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Wahner Hendrickson A, Costello B, Jewell A, Kennedy V, Fleming G, Corr B, Taylor S, Lea J, Reid J, Swisher E, Satele D, Allred J, Lensing J, Ivy S, Erlichman C, Adjei A, Kaufmann S. A phase II clinical trial of veliparib and topotecan in patients with platinum resistant ovarian cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Borad M, Renfro L, Foster N, Martin P, Alberts S, Hubbard J, Silva A, Halfdanarson T, Byrne T, Erlichman C. P-100 Phase IB study of sorafenib + evofosfamide in patients (pts) with advanced hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC): NCCTG N1153 (Alliance). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Goetz MP, Suman VJ, Reid JM, Northfelt DW, Mahr MA, Dockter T, Kuffel M, Buhrow SA, Safgren SL, McGovern RM, Collins JM, Streicher H, Hawse JR, Haddad TC, Erlichman C, Ames MM, Ingle JN. Abstract PD2-03: Final results of a first-in-human phase I study of the tamoxifen (TAM) metabolite, Z-Endoxifen hydrochloride (Z-Endx) in women with aromatase inhibitor (AI) refractory metastatic breast cancer (MBC) (NCT01327781). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-pd2-03] [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: AI's are more effective than TAM in ER+ breast cancer. In AI refractory MBC, the response rate to TAM is 0% (Osborne 2011). Z-Endx is an active metabolite of TAM and among TAM treated women in the adjuvant and metastatic settings, reduced CYP2D6 metabolism and low Endx concentrations (Css <20 nM) have been associated with increased likelihood of disease recurrence. Preclinical studies have demonstrated greater Z-Endx exposure and anti-tumor activity with oral Z-Endx compared to equivalent doses of oral TAM (Reid 2014)
Methods: We conducted a phase I trial to determine the maximum-tolerated dose (MTD) and evaluate the toxicities, clinical activity, and pharmacokinetics (PK) of Z-Endx in patients (pts) with ER+, AI refractory MBC. Unlimited prior endocrine regimens were allowed. An accelerated titration schedule was applied (2 pts/dose level) until moderate toxicity or DLT, followed by a 3+3 design and then to expansion cohorts (40, 80, and 100 mg/day). Z-Endx was administered orally once daily (28 day cycle). Eye exams were performed at baseline, and end of cycles 2 and 6. PK was performed during cycle 1 and prior to subsequent cycles. For pts in the expansion cohorts, tumor biopsies were obtained at baseline for DNA sequencing (Foundation Medicine). Plasma cholesterol levels were obtained at baseline and after 1 cycle.
Results: From March 2011 to Dec 2014, 41 pts (38 evaluable), median age 60, received Z-Endx once daily encompassing 7 dose levels (20-160 mg/daily). The median number of prior hormonal regimens was 2 and 3 for the dose escalation and expansion cohorts, respectively. Dose escalation was stopped at 160 mg/day given MTD not reached and attainment of mean Endx Css of 3.6 uM. Cycle 1 DLT (PE) was observed in one patient (60 mg). No eye toxicity was observed. PK demonstrated mean Endx Css of > 1 uM at all dose levels ≥ 40 mg/day. Antitumor activity was observed at multiple dose levels including 3 confirmed partial responses and an additional 7 with stable disease for ≥6 cycles. Of these 10 pts, 9 had prior progression on both AI and fulvestrant and 3 additionally on TAM. After 1 cycle, total and LDL cholesterol decreased > 20 points in 54% and 40% of pts, respectively. Tumor sequencing in the expansion cohorts (n=14) did not identify ESR1 mutations; however, ESR1 amplification was identified in 1 pt with prolonged stable disease (>200 days). Of 6 pts with rapid progression (≤2 cycles), 4/6 had either CCND1 amplification (n=1) or at least one of the following activating mutations: ERBB2 L755S (n=1), AKT1 E17K (n=1), MTOR E1799K (n=1).
Conclusions: The direct administration of Z-END provides substantial drug exposure, acceptable toxicity, and "proof of principle" antitumor activity in endocrine resistant MBC. While the MTD was not determined, the goal of achieving Endx Css concentrations of > 1 uM was achieved. Tumor sequencing identified pts with predicted and confirmed endocrine resistance. A randomized phase II comparing endoxifen (80 mg/day) with TAM in AI refractory MBC was recently activated (NCT02311933). Supported in part by CA 133049, CA186686, CA15083, CA116201, and CA15083.
Citation Format: Goetz MP, Suman VJ, Reid JM, Northfelt DW, Mahr MA, Dockter T, Kuffel M, Buhrow SA, Safgren SL, McGovern RM, Collins JM, Streicher H, Hawse JR, Haddad TC, Erlichman C, Ames MM, Ingle JN. Final results of a first-in-human phase I study of the tamoxifen (TAM) metabolite, Z-Endoxifen hydrochloride (Z-Endx) in women with aromatase inhibitor (AI) refractory metastatic breast cancer (MBC) (NCT01327781). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD2-03.
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Affiliation(s)
- MP Goetz
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - VJ Suman
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - JM Reid
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - DW Northfelt
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - MA Mahr
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - T Dockter
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - M Kuffel
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - SA Buhrow
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - SL Safgren
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - RM McGovern
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - JM Collins
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - H Streicher
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - JR Hawse
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - TC Haddad
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - C Erlichman
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - MM Ames
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
| | - JN Ingle
- Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD; Mayo Clinic, Scottsdale, AZ
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Ma CX, Suman VJ, Goetz M, Northfelt D, Burkard M, Ademuyiwa F, Naughton M, Margenthaler J, Aft R, Gray R, Tavaarwerk A, Wilke L, Haddad T, Moynihan T, Loprinzi C, Hieken T, Hoog J, Guo Z, Han J, Vij K, Mardis E, Sanati S, Al-Kateb H, Doyle L, Erlichman C, Ellis MJ. Abstract P5-13-04: A phase II neoadjuvant trial of MK-2206, an AKT inhibitor, in combination with anastrozole for clinical stage 2 or 3 PIK3CA mutant estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-13-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Activating mutations in PIK3CA occur in approximately 40% ER+BC. MK-2206 (M), a pan-AKT inhibitor, induced apoptosis of ER+ BC under estrogen deprivation in preclinical studies. We conducted this neoadjuvant trial to determine the pathologic complete response (pCR) rate of M plus anastrozole (A) for PIK3CA mutant (Mut) ER+ BC.
Methods
This single arm open label study of M+A used a 2-stage Simon phase II design (stage 1, n=16; stage 2, n=13, alpha=0.10, power=0.90) to test whether pCR rate <1% (based on historical data with A alone), against the alternative that pCR rate ≥15% in PIK3CA Mut ER+ BC. At least 1 pCR in stage 1 was required to proceed to stage 2.
Eligible patients (pts) with clinical stage II or III ER+HER2- BC were pre-registered and proceeded to a research tumor biopsy for PIK3CA sequencing, followed by treatment with daily A monotherapy for 28 days (cycle 0). Pts with PIK3CA Mut BC were subsequently registered, underwent a second biopsy, and started M (150mg PO weekly) with daily A on cycle 1 day 1 (C1D1) for a maximum of four 28-day cycles followed by surgery. Goserelin was added for premenopausal pts. A tumor biopsy on C1D17, 17 days post the start of M, was performed. Those with C1D17 Ki67 >10% discontinued study treatment. pCR was defined as no invasive cancer in the breast and the lymph nodes. Tumor specimens collected at all timepoints are being analyzed for markers of proliferation, apoptosis, and PI3K pathway activity, gene expression microarray, intrinsic subtypes, and next generation sequencing of 83 genes.
Results
Of the 51 pts pre-registered, 35 pts did not register due to no PIK3CA mutation (n=22), inadequate specimen for testing (n=6), physician/pt decision (n=7). The remaining 16 pts (median age: 58, range: 40-77 years) received combination therapy. Three pts did not complete 4 cycles due to C1D17 Ki67 >10% (n=2) and intolerability (grade (Gr) 4 transaminase elevation in C1, n=1). Other severe toxicities possibly related to M included Gr 3 rash (25%) and pruritus (12.5%). Of the 13 pts completed study therapy and underwent surgery, all had residual disease in the breast and 7 also had positive nodes. Table 1 summarized changes in Ki67 during treatment.
ComparisonsnAbsolute changes in Ki67 median (range)Wilcoxon signed rank p-valueC1D1 relative to pre-registration11-17.0% (-49.8 to 4.1%)0.0020C1D17 relative to pre-registration14-16.4% (-51.4 to 4.1%)0.0004C1D17 relative to C1D112-1.5% (-18.6 to 15.8%)0.9697C1D1, biopsy post 28 days of A alone; C1D17 biopsy post 17 days on combination therapy
Although Ki67 levels post A monotherapy (C1D1) or M+A (C1D17) were significantly lower than that of pre-registration samples, Ki67 did not differ between C1D17 and C1D1 samples. Other correlative studies are ongoing and results will be presented.
Conclusion
Despite the small sample size, biomarker analysis on serial biopsy specimens demonstrated that M+A is unlikely to be more effective than A alone in PIK3CA Mut ER+ BC. This trial demonstrated the feasibility of genomic sequencing for pt selection and the value of a small, well-designed proof-of-principle neoadjuvant trial for the evaluation of targeted agents.
Citation Format: Ma CX, Suman VJ, Goetz M, Northfelt D, Burkard M, Ademuyiwa F, Naughton M, Margenthaler J, Aft R, Gray R, Tavaarwerk A, Wilke L, Haddad T, Moynihan T, Loprinzi C, Hieken T, Hoog J, Guo Z, Han J, Vij K, Mardis E, Sanati S, Al-Kateb H, Doyle L, Erlichman C, Ellis MJ. A phase II neoadjuvant trial of MK-2206, an AKT inhibitor, in combination with anastrozole for clinical stage 2 or 3 PIK3CA mutant estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-13-04.
