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Elf S, Lin R, Xia S, Pan Y, Shan C, Wu S, Lonial S, Gaddh M, Arellano ML, Khoury HJ, Khuri FR, Lee BH, Boggon TJ, Fan J, Chen J. Targeting 6-phosphogluconate dehydrogenase in the oxidative PPP sensitizes leukemia cells to antimalarial agent dihydroartemisinin. Oncogene 2016; 36:254-262. [PMID: 27270429 PMCID: PMC5464402 DOI: 10.1038/onc.2016.196] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 04/19/2016] [Accepted: 04/24/2016] [Indexed: 12/13/2022]
Abstract
The oxidative pentose phosphate pathway (PPP) is crucial for cancer cell metabolism and tumor growth. We recently reported that targeting a key oxidative PPP enzyme, 6-phosphogluconate dehydrogenase (6PGD), using our novel small molecule 6PGD inhibitors Physcion and its derivative S3, shows anti-cancer effects. Notably, humans with genetic deficiency of either 6PGD or another oxidative PPP enzyme, glucose-6-phosphate dehydrogenase (G6PD), exhibit non-immune hemolytic anemia upon exposure to aspirin and various anti-malarial drugs. Inspired by these clinical observations, we examined the anti-cancer potential of combined treatment with 6PGD inhibitors and anti-malarial drugs. We found that stable knockdown of 6PGD sensitizes leukemia cells to anti-malarial agent dihydroartemisinin (DHA). Combined treatment with DHA and Physcion activates AMP-activated protein kinase, leading to synergistic inhibition of human leukemia cell viability. Moreover, our combined therapy synergistically attenuates tumor growth in xenograft nude mice injected with human K562 leukemia cells and cell viability of primary leukemia cells from human patients, but shows minimal toxicity to normal hematopoietic cells in mice as well as red blood cells and mononucleocytes from healthy human donors. Our findings reveal the potential for combined therapy using optimized doses of Physcion and DHA as a novel anti-leukemia treatment without inducing hemolysis.
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Affiliation(s)
- S Elf
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - R Lin
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - S Xia
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - Y Pan
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - C Shan
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - S Wu
- Department of Chemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - S Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - M Gaddh
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - M L Arellano
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - H J Khoury
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - F R Khuri
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - B H Lee
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - T J Boggon
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT, USA
| | - J Fan
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - J Chen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory, Emory University School of Medicine, Atlanta, GA, USA
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Alesi GN, Jin L, Li D, Magliocca KR, Kang Y, Chen ZG, Shin DM, Khuri FR, Kang S. RSK2 signals through stathmin to promote microtubule dynamics and tumor metastasis. Oncogene 2016; 35:5412-5421. [PMID: 27041561 DOI: 10.1038/onc.2016.79] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 02/01/2016] [Accepted: 02/13/2016] [Indexed: 12/16/2022]
Abstract
Metastasis is responsible for >90% of cancer-related deaths. Complex signaling in cancer cells orchestrates the progression from a primary to a metastatic cancer. However, the mechanisms of these cellular changes remain elusive. We previously demonstrated that p90 ribosomal S6 kinase 2 (RSK2) promotes tumor metastasis. Here we investigated the role of RSK2 in the regulation of microtubule dynamics and its potential implication in cancer cell invasion and tumor metastasis. Stable knockdown of RSK2 disrupted microtubule stability and decreased phosphorylation of stathmin, a microtubule-destabilizing protein, at serine 16 in metastatic human cancer cells. We found that RSK2 directly binds and phosphorylates stathmin at the leading edge of cancer cells. Phosphorylation of stathmin by RSK2 reduced stathmin-mediated microtubule depolymerization. Moreover, overexpression of phospho-mimetic mutant stathmin S16D significantly rescued the decreased invasive and metastatic potential mediated by RSK2 knockdown in vitro and in vivo. Furthermore, stathmin phosphorylation positively correlated with RSK2 expression and metastatic cancer progression in primary patient tumor samples. Our finding demonstrates that RSK2 directly phosphorylates stathmin and regulates microtubule polymerization to provide a pro-invasive and pro-metastatic advantage to cancer cells. Therefore, the RSK2-stathmin pathway represents a promising therapeutic target and a prognostic marker for metastatic human cancers.
