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Tan DSW, Lim KH, Tai WM, Ahmad A, Pan S, Ng QS, Ang MK, Gogna A, Ng YL, Tan BS, Lee HY, Krisna SS, Lau DPX, Zhong L, Iyer G, Chowbay B, Lim AST, Takano A, Lim WT, Tan EH. A phase Ib safety and tolerability study of a pan class I PI3K inhibitor buparlisib (BKM120) and gefitinib (gef) in EGFR TKI-resistant NSCLC. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.8107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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
8107 Background: Overcoming EGFR TKI resistance (R) is a major clinical challenge; reported mechanisms include EGFR T790M mutation (mt), MET amplification (amp) and PIK3CA mt. As the PI3K pathway is a central convergent signaling node, we hypothesized that addition of buparlisib (BKM) could overcome EGFR TKI-R. Methods: Patients (pt) resistant to EGFR TKI (Jackman JCO 2010) were enrolled to determine safety, tolerability, pharmacokinetics (PK) and pharmacodynamics of BKM-gef. Using a “3+3” design, escalating doses of BKM were added to pt progressing on gef (Gp A). Pt not on gef preceding enrolment received a 2 wk run in (Gp B). Given the favorable CNS penetration of BKM, a CNS gp with brain metastases only was included. Pt had pretreatment biopsies and sequential PET-CT scans (baseline & d28). Results: 15 pt have been treated at 3 dose levels: BKM 80 mg/d (n=6), 100 mg/d (n=6), 80 mg 5d on 2d off (5/2, n=3), with gef 250 mg/d. Gp A (n=9, 1 CNS), B (n=6, 1 CNS), F:M (9:6), median age 63 (47-73) and majority >3 lines of therapy. DLT was G3 diarrhea observed in 2/6 pt at BKM100. Common adverse events (AE, all grades) include rash (80%), diarrhea (73%), fatigue (60%), anorexia (47%), mucositis (40%). Notably, 40% of pt had late (beyond DLT period) G3 toxicities such as rash and diarrhea. MTD is BKM 80/d and gef 250/d. To improve the overall safety profile, an intermittent schedule of BKM80 5/2 was also found to be feasible. In gp B, PET-CT done after 2 wk run-in of gef, 3/4 evaluable pt demonstrated reduction in SUVmax of which 1 had PR. With addition of BKM, reduction in SUVmax (>25%) was seen in 4/10 pt (gp A & B). Median PFS 2.8 m (95%CI 2.3 – 8.1), two pt in CNS gp had PFS of 2.8 and 10.7 m. Molecular analyses revealed 6/12 (50%) harbored T790M mt, 2/5 (40%) MET amp, 0/12 PI3KCA mt. In gp A, 4/9 pt (2 T790M; 1 MET amp) had clinical responses, including slight tumor shrinkage and reduced pleural effusion, but required dose reductions due to AE. PK profiles are being analyzed. Conclusions: MTD is gef 250-BKM 80/d. Antitumor activity has been observed with addition of BKM in EGFR TKI-R pt. In view of late toxicities and long t½ of BKM, exploring alternative schedules is warranted. A dose expansion cohort at MTD is currently ongoing. Clinical trial information: NCT01570296.