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Affiliation(s)
- CX Ma
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - VJ Suman
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - M Goetz
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - D Northfelt
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - M Burkard
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - F Ademuyiwa
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - M Naughton
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - J Margenthaler
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - R Aft
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - R Gray
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - A Tavaarwerk
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - L Wilke
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - T Haddad
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - T Moynihan
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - C Loprinzi
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - T Hieken
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - J Hoog
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - Z Guo
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - J Han
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - K Vij
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - E Mardis
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - S Sanati
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - H Al-Kateb
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - L Doyle
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - C Erlichman
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - MJ Ellis
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
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Yoon HH, Foster NR, Meyers JP, Steen PD, Visscher DW, Pillai R, Prow DM, Reynolds CM, Marchello BT, Mowat RB, Mattar BI, Erlichman C, Goetz MP. Gene expression profiling identifies responsive patients with cancer of unknown primary treated with carboplatin, paclitaxel, and everolimus: NCCTG N0871 (alliance). Ann Oncol 2015; 27:339-44. [PMID: 26578722 DOI: 10.1093/annonc/mdv543] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 09/11/2015] [Accepted: 10/27/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Carboplatin (C) and paclitaxel (P) are standard treatments for carcinoma of unknown primary (CUP). Everolimus, an mTOR inhibitor, exhibits activity in diverse cancer types. We did a phase II trial combining everolimus with CP for CUP. We also evaluated whether a gene expression profiling (GEP) test that predicts tissue of origin (TOO) could identify responsive patients. PATIENTS AND METHODS A tumor biopsy was required for central confirmation of CUP and GEP. Patients with metastatic, untreated CUP received everolimus (30 mg weekly) with P (200 mg/m(2)) and C (area under the curve 6) every 3 weeks. The primary end point was response rate (RR), with 22% needed for success. The GEP test categorized patients into two groups: those having a TOO where CP is versus is not considered standard therapy. RESULTS Of 45 assessable patients, the RR was 36% (95% confidence interval 22% to 51%), which met criteria for success. Grade ≥3 toxicities were predominantly hematologic (80%). Adequate tissue for GEP was available in 38 patients and predicted 10 different TOOs. Patients with a TOO where platinum/taxane is a standard (n = 19) tended to have higher RR (53% versus 26%) and significantly longer PFS (6.4 versus 3.5 months) and OS (17.8 versus 8.3 months, P = 0.005), compared with patients (n = 19) with a TOO where platinum/taxane is not standard. CONCLUSIONS Everolimus combined with CP demonstrated promising antitumor activity and an acceptable side-effect profile. A tumor biomarker identifying TOO may be useful to select CUP patients for specific antitumor regimens. CLINICALTRIALSGOV NCT00936702.
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Affiliation(s)
| | - N R Foster
- Alliance Statistics and Data Center, Mayo Clinic, Rochester
| | - J P Meyers
- Alliance Statistics and Data Center, Mayo Clinic, Rochester
| | - P D Steen
- Department of Medical Oncology, Meritcare Hospital CCOP, Fargo
| | - D W Visscher
- Department of Anatomic Pathology, Mayo Clinic, Rochester
| | - R Pillai
- Pathwork Diagnostics, Redwood City
| | - D M Prow
- Department of Medical Oncology, Iowa Oncology Research Association CCOP, Des Moines
| | - C M Reynolds
- Department of Hematology/Medical Oncology, Michigan Cancer Research Consortium, Ann Arbor
| | - B T Marchello
- Department of Medical Oncology, Montana Cancer Consortium, Billings
| | - R B Mowat
- Department of Medical Oncology/Hematology, Toledo Community Hospital Oncology Program CCOP, Toledo
| | - B I Mattar
- Department of Medical Oncology/Hematology, Wichita Community Clinical Oncology Program, Wichita, USA
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Saif MW, Erlichman C, Dragovich T, Mendelson D, Toft D, Burrows F, Storgard C, Von Hoff D. Open-label, dose-escalation, safety, pharmacokinetic, and pharmacodynamic study of intravenously administered CNF1010 (17-(allylamino)-17-demethoxygeldanamycin [17-AAG]) in patients with solid tumors. Cancer Chemother Pharmacol 2013; 71:1345-55. [PMID: 23564374 DOI: 10.1007/s00280-013-2134-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/25/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND 17-(Allylamino)-17-demethoxygeldanamycin (17-AAG) is a benzoquinone ansamycin that binds to and inhibits the Hsp90 family of molecular chaperones leading to the proteasomal degradation of client proteins critical in malignant cell proliferation and survival. We have undertaken a Phase 1 trial of CNF1010, an oil-in-water nanoemulsion of 17-AAG. METHODS Patients with advanced solid tumors and adequate organ functions received CNF1010 by 1-h intravenous (IV) infusion, twice a week, 3 out of 4 weeks. Doses were escalated sequentially in single-patient (6 and 12 mg/m(2)/day) and three-to-six-patient (≥25 mg/m(2)/day) cohorts according to a modified Fibonacci's schema. Plasma pharmacokinetic (PK) profiles and biomarkers, including Hsp70 in PBMCs, HER-2 extracellular domain, and IGFBP2 in plasma, were performed. RESULTS Thirty-five patients were treated at doses ranging from 6 to 225 mg/m(2). A total of 10 DLTs in nine patients (2 events of fatigue, 83 and 175 mg/m(2); shock, abdominal pain, ALT increased, increased transaminases, and pain in extremity at 175 mg/m(2); extremity pain, atrial fibrillation, and metabolic encephalopathy at 225 mg/m(2)) were noted. The PK profile of 17-AAG after the first dose appeared to be linear up to 175 mg/m(2), with a dose-proportional increase in C max and AUC0-inf. Hsp70 induction in PBMCs and inhibition of serum HER-2 neu extracellular domain indicated biological effects of CNF1010 at doses >83 mg/m(2). CONCLUSION The maximum tolerated dose was not formally established. Hsp70 induction in PBMCs and inhibition of serum HER-2 neu extracellular domain indicated biological effects. The CNF1010 clinical program is no longer being pursued due to the toxicity profile of the drug and the development of second-generation Hsp90 molecules.
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Affiliation(s)
- M W Saif
- Hematology/Oncology, Section of GI Cancers and Experimental Therapeutics, Tufts University School of Medicine, Boston, MA 02111, USA.
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Ansell SM, Tang H, Kurtin PJ, Koenig PA, Nowakowski GS, Nikcevich DA, Nelson GD, Yang Z, Grote DM, Ziesmer SC, Silberstein PT, Erlichman C, Witzig TE. Denileukin diftitox in combination with rituximab for previously untreated follicular B-cell non-Hodgkin's lymphoma. Leukemia 2011; 26:1046-52. [PMID: 22015775 PMCID: PMC3266999 DOI: 10.1038/leu.2011.297] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [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] [Indexed: 11/18/2022]
Abstract
Follicular lymphoma exhibits intratumoral infiltration by non-malignant T lymphocytes inluding CD4+CD25+ regulatory T (Treg) cells. We combined denileukin diftitox with rituximab in previously untreated, advanced-stage follicular lymphoma patients anticipating that denileukin diftitox would deplete CD25+ Treg cells while rituximab would deplete malignant B-cells. Patients received rituximab 375 mg/m2 weekly for 4 weeks and denileukin diftitox 18 mcg/kg/day for 5 days every 3 weeks for 4 cycles; neither agent was given as maintenance therapy. Between August 2008 and March 2010, 24 patients were enrolled. One patient died before treatment was given and was not included in the analysis. Eleven of 23 patients (48%; 95% CI: 27–69%) responded; 2 (9%) had complete responses and 9 (39%) had partial responses. The progression-free rate at 2 years was 55% (95%CI: 37–82%). Thirteen patients (57%) experienced grade ≥3 adverse events and 1 patient (4%) died. In correlative studies, soluble CD25 and the number of CD25+ T-cells decreased after treatment, however there was a compensatory increase in IL-15 and IP-10. We conclude that while the addition of denileukin diftitox to rituximab decreased the number of CD25+ T-cells, denileukin diftitox contributed to the toxicity of the combination without an improvement in response rate or time to progression.
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Affiliation(s)
- S M Ansell
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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Morgan R, Oza AM, Qin R, Laumann KM, Mackay H, Strevel EL, Welch S, Sullivan D, Wenham RM, Chen HX, Doyle LA, Gandara DR, Erlichman C. A phase II trial of temsirolimus and bevacizumab in patients with endometrial, ovarian, hepatocellular carcinoma, carcinoid, or islet cell cancer: Ovarian cancer (OC) subset—A study of the Princess Margaret, Mayo, Southeast phase II, and California Cancer (CCCP) N01 Consortia NCI#8233. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5015] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
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Merchan JR, Pitot HC, Qin R, Liu G, Fitch TR, Maples WJ, Picus J, Erlichman C. Final phase II safety and efficacy results of study MC0452: Phase I/II trial of CCI 779 and bevacizumab in advanced renal cell carcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Attia S, Mahoney MR, Okuno SH, Adkins D, Ahuja HG, Ducker TP, Maples WJ, Ochs L, Wentworth-Hartung NL, Erlichman C, Bailey HH. A phase II consortium trial of vorinostat and bortezomib for advanced soft tissue sarcomas. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Goetz MP, Reid JM, Qi Y, Chen A, McGovern RM, Kuffel MJ, Scanlon PD, Erlichman C, Ames MM. A phase I study of once-weekly aminoflavone prodrug (AFP464) in solid tumor patients. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Palmer SR, Erlichman C, Fernandez-Zapico M, Qi Y, Almada L, McCleary-Wheeler A, Borad MJ, Molina JR, Grothey A, Pitot HC, Jatoi A, Northfelt DW, McWilliams RR, Okuno SH, Haluska P, Kim GP, Colon-Otero G. Phase I trial erlotinib, gemcitabine, and the hedgehog inhibitor, GDC-0449. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Moley JF, Adkins D, Bible KC, Traynor AM, Molina JR, Colon-Otero G, Pluard TJ, Shah MH, Suresh R, Erlichman C, Ivy SP, Suman V, Geyer SM, Fracasso PM, Cohen MS, Tang H, Fialkowski E, Traugott A, Smallridge RC. 17-allylaminogeldanamycin in advanced medullary and differentiated thyroid carcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Juckett M, LaPlant B, Flynn PJ, Jumonville A, Moreno-Aspitia A, Erlichman C. Phase II study of AZD2171 for the treatment of patients with acute myelogenous leukemia. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6574] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
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15
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Pili R, Qin R, Flynn PJ, Picus J, Millward M, Ho WM, Pitot HC, Tan W, Erlichman C, Vaishampayan UN. MC0553: A phase II safety and efficacy study with the VEGF receptor tyrosine kinase inhibitor pazopanib in patients with metastatic urothelial cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.259] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
259 Background: Vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF) are produced by bladder cancer cell lines in vitro and expressed in human tumor tissues. Preclinical studies have also shown that bladder cancer cell lines express VEGF receptor 1 and 2 on their surface membrane. Pazopanib is a vascular endothelial receptor tyrosine kinase inhibitor with anti-angiogenesis and antitumor activity in several preclinical models. A two-stage phase II study was conducted to assess the activity and toxicity profile of pazopanib administered to patients with metastatic, urothelial carcinoma. Methods: Patients with one prior systemic therapy for recurrent, metastatic urothelial carcinoma were eligible. Patients received pazopanib at a dose of 800 mg orally daily for 4 week cycle. Results: Nineteen patients were enrolled. Median age was 66 years, with > 89% of patients presenting poorly differentiated bladder cancer. Adverse event data is available on 18 patients. No grade 4 or 5 events have been experienced. Nine patients have experienced 11 grade 3 adverse events of which 7 were deemed at least possibly related to treatment. Most common toxicities were anemia, thrombocytopenia, leucopenia and fatigue. For stage 1, none of the first 16 evaluable patients were deemed success (CR or PR) by the RECIST criteria during the first four 4-week cycles of treatment. Median progression- free survival was 1.9 months. This met the futility stopping rule of interim analysis, and therefore, the trial was recommended to be permanently closed. Correlative studies including measurement of VEGF levels in archived tissues and blood are pending. Conclusions: Pazopanib did not show activity in urothelial carcinoma patients. The role of anti-VEGF therapies in urothelial carcinoma may need further evaluation in rational combination strategies. [Table: see text]
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Affiliation(s)
- R. Pili
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic Rochester, Rochester, MN; Metro Minnesota, Minneapolis, MN; Washington University School of Medicine, St. Louis, MO; Sir Charles Gairdner Hospital, Nedlands, Australia; Prince of Wales Hospital, Shatin, Hong Kong; Mayo Clinic Jacksonville, Jacksonville, FL; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - R. Qin
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic Rochester, Rochester, MN; Metro Minnesota, Minneapolis, MN; Washington University School of Medicine, St. Louis, MO; Sir Charles Gairdner Hospital, Nedlands, Australia; Prince of Wales Hospital, Shatin, Hong Kong; Mayo Clinic Jacksonville, Jacksonville, FL; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - P. J. Flynn
