - Christin Pink
- Helios Klinikum Bad Saarow, Bad Saarow, Brandenburg, Germany
| | | | - Harald Schmalenberg
- Krankenhaus Dresden-Friedrichstadt, IV, Medizinische Klinik, Dresden, Germany
| | | | | | - Claudia Pauligk
- University Cancer Center Frankfurt, Institut für Klinisch-Onkologische Forschung and IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Thorsten Oliver Goetze
- University Cancer Center Frankfurt, Institut für Klinisch-Onkologische Forschung and IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Nils Homann
- MED. Klinik II, Klinikum Wolfsburg, Wolfsburg, Germany
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24
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Al-Batran SE, Pauligk C, Hofheinz R, Lorenzen S, Wicki A, Siebenhuener A, Schenk M, Thuss-Patience P, Kretzschmar A, Bolling C, Eigendorff E, Angermeier S, Pink D, Geissler M, Goekkurt E, Schmalenberg H, Waberer L, Talbot J, Goetze T, Homann N. Perioperative atezolizumab in combination with FLOT versus FLOT alone in patients with resectable esophagogastric adenocarcinoma: DANTE, a randomized, open-label phase II trial of the German Gastric Group of the AIO and the SAKK. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Al-Batran SE, Pauligk C, Hofheinz R, Lorenzen S, Wicki A, Siebenhuener AR, Schenk M, Welslau M, Heuer V, Goekkurt E, Schmalenberg H, Thuss-Patience PC, Waberer L, Talbot J, Goetze TO, Homann N. Perioperative atezolizumab in combination with FLOT versus FLOT alone in patients with resectable esophagogastric adenocarcinoma: DANTE, a randomized, open-label phase II trial of the German Gastric Group of the AIO and the SAKK. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps4142] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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
TPS4142 Background: Perioperative FLOT chemotherapy has become a standard of care for locally advanced, resectable gastric cancer and adenocarcinoma of the GEJ. However, patient outcomes are still unsatisfactory and 5-year survival in T3-4 or nodal positive disease is still around 50%. Targeting the PD-1/PD-L1 pathway has proven active in different cancers, including esophagogastric cancer, and was associated with response rates in the 10-15% range in unselected, heavily pre-treated gastric cancer patients. Atezolizumab is a PD-L1 inhibitor with established efficacy and tolerability profiles. This study evaluates atezolizumab in the perioperative treatment of locally advanced, potentially resectable gastric or GEJ adenocarcinoma in combination with FLOT. Methods: This is a large, multinational, prospective, multicenter, randomized, investigator-initiated, open label phase II trial. Patients with locally advanced, potentially resectable adenocarcinoma of the stomach and GEJ (≥cT2 and/or N-positive) without distant metastases are enrolled. Eligibility status is centrally evaluated. Patients are randomized 1:1 to 4 pre-operative 2-week cycles (8 weeks) of FLOT (Docetaxel 50 mg/m²; Oxaliplatin 85 mg/m²; Leucovorin 200 mg/m²; 5-FU 2600 mg/m²) followed by surgery and 4 additional cycles of FLOT plus atezolizumab at 840 mg every 2 weeks, followed by a total of 8 additional cycles of atezolizumab at 1200 mg every 3 weeks as monotherapy (arm A) or FLOT alone (arm B). Primary endpoint is time to disease progression or relapse after surgery (PFS/DFS) as assessed by the Kaplan-Meier-Method. The statistical design is based on a target HR of 0.68, a power of 0.8, and a significance level of p< 0.05 (1-sided log rank test). A total of 295 patients will be randomized. Main secondary endpoints are rates of centrally assessed pathological regression (rates of complete and nearly complete pathological regression), overall survival, R0 resection, and safety. Recruitment started in Sept 2018; by February 2019, a total of 27 patients have been randomized. Clinical trial information: NCT03421288.
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Affiliation(s)
- Salah-Eddin Al-Batran
- Institute of Clinical Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Claudia Pauligk
- University Cancer Center Frankfurt, Institut für Klinisch-Onkologische Forschung and IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Ralf Hofheinz
- University Medical Center Mannheim, Tagestherapiezentrum am ITM, Mannheim, Germany
| | - Sylvie Lorenzen
- Third Department of Internal Medicine (Hematology/Medical Oncology), Klinikum rechts der Isar, Technische Universitat Munchen, Munich, Germany
| | | | | | - Michael Schenk
- Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Manfred Welslau
- Klinikum Aschaffenburg, Medizinische Klinik II, Aschaffenburg, Germany
| | | | - Eray Goekkurt
- Hämatologisch-Onkologische Praxis Eppendorf (HOPE), Facharztzentrum Eppendorf, Hamburg, Germany
| | - Harald Schmalenberg
- Krankenhaus Dresden-Friedrichstadt, IV. Medizinische Klinik, Dresden, Germany
| | - Peter C. Thuss-Patience
- Charité–University Medicine Berlin, Department of Haematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Lisa Waberer
- IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | | | - Thorsten Oliver Goetze
- University Cancer Center Frankfurt, Institut für Klinisch-Onkologische Forschung and IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Nils Homann
- MED. Klinik II, Klinikum Wolfsburg, Wolfsburg, Germany
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26
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Kienle DL, Dietrich D, Ribi K, Wicki A, Quagliata L, Winterhalder RC, Koeberle D, Horber D, Bastian S, Kueng M, Saletti P, Helbling D, Baertschi D, Lugli A, Bernhard J, Andrieu C, von Moos R. Cetuximab monotherapy and cetuximab plus capecitabine as first-line treatment in older patients with RAS- and BRAF wild-type metastatic colorectal cancer. Results of the multicenter phase II trial SAKK 41/10. J Geriatr Oncol 2019; 10:304-310. [DOI: 10.1016/j.jgo.2018.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/23/2018] [Accepted: 11/30/2018] [Indexed: 02/07/2023]
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Singer F, Irmisch A, Toussaint NC, Grob L, Singer J, Thurnherr T, Beerenwinkel N, Levesque MP, Dummer R, Quagliata L, Rothschild SI, Wicki A, Beisel C, Stekhoven DJ. SwissMTB: establishing comprehensive molecular cancer diagnostics in Swiss clinics. BMC Med Inform Decis Mak 2018; 18:89. [PMID: 30373609 PMCID: PMC6206832 DOI: 10.1186/s12911-018-0680-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 05/08/2018] [Accepted: 10/18/2018] [Indexed: 12/18/2022] Open
Abstract
Background Molecular precision oncology is an emerging practice to improve cancer therapy by decreasing the risk of choosing treatments that lack efficacy or cause adverse events. However, the challenges of integrating molecular profiling into routine clinical care are manifold. From a computational perspective these include the importance of a short analysis turnaround time, the interpretation of complex drug-gene and gene-gene interactions, and the necessity of standardized high-quality workflows. In addition, difficulties faced when integrating molecular diagnostics into clinical practice are ethical concerns, legal requirements, and limited availability of treatment options beyond standard of care as well as the overall lack of awareness of their existence. Methods To the best of our knowledge, we are the first group in Switzerland that established a workflow for personalized diagnostics based on comprehensive high-throughput sequencing of tumors at the clinic. Our workflow, named SwissMTB (Swiss Molecular Tumor Board), links genetic tumor alterations and gene expression to therapeutic options and clinical trial opportunities. The resulting treatment recommendations are summarized in a clinical report and discussed in a molecular tumor board at the clinic to support therapy decisions. Results Here we present results from an observational pilot study including 22 late-stage cancer patients. In this study we were able to identify actionable variants and corresponding therapies for 19 patients. Half of the patients were analyzed retrospectively. In two patients we identified resistance-associated variants explaining lack of therapy response. For five out of eleven patients analyzed before treatment the SwissMTB diagnostic influenced treatment decision. Conclusions SwissMTB enables the analysis and clinical interpretation of large numbers of potentially actionable molecular targets. Thus, our workflow paves the way towards a more frequent use of comprehensive molecular diagnostics in Swiss hospitals. Electronic supplementary material The online version of this article (10.1186/s12911-018-0680-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Franziska Singer