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Affiliation(s)
| | - Kiat Hon Lim
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | | | - Aziah Ahmad
- Singhealth Investigational Medicine Unit, Singapore, Singapore
| | - Summer Pan
- National Cancer Centre, Singapore, Singapore
| | | | - Mei-Kim Ang
- National Cancer Centre, Singapore, Singapore
| | - Apoorva Gogna
- Department of Radiology, Singapore General Hospital, Singapore, Singapore
| | - Yuen Li Ng
- Department of Radiology, Singapore General Hospital, Singapore, Singapore
| | - Bien Soo Tan
- Department of Radiology, Singapore General Hospital, Singapore, Singapore
| | - Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | | | - Dawn PX Lau
- National Cancer Centre, Singapore, Singapore
| | - Liz Zhong
- National Cancer Centre, Singapore, Singapore
| | - Gopal Iyer
- National Cancer Centre, Singapore, Singapore
| | | | - Alvin ST Lim
- Cytogenetics Laboratory, Singapore General Hospital, Singapore, Singapore
| | - Angela Takano
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
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Chng CB, Lau DP, Choo JQ, Chui CK. A bioabsorbable microclip for laryngeal microsurgery: design and evaluation. Acta Biomater 2012; 8:2835-44. [PMID: 22487927 DOI: 10.1016/j.actbio.2012.03.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 03/26/2012] [Accepted: 03/29/2012] [Indexed: 11/19/2022]
Abstract
Epithelial flaps created during laryngeal microsurgery require apposition to facilitate proper healing. Current technologies are restricted by minimal access of the surgical site, posing various limitations in application. In this paper, we propose a novel magnesium-based bioabsorbable microclip, discuss our design considerations and evaluate the microclip's feasibility as a miniature wound closure device. Ex vivo experiments demonstrate that the microclip fastens securely to the vocal fold, while in vivo studies show bioabsorbability and a lack of adverse side effects, suggesting that the microclips are viable as implantable devices.
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Affiliation(s)
- C B Chng
- Department of Mechanical Engineering, National University of Singapore, Singapore
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Abstract
This paper focuses on the spectrum of sphenoid sinus lesions that may be seen radiologically and the mapping of disease extent. Imaging plays a central role in the assessment of sphenoid sinus disease. Although primary sphenoid sinus disease is uncommon, this sinus is nevertheless affected secondarily by a variety of pathological processes.
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Affiliation(s)
- V F Chong
- Department of Diagnostic Radiology, Singapore General Hospital, Republic of Singapore.
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Sethi DS, Lau DP, Chee LW, Chong V. Isolated sphenoethmoid recess polyps. J Laryngol Otol 1998; 112:660-3. [PMID: 9775300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Isolated sphenoethmoid recess (SER) polyps are rare. They usually arise from the sphenoid sinus. We report six patients with SER polyps as the only abnormal clinical finding at initial presentation. All cases were investigated with outpatient biopsy and computed tomography (CT) or magnetic resonance (MR) imaging. Pre-operative histology revealed three cases of inflammatory disease, two cases with inverted papilloma, and one case of an ectopic pituitary adenoma arising from the sphenoid sinus. One of the inflammatory polyps arose directly from the mucosa around the sphenoid ostium. The other five cases involved the sphenoid sinus. Except for the ectopic pituitary adenoma all the polyps were managed by transnasal endoscopic surgery. We emphasize that isolated SER polyps may signify existing sphenoid pathology and a pre-operative biopsy is valuable for planning surgery.
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Affiliation(s)
- D S Sethi
- Department of Otolaryngology, Singapore General Hospital, Singapore
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Abstract
Epithelial-myoepithelial carcinoma (EMC) accounts for approximately one per cent of salivary gland tumours. This tumour is gaining wider recognition following inclusion into the WHO histological classification of salivary gland tumours in 1990. Salivary gland tumours characteristically present with an enlarging mass. We describe an unusual presentation of a salivary gland tumour with stenosis of the external ear canal in the absence of a palpable mass. EMC usually arises from the salivary glands but isolated cases have been described arising primarily from the paranasal sinuses, trachea and lacrimal gland. The management of this tumour is still evolving with surgical excision being the main-stay of treatment. The efficacy of radiotherapy has not yet been established but high local recurrence rates despite apparently adequate excision and the possibility of a multicentric origin of the tumour may herald an increasing role for radiotherapy in the future. We stress the importance of awareness of adjacent structures when considering the cause of cartilaginous canal stenosis.
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Affiliation(s)
- D P Lau
- Department of Otolaryngology, Addenbrookes Hospital, Cambridge, UK
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