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic Rochester, Rochester, MN; Metro Minnesota, Minneapolis, MN; Washington University School of Medicine, St. Louis, MO; Sir Charles Gairdner Hospital, Nedlands, Australia; Prince of Wales Hospital, Shatin, Hong Kong; Mayo Clinic Jacksonville, Jacksonville, FL; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - J. Picus
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic Rochester, Rochester, MN; Metro Minnesota, Minneapolis, MN; Washington University School of Medicine, St. Louis, MO; Sir Charles Gairdner Hospital, Nedlands, Australia; Prince of Wales Hospital, Shatin, Hong Kong; Mayo Clinic Jacksonville, Jacksonville, FL; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - M. Millward
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic Rochester, Rochester, MN; Metro Minnesota, Minneapolis, MN; Washington University School of Medicine, St. Louis, MO; Sir Charles Gairdner Hospital, Nedlands, Australia; Prince of Wales Hospital, Shatin, Hong Kong; Mayo Clinic Jacksonville, Jacksonville, FL; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - W. M. Ho
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic Rochester, Rochester, MN; Metro Minnesota, Minneapolis, MN; Washington University School of Medicine, St. Louis, MO; Sir Charles Gairdner Hospital, Nedlands, Australia; Prince of Wales Hospital, Shatin, Hong Kong; Mayo Clinic Jacksonville, Jacksonville, FL; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - H. C. Pitot
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic Rochester, Rochester, MN; Metro Minnesota, Minneapolis, MN; Washington University School of Medicine, St. Louis, MO; Sir Charles Gairdner Hospital, Nedlands, Australia; Prince of Wales Hospital, Shatin, Hong Kong; Mayo Clinic Jacksonville, Jacksonville, FL; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - W. Tan
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic Rochester, Rochester, MN; Metro Minnesota, Minneapolis, MN; Washington University School of Medicine, St. Louis, MO; Sir Charles Gairdner Hospital, Nedlands, Australia; Prince of Wales Hospital, Shatin, Hong Kong; Mayo Clinic Jacksonville, Jacksonville, FL; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - C. Erlichman
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic Rochester, Rochester, MN; Metro Minnesota, Minneapolis, MN; Washington University School of Medicine, St. Louis, MO; Sir Charles Gairdner Hospital, Nedlands, Australia; Prince of Wales Hospital, Shatin, Hong Kong; Mayo Clinic Jacksonville, Jacksonville, FL; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - U. N. Vaishampayan
- Roswell Park Cancer Institute, Buffalo, NY; Mayo Clinic Rochester, Rochester, MN; Metro Minnesota, Minneapolis, MN; Washington University School of Medicine, St. Louis, MO; Sir Charles Gairdner Hospital, Nedlands, Australia; Prince of Wales Hospital, Shatin, Hong Kong; Mayo Clinic Jacksonville, Jacksonville, FL; Karmanos Cancer Institute, Wayne State University, Detroit, MI
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Cashen AF, Juckett M, Jumonville A, Litzow MR, Flynn PJ, Eckardt JR, LaPlant B, Laumann KM, Erlichman C, DiPersio JF. Phase II study of the histone deacetylase (HDAC) inhibitor belinostat for the treatment of myelodysplastic syndrome (MDS). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6607] [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: 11/20/2022] Open
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17
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Erlichman C, Menefee ME, Northfelt DW, Qin R, Reid JM, Oursler M, Marks R, Haluska P, Molina JR, Koch K. Phase I trial of dasatinib (D) and lapatinib (L). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2610] [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: 11/20/2022] Open
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18
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Costello BA, Qi Y, Borad MJ, Kim GP, Northfelt DW, Erlichman C, Alberts SR. Phase I trial of everolimus and gemcitabine for patients with solid tumors refractory to standard therapy and for a cohort of patients with cholangiocarcinoma/gallbladder cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Baggstrom MQ, Govindan R, Koczywas M, Argiris A, Millward M, Johnson E, Qi Y, Erlichman C. Phase II trial of R-(-)-gossypol acetic acid (NSC 726190, AT-101) in patients with recurrent extensive stage small cell lung cancer (ES-SCLC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e17523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Shanafelt TD, Call T, Zent CS, LaPlant B, Leis JF, Bowen D, Roos M, Jelinek DF, Erlichman C, Kay NE. Phase II trial of daily, oral green tea extract in patients with asymptomatic, Rai stage 0-II chronic lymphocytic leukemia (CLL). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6522] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
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21
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Sideras K, Menefee ME, Burton JK, Ivy SP, Erlichman C, Bible KC. Effect of pazopanib on hair and skin hypopigmentation: A series of three patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Messersmith WA, Nallapareddy S, Arcaroli J, Tan A, Foster NR, Wright JJ, Picus J, Goh BC, Hidalgo M, Erlichman C. A phase II trial of saracatinib (AZD0530), an oral Src inhibitor, in previously treated metastatic pancreatic cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Bible KC, Smallridge RC, Maples WJ, Molina JR, Menefee ME, Suman VJ, Burton JK, Bieber CC, Ivy SP, Erlichman C. Phase II trial of pazopanib in progressive, metastatic, iodine-insensitive differentiated thyroid cancers. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.3521] [Citation(s) in RCA: 18] [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] [Indexed: 11/20/2022] Open
Abstract
3521 Background: Systemic therapies have had little impact on the outcomes of patients with advanced differentiated thyroid cancers. Methods: A three-outcome one-stage Phase II trial was conducted to assess the anti-tumor activity and toxicities of the orally bioavailable VEGF/tyrosine kinase inhibitor pazopanib (800 mg daily) in patients with advanced and progressive radioiodine-insensitive differentiated thyroid cancers. Up to 2 prior therapies were allowed, with measurable disease required. Design: at the 0.10 significance level, there would be a 90% chance of detecting a RECIST response rate of >20% given a true response rate of >5%; with the regimen considered promising if >4 confirmed responses observed. Results: From February to November 2008, 32 patients (53% male) aged 23–79 years (median: 63 years) were enrolled. Common sites of metastases were: lung (100%), nodes (52%), and bone (39%). Measurement data are available for 26 patients, with the median number of cycles administered thus far 4 (range: 1–8, total: 101). Overall, therapy has been well tolerated. Six patients (23%) required dose reduction due to: grade 2+ ALT (3 pts), grade 3 mucositis (1 pt); grade 3 diarrhea and dehydration (1 pt), and grade 3 abdominal pain (1 pt.). Other serious toxicities included grade 3 colon perforation and grade 3 chest pain (1 pt). No thyroglobulin antibody (TGA) negative patient has become TGA positive, and 11 of 16 patients (69%) with initially elevated thyroglobulin levels experienced a decline in thyroglobulin of >50%. Five RECIST partial responses have been confirmed to date (19%). Two patients are alive with disease progression and another has died from disease progression. Conclusions: Pazopanib appears to have both a favorable toxicity profile and promising clinical activity in patients with advanced and progressive differentiated thyroid cancers. Supported in part by NCI CA15083 and CM62205. No significant financial relationships to disclose.
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Affiliation(s)
- K. C. Bible
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; National Cancer Institute, Bethesda, MD
| | - R. C. Smallridge
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; National Cancer Institute, Bethesda, MD
| | - W. J. Maples
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; National Cancer Institute, Bethesda, MD
| | - J. R. Molina
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; National Cancer Institute, Bethesda, MD
| | - M. E. Menefee
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; National Cancer Institute, Bethesda, MD
| | - V. J. Suman
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; National Cancer Institute, Bethesda, MD
| | - J. K. Burton
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; National Cancer Institute, Bethesda, MD
| | - C. C. Bieber
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; National Cancer Institute, Bethesda, MD
| | - S. P. Ivy
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; National Cancer Institute, Bethesda, MD
| | - C. Erlichman
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; National Cancer Institute, Bethesda, MD
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24
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Merchan JR, Pitot HC, Qin R, Liu G, Fitch TR, Picus J, Maples WJ, Erlichman C. Phase I/II trial of CCI 779 and bevacizumab in advanced renal cell carcinoma (RCC): Safety and activity in RTKI refractory RCC patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5039] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [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
5039 Background: Combined mTOR and VEGF blockade is a potentially promising and rational strategy for the treatment of advanced RCC. We previously reported the phase I safety and efficacy results of CCI 779 (C) +bevacizumab (B) n RTKI naïve stage IV RCC patients (pts) (J Clin Oncol. 2007;25[18S Suppl]:5034). We now report the interim results of the phase 2 study of C+B in RTKI refractory RCC patients. Methods: Design: Open label, phase I/II study of C+B in advanced RCC pts. Patients with measurable stage IV RCC with a component of clear/conventional cell type, performance status 0–2 and good organ function were eligible. Up to two prior treatment regimens were allowed (at least one prior RTKI). Phase II dose was C = 25 mg IV weekly and B = 10 mg/kg every 2 weeks repeated in 4 week cycles. The primary objective of the phase II portion was to assess the proportion of patients who were progression-free 6 months after study entry. Secondary objectives were assessment of response rates and toxicity. Accrual goal = 40 pts. Results: Thirty-five pts have been enrolled into the phase 2 portion to date with 4 pts ineligible. Twenty-five pts are evaluable for response assessment and 29 pts are evaluable for toxicity. Baseline characteristics (N: 35): M/F: 28/7; Number of met. sites: 1/2/3+: 15/9/11; prior nephrectomy: 31; Number of prior therapies: 1 = 29; 2 = 2. Most common (>5%) Gr 3–4 AEs (N = 29) included fatigue (6), hypercholesterolemia (2), hypertriglyceridemia (2), anorexia (2), rash (2), and anemia (2). Responses were: PR/SD/PD = 4 (16%)/18 (72%)/3 (12%). Median number of cycles administered was 4. Six month progression free rates will mature by may 2009. Conclusions: C+B combination at the recommended phase 2 doses is feasible and well tolerated. Clinical benefit rates (PR/SD) in RTKI refractory RCC patients (88%) are encouraging. Data on 6 month progression-free rates are expected to mature in 4/09. Updated data on safety, response rates, and 6-month progression free rates will be presented on all evaluable patients. Correlative studies on available plasma, serum and tumor samples for angiogenic and molecular biomarkers are underway. Supported by N01-CM62205, R21 CA 119545–02, and Commonwealth Foundation. [Table: see text]
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Affiliation(s)
- J. R. Merchan
- University of Miami School of Medicine, Miami, FL; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; Washington University, St Louis, MO; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Rochester, MN
| | - H. C. Pitot
- University of Miami School of Medicine, Miami, FL; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; Washington University, St Louis, MO; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Rochester, MN
| | - R. Qin
- University of Miami School of Medicine, Miami, FL; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; Washington University, St Louis, MO; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Rochester, MN
| | - G. Liu
- University of Miami School of Medicine, Miami, FL; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; Washington University, St Louis, MO; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Rochester, MN
| | - T. R. Fitch
- University of Miami School of Medicine, Miami, FL; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; Washington University, St Louis, MO; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Rochester, MN
| | - J. Picus
- University of Miami School of Medicine, Miami, FL; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; Washington University, St Louis, MO; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Rochester, MN
| | - W. J. Maples
- University of Miami School of Medicine, Miami, FL; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; Washington University, St Louis, MO; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Rochester, MN
| | - C. Erlichman
- University of Miami School of Medicine, Miami, FL; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ; Washington University, St Louis, MO; Mayo Clinic, Jacksonville, FL; Mayo Clinic, Rochester, MN
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25
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Haluska P, Carboni JM, Asmann YW, Ten Eyck C, Attar RM, Tibodeau JD, Hou X, Nakanishi T, Ross DD, Kaufmann SH, Gottardis MM, Erlichman C. Drug efflux by breast cancer resistance protein (BCRP) is a mechanism of resistance to the insulin-like growth factor receptor/insulin receptor inhibitor, BMS-536924. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-2149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #2149
Background: Inhibitors of the insulin-like growth factor 1 receptor (IGF-1R) are currently undergoing clinical testing. Preclinical investigations have identified IGF-1 signaling as a key mechanism for breast cancer growth and resistance to clinically useful therapies, including tamoxifen and trastuzumab. Thus, agents targeting IGF-1R have promise in the treatment of breast cancer. Determining mechanisms that can confer resistance to these agents may aid their clinical development.