- NEXUS Personalized Health Technologies, ETH Zurich, Otto-Stern-Weg 7, 8093, Zurich, Switzerland.,SIB Swiss Institute of Bioinformatics, 4058, Basel, Switzerland
| | - Anja Irmisch
- Department of Dermatology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Nora C Toussaint
- NEXUS Personalized Health Technologies, ETH Zurich, Otto-Stern-Weg 7, 8093, Zurich, Switzerland.,SIB Swiss Institute of Bioinformatics, 4058, Basel, Switzerland
| | - Linda Grob
- NEXUS Personalized Health Technologies, ETH Zurich, Otto-Stern-Weg 7, 8093, Zurich, Switzerland.,SIB Swiss Institute of Bioinformatics, 4058, Basel, Switzerland
| | - Jochen Singer
- SIB Swiss Institute of Bioinformatics, 4058, Basel, Switzerland.,Department of Biosystems Science and Engineering, ETH Zurich, 4058, Basel, Switzerland
| | - Thomas Thurnherr
- SIB Swiss Institute of Bioinformatics, 4058, Basel, Switzerland.,Department of Biosystems Science and Engineering, ETH Zurich, 4058, Basel, Switzerland
| | - Niko Beerenwinkel
- SIB Swiss Institute of Bioinformatics, 4058, Basel, Switzerland.,Department of Biosystems Science and Engineering, ETH Zurich, 4058, Basel, Switzerland
| | - Mitchell P Levesque
- Department of Dermatology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Luca Quagliata
- Department of Pathology, University Hospital Basel, Schönbeinstrasse 40, 4056, Basel, Switzerland
| | - Sacha I Rothschild
- Division of Oncology, Department of Biomedicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Andreas Wicki
- Division of Oncology, Department of Biomedicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Christian Beisel
- Department of Biosystems Science and Engineering, ETH Zurich, 4058, Basel, Switzerland
| | - Daniel J Stekhoven
- NEXUS Personalized Health Technologies, ETH Zurich, Otto-Stern-Weg 7, 8093, Zurich, Switzerland. .,SIB Swiss Institute of Bioinformatics, 4058, Basel, Switzerland.
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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.
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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
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Abstract
The transcription factor Twist is an important regulator of cranial suture during embryogenesis. Closure of the neural tube is achieved via Twist-triggered cellular transition from an epithelial to mesenchymal phenotype, a process known as epithelial-mesenchymal transition (EMT), characterized by a remarkable increase in cell motility. In the absence of Twist activity, EMT and associated phenotypic changes in cell morphology and motility can also be induced, albeit moderately, by other transcription factor families, including Snail and Zeb. Aberrant EMT triggered by Twist in human mammary tumour cells was first reported to drive metastasis to the lung in a metastatic breast cancer model. Subsequent analysis of many types of carcinoma demonstrated overexpression of these unique EMT transcription factors, which statistically correlated with worse outcome, indicating their potential as biomarkers in the clinic. However, the mechanisms underlying their activation remain unclear. Interestingly, increasing evidence indicates they are selectively activated by distinct intracellular kinases, thereby acting as downstream effectors facilitating transduction of cytoplasmic signals into nucleus and reprogramming EMT and mesenchymal-epithelial transition (MET) transcription to control cell plasticity. Understanding these relationships and emerging data indicating differential phosphorylation of Twist leads to complex and even paradoxical functionalities, will be vital to unlocking their potential in clinical settings.
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Affiliation(s)
- Huifang Tang
- Department of Pharmacology, Zhejiang University School of Basic Medical Sciences, Hangzhou, China
| | - Daniela Massi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Brian A Hemmings
- Department of Mechanisms of Cancer, Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Mario Mandalà
- Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Zhengqiang Hu
- Department of Pharmacology, Zhejiang University School of Basic Medical Sciences, Hangzhou, China
| | - Andreas Wicki
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Gongda Xue
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
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30
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Rentsch C, Bosshard P, Mayor G, Rieken M, Püschel H, Wirth G, Cathomas R, Grode L, Parzmair G, Eisele B, Sharma H, Shaligram U, Goldenberger D, Spertini F, Audran R, Enoui M, Berardi-Vilei S, Hayoz S, Wicki A. Results of the phase-I open-label clinical trial SAKK 06/14 assessing safety of intravesical instillation of the recombinant BCG VPM1002BC in patients with non-muscle invasive bladder cancer and previous failure to conventional BCG therapy. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)31563-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Kunita A, Baeriswyl V, Meda C, Cabuy E, Takeshita K, Giraudo E, Wicki A, Fukayama M, Christofori G. Inflammatory Cytokines Induce Podoplanin Expression at the Tumor Invasive Front. Am J Pathol 2018; 188:1276-1288. [PMID: 29458011 DOI: 10.1016/j.ajpath.2018.01.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 01/02/2018] [Accepted: 01/23/2018] [Indexed: 01/12/2023]
Abstract
Tumor invasion is a critical first step in the organismic dissemination of cancer cells and the formation of metastasis in distant organs, the most important prognostic factor and the actual cause of death in most of the cancer patients. We report herein that the cell surface protein podoplanin (PDPN), a potent inducer of cancer cell invasion, is conspicuously expressed by the invasive front of squamous cell carcinomas (SCCs) of the cervix in patients and in the transgenic human papillomavirus/estrogen mouse model of cervical cancer. Laser capture microscopy combined with gene expression profiling reveals that the expression of interferon-responsive genes is up-regulated in PDPN-expressing cells at the tumor invasive front, which are exposed to CD45-positive inflammatory cells. Indeed, PDPN expression can be induced in cultured SCC cell lines by single or combined treatments with interferon-γ, transforming growth factor-β, and/or tumor necrosis factor-α. Notably, shRNA-mediated ablation of either PDPN or STAT1 in A431 SCC cells repressed cancer cell invasion on s.c. transplantation into immunodeficient mice. The results highlight the induction of tumor cell invasion by the inflammatory cytokine-stimulated expression of PDPN in the outermost cell layers of cervical SCC.