 Methods: To understand factors may be important in predicting sensitivity to targeting the IGF-1 signaling pathway, we developed a cell line (MCF-7R4) that is resistant to BMS-554417, a small molecule, dual-kinase inhibitor of IGF-1R and insulin receptor (InsR). Compared with the parental MCF-7 cells, MCF-7R4 cells are 40- to 50-fold resistant to BMS-554417 and cross-resistant to the similar compound BMS-536924. The expression profiles of MCF-7R4 and that of MCF-7 were compared using Affymetrix GeneChip Human Genome U133 Plus 2.0 Arrays. Intracellular concentrations of BMS-536924 were examined by reverse phase high performance liquid chromatography. BMS-536924 cellular accumulation in vitro was visualized by fluorescence microscopy using a DAPI filter set. MCF-7 cells stably transfected with either the empty mammalian expression vector pcDNA (MCF-EV) or full length BCRP (MCF-BCRP) were examined for sensitivity to BMS 536924 by MTS assays.
 Results: Compared to MCF-7 cells, BCRP expression was increased 9-fold in MCF-7R4, which was highly statistically significant by t-test (p= 7.13E-09). Little change was observed in other ABC transporter proteins, including ABCB1. No change was observed in IGF-1R or InsR expression. BCRP overexpression in MCF-7R4 cells was confirmed by western blotting. MCF-7R4 cells had significantly lower intracellular accumulation of BMS-536924 compared to MCF-7 cells. Confirming these results, MCF-BCRP cells were significantly less sensitive to the cytoxic effects of BMS-536924 cells than MCF-EV cells.
 Conclusions: BCRP expression was stimulated by prolonged exposure of MCF-7 cells to BMS-554417. Upregulation of BCRP is one of the most significant changes observed in MCF-7R4 cells in comparison to parental cells. BCRP expression decreased cellular exposure to BMS-536924 and was sufficient to confer resistance. These data suggest that BSM-536924 is a substrate for BCRP-mediated efflux. Expression of BCRP may be important in de novo and acquired resistance to benzimidazole –based inhibitors of IGF-1R/InsR. Supported in part by the Mayo Clinic Breast SPORE (CA116201-03), NIH K12 (CA090628-05) and the Mayo Clinic Cancer Center (CA15083).
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2149.
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Affiliation(s)
- P Haluska
- 1 Oncology, Mayo Clinic, Rochester, MN
| | - JM Carboni
- 2 Oncology Drug Discovery, Bristol Myers Squibb, Princeton, NJ
| | - YW Asmann
- 3 Biomedical Informatics, Mayo Clinic, Rochester, MN
| | | | - RM Attar
- 2 Oncology Drug Discovery, Bristol Myers Squibb, Princeton, NJ
| | | | - X Hou
- 1 Oncology, Mayo Clinic, Rochester, MN
| | - T Nakanishi
- 4 Medicine and Division of Hematology/Oncology, University of Maryland, Baltimore, MD
| | - DD Ross
- 4 Medicine and Division of Hematology/Oncology, University of Maryland, Baltimore, MD
| | | | - MM Gottardis
- 2 Oncology Drug Discovery, Bristol Myers Squibb, Princeton, NJ
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Mesa RA, Camoriano JK, Geyer SM, Wu W, Kaufmann SH, Rivera CE, Erlichman C, Wright J, Pardanani A, Lasho T, Finke C, Li CY, Tefferi A. A phase II trial of tipifarnib in myelofibrosis: primary, post-polycythemia vera and post-essential thrombocythemia. Leukemia 2007; 21:1964-70. [PMID: 17581608 DOI: 10.1038/sj.leu.2404816] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with primary myelofibrosis (PMF) or post-polycythemia vera or post-essential thrombocythemia myelofibrosis (post-PV/ET MF) have limited therapeutic options. The farnesyltransferase-inhibitor tipifarnib inhibits in vitro proliferation of myeloid progenitors from such patients. In the current phase II clinical trial, single-agent oral tipifarnib (300 mg twice daily x 21 of 28 days) was given to 34 symptomatic patients with either PMF (n=28) or post-PV/ET MF (n=6). Median time to discontinuation of protocol therapy was 4.6 months; reasons for early termination (n=19; 56%) included disease progression (21%) and adverse drug effects (18%). Toxicities (>/=grade 3) included myelosuppression (n=16), neuropathy (n=2), fatigue (n=1), rash (n=1) and hyponatremia (n=1). Response rate was 33% for hepatosplenomegaly and 38% for transfusion-requiring anemia. No favorable changes occurred in bone marrow fibrosis, angiogenesis or cytogenetic status. Pre- and post-treatment patient sample analysis for in vitro myeloid colony growth revealed substantial reduction in the latter. Clinical response did not correlate with either degree of colony growth, measurable decrease in quantitative JAK2(V617F) levels or tipifarnib IC(50) values (median 11.8 nM) seen in pretreatment samples. The current study indicates both in vitro and in vivo tipifarnib activity in PMF and post-PV/ET MF.
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Affiliation(s)
- R A Mesa
- Division of Hematology, Rochester, MN, USA.
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Hobday TJ, Rubin J, Holen K, Picus J, Donehower R, Marschke R, Maples W, Lloyd R, Mahoney M, Erlichman C. MC044h, a phase II trial of sorafenib in patients (pts) with metastatic neuroendocrine tumors (NET): A Phase II Consortium (P2C) study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4504] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [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
4504 Background: Treatment options for metastatic NET, including islet cell carcinoma (ICC) and carcinoid tumor (CT), are limited. These tumors frequently express vascular endothelial growth factor receptor-2 (VEGFR-2) and platelet derived growth factor receptor receptor-β (PDGFR-β). Sorafenib, a small-molecule inhibitor of the VEGFR-2 and PDGFR-β tyrosine kinase domains, is a rational targeted therapy to evaluate in NET. Methods: Eligibility criteria included: ECOG PS = 2, = 1 prior chemotherapy, good organ function and signed informed consent. Prior interferon and prior or concurrent octreotide at a stable dose were allowed. Pts unable to take oral medications, with uncontrolled hypertension or with symptomatic coronary artery disease were excluded. Pts received sorafenib 400 mg po BID. Primary endpoint was response by RECIST in two cohorts (ie, CT and ICC) using separate 2-stage phase II designs. Results: 93 pts were enrolled: (50 CT, 43 ICC). For pts evaluable for the primary endpoint, 4 of 41 (10%) CT pts and 4 of 41 (10%) ICC pts had a PR. There were 3 minor responses (MR = 20–29% decrease in sum of target lesion diameters) in CT pts and 9 MRs in ICC pts for PR+MR rate of 17% for CT pts and 32% for ICC pts. For pts evaluable, 6-month progression-free survival was observed in 8/20 CT and 14/23 ICC pts. Grade 3–4 toxicity occurred in 43% of pts, with skin (20%), GI (7%) and fatigue (9%) most common. Translational studies from tumor tissue will be presented. Conclusions: Sorafenib at 400 mg po BID has modest activity in metastatic neuroendocrine tumors, with frequent grade = 3 toxicity. Supported by NOI CM6225. No significant financial relationships to disclose.
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Affiliation(s)
- T. J. Hobday
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Washington University, St. Louis, MO; Johns Hopkins University, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL
| | - J. Rubin
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Washington University, St. Louis, MO; Johns Hopkins University, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL
| | - K. Holen
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Washington University, St. Louis, MO; Johns Hopkins University, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL
| | - J. Picus
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Washington University, St. Louis, MO; Johns Hopkins University, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL
| | - R. Donehower
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Washington University, St. Louis, MO; Johns Hopkins University, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL
| | - R. Marschke
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Washington University, St. Louis, MO; Johns Hopkins University, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL
| | - W. Maples
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Washington University, St. Louis, MO; Johns Hopkins University, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL
| | - R. Lloyd
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Washington University, St. Louis, MO; Johns Hopkins University, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL
| | - M. Mahoney
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Washington University, St. Louis, MO; Johns Hopkins University, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL
| | - C. Erlichman
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Washington University, St. Louis, MO; Johns Hopkins University, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL
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Molina JR, Erlichman C, Kaufmann S, Adjei A, Rubin S, Friedman R, Reid J, Qin R, Felten S. A phase I study of lapatinib and topotecan in patients with solid tumors. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3598 Background: Drug resistance to topotecan can be the result of BCRP/ABCG2 expression. BCRP is a member of the ABC transporter family that pumps anticancer drugs out of the cell. Lapatinib is a potent and selective dual inhibitor of epidermal growth factor receptor (EGFR or ErbB1) and ErbB2 (Her2/Neu). 4-aminoquinazoline tyrosine kinase inhibitors have been shown to enhance the cytotoxicity of topotecan through inhibition of BCRP-mediated drug efflux in cancer cells. Methods: Thirty-seven patients with advanced stage cancers were enrolled at escalating dose levels of lapatinib and topotecan in cohorts IA, IB and IIB (MTD). Treatment schedule included lapatinib (750 - 1500 mg/d) daily for 21 (cohort IA) or 28 days (cohort IB) and topotecan (2.4 - 4.0 mg/ m2), days 1, 8 and 15; cycles were repeated every 28 days. Three patients were treated at each dose level, 18 on cohort IA, 9 on cohort IB and 10 at MTD (cohort IIB). Assessments of toxicity were performed with each cycle and clinical response was determined per RECIST criteria every other cycle. Results: The MTD for cohorts IA and IB was reached at a dose of 1250 mg of lapatinib and 3.2 mg/m2 of IV topotecan on days 1, 8 and 15. No DLT were seen during the dose escalation stage of cohorts IA and IB. Ten patients were enrolled at the MTD. There were no grade 4+ events. Thirteen grade 3+ events, considered to be related to treatment, were seen in 6 patients. The most common grade 3+ toxicities included dehydration (2) diarrhea (2), nausea (3), vomiting (2), neutropenia (1), thrombocytopenia (1), and fatigue (1). No abnormalities in left ventricular ejection fraction were noted. Stable disease was seen in 46% of the 37 patients. Conclusions: The combination of lapatinib and topotecan is a well-tolerated regimen. The MTD for the combination is lapatinib 1,250 mg orally once daily for 21 or 28 days and topotecan 3.2 mg/m2 on days 1, 8 and 15. Pharmacokinetic analysis for drug interaction will be available for presentation at the meeting. Supported in part by GSK and Mayo Clinic No significant financial relationships to disclose.
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Affiliation(s)
- J. R. Molina
- Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY; GlaxoSmithKline, Collegeville, PA
| | - C. Erlichman
- Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY; GlaxoSmithKline, Collegeville, PA
| | - S. Kaufmann
- Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY; GlaxoSmithKline, Collegeville, PA
| | - A. Adjei
- Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY; GlaxoSmithKline, Collegeville, PA
| | - S. Rubin
- Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY; GlaxoSmithKline, Collegeville, PA
| | - R. Friedman
- Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY; GlaxoSmithKline, Collegeville, PA
| | - J. Reid
- Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY; GlaxoSmithKline, Collegeville, PA
| | - R. Qin
- Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY; GlaxoSmithKline, Collegeville, PA
| | - S. Felten
- Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY; GlaxoSmithKline, Collegeville, PA
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Merchan JR, Liu G, Fitch T, Picus J, Qin R, Pitot HC, Maples W, Erlichman C. Phase I/II trial of CCI-779 and bevacizumab in stage IV renal cell carcinoma: Phase I safety and activity results. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5034] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [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
5034 Background: The mammalian target of rapamicin (mTOR) and vascular endothelial growth factor (VEGF) pathways are critically involved in the pathogenesis and progression of clear cell renal cell carcinoma. Methods: The goal of the phase I portion of the trial was to determine the maximum tolerated dose (MTD) and dose limiting toxicity (DLT) of the combination of the mTOR inhibitor CCI-779 (C) and the anti-VEGF monoclonal antibody Bevacizumab (B). Patients with measurable stage IV clear cell RCC, performance status 0–2 and good organ function were eligible. Up to two prior treatment regimens were allowed. Treatment consisted of 25 mg IV weekly C and escalating IV doses of B (level 1= 5 mg/kg; level 2= 10 mg/kg) every other week. A cycle was defined as 4 weeks. Results: A total of 10 male and 2 female patients, median age 66 yrs (50–77) were enrolled to the phase I portion of the trial. PS: 0/1= 6/6; prior nephrectomy = 10; prior systemic therapy = 7 (prior cytokine therapy = 6); Number of metastatic sites: 1/2/≥3 = 2/2/8; one patient (out of 6) in dose level 1 experienced DLT which consisted of grade 3 hypertriglyceridemia. 1/6 patient in dose level 2 experienced DLT with grade 3 mucositis. Other grade 3 toxicities that were not DLTs included hypertension, proteinuria, hemorrhage, nausea/vomiting, dehydration, anorexia, pneumonitis, anemia, and hypophosphatemia. The best responses in the 12 evaluable patients included 7 PRs and 3 SDs. One patient had PD due to symptomatic deterioration and in one patient response information is not available at the time of this submission. Conclusions: Combination therapy with CCI-779 and Bevacizumab is safe and shows promising clinical antitumor activity. The recommended phase II dose is CCI-779 25 mg/week with bevacizumab 10 mg/kg every other week. The phase II study in stage IV renal cell cancer patients refractory to FDA approved receptor tyrosine kinase inhibitors is under way. The goals of the phase II portion are to determine the proportion of patients who have not had disease progression at 6 months, safety, response rates and correlative biomarker studies including determination of the tumor’s VHL-HIF-VEGF status, PTEN/AKT expression, plasma angiogenic activity and angiogenic cytokines. Supported by NCI N01-CM-62205 No significant financial relationships to disclose.
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Affiliation(s)
- J. R. Merchan
- University of Miami Miller School of Medicine, Miami, FL; University of Wisconsin, Madison, WI; Mayo College of Medicine, Scottsdale, AZ; Washington University School of Medicine, St Louis, MO; Mayo College of Medicine, Rochester, MN; Mayo College of Medicine, Jacksonville, FL
| | - G. Liu
- University of Miami Miller School of Medicine, Miami, FL; University of Wisconsin, Madison, WI; Mayo College of Medicine, Scottsdale, AZ; Washington University School of Medicine, St Louis, MO; Mayo College of Medicine, Rochester, MN; Mayo College of Medicine, Jacksonville, FL
| | - T. Fitch
- University of Miami Miller School of Medicine, Miami, FL; University of Wisconsin, Madison, WI; Mayo College of Medicine, Scottsdale, AZ; Washington University School of Medicine, St Louis, MO; Mayo College of Medicine, Rochester, MN; Mayo College of Medicine, Jacksonville, FL
| | - J. Picus
- University of Miami Miller School of Medicine, Miami, FL; University of Wisconsin, Madison, WI; Mayo College of Medicine, Scottsdale, AZ; Washington University School of Medicine, St Louis, MO; Mayo College of Medicine, Rochester, MN; Mayo College of Medicine, Jacksonville, FL
| | - R. Qin
- University of Miami Miller School of Medicine, Miami, FL; University of Wisconsin, Madison, WI; Mayo College of Medicine, Scottsdale, AZ; Washington University School of Medicine, St Louis, MO; Mayo College of Medicine, Rochester, MN; Mayo College of Medicine, Jacksonville, FL
| | - H. C. Pitot
- University of Miami Miller School of Medicine, Miami, FL; University of Wisconsin, Madison, WI; Mayo College of Medicine, Scottsdale, AZ; Washington University School of Medicine, St Louis, MO; Mayo College of Medicine, Rochester, MN; Mayo College of Medicine, Jacksonville, FL
| | - W. Maples
- University of Miami Miller School of Medicine, Miami, FL; University of Wisconsin, Madison, WI; Mayo College of Medicine, Scottsdale, AZ; Washington University School of Medicine, St Louis, MO; Mayo College of Medicine, Rochester, MN; Mayo College of Medicine, Jacksonville, FL
| | - C. Erlichman
- University of Miami Miller School of Medicine, Miami, FL; University of Wisconsin, Madison, WI; Mayo College of Medicine, Scottsdale, AZ; Washington University School of Medicine, St Louis, MO; Mayo College of Medicine, Rochester, MN; Mayo College of Medicine, Jacksonville, FL
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Egorin MJ, Belani CP, Remick SC, Erlichman C, Teneyck CJ, Holleran JL, Ivy SP, Ramalingam S, Naret CL, Ramanathan RK. Phase I, pharmacokinetic (PK), & pharmacodynamic (PD) study of 17-dimethylaminoethylamino-17-demethoxygeldanamycin, (17DMAG, NSC 707545) in patients with advanced solid tumors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3021 Background: 17DMAG is a water-soluble analog of 17-allylamino-17-demethoxygeldanamycin (17AAG), the first geldanamycin compound to enter clinical trials. 17DMAG causes oncoprotein degradation by binding to heat shock protein 90 (HSP90) & has greater in-vitro activity than 17AAG. In animals treated with 17DMAG, liver toxicity is dose-limiting. The objectives of this first-in-human study are to: establish the dose-limiting toxicity (DLT); recommend a phase 2 dose; & characterize the PK & PD of 17DMAG. Methods: Using a modified accelerated schema, escalating doses of 17DMAG are given IV over 1 h daily x 5 (schedule A) or daily x 3 (schedule B) every 3 weeks. Plasma 17DMAG concentrations during cycle 1 are quantitated by LC/MS. HSP70 & ILK levels in peripheral mononuclear cells are measured by western blot at baseline & 24 h on d 1. Results: 37 pts have been enrolled. On schedule A, dose levels are 1.5, 3, 6, 9, 12 & 16 mg/m2/d (n = 20). On schedule B, the starting dose was 2.5 mg/m2/d. Based on safety information from schedule A, subsequent schedule B dose levels were 14, 19, 25 & 34 mg/m2/d (n = 17). One DLT was noted in schedule A (16 mg/m2) & consisted of reversible liver enzyme elevation. End-of-infusion (EOI) 17DMAG concentrations (33–2074 ng/ml) & AUC0–24 (200–5200 ng/ml x h) increase linearly with dose. Interpatient PK variability was substantial, with CV% of 16–59%. The daily administration schedule precluded precise definition of 17DMAG t1/2 & clearance, but estimates of t1/2 & clearance ranged from 10.8 to 77 h & 19–160 ml/min/m2, respectively. Between 0 & 24 h, 20.5 ± 8.6% (range 4–43.8%) of the administered dose was excreted in urine. HSP70 increased between 0.2 & 3.7 fold above baseline in PBMCs at 24 h at 12, 16, & 25 mg/m2. There is an indication of ILK degradation in 3 of 4 patients evaluated at 25 mg/m2. Conclusions: 17DMAG is well tolerated at current dose levels & maximal tolerated dose has not been reached. 17DMAG plasma PK are linear over the doses delivered to date, & there is evidence of a target effect as manifested by↑HSP70 & ↓ILK. Support: U01CA099168–01, U01CA62502, U01CA69912, R01CA90390 & NIH/NCCR/GCRC grants #5M01 RR 00056 & M01 RR00080 No significant financial relationships to disclose.