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Affiliation(s)
- Akiko Kunita
- Department of Biomedicine, University of Basel, Basel, Switzerland; Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Claudia Meda
- Laboratory of Transgenic Mouse Models, Candiolo Cancer Institute-The Fondazione del Piemonte per l'Oncologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Torino, Italy, the Department of Science and Drug Technology, University of Torino, Candiolo, Italy
| | - Erik Cabuy
- Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland; The CAEX Project, CAEX NV, Lier, Belgium
| | - Kimiko Takeshita
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Enrico Giraudo
- Laboratory of Transgenic Mouse Models, Candiolo Cancer Institute-The Fondazione del Piemonte per l'Oncologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Torino, Italy, the Department of Science and Drug Technology, University of Torino, Candiolo, Italy
| | - Andreas Wicki
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Voegeli M, Wicki A. [Neoadjuvant, adjuvant and palliative systemic therapy of colorectal cancer]. Ther Umsch 2018; 75:622-626. [PMID: 31232658 DOI: 10.1024/0040-5930/a001049] [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: 11/19/2022]
Abstract
Neoadjuvant, adjuvant and palliative systemic therapy of colorectal cancer Abstract. Neoadjuvant therapy is indicated for stage T3 / 4 and all N1 rectal cancers. Usually, chemoradiotherapy with capecitabine or 5FU is applied within a timeframe of 5 ½ weeks. 6 to 9 weeks later surgery is performed. The aim of neoadjuvant chemoradiotherapy is resectability and a low local recurrence rate. After surgery with curative intent, adjuvant chemotherapy increases the cure rate by 20 % in node-positive (stage III) colon cancer. For most patients, 3 months of capecitabine / oxaliplatin are adequate. For high risk patients, 6 months of therapy are necessary if a Folfox regimen is used. In the palliative setting, understanding the biology of the tumor is the key to systemic therapy. Next generation sequencing of tumor DNA is mandatory. Mismatch repair proficient tumors benefit from dual chemotherapy in combination with an antibody. Median survival increases from 6 to 30 months through palliative chemotherapy. Mismatch repair deficient tumors are in need of immunotherapy. Long lasting remission have been observed in this population.
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Affiliation(s)
- Michèle Voegeli
- 1 Medizinische Universitätsklinik, Onkologie, Kantonsspital Baselland, Liestal
| | - Andreas Wicki
- 1 Medizinische Universitätsklinik, Onkologie, Kantonsspital Baselland, Liestal
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Tarantelli C, Gaudio E, Arribas AJ, Kwee I, Hillmann P, Rinaldi A, Cascione L, Spriano F, Bernasconi E, Guidetti F, Carrassa L, Pittau RB, Beaufils F, Ritschard R, Rageot D, Sele A, Dossena B, Rossi FM, Zucchetto A, Taborelli M, Gattei V, Rossi D, Stathis A, Stussi G, Broggini M, Wymann MP, Wicki A, Zucca E, Cmiljanovic V, Fabbro D, Bertoni F. PQR309 Is a Novel Dual PI3K/mTOR Inhibitor with Preclinical Antitumor Activity in Lymphomas as a Single Agent and in Combination Therapy. Clin Cancer Res 2017; 24:120-129. [PMID: 29066507 DOI: 10.1158/1078-0432.ccr-17-1041] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/18/2017] [Accepted: 10/20/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Activation of the PI3K/mTOR signaling pathway is recurrent in different lymphoma types, and pharmacologic inhibition of the PI3K/mTOR pathway has shown activity in lymphoma patients. Here, we extensively characterized the in vitro and in vivo activity and the mechanism of action of PQR309 (bimiralisib), a novel oral selective dual PI3K/mTOR inhibitor under clinical evaluation, in preclinical lymphoma models.Experimental Design: This study included preclinical in vitro activity screening on a large panel of cell lines, both as single agent and in combination, validation experiments on in vivo models and primary cells, proteomics and gene-expression profiling, and comparison with other signaling inhibitors.Results: PQR309 had in vitro antilymphoma activity as single agent and in combination with venetoclax, panobinostat, ibrutinib, lenalidomide, ARV-825, marizomib, and rituximab. Sensitivity to PQR309 was associated with specific baseline gene-expression features, such as high expression of transcripts coding for the BCR pathway. Combining proteomics and RNA profiling, we identified the different contribution of PQR309-induced protein phosphorylation and gene expression changes to the drug mechanism of action. Gene-expression signatures induced by PQR309 and by other signaling inhibitors largely overlapped. PQR309 showed activity in cells with primary or secondary resistance to idelalisib.Conclusions: On the basis of these results, PQR309 appeared as a novel and promising compound that is worth developing in the lymphoma setting. Clin Cancer Res; 24(1); 120-9. ©2017 AACR.
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Affiliation(s)
- Chiara Tarantelli
- Università della Svizzera Italiana (USI), Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Eugenio Gaudio
- Università della Svizzera Italiana (USI), Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Alberto J Arribas
- Università della Svizzera Italiana (USI), Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Ivo Kwee
- Università della Svizzera Italiana (USI), Institute of Oncology Research (IOR), Bellinzona, Switzerland.,Dalle Molle Institute for Artificial Intelligence (IDSIA), Manno, Switzerland.,Swiss Institute of Bioinformatics (SIB), Lausanne, Switzerland
| | | | - Andrea Rinaldi
- Università della Svizzera Italiana (USI), Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Luciano Cascione
- Università della Svizzera Italiana (USI), Institute of Oncology Research (IOR), Bellinzona, Switzerland.,Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Filippo Spriano
- Università della Svizzera Italiana (USI), Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Elena Bernasconi
- Università della Svizzera Italiana (USI), Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Francesca Guidetti
- Università della Svizzera Italiana (USI), Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Laura Carrassa
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | - Florent Beaufils
- PIQUR Therapeutics AG, Basel, Switzerland.,Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Reto Ritschard
- Department of Oncology, University Hospital Basel, Basel, Switzerland
| | - Denise Rageot
- PIQUR Therapeutics AG, Basel, Switzerland.,Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Alexander Sele
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Barbara Dossena
- Cytogenetics Laboratory, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Francesca Maria Rossi
- Clinical and Experimental Onco-Hematology Unit, IRCCS-Centro di Riferimento Oncologico, Aviano, Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, IRCCS-Centro di Riferimento Oncologico, Aviano, Italy
| | - Monica Taborelli
- Cytogenetics Laboratory, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, IRCCS-Centro di Riferimento Oncologico, Aviano, Italy
| | - Davide Rossi
- Università della Svizzera Italiana (USI), Institute of Oncology Research (IOR), Bellinzona, Switzerland.,Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Georg Stussi
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Massimo Broggini
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | - Andreas Wicki
- Department of Oncology, University Hospital Basel, Basel, Switzerland
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | | | | | - Francesco Bertoni
- Università della Svizzera Italiana (USI), Institute of Oncology Research (IOR), Bellinzona, Switzerland. .,Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
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Xue G, Kohler R, Tang F, Hynx D, Wang Y, Orso F, Prêtre V, Ritschard R, Hirschmann P, Cron P, Roloff T, Dummer R, Mandalà M, Bichet S, Genoud C, Meyer AG, Muraro MG, Spagnoli GC, Taverna D, Rüegg C, Merghoub T, Massi D, Tang H, Levesque MP, Dirnhofer S, Zippelius A, Hemmings BA, Wicki A. mTORC1/autophagy-regulated MerTK in mutant BRAFV600 melanoma with acquired resistance to BRAF inhibition. Oncotarget 2017; 8:69204-69218. [PMID: 29050198 PMCID: PMC5642473 DOI: 10.18632/oncotarget.18213] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 05/09/2017] [Accepted: 05/17/2017] [Indexed: 12/19/2022] Open
Abstract
BRAF inhibitors (BRAFi) and the combination therapy of BRAF and MEK inhibitors (MEKi) were recently approved for therapy of metastatic melanomas harbouring the oncogenic BRAFV600 mutation. Although these therapies have shown pronounced therapeutic efficacy, the limited durability of the response indicates an acquired drug resistance that still remains mechanistically poorly understood at the molecular level. We conducted transcriptome gene profiling in BRAFi-treated melanoma cells and identified that Mer tyrosine kinase (MerTK) is specifically upregulated. MerTK overexpression was demonstrated not only in melanomas resistant to BRAFi monotherapy (5 out of 10 samples from melanoma patients) but also in melanoma resistant to BRAFi+MEKi (1 out of 3), although MEKi alone does not affect MerTK. Mechanistically, BRAFi-induced activation of Zeb2 stimulates MerTK in BRAFV600 melanoma through mTORC1-triggered activation of autophagy. Co-targeting MerTK and BRAFV600 significantly reduced tumour burden in xenografted mice, which was pheno-copied by co-inhibition of autophagy and mutant BRAFV600.
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Affiliation(s)
- Gongda Xue
- Department of Mechanisms of Cancer, Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Reto Kohler
- Department of Mechanisms of Cancer, Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Fengyuan Tang
- Department of Mechanisms of Cancer, Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland.,Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Debby Hynx
- Department of Mechanisms of Cancer, Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Yuhua Wang
- Department of Mechanisms of Cancer, Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Francesca Orso
- Molecular Biotechnology Center and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Vincent Prêtre
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Reto Ritschard
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | | | - Peter Cron
- Department of Mechanisms of Cancer, Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Tim Roloff
- Department of Mechanisms of Cancer, Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Mario Mandalà
- Unit of Clinical and Translational Research, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sandrine Bichet
- Department of Mechanisms of Cancer, Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Christel Genoud
- Department of Mechanisms of Cancer, Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Alexandra G Meyer
- Department of Mechanisms of Cancer, Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Manuele G Muraro
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Giulio C Spagnoli
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Daniela Taverna
- Molecular Biotechnology Center and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Curzio Rüegg
- Department of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Taha Merghoub
- Ludwig Center for Cancer Immunotherapy, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daniela Massi
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Huifang Tang
- Department of Pharmacology, Zhejiang University, School of Basic Medical Sciences, Hangzhou, China
| | - Mitchell P Levesque
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Alfred Zippelius
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Brian A Hemmings
- Department of Mechanisms of Cancer, Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Andreas Wicki
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
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35
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Prêtre V, Wicki A. Inhibition of Akt and other AGC kinases: A target for clinical cancer therapy? Semin Cancer Biol 2017; 48:70-77. [PMID: 28473255 DOI: 10.1016/j.semcancer.2017.04.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/29/2016] [Revised: 04/04/2017] [Accepted: 04/25/2017] [Indexed: 01/27/2023]
Abstract
AGC kinases have been identified to contribute to cancer development and progression. Currently, most AGC inhibitors in clinical development are Akt inhibitors such as MK-2206 or GDC-0068, which are known to promote cell growth arrest and to sensitize cancer cells to radiotherapy. Response rates in clinical trials with single agent Akt inhibitors are typically low. The observed adverse events are within the expected limits for compounds inhibiting the PI3K-mTOR axis. Preclinical and early clinical data for combination therapies are accumulating. Based on these data, several Akt inhibitors are about to enter phase 3 trials. Besides drugs that target Akt, p70S6K inhibitors have entered clinical development. Again, the response rates were rather low. In addition, relevant toxicities were identified, including a risk for coagulopathies with these compounds. Multi-AGC kinase inhibitors are also in early clinical development but the data is not sufficient yet to draw conclusions regarding their efficacy and side-effect profile. PKC inhibitors have been tested in the phase 3 setting but were found to lack efficacy. More trials with isoform-specific PKC inhibitors are expected. Taken together, therapies with AGC kinase inhibitors as single agents are unlikely to meet success. However, combination therapies and a precise stratification of patients according to the activation of signaling axes may increase the probability to see relevant efficacy with these compounds. The emergence of onco-immunotherapies holds some new challenges for these agents.
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Affiliation(s)
- Vincent Prêtre
- Department of Biomedicine, University of Basel, 4031 Basel, Switzerland
| | - Andreas Wicki
- Department of Biomedicine, University of Basel, 4031 Basel, Switzerland; Department of Medical Oncology, University Hospital Basel, 4031 Basel, Switzerland.
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Rochlitz C, Bigler M, von Moos R, Bernhard J, Matter-Walstra K, Wicki A, Zaman K, Anchisi S, Küng M, Na KJ, Bärtschi D, Borner M, Rordorf T, Rauch D, Müller A, Ruhstaller T, Vetter M, Trojan A, Hasler-Strub U, Cathomas R, Winterhalder R. SAKK 24/09: safety and tolerability of bevacizumab plus paclitaxel vs. bevacizumab plus metronomic cyclophosphamide and capecitabine as first-line therapy in patients with HER2-negative advanced stage breast cancer - a multicenter, randomized phase III trial. BMC Cancer 2016; 16:780. [PMID: 27724870 PMCID: PMC5057418 DOI: 10.1186/s12885-016-2823-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 09/29/2016] [Indexed: 01/08/2023] Open
Abstract
Background Adding bevacizumab to chemotherapy improves response rates and progression-free survival (PFS) in metastatic breast cancer (mBC). We aimed to demonstrate decreased toxicity with metronomic chemotherapy/bevacizumab compared with paclitaxel/bevacizumab. Methods This multicenter, randomized phase III trial compared bevacizumab with either paclitaxel (arm A) or daily oral capecitabine-cyclophosphamide (arm B) as first-line treatment in patients with HER2-negative advanced breast cancer. The primary endpoint was the incidence of selected grade 3–5 adverse events (AE) including: febrile neutropenia, infection, sensory/motor neuropathy, and mucositis. Secondary endpoints included objective response rate, disease control rate, PFS, overall survival (OS), quality of life (QoL), and pharmacoeconomics. The study was registered prospectively with ClinicalTrials.gov, number NCT01131195 on May 25, 2010. Results Between September 2010 and December 2012, 147 patients were included at 22 centers. The incidence of primary endpoint-defining AEs was similar in arm A (25 % [18/71]; 95 % CI 15–35 %) and arm B (24 % [16/68]; 95 % CI 13–34 %; P = 0.96). Objective response rates were 58 % (42/73; 95 % CI 0.46–0.69) and 50 % (37/74; 95 % CI 0.39–0.61) in arms A and B, respectively (P = 0.45). Median PFS was 10.3 months (95 % CI 8.7–11.3) in arm A and 8.5 months (95 % CI 6.5–11.9) in arm B (P = 0.90). Other secondary efficacy endpoints were not significantly different between study arms. The only statistically significant differences in QoL were less hair loss and less numbness in arm B. Treatment costs between the two arms were equivalent. Conclusion This trial failed to meet its primary endpoint of a reduced rate of prespecified grade 3–5 AEs with metronomic bevacizumab, cyclophosphamide and capecitabine. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2823-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christoph Rochlitz
- Department of Oncology, University Hospital Basel, Petersgraben 4, Basel, CH-4031, Switzerland.