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Affiliation(s)
- M. J. Egorin
- University of Pittsburgh Cancer Institute, Pittsburgh, PA; Case Comprehensive Cancer Center, Cleveland, OH; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - C. P. Belani
- University of Pittsburgh Cancer Institute, Pittsburgh, PA; Case Comprehensive Cancer Center, Cleveland, OH; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - S. C. Remick
- University of Pittsburgh Cancer Institute, Pittsburgh, PA; Case Comprehensive Cancer Center, Cleveland, OH; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - C. Erlichman
- University of Pittsburgh Cancer Institute, Pittsburgh, PA; Case Comprehensive Cancer Center, Cleveland, OH; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - C. J. Teneyck
- University of Pittsburgh Cancer Institute, Pittsburgh, PA; Case Comprehensive Cancer Center, Cleveland, OH; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - J. L. Holleran
- University of Pittsburgh Cancer Institute, Pittsburgh, PA; Case Comprehensive Cancer Center, Cleveland, OH; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - S. P. Ivy
- University of Pittsburgh Cancer Institute, Pittsburgh, PA; Case Comprehensive Cancer Center, Cleveland, OH; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - S. Ramalingam
- University of Pittsburgh Cancer Institute, Pittsburgh, PA; Case Comprehensive Cancer Center, Cleveland, OH; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - C. L. Naret
- University of Pittsburgh Cancer Institute, Pittsburgh, PA; Case Comprehensive Cancer Center, Cleveland, OH; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - R. K. Ramanathan
- University of Pittsburgh Cancer Institute, Pittsburgh, PA; Case Comprehensive Cancer Center, Cleveland, OH; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
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Hobday TJ, Holen K, Donehower R, Camoriano J, Kim G, Picus J, Philip P, Lloyd R, Mahoney M, Erlichman C. A phase II trial of gefitinib in patients (pts) with progressive metastatic neuroendocrine tumors (NET): A Phase II Consortium (P2C) study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4043] [Citation(s) in RCA: 36] [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
4043 Background: Systemic treatment options for progressive metastatic NET, including islet cell carcinoma (ICC) and carcinoid tumor (CT), are limited. These tumors frequently express the epidermal growth factor receptor (EGFR). Gefitinib, a small-molecule inhibitor of the EGFR tyrosine kinase, has been shown to inhibit the growth of NET cell lines. Methods: Eligibility criteria included: radiographic progression by RECIST criteria, ECOG PS ≤ 2, ≤ 1 prior chemotherapy, and good organ function. Prior interferon and prior or concurrent octreotide (if disease progression documented on stable dose) were allowed. Pts received gefitinib 250 mg po daily. We evaluated 6 month (mos) progression-free survival (PFS) in two cohorts (ie, CT and ICC) using separate 2-stage phase II designs. 6 mos PFS rates of 30% (CT) and 10% (ICC) were considered promising. Results: 96 pts were enrolled: (57 CT, 39 ICC). For pts evaluable for the primary endpoint, 23 of 38 (61%) CT pts and 9 of 29 (31%) pts with ICC were progression-free at 6 mos. 1 PR and one minor response (MR = 20–29% decrease in sum of target lesion diameters) were observed in 40 CT pts; 2 PR and 1 MR in 31 ICC pts. In addition, 32% (12/38) of CT and 14% (4/29) of ICC pts had stable disease on study for a duration that exceeded by at least 4 months the time to progression documented prior to study entry. Grade 3–4 toxicity was infrequent with fatigue (6%), diarrhea (5%) and rash (3%) most common. Evaluation of markers of the EGFR pathway on tumor tissue will be presented. Conclusions: Gefitinib is well-tolerated and results in prolonged disease stabilization in pts with prior documented objective progression of CT and ICC, with rare objective responses. Supported by NOI CM17104. No significant financial relationships to disclose.
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Affiliation(s)
- T. J. Hobday
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO; Wayne State University, Detroit, MI
| | - K. Holen
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO; Wayne State University, Detroit, MI
| | - R. Donehower
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO; Wayne State University, Detroit, MI
| | - J. Camoriano
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO; Wayne State University, Detroit, MI
| | - G. Kim
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO; Wayne State University, Detroit, MI
| | - J. Picus
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO; Wayne State University, Detroit, MI
| | - P. Philip
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO; Wayne State University, Detroit, MI
| | - R. Lloyd
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO; Wayne State University, Detroit, MI
| | - M. Mahoney
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO; Wayne State University, Detroit, MI
| | - C. Erlichman
- Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO; Wayne State University, Detroit, MI
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Groteluschen DL, Mahoney MR, Pitot HC, Laheru D, Kolesar J, Thomas JP, Erlichman C, Holen KD. A multicenter phase 2 consortium (P2C) study of triapine in patients (pts) with advanced adenocarcinoma of the pancreas. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14118 Background: Triapine is a small molecule iron chelator that has been shown to inhibit ribonucleotide reductase (RR) at the M2 subunit. Early trials suggested activity in pancreatic cancer. The P2C initiated a study of single agent Triapine as both first-line therapy and for pts with gemcitabine-refractory disease. Correlatives included: pharmacokinetics, MDR polymorphisms, and the effects of Triapine on cell cycle and electron paramagnetic resonance spectroscopy (EPR). Methods: Standard eligibility criteria were used, however, pts with G6PD deficiency were excluded. Triapine was given 96 mg/m2 IV over 2 hours, days 1–4 and 15–18, repeated q 28 days. Primary goals - evaluate survival (S) at 6 mos (previously untreated pts) and 4 mos (refractory pts). Interim analyses were planned when 28 previously untreated and 20 refractory pts were enrolled. Results: 14 eligible pts were enrolled in 10 mos (13 refractory, 9 male). The previously untreated pt received only 1 cycle secondary to progressive disease. Of the 13 refractory pts, 7 pts received at most 2 cycles; 6 received 1. Disease progression precluded further treatment in 11 pts. 6 pts had Gr 4 toxicities at least possibly related to drug, including: neutropenia-4, hyperkalemia-1, hyponatremia-1, leukopenia-1, thrombocytopenia-1, hypophosphatemia-1. 6 pts had a Gr 3 fatigue. One refractory patient expired on study. No responses were seen. Estimated 4 mos S in refractory pts is 16% (95% CI 3–94). EPR studies showed that Triapine led to a loss of the RR tyrosine radical EPR signal. Conclusions: Enrollment was suspended due to excess toxicity and lack of activity in pts refractory to gemcitabine. Correlative studies confirm the mechanism of action of Triapine as a chelating agent on RR. Supported by NCI Grant N01 CM17104 and the NCI Translational Research Fund. No significant financial relationships to disclose.
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Affiliation(s)
- D. L. Groteluschen
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD; Ohio State University, Columbus, OH
| | - M. R. Mahoney
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD; Ohio State University, Columbus, OH
| | - H. C. Pitot
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD; Ohio State University, Columbus, OH
| | - D. Laheru
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD; Ohio State University, Columbus, OH
| | - J. Kolesar
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD; Ohio State University, Columbus, OH
| | - J. P. Thomas
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD; Ohio State University, Columbus, OH
| | - C. Erlichman
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD; Ohio State University, Columbus, OH
| | - K. D. Holen
- University of Wisconsin Comprehensive Cancer Center, Madison, WI; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD; Ohio State University, Columbus, OH
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Saif MW, Erlichman C, Dragovich T, Mendelson D, Toft D, Timony G, Burrows F, Padgett C, De Jager R, Von Hoff D. Phase I study of CNF1010 (lipid formulation of 17-(allylamino)-17-demethoxygeldanamycin: 17-AAG) in patients with advanced solid tumors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10062 Background: 17-AAG is a benzoquinone ansamycin that binds to and inhibits the HSP90 family of molecular chaperones leading to the proteasomal degradation of client proteins critical in malignant cell proliferation and survival. We have undertaken a Phase 1 trial of CNF1010, an oil-in-water nanoemulsion of 17-AAG. Methods: Patients (pts) with advanced solid tumors, ECOG PS 0–2, and adequate hematologic, hepatic, renal and cardiac functions received CNF1010 by 1 h intravenous infusion, twice-a-week, three weeks out of four, starting at 6 mg/m2 per dose. Doses were escalated sequentially in single pts (6 and 12 mg/m2) and 3–6 pts (≥ 25 mg/m2) cohorts according to a modified Fibonacci’s schema. Plasma pharmacokinetic (PK) profiles were obtained on days 1 and 18. Biomarkers were measured in PBMC’s (HSP70) and plasma (HER-2 ectodomain (HER-2 ECD)). Results: 30 pts (M/F: 14/16; median age 63, range 48–78) with colorectal cancer (11), pancreatic cancer (5), melanoma (5), ovarian (2), others (7) were treated with a median of 2 courses (range: 1–10). There was no dose-limiting toxicity up to 175 mg/m2. One pt at 175 mg/m2 died on study, but drug relation was unclear. Grade 1–2 gastrointestinal toxicities (nausea, vomiting, diarrhea) and serum creatinine elevation were observed. Severe toxicities (grade 3 but no grade 4) consisted of reversible hepatic enzyme elevation, hyperbilirubinemia, fatigue, anemia and hyperglycemia. There were no hematological toxicities. Plasma 17-AAG PK appeared dose-proportional (AUC, Cmax); CL (17 L/h/m2) and t1/2 (5.2 h) were dose independent and unchanged after repeated dosing (day 18). Post-treatment increases in HSP70 were observed in PBMCs and decreases in plasma HER-2 ECD were observed at doses ≥ 83 mg/m2. Minor tumor regressions were seen in 1 pt with duodenal cancer (83 mg/m2), 1 pt with gastric carcinoid (175 mg/m2) and 1 pt with melanoma (175 mg/m2). Conclusion: The threshold of biologic activity for CNF1010 administered by a twice a week schedule appears to be 83 mg/m2. This dosing regimen appears to be optimal and supported by the pharmacokinetic and pharmacodynamic data. The MTD has not yet been determined. Dose escalation of CNF1010 continues at 225 mg/m2. [Table: see text]
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Affiliation(s)
- M. W. Saif
- University of Alabama at Birmingham, Birmingham, AL; Mayo Clinic, Rochester, MN; Arizona Cancer Center, Tucson, AZ; Conforma Therapeutics Corporation, San Diego, CA
| | - C. Erlichman
- University of Alabama at Birmingham, Birmingham, AL; Mayo Clinic, Rochester, MN; Arizona Cancer Center, Tucson, AZ; Conforma Therapeutics Corporation, San Diego, CA
| | - T. Dragovich
- University of Alabama at Birmingham, Birmingham, AL; Mayo Clinic, Rochester, MN; Arizona Cancer Center, Tucson, AZ; Conforma Therapeutics Corporation, San Diego, CA