| | | | - Roger von Moos
- Department of Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Jürg Bernhard
- International Breast Cancer Study (IBCSG) and Inselspital, Bern University Hospital, Bern, Switzerland
| | - Klazien Matter-Walstra
- SAKK Coordinating Center, Bern, Switzerland and European Center for Pharmaceutical Medicine, University Basel, Basel, Switzerland
| | - Andreas Wicki
- Department of Oncology, University Hospital Basel, Petersgraben 4, Basel, CH-4031, Switzerland
| | - Khalil Zaman
- Department of Oncology, University Hospital Lausanne, Lausanne, Switzerland
| | - Sandro Anchisi
- Department of Oncology, Hospital of Valais, Sion, Switzerland
| | - Marc Küng
- Department of Oncology, Kantonsspital Fribourg, Fribourg, Switzerland
| | - Kyung-Jae Na
- SAKK Coordinating Center, Bern, Switzerland.,Present Address: Novartis Pharma, Stein, Switzerland
| | | | - Markus Borner
- Department of Oncology, Spitalzentrum Biel, Biel, Switzerland
| | - Tamara Rordorf
- Department of Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Rauch
- Department of Oncology, Spital STS, Thun, Switzerland
| | - Andreas Müller
- Department of Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Thomas Ruhstaller
- Department of Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marcus Vetter
- Department of Oncology, University Hospital Basel, Petersgraben 4, Basel, CH-4031, Switzerland
| | - Andreas Trojan
- Department of Oncology, OnkoZentrum Zürich, Zürich, Switzerland
| | | | - Richard Cathomas
- Department of Oncology, Kantonsspital Graubünden, Chur, Switzerland
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Koelzer VH, Buser T, Willi N, Rothschild SI, Wicki A, Schiller P, Cathomas G, Zippelius A, Mertz KD. Grover's-like drug eruption in a patient with metastatic melanoma under ipilimumab therapy. J Immunother Cancer 2016; 4:47. [PMID: 27532022 PMCID: PMC4986338 DOI: 10.1186/s40425-016-0151-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Dermatologic toxicity is an important adverse effect of immune checkpoint inhibitors targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death 1 receptor (PD-1) or PD ligand 1 (PD-L1). Skin toxicity most commonly includes a maculopapular erythematous rash and pruritus. Rarely life threatening complications such as Steven’s Johnson syndrome or toxic epidermal necrolysis may occur. Case presentation Here we report the uncommon event of a drug-induced transient acantholytic dermatosis (Grover’s disease) in a 73-year-old Caucasian male treated with ipilimumab for metastatic melanoma. Five weeks after initiation of therapy, the patient developed a widespread polymorphic papulovesicular dermatosis on the trunk and proximal extremities with intense pruritus. Skin biopsy showed acantholytic dyskeratosis with interface dermatitis consistent with a Grover’s-like drug eruption. Conclusions These findings should raise awareness for uncommon immune-related dermatological toxicities of immunomodulatory antibodies targeting the CTLA-4 signaling axis. We recommend biopsies of unexpected skin lesions to rapidly identify dermatological adverse events of immune checkpoint inhibitors.
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Affiliation(s)
- Viktor H Koelzer
- Cantonal Hospital Baselland, Institute of Pathology, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland ; Translational Research Unit (TRU), Institute of Pathology, University of Bern, Murtenstrasse 31, CH-3010 Bern, Switzerland
| | - Tobias Buser
- Division of Medical Oncology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Niels Willi
- Cantonal Hospital Baselland, Institute of Pathology, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland
| | - Sacha I Rothschild
- Division of Medical Oncology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Andreas Wicki
- Division of Medical Oncology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Peter Schiller
- Cantonal Hospital Baselland, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland
| | - Gieri Cathomas
- Cantonal Hospital Baselland, Institute of Pathology, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland
| | - Alfred Zippelius
- Division of Medical Oncology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Kirsten D Mertz
- Cantonal Hospital Baselland, Institute of Pathology, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland
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Wicki A, Prêtre V, Ritschard R, Brown N, Bize V, Fabbro T, Cmiljanovic N, Dimitrijevic S, Schmitz D, Stumm M, Kristeleit R. Abstract 2287: Final results of the pharmacodynamic (PD) data of PQR309-001, a first-in-human trial of a combined PI3K/mTOR inhibitor in advanced solid tumors. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-2287] [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-class 1 PI3K, mTORC1 and mTORC2 inhibitor. PQR309-001 was a first-in-man dose escalation study evaluating PQR309 in patients with advanced solid tumours.
The primary objective of the study was to establish the maximum tolerated dose (MTD) of PQR309, its safety and tolerability. Secondary objectives included characterization of PQR309 pharmacokinetics (PK) and pharmacodynamics (PD).
Methods: We investigated PQR309 treatment-induced PD, including changes of 16 PI3K-mTOR and MAPK associated phospho-proteins, and 84 mRNAs in serial tumor biopsies obtained from patients enrolled in study PQR309-001. 13 patients were eligible for PD analysis after histologic evaluation of fresh-frozen tissue. A solid-phase assay with phospho-specific antibodies was used for the investigation of PI3K/mTOR and MAPK signalling. RNA analysis was performed with an RTK/PI3K-specific RNA array.
Results: Under treatment with PQR309, phospho-Akt (p_T308 and p_S473), phospho-mTOR and phospho-S6 were significantly downregulated compared to baseline (p<0.05, Wilcoxon signed-rank test). Moreover, patients with radiographic tumor shrinkage (n = 7) had significantly stronger phospho-Akt (p_T308), phospho-mTOR and phospho-S6 reduction than patients whose tumor was growing (n = 6) (p<0.05, Mann-Whitney test). Importantly, ERK1/2 phosphorylation, as the readout of MAPK activity, was decreased overall with no statistically significant difference between shrinking and growing tumors. The analysis of mRNAs showed a trend towards upregulation of PDGFRA (3.2 times, not statistically significant) after 21 days of therapy with PQR309. Intriguingly, no consistent changes of other PI3K-related RNAs was observed.
Conclusion: PD assessments in tumour tissue samples from patients treated with PQR309 demonstrated a reduction of phosphorylation of direct targets for PQR309 (PI3K and mTOR) as well as downstream effectors of mTOR. Furthermore, the data indicate that downregulation of phospho-Akt (p_T308) and mTORC1 activity may be predictive of tumor shrinkage while upregulation of PDGFRA may represent a mechanism of resistance against PI3K/mTOR inhibition.
Citation Format: Andreas Wicki, Vincent Prêtre, Reto Ritschard, Nicholas Brown, Vincent Bize, Thomas Fabbro, Natasa Cmiljanovic, Sasa Dimitrijevic, Deborah Schmitz, Michael Stumm, Rebecca Kristeleit. Final results of the pharmacodynamic (PD) data of PQR309-001, a first-in-human trial of a combined PI3K/mTOR inhibitor in advanced solid tumors. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2287.
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Affiliation(s)
| | | | | | | | - Vincent Bize
- 3Swiss Group for Clinical Cancer Research, Bern, Switzerland
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Wicki A, Mandalà M, Massi D, Taverna D, Tang H, Hemmings BA, Xue G. Acquired Resistance to Clinical Cancer Therapy: A Twist in Physiological Signaling. Physiol Rev 2016; 96:805-29. [DOI: 10.1152/physrev.00024.2015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Although modern therapeutic strategies have brought significant progress to cancer care in the last 30 years, drug resistance to targeted monotherapies has emerged as a major challenge. Aberrant regulation of multiple physiological signaling pathways indispensable for developmental and metabolic homeostasis, such as hyperactivation of pro-survival signaling axes, loss of suppressive regulations, and impaired functionalities of the immune system, have been extensively investigated aiming to understand the diversity of molecular mechanisms that underlie cancer development and progression. In this review, we intend to discuss the molecular mechanisms of how conventional physiological signal transduction confers to acquired drug resistance in cancer patients. We will particularly focus on protooncogenic receptor kinase inhibition-elicited tumor cell adaptation through two major core downstream signaling cascades, the PI3K/Akt and MAPK pathways. These pathways are crucial for cell growth and differentiation and are frequently hyperactivated during tumorigenesis. In addition, we also emphasize the emerging roles of the deregulated host immune system that may actively promote cancer progression and attenuate immunosurveillance in cancer therapies. Understanding these mechanisms may help to develop more effective therapeutic strategies that are able to keep the tumor in check and even possibly turn cancer into a chronic disease.
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Affiliation(s)
- Andreas Wicki
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland; Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy; Department of Surgery and Translational Medicine, University of Florence, Florence, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy; Department of Pharmacology, Zhejiang University School of Medicine, Hangzhou, China; and Department of Mechanisms of Cancer, Friedrich Miescher Institute for
| | - Mario Mandalà
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland; Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy; Department of Surgery and Translational Medicine, University of Florence, Florence, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy; Department of Pharmacology, Zhejiang University School of Medicine, Hangzhou, China; and Department of Mechanisms of Cancer, Friedrich Miescher Institute for
| | - Daniela Massi
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland; Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy; Department of Surgery and Translational Medicine, University of Florence, Florence, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy; Department of Pharmacology, Zhejiang University School of Medicine, Hangzhou, China; and Department of Mechanisms of Cancer, Friedrich Miescher Institute for
| | - Daniela Taverna
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland; Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy; Department of Surgery and Translational Medicine, University of Florence, Florence, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy; Department of Pharmacology, Zhejiang University School of Medicine, Hangzhou, China; and Department of Mechanisms of Cancer, Friedrich Miescher Institute for
| | - Huifang Tang
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland; Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy; Department of Surgery and Translational Medicine, University of Florence, Florence, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy; Department of Pharmacology, Zhejiang University School of Medicine, Hangzhou, China; and Department of Mechanisms of Cancer, Friedrich Miescher Institute for
| | - Brian A. Hemmings
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland; Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy; Department of Surgery and Translational Medicine, University of Florence, Florence, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy; Department of Pharmacology, Zhejiang University School of Medicine, Hangzhou, China; and Department of Mechanisms of Cancer, Friedrich Miescher Institute for
| | - Gongda Xue
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland; Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy; Department of Surgery and Translational Medicine, University of Florence, Florence, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy; Department of Pharmacology, Zhejiang University School of Medicine, Hangzhou, China; and Department of Mechanisms of Cancer, Friedrich Miescher Institute for
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Koelzer VH, Rothschild SI, Zihler D, Wicki A, Willi B, Willi N, Voegeli M, Cathomas G, Zippelius A, Mertz KD. Systemic inflammation in a melanoma patient treated with immune checkpoint inhibitors-an autopsy study. J Immunother Cancer 2016; 4:13. [PMID: 26981243 PMCID: PMC4791920 DOI: 10.1186/s40425-016-0117-1] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/09/2016] [Indexed: 01/05/2023] Open
Abstract
Background Immune checkpoint inhibitors targeting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1) have been recently approved for treatment of patients with metastatic melanoma and non-small cell lung cancer (NSCLC). Despite important clinical benefits, these therapies are associated with a diverse spectrum of immune-related adverse events (irAEs) that are typically transient, but occasionally severe or even fatal. Case presentation This autopsy case illustrates that clinically overt irAEs may represent only a fraction of the total spectrum of immune-related organ pathology in patients treated with immune checkpoint inhibitors. We report a comprehensive analysis of systemic irAE pathology based on the autopsy of a 35-year-old female patient with metastatic melanoma treated first with ipilimumab and then nivolumab. The clinical course was characterized by a mixed tumor response with regression of skin and lung metastases and fatal progression of metastatic disease in the small bowel, peritoneum and brain. During therapy with ipilimumab, radiographic features of immune-related pneumonitis were noted. The autopsy examination established a sarcoid-like granulomatous reaction of the lung, pulmonary fibrosis and diffuse alveolar damage. Importantly, a clinically unapparent but histologically striking systemic inflammation involving the heart, central nervous system, liver and bone marrow was identified. Severe immune-related end-organ damage due to lymphocytic myocarditis was found. Conclusions Autopsy studies are an important measure of quality control and may identify clinically unapparent irAEs in patients treated with immunotherapy. Pathologists and clinicians need to be aware of the broad spectrum of irAEs for timely management of treatment-related morbidity. Electronic supplementary material The online version of this article (doi:10.1186/s40425-016-0117-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Viktor H Koelzer
- Institute of Pathology, Cantonal Hospital Baselland, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland ; Translational Research Unit (TRU), Institute of Pathology, University of Bern, Murtenstrasse 31, CH-3010 Bern, Switzerland
| | - Sacha I Rothschild
- Division of Medical Oncology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Deborah Zihler
- Department of Medical Oncology, Cantonal Hospital Baselland, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland
| | - Andreas Wicki
- Division of Medical Oncology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Berenika Willi
- Institute of Radiology, Cantonal Hospital Baselland, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland
| | - Niels Willi
- Institute of Pathology, Cantonal Hospital Baselland, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland
| | - Michèle Voegeli
- Department of Medical Oncology, Cantonal Hospital Baselland, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland
| | - Gieri Cathomas
- Institute of Pathology, Cantonal Hospital Baselland, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland
| | - Alfred Zippelius
- Division of Medical Oncology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Kirsten D Mertz
- Institute of Pathology, Cantonal Hospital Baselland, Mühlemattstrasse 11, CH-4410 Liestal, Switzerland
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Tarantelli C, Gaudio E, Kwee I, Cascione L, Bernasconi E, Hillmann P, Stussi G, Fabbro D, Zucca E, Wicki A, Cmiljanovic V, Bertoni F. Abstract A117: An integrated phosphoproteomic approach to dissect the mechanism of action of the novel dual PI3K/mTOR inhibitor PQR309 in B-cell lymphomas. Mol Cancer Ther 2015. [DOI: 10.1158/1535-7163.targ-15-a117] [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
Introduction. PQR309 is a novel oral dual PI3K/mTOR inhibitor (Cmiljanovic et al, AACR 2015) that has shown pre-clinical activity in lymphomas (Tarantelli et al, ASH 2014). Positive results from the first-in-human Phase 1 trial in patients with advanced solid tumors have just been presented (NCT01940133; Kristeleit et al, ASCO 2015). A phase I is now open in patients with relapsed or refractory lymphomas (NCT02249429). Here, we present results from extensive proteomic studies to dissect the PQR309 mechanism of action in lymphomas.