| | - D. Mendelson
- University of Alabama at Birmingham, Birmingham, AL; Mayo Clinic, Rochester, MN; Arizona Cancer Center, Tucson, AZ; Conforma Therapeutics Corporation, San Diego, CA
| | - D. Toft
- University of Alabama at Birmingham, Birmingham, AL; Mayo Clinic, Rochester, MN; Arizona Cancer Center, Tucson, AZ; Conforma Therapeutics Corporation, San Diego, CA
| | - G. Timony
- University of Alabama at Birmingham, Birmingham, AL; Mayo Clinic, Rochester, MN; Arizona Cancer Center, Tucson, AZ; Conforma Therapeutics Corporation, San Diego, CA
| | - F. Burrows
- University of Alabama at Birmingham, Birmingham, AL; Mayo Clinic, Rochester, MN; Arizona Cancer Center, Tucson, AZ; Conforma Therapeutics Corporation, San Diego, CA
| | - C. Padgett
- University of Alabama at Birmingham, Birmingham, AL; Mayo Clinic, Rochester, MN; Arizona Cancer Center, Tucson, AZ; Conforma Therapeutics Corporation, San Diego, CA
| | - R. De Jager
- University of Alabama at Birmingham, Birmingham, AL; Mayo Clinic, Rochester, MN; Arizona Cancer Center, Tucson, AZ; Conforma Therapeutics Corporation, San Diego, CA
| | - D. Von Hoff
- University of Alabama at Birmingham, Birmingham, AL; Mayo Clinic, Rochester, MN; Arizona Cancer Center, Tucson, AZ; Conforma Therapeutics Corporation, San Diego, CA
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Hobday TJ, Mahoney M, Erlichman C, Lloyd R, Kim G, Mulkerin D, Picus J, Fitch T, Donehower R. Preliminary results of a phase II trial of gefitinib in progressive metastatic neuroendocrine tumors (NET): A Phase II Consortium (P2C) study. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4083] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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)
- T. J. Hobday
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Univ of Wisconsin, Madison, WI; Washington Univ, St Louis, MO; Mayo Clinic, Scottsdale, AZ; Johs Hopkins Univ, Baltimore, MD
| | - M. Mahoney
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Univ of Wisconsin, Madison, WI; Washington Univ, St Louis, MO; Mayo Clinic, Scottsdale, AZ; Johs Hopkins Univ, Baltimore, MD
| | - C. Erlichman
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Univ of Wisconsin, Madison, WI; Washington Univ, St Louis, MO; Mayo Clinic, Scottsdale, AZ; Johs Hopkins Univ, Baltimore, MD
| | - R. Lloyd
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Univ of Wisconsin, Madison, WI; Washington Univ, St Louis, MO; Mayo Clinic, Scottsdale, AZ; Johs Hopkins Univ, Baltimore, MD
| | - G. Kim
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Univ of Wisconsin, Madison, WI; Washington Univ, St Louis, MO; Mayo Clinic, Scottsdale, AZ; Johs Hopkins Univ, Baltimore, MD
| | - D. Mulkerin
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Univ of Wisconsin, Madison, WI; Washington Univ, St Louis, MO; Mayo Clinic, Scottsdale, AZ; Johs Hopkins Univ, Baltimore, MD
| | - J. Picus
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Univ of Wisconsin, Madison, WI; Washington Univ, St Louis, MO; Mayo Clinic, Scottsdale, AZ; Johs Hopkins Univ, Baltimore, MD
| | - T. Fitch
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Univ of Wisconsin, Madison, WI; Washington Univ, St Louis, MO; Mayo Clinic, Scottsdale, AZ; Johs Hopkins Univ, Baltimore, MD
| | - R. Donehower
- Mayo Clinic, Rochester, MN; Mayo Clinic, Jacksonville, FL; Univ of Wisconsin, Madison, WI; Washington Univ, St Louis, MO; Mayo Clinic, Scottsdale, AZ; Johs Hopkins Univ, Baltimore, MD
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Erlichman C, Goldberg RM, Mahoney MR, Kabat BF, Huntington JL, Sargent DJ, Sebo TJ, Kaufmann SH, Egner JR, Pitot HC. A phase II trial of CPT-11 in patients (pts) with advanced gastric or gastroesophageal (GE) junction adenocarcinoma (ADCA): A clinical and pharmacodynamic evaluation. A North Central Cancer Treatment Group (NCCTG) Study. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. Erlichman
- Mayo Clinic, Rochester, MN; Univ of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Carle Clinic, Urbana, IL
| | - R. M. Goldberg
- Mayo Clinic, Rochester, MN; Univ of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Carle Clinic, Urbana, IL
| | - M. R. Mahoney
- Mayo Clinic, Rochester, MN; Univ of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Carle Clinic, Urbana, IL
| | - B. F. Kabat
- Mayo Clinic, Rochester, MN; Univ of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Carle Clinic, Urbana, IL
| | - J. L. Huntington
- Mayo Clinic, Rochester, MN; Univ of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Carle Clinic, Urbana, IL
| | - D. J. Sargent
- Mayo Clinic, Rochester, MN; Univ of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Carle Clinic, Urbana, IL
| | - T. J. Sebo
- Mayo Clinic, Rochester, MN; Univ of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Carle Clinic, Urbana, IL
| | - S. H. Kaufmann
- Mayo Clinic, Rochester, MN; Univ of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Carle Clinic, Urbana, IL
| | - J. R. Egner
- Mayo Clinic, Rochester, MN; Univ of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Carle Clinic, Urbana, IL
| | - H. C. Pitot
- Mayo Clinic, Rochester, MN; Univ of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Carle Clinic, Urbana, IL
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Goetz MP, Safgren S, Goldberg RM, Grothey AF, Mandrekar SJ, Reid JM, Erlichman C, Adjei AA, Rubin J, Ames MM. A phase I dose escalation study of irinotecan (CPT-11), oxaliplatin (Oxal), and capecitabine (Cap) within three UGT1A1 TA promoter cohorts (6/6, 6/7, and 7/7). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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)
- M. P. Goetz
- Mayo Clinic Coll of Medicine, Rochester, MN; Univ of North Carolina, Chapel Hill, NC
| | - S. Safgren
- Mayo Clinic Coll of Medicine, Rochester, MN; Univ of North Carolina, Chapel Hill, NC
| | - R. M. Goldberg
- Mayo Clinic Coll of Medicine, Rochester, MN; Univ of North Carolina, Chapel Hill, NC
| | - A. F. Grothey
- Mayo Clinic Coll of Medicine, Rochester, MN; Univ of North Carolina, Chapel Hill, NC
| | - S. J. Mandrekar
- Mayo Clinic Coll of Medicine, Rochester, MN; Univ of North Carolina, Chapel Hill, NC
| | - J. M. Reid
- Mayo Clinic Coll of Medicine, Rochester, MN; Univ of North Carolina, Chapel Hill, NC
| | - C. Erlichman
- Mayo Clinic Coll of Medicine, Rochester, MN; Univ of North Carolina, Chapel Hill, NC
| | - A. A. Adjei
- Mayo Clinic Coll of Medicine, Rochester, MN; Univ of North Carolina, Chapel Hill, NC
| | - J. Rubin
- Mayo Clinic Coll of Medicine, Rochester, MN; Univ of North Carolina, Chapel Hill, NC
| | - M. M. Ames
- Mayo Clinic Coll of Medicine, Rochester, MN; Univ of North Carolina, Chapel Hill, NC
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Galanis E, Okuno SH, Nascimento AG, Lewis BD, Lee RA, Oliveira AM, Sloan JA, Atherton P, Edmonson JH, Erlichman C, Randlev B, Wang Q, Freeman S, Rubin J. Phase I-II trial of ONYX-015 in combination with MAP chemotherapy in patients with advanced sarcomas. Gene Ther 2005; 12:437-45. [PMID: 15647767 DOI: 10.1038/sj.gt.3302436] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
ONYX-015 is a provisionally replication competent adenovirus with oncolytic activity in cells with malfunctioning p53. Sarcomas represent a rational target for this approach given the high frequency of p53 mutations (40-75%) and MDM-2 amplification (10-30%). We, therefore, undertook a phase I/II study of ONYX-015, days 1-5 every month administered intratumorally under radiographic guidance, in combination with MAP (mitomycin-C, doxorubicin, cisplatin) chemotherapy in patients with advanced sarcoma. Six patients were treated. Injected lesions included liver metastases in four patients and chest wall metastases in two patients. Sarcoma histologies were gastrointestinal stromal tumors (GIST, two patients), leiomyosarcoma (two patients), liposarcoma (one patient), and malignant peripheral nerve sheath tumor (1 patient). Dose escalation was performed from 10(9) plaque forming units (PFU)/dose (total dose of 5 x 10(9) PFU/cycle) to 10(10) PFU/dose (total dose of 5 x 10(10) PFU/cycle) without dose-limiting toxicity being encountered. Immunohistochemistry of the metastatic lesions prior to treatment showed that five out of six patients were positive for p53, while two patients also had mdm-2 overexpression. Adenoviral replication was detected in two out of six patient biopsies on day 5 of the first cycle, by in situ hybridization (ISH). Both patients were treated at the highest dose level. ONYX-015 viral DNA was detected by quantitative PCR in the plasma of 5/6 patients on day 5 of the first cycle, and up to day 12 (7 days after the last viral dose) in one patient who had extended sampling for viral kinetics performed, suggesting viral replication in sarcoma tissue. One patient with p53 mutation and MDM-2 amplification achieved a partial response to treatment that lasted 11 months. In conclusion, intratumoral administration of ONYX-015 in combination with MAP chemotherapy is well tolerated with no significant toxicity due to ONYX-015 being encountered. Detection of viral DNA in post treatment tumor specimens by ISH and detection of the ONYX-015 genome in the peripheral blood by quantitative PCR, up to 7 days after the last viral dose provide evidence for adenoviral replication. There was evidence of antitumor activity in one out of six patients. Further investigation of this approach in patients with recurrent sarcomas is warranted.
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Affiliation(s)
- E Galanis
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
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Dispenzieri A, Wiseman GA, Lacy MQ, Litzow MR, Anderson PM, Gastineau DA, Tefferi A, Inwards DJ, Micallef INM, Ansell SM, Porrata L, Elliott MA, Lust JA, Greipp PR, Rajkumar SV, Fonseca R, Witzig TE, Erlichman C, Sloan JA, Gertz MA. A phase I study of 153Sm-EDTMP with fixed high-dose melphalan as a peripheral blood stem cell conditioning regimen in patients with multiple myeloma. Leukemia 2004; 19:118-25. [PMID: 15526021 DOI: 10.1038/sj.leu.2403575] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite response rates of 30% after high-dose chemotherapy with autologous hematopoietic stem cell transplant, patients with multiple myeloma are not cured. 153Samarium ethylenediaminetetramethylenephosphonate (153Sm-EDTMP; Quadramet) is a short-range, beta-emitting therapeutic radiopharmaceutical with avid skeletal uptake. In total, 12 patients were treated with escalating doses of 153Sm-EDTMP (N=3/group; 6, 12, 19.8, and 30 mCi/kg) and a fixed dose of melphalan (200 mg/m(2)). No dose limiting toxicity was seen. To better standardize the marrow compartment radiation dose, the study was modified such that an additional six patients were treated at a targeted absorbed radiation dose to the red marrow of 40 Gy based on a trace labeled infusion 1 week prior to the therapy. Despite rapid elimination of unbound radiopharmaceutical via kidneys and bladder, no episodes of nephrotoxicity, hemorrhagic cystitis, or delayed radiation nephritis were observed with a median follow-up of 31 months (range 8.5-44). Median times to ANC>0.5 and platelet >20 x 10(6)/l were 12 and 11 days, respectively, with no graft failures. Overall response rate was 94% including seven very good partial responses and five complete responses. Addition of 153Sm EDTMP to melphalan conditioning appears to be safe, well-tolerated and worthy of further study.
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Affiliation(s)
- A Dispenzieri
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Bailey H, Mahoney M, Okuno S, Ettinger D, Maples W, Fracasso P, Erlichman C. 377 Tolerability and limited activity of perifosine in patients with advanced soft tissue sarcoma (STS): a multi-center phase 2 consortium (P2C) study. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80384-7] [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: 10/26/2022] Open
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40
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Rao RD, Reid JM, Goetz MP, Furth AF, Mandrekar SJ, Adjei AA, Ames MM, Safgren SL, Erlichman C, Pitot HC. Phase I trial of OSI-774 and CPT-11 in patients with advanced solid tumors. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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41
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Philip PA, Mahoney M, Thomas J, Pitot H, Donehower R, Kim G, Picus J, Fitch T, Geyer S, Erlichman C. Phase II Trial of erlotinib (OSI-774) in patients with hepatocellular or biliary cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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)
- P. A. Philip
- Karmanos Cancer Institute, Detroit, MI; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Jacksonville, FL; Washington School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ
| | - M. Mahoney
- Karmanos Cancer Institute, Detroit, MI; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Jacksonville, FL; Washington School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ
| | - J. Thomas
- Karmanos Cancer Institute, Detroit, MI; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Jacksonville, FL; Washington School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ
| | - H. Pitot
- Karmanos Cancer Institute, Detroit, MI; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Jacksonville, FL; Washington School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ
| | - R. Donehower
- Karmanos Cancer Institute, Detroit, MI; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Jacksonville, FL; Washington School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ
| | - G. Kim
- Karmanos Cancer Institute, Detroit, MI; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Jacksonville, FL; Washington School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ
| | - J. Picus
- Karmanos Cancer Institute, Detroit, MI; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Jacksonville, FL; Washington School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ
| | - T. Fitch
- Karmanos Cancer Institute, Detroit, MI; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Jacksonville, FL; Washington School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ
| | - S. Geyer
- Karmanos Cancer Institute, Detroit, MI; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Jacksonville, FL; Washington School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ
| | - C. Erlichman
- Karmanos Cancer Institute, Detroit, MI; Mayo Clinic, Rochester, MN; University of Wisconsin, Madison, WI; Johns Hopkins, Baltimore, MD; Mayo Clinic, Jacksonville, FL; Washington School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ
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Erlichman C, Toft D, Reid J, Goetz M, Ames M, Mandrekar S, Ajei A, McCollum A, Ivy P. A phase I trial of 17-allylamino-geldanamycin (17AAG) in patients with advanced cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3030] [Citation(s) in RCA: 4] [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)
- C. Erlichman
- Mayo Clinic in Rochester, Rochester, MN; National Cancer Institute/NIH, Rockville, MD
| | - D. Toft
- Mayo Clinic in Rochester, Rochester, MN; National Cancer Institute/NIH, Rockville, MD
| | - J. Reid
- Mayo Clinic in Rochester, Rochester, MN; National Cancer Institute/NIH, Rockville, MD
| | - M. Goetz
- Mayo Clinic in Rochester, Rochester, MN; National Cancer Institute/NIH, Rockville, MD
| | - M. Ames
- Mayo Clinic in Rochester, Rochester, MN; National Cancer Institute/NIH, Rockville, MD
| | - S. Mandrekar
- Mayo Clinic in Rochester, Rochester, MN; National Cancer Institute/NIH, Rockville, MD
| | - A. Ajei
- Mayo Clinic in Rochester, Rochester, MN; National Cancer Institute/NIH, Rockville, MD
| | - A. McCollum
- Mayo Clinic in Rochester, Rochester, MN; National Cancer Institute/NIH, Rockville, MD
| | - P. Ivy
- Mayo Clinic in Rochester, Rochester, MN; National Cancer Institute/NIH, Rockville, MD
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Geyer SM, Markovic SM, Fitch TR, Albertini MR, Maples WJ, Fracasso PM, Erlichman C. Phase 2 study of PS-341 (bortezomib) in the treatment of metastatic malignant melanoma (MMM). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- S. M. Geyer
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; University of Wisconsin, Madison, WI; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO
| | - S. M. Markovic
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; University of Wisconsin, Madison, WI; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO
| | - T. R. Fitch
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; University of Wisconsin, Madison, WI; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO
| | - M. R. Albertini
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; University of Wisconsin, Madison, WI; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO
| | - W. J. Maples
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; University of Wisconsin, Madison, WI; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO
| | - P. M. Fracasso
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; University of Wisconsin, Madison, WI; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO
| | - C. Erlichman
- Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; University of Wisconsin, Madison, WI; Mayo Clinic, Jacksonville, FL; Washington University, St. Louis, MO
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Dy GK, Bruzek LM, Croghan GA, Mandrekar S, Peethambaram P, Hanson LJ, Erlichman C, Cheng S. A phase I trial of the farnesyltransferase (FT) inhibitor, BMS-214662 (B) in combination with paclitaxel (P) and carboplatin (C) in patients with advanced cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- G. K. Dy
- Mayo Clinic College of Medicine, Rochester, MN; Bristol-Myers Squibb, Wallingford, CT
| | - L. M. Bruzek
- Mayo Clinic College of Medicine, Rochester, MN; Bristol-Myers Squibb, Wallingford, CT
| | - G. A. Croghan
- Mayo Clinic College of Medicine, Rochester, MN; Bristol-Myers Squibb, Wallingford, CT
| | - S. Mandrekar
- Mayo Clinic College of Medicine, Rochester, MN; Bristol-Myers Squibb, Wallingford, CT
| | - P. Peethambaram
- Mayo Clinic College of Medicine, Rochester, MN; Bristol-Myers Squibb, Wallingford, CT
| | - L. J. Hanson
- Mayo Clinic College of Medicine, Rochester, MN; Bristol-Myers Squibb, Wallingford, CT
| | - C. Erlichman
- Mayo Clinic College of Medicine, Rochester, MN; Bristol-Myers Squibb, Wallingford, CT
| | - S. Cheng
- Mayo Clinic College of Medicine, Rochester, MN; Bristol-Myers Squibb, Wallingford, CT
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Haluska P, Toft DO, Steinmetz SM, Furth A, Mandrekar S, Stensgard BA, McCollum AK, Hanson LJ, Adjei AA, Erlichman C. A phase I trial of gemcitabine (Gem), 17-allylaminogeldanamycin (17-AAG) and cisplatin (CDDP) in solid tumor patients. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
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46
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Ansell SM, Geyer SM, Witzig TE, Jelinek DF, Kurtin PJ, Micallef INM, Stella P, Etzell P, Erlichman C, Novak AJ. NCCTG trial of concomitant or sequential IL-12 in combination with rituximab in previously treated non-Hodgkin lymphoma patients. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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47
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Atherton PJ, Jasperson BJ, Sloan JA, Mandrekar S, Smith DJ, Erlichman C, Adjei AA. A pooled analysis of demographic characteristics and clinical outcomes of phase I oncology clinical trials, the Mayo Clinic experience. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
BACKGROUND Heat shock protein 90 (Hsp90) is responsible for chaperoning proteins involved in cell signaling, proliferation and survival. 17-allylamino-17-demethoxygeldanamycin (17-AAG) is an anticancer agent currently in phase I trials in the USA and UK. It represents a class of drugs, the benzoquinone ansamycin antibiotics, capable of binding and disrupting the function of Hsp90, leading to the depletion of multiple oncogenic client proteins. MATERIALS AND METHODS Studies were identified through a PubMed search, review of bibliographies of relevant articles and review of abstracts from national meetings. RESULTS Preclinical studies have demonstrated that disruption of many client proteins chaperoned by Hsp90 is achievable and associated with significant growth inhibition, both in vitro and in tumor xenografts. Following an overview of the mechanism of action of ansamycin antibiotics and the pathways they disrupt, we review the current clinical status of 17-AAG, and discuss future directions for combinations of traditional antineoplastics with 17-AAG. CONCLUSIONS 17-AAG represents a class of drugs capable of affecting multiple targets in the signal transduction pathway involved in tumor cell proliferation and survival. Early results from phase I studies indicate that 17-AAG administration results in an acceptable toxicity profile while achieving in vivo disruption of client proteins.
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Affiliation(s)
- M P Goetz
- Division Medical Oncology, Department of Biochemistry, Mayo Graduate School, Rochester, MN 55905, USA
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49
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Goldberg RM, Kaufmann SH, Atherton P, Sloan JA, Adjei AA, Pitot HC, Alberts SR, Rubin J, Miller LL, Erlichman C. A phase I study of sequential irinotecan and 5-fluorouracil/leucovorin. Ann Oncol 2002; 13:1674-80. [PMID: 12377659 DOI: 10.1093/annonc/mdf260] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Irinotecan (CPT-11) and 5-fluorouracil (5-FU)/leucovorin are active agents in colorectal cancer. A sequence-dependent synergism of SN-38 followed by 5-FU/leucovorin in vitro led us to conduct a phase I trial of CPT-11 followed by 5-FU/leucovorin to determine the maximum tolerated dose (MTD) and toxicities of this regimen and to obtain preliminary indications of its activity in patients with advanced solid tumors. PATIENTS AND METHODS Fifty-six patients were enrolled in sequential cohorts to receive escalating doses of CPT-11 (90 min infusion) on day 1, followed by leucovorin 20 mg/m(2) (intravenous push) and 5-FU (90 min infusion) on days 2-5 of each 21-day cycle. RESULTS A total of 347 treatment cycles (median 4, range 1-25) were administered. Dose-limiting toxicities were diarrhea, neutropenia and fatigue. Nine patients with colorectal cancer and one with gastric cancer had partial or minor responses. Eight of the 10 had prior chemotherapy. CONCLUSIONS CPT-11 and 5-FU/leucovorin, as constituents of this novel mechanism-based schedule, have promising activity in patients who have received prior chemotherapy. The recommended phase II/III starting doses are CPT-11 275 mg/m(2) over 90 min on day 1, and 5-FU 400 mg/m(2) plus leucovorin 20 mg/m(2) on days 2-5 every 21 days. This combination can be administered safely to this schedule if there is strict adherence to the 90 min infusion time for both CPT-11 and 5-FU.
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Affiliation(s)
- R M Goldberg
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
PURPOSE We developed limited sampling models (LSMs) for predicting the area under the curve (AUC) of irinotecan (CPT-11) and its metabolites SN-38 and SN-38 glucuronide (SN-38G). PATIENTS AND METHODS Regression models were developed based on data from a phase I clinical trial involving 34 patients with advanced solid tumor malignancies who received CPT-11 as a 90-min infusion on an every 3-week dosing schedule. Multiple stepwise regression procedures were supplemented by all possible subsets regression analysis. Alternative clinically based and empirically derived LSMs were determined via model validation assessment including bootstrap simulation testing. RESULTS The best LSMs for CPT-11 AUC included concentrations recorded at the end of infusion and 4 h later with an option to include a blood draw at 7.5 h from infusion start. For SN-38 and SN-38G AUC, optimal LSMs included the additional metabolite concentration at 48 h after infusion. The LSMs were able to predict most patient AUC values to within 10% of the true value. CONCLUSION CPT-11 AUC can be modeled with acceptable accuracy using only two or three plasma concentration time-points. A variety of LSM alternatives provided comparable accuracy in predicting AUC. Given the wide variety of LSM alternatives, clinical considerations and patient burden become more important performance parameters than statistical considerations for the choice of time-points in constructing LSMs.
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Affiliation(s)
- J A Sloan
- Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
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