Methods. 8 cell lines derived from mantle cell lymphoma (MCL, n = 3), activated B-cell like diffuse large B cell lymphoma (ABC-DLBCL, n = 2), germinal center B cell DLBCL (GCB-DLBCL, n = 2), prolymphocytic leukemia (n = 1), exposed to DMSO or PQR309, were analyzed with the PathScan Akt Signaling Antibody Array (Cell Signaling Technology). Six of the cell lines (2 MCL, 2 ABC-DLBCL, 2 GCB-DLBCL) were also analyzed via Reverse Phase Protein Array (RPPA) (Carna Biosciences, Inc., Kobe Japan) and mass spectrometry (Biognosys, Schlieren, Switzerland). Changes at individual phosphoresidues were validated by immunoblotting or flow cytometry.
Results. Lymphoma cell lines derived from mature lymphoid neoplasms were exposed to PQR309 or to DMSO and analyzed for phosphorylation changes using different proteomic approaches. We first performed an analysis using an antibody-based array exploring phosphorylation changes in 14 proteins involved in the AKT signaling pathway, detecting reduced phosphoresidues after PQR309 in 10 of these proteins (RPS6, PDK1, GSK3B, AKT1S1, BAD, RPS6KA1, PTEN, PRKAA1/PRKAA2, AKT-Thr308, P70S6K-Thr421/Ser424). Then, we assessed 180 phospho-residues via RPPA, detecting a down-regulation of phosphoresidues in 7 proteins (RPS6, EIF4G, EIF4EBP1, MAPK1/MAPK3, SMAD3, AKT1S1, MTOR). Finally, phosphopeptides were enriched and prepared for mass spectrometry. LC-MS/MS shotgun measurements were carried out on protein libraries enriched for phosphopeptides, identifying a total of 4,349 unique phosphopeptide sequences. A functional analyses of the observed changes in phosphopeptides showed that these were enriched in proteins involved in transcription and metabolism regulation, RAS signaling, G2/M checkpoint, mitotic spindle assembly, unfolded protein response, NF-kB signaling, PI3K/AKT/mTOR pathway, DNA repair, and in proteins encoded by target genes of E2F, MYC and SP1. CXCR4, T2FA, SRRM2, SUGP2 were among the top up-regulated phosphopeptides, while RPS6, PDCD4, IF4B were among the top down-regulated phosphopeptides.
Conclusions. The use of multiple proteomic approaches allowed the identification of pathway and proteins affected by PQR309 in lymphoma cells, providing insights of the drug mechanism of action and new potential pharmacodynamics markers.
Citation Format: Chiara Tarantelli, Eugenio Gaudio, Ivo Kwee, Luciano Cascione, Elena Bernasconi, Petra Hillmann, Georg Stussi, Doriano Fabbro, Emanuele Zucca, Andreas Wicki, Vladimir Cmiljanovic, Francesco Bertoni. An integrated phosphoproteomic approach to dissect the mechanism of action of the novel dual PI3K/mTOR inhibitor PQR309 in B-cell lymphomas. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr A117.
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Affiliation(s)
| | - Eugenio Gaudio
- 1Institute of Oncology Research - IOR, Bellinzona, Switzerland
| | - Ivo Kwee
- 1Institute of Oncology Research - IOR, Bellinzona, Switzerland
| | | | | | | | - Georg Stussi
- 3IOSI Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Emanuele Zucca
- 3IOSI Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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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
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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
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Orleth A, Mamot C, Rochlitz C, Ritschard R, Alitalo K, Christofori G, Wicki A. Simultaneous targeting of VEGF-receptors 2 and 3 with immunoliposomes enhances therapeutic efficacy. J Drug Target 2015. [PMID: 26204325 DOI: 10.3109/1061186x.2015.1056189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tumor progression depends on angiogenesis. Vascular endothelial growth factor (VEGF) receptors (VEGFRs) are the main signal transducers that stimulate endothelial cell migration and vessel sprouting. At present, only VEGFR2 is targeted in the clinical practice. PURPOSE To develop new, anti-angiogenic nanoparticles (immunoliposomes, ILs), that redirect cytotoxic compounds to tumor-associated vascular cells. METHODS Pegylated liposomal doxorubicin (PLD) was targeted against VEGFR2- and VEGFR3-expressing cells by inserting anti-VEGFR2 and/or anti-VEGFR3 antibody fragments into the lipid bilayer membrane of PLD. These constructs were tested in vitro, and in vivo in the Rip1Tag2 mouse model of human cancer. RESULTS The combination treatment with anti-VEGFR2-ILs-dox and anti-VEGFR3-ILs-dox was superior to targeting only VEGFR2 cells and provides a highly efficient approach of depleting tumor-associated vasculature. This leads to tumor starvation and pronounced reduction of tumor burden. CONCLUSION Nanoparticles against VEGFR2 and -3 expressing tumor-associated endothelial cells represent a promising and novel anti-cancer strategy.
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Affiliation(s)
- Annette Orleth
- a Department of Medical Oncology , University Hospital , Basel , Switzerland .,b Department of Biomedicine , University of Basel, Basel , Switzerland
| | - Christoph Mamot
- b Department of Biomedicine , University of Basel, Basel , Switzerland .,c Division of Medical Oncology , Cantonal Hospital , Aarau , Switzerland , and
| | - Christoph Rochlitz
- a Department of Medical Oncology , University Hospital , Basel , Switzerland .,b Department of Biomedicine , University of Basel, Basel , Switzerland
| | - Reto Ritschard
- a Department of Medical Oncology , University Hospital , Basel , Switzerland .,b Department of Biomedicine , University of Basel, Basel , Switzerland
| | - Kari Alitalo
- d Biomedicum Helsinki, Haartman Institute, University of Helsinki , Helsinki , Finland
| | | | - Andreas Wicki
- a Department of Medical Oncology , University Hospital , Basel , Switzerland .,b Department of Biomedicine , University of Basel, Basel , Switzerland
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Xue G, Zippelius A, Wicki A, Mandala M, Tang F, Massi D, Hemmings BA. Integrated Akt/PKB Signaling in Immunomodulation and Its Potential Role in Cancer Immunotherapy. J Natl Cancer Inst 2015; 107:djv171. [DOI: 10.1093/jnci/djv171] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/22/2015] [Indexed: 12/17/2022] Open
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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
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Wicki A, Ritschard R, Loesch U, Deuster S, Rochlitz C, Mamot C. Large-scale manufacturing of GMP-compliant anti-EGFR targeted nanocarriers: production of doxorubicin-loaded anti-EGFR-immunoliposomes for a first-in-man clinical trial. Int J Pharm 2015; 484:8-15. [PMID: 25701632 DOI: 10.1016/j.ijpharm.2015.02.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 02/10/2015] [Accepted: 02/12/2015] [Indexed: 11/26/2022]
Abstract
We describe the large-scale, GMP-compliant production process of doxorubicin-loaded and anti-EGFR-coated immunoliposomes (anti-EGFR-ILs-dox) used in a first-in-man, dose escalation clinical trial. 10 batches of this nanoparticle have been produced in clean room facilities. Stability data from the pre-GMP and the GMP batch indicate that the anti-EGFR-ILs-dox nanoparticle was stable for at least 18 months after release. Release criteria included visual inspection, sterility testing, as well as measurements of pH (pH 5.0-7.0), doxorubicin HCl concentration (0.45-0.55 mg/ml), endotoxin concentration (<1.21 IU/ml), leakage (<10%), particle size (Z-average of Caelyx ± 20 nm), and particle uptake (uptake absolute: >0.50 ng doxorubicin/μg protein; uptake relatively to PLD: >5 fold). All batches fulfilled the defined release criteria, indicating a high reproducibility as well as batch-to-batch uniformity of the main physico-chemical features of the nanoparticles in the setting of the large-scale GMP process. In the clinical trial, 29 patients were treated with this nanoparticle between 2007 and 2010. Pharmacokinetic data of anti-EGFR-ILs-dox collected during the clinical study revealed stability of the nanocarrier in vivo. Thus, reliable and GMP-compliant production of anti-EGFR-targeted nanoparticles for clinical application is feasible.
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Affiliation(s)
- Andreas Wicki
- Department of Oncology and Department of Biomedicine, University and University Hospital, Basel, Switzerland.
| | - Reto Ritschard
- Department of Oncology and Department of Biomedicine, University and University Hospital, Basel, Switzerland
| | - Uli Loesch
- Hospital Pharmacy, University Hospital, Basel, Switzerland
| | | | - Christoph Rochlitz
- Department of Oncology and Department of Biomedicine, University and University Hospital, Basel, Switzerland
| | - Christoph Mamot
- Department of Hematology and Oncology, Cantonal Hospital, Aarau, Switzerland
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Conen K, Mosna-Firlejczyk K, Rochlitz C, Wicki A, Itin P, Arnold AW, Gross M, Zimmermann F, Zippelius A. Vemurafenib-induced radiation recall dermatitis: case report and review of the literature. Dermatology 2014; 230:1-4. [PMID: 25472806 DOI: 10.1159/000365918] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/12/2014] [Indexed: 12/27/2022] Open
Abstract
The cutaneous effects of BRAF (serine/threonine protein kinase B-raf) inhibitors such as vemurafenib remain poorly defined. Rash, squamous cell carcinoma, keratoacanthoma and photosensitivity are the most common grade 2 or 3 adverse events observed in clinical trials. We here report the case of a patient with a BRAF V600E mutated metastatic melanoma who developed severe radiation recall dermatitis 6 weeks after completing radiotherapy. Vemurafenib treatment had been initiated 1 week before the development of dermatitis because of rapidly progressing disease. Upon topical treatment of the affected skin areas, clinical symptoms regressed over a period of 2 months, although vemurafenib was continuously administered. As our case goes in line with other reports, we believe that physicians should be aware of this additional cutaneous side effect of vemurafenib and that continuation of the treatment is safe when close clinical control and interdisciplinary management can be provided.
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Affiliation(s)
- Katrin Conen
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
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Wicki A. [Stivarga shows effectiveness in practice]. Rev Med Suisse 2014; 10:1109. [PMID: 24941679] [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: 06/03/2023]
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Wicki A, Hermann F, Prêtre V, Winterhalder R, Kueng M, von Moos R, Rochlitz C, Herrmann R. Pre-existing antihypertensive treatment predicts early increase in blood pressure during bevacizumab therapy: the prospective AVALUE cohort study. Oncol Res Treat 2014; 37:230-6. [PMID: 24853781 DOI: 10.1159/000362376] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/06/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antiangiogenic therapy is routinely used in a variety of cancer entities. Hypertension is the most common side effect of all currently available antiangiogenic treatments. PATIENTS AND METHODS In this prospective observational clinical trial, we investigated risk factors for blood pressure elevation in patients exposed to an antiangiogenic agent and explored the correlation between hypertension and the duration of antiangiogenic treatment. RESULTS In 169 patients, pre-existing antihypertensive medication was the most prominent risk factor associated with increased blood pressure during therapy. Between visits 1 and 3, the median systolic blood pressure increased by 10.85 mmHg in patients with pre-existing hypertension receiving antihypertensive medication while it increased by only 2.69 mmHg in patients without hypertension. The median increase in diastolic pressure was 7.28 versus 0.11 mmHg in patients with versus without pre-existing hypertension. Increases in blood pressure occurred early (within 6 weeks of starting therapy). In spite of this significant increase in the blood pressure, no major bleeding events or other related complications were observed during antiangiogenic therapy. CONCLUSIONS Pre-existing hypertension and treatment with antihypertensive medication correlated with a more pronounced increase in blood pressure. Thus, intensified antihypertensive therapy might be warranted early during bevacizumab therapy in patients already receiving antihypertensive treatment.
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Affiliation(s)
- Andreas Wicki
- Division of Oncology, Department of Internal Medicine, University Hospital, Basel, Switzerland
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Abstract
Until two years ago, there was no systemic therapy that prolonged overall survival in patients with malignant melanoma. In the meantime, two new therapeutic approaches have improved the prognosis of this disease. Ipilimumab is an activator of cytotoxic T-cells. It induces an immune response which results in prolonged remission in 15-20% of patients. Vemurafenib is a specific BRAF inhibitor and induces quick and sometimes complete remissions in patients with BRAF V600E mutated melanomas. Thus, there are two new treatments with proven survival benefit in patients with metastatic melanoma.
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Affiliation(s)
- Andreas Wicki
- Departement Biomedizin, Universitätsspital und Universität Basel.
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