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Affiliation(s)
- G N Alesi
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - L Jin
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - D Li
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - K R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Y Kang
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - Z G Chen
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - D M Shin
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - F R Khuri
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - S Kang
- Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Li S, Oh YT, Yue P, Khuri FR, Sun SY. Inhibition of mTOR complex 2 induces GSK3/FBXW7-dependent degradation of sterol regulatory element-binding protein 1 (SREBP1) and suppresses lipogenesis in cancer cells. Oncogene 2015; 35:642-50. [PMID: 25893295 PMCID: PMC4615269 DOI: 10.1038/onc.2015.123] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 03/05/2015] [Accepted: 03/20/2015] [Indexed: 01/01/2023]
Abstract
Cancer cells feature increased de novo lipogenesis. Sterol regulatory element-binding protein 1 (SREBP1), when presented in its mature form (mSREBP1), enhances lipogenesis through increasing transcription of several of its target genes. Mammalian target of rapamycin (mTOR) complexes, mTORC1 and mTORC2, are master regulators of cellular survival, growth and metabolism. A role for mTORC1 in the regulation of SREBP1 activity has been suggested; however the connection between mTORC2 and SREBP1 has not been clearly established and hence is the focus of this study. mTOR kinase inhibitors (e.g., INK128), which inhibit both mTORC1 and mTORC2, decreased mSREBP1 levels in various cancer cell lines. Knockdown of rictor, but not raptor, also decreased mSREBP1. Consistently, reduced mSREBP1 levels were detected in cells deficient in rictor or Sin1 compared to parent or rictor-deficient cells with re-expression of ectopic rictor. Hence it is mTORC2 inhibition that causes mSREBP1 reduction. As a result, expression of the mSREBP1 target genes acetyl-CoA carboxylase and fatty acid synthase was suppressed, accompanied with suppressed lipogenesis in cells exposed to INK128. Moreover, mSREBP1 stability was reduced in cells treated with INK128 or rictor knockdown. Inhibition of proteasome, GSK3 or the E3 ubiquitin ligase, FBXW7, prevented mSREBP1 reduction induced by mTORC2 inhibition. Thus mTORC2 inhibition clearly facilitates GSK3-dependent, FBXW7-mediated mSREBP1 degradation, leading to mSREBP1 reduction. Accordingly, we conclude that mTORC2 positively regulates mSREBP1 stability and lipogenesis. Our findings reveal a novel biological function of mTORC2 in the regulation of lipogenesis and warrant further study in this direction.
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Affiliation(s)
- S Li
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA.,Department of Biochemistry and Molecular Biology, Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China
| | - Y-T Oh
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA
| | - P Yue
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA
| | - F R Khuri
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA
| | - S-Y Sun
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA
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Wang B, Xie M, Li R, Owonikoko TK, Ramalingam SS, Khuri FR, Curran WJ, Wang Y, Deng X. Role of Ku70 in deubiquitination of Mcl-1 and suppression of apoptosis. Cell Death Differ 2014; 21:1160-9. [PMID: 24769731 DOI: 10.1038/cdd.2014.42] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 02/17/2014] [Accepted: 03/06/2014] [Indexed: 01/12/2023] Open
Abstract
Mcl-1 is a unique antiapoptotic Bcl2 family member with a short half-life due to its rapid turnover through ubiquitination. We discovered that Ku70, a DNA double-strand break repair protein, functions as a deubiquitinase to stabilize Mcl-1. Ku70 knockout in mouse embryonic fibroblast (MEF) cells or depletion from human lung cancer H1299 cells leads to the accumulation of polyubiquitinated Mcl-1 and a reduction in its half-life and protein expression. Conversely, expression of exogenous Ku70 in Ku70(-/-) MEF cells restores Mcl-1 expression. Subcellular fractionation indicates that Ku70 extensively colocalizes with Mcl-1 in mitochondria, endoplasmic reticulum and nucleus in H1299 cells. Ku70 directly interacts with Mcl-1 via its C terminus (that is, aa 536-609), which is required and sufficient for deubiquitination and stabilization of Mcl-1, leading to suppression of apoptosis. Purified Ku70 protein directly deubiquitinates Mcl-1 by removing K48-linked polyubiquitin chains. Ku70 knockdown not only promotes Mcl-1 turnover but also enhances antitumor efficacy of the BH3-mimetic ABT-737 in human lung cancer xenografts. These findings identify Ku70 as a novel Mcl-1 deubiquitinase that could be a potential target for cancer therapy by manipulating Mcl-1 deubiquitination.
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Affiliation(s)
- B Wang
- Division of Cancer Biology, Department of Radiation Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - M Xie
- Division of Cancer Biology, Department of Radiation Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - R Li
- Division of Cancer Biology, Department of Radiation Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - T K Owonikoko
- Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - S S Ramalingam
- Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - F R Khuri
- Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - W J Curran
- Division of Cancer Biology, Department of Radiation Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Y Wang
- Division of Cancer Biology, Department of Radiation Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - X Deng
- Division of Cancer Biology, Department of Radiation Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
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Harvey RD, Owonikoko TK, Lewis CM, Akintayo A, Chen Z, Tighiouart M, Ramalingam SS, Fanucchi MP, Nadella P, Rogatko A, Shin DM, El-Rayes B, Khuri FR, Kauh JS. A phase 1 Bayesian dose selection study of bortezomib and sunitinib in patients with refractory solid tumor malignancies. Br J Cancer 2013; 108:762-5. [PMID: 23322195 PMCID: PMC3590658 DOI: 10.1038/bjc.2012.604] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This phase 1 trial utilising a Bayesian continual reassessment method evaluated bortezomib and sunitinib to determine the maximum tolerated dose (MTD), dose-limiting toxicities (DLT), and recommended doses of the combination. METHODS Patients with advanced solid organ malignancies were enrolled and received bortezomib weekly with sunitinib daily for 4 weeks, every 6 weeks. Initial doses were sunitinib 25 mg and bortezomib 1 mg m(-2). Cohort size and dose level estimation was performed utilising the Escalation with Overdose Control (EWOC) adaptive method. Seven dose levels were evaluated; initially, sunitinib was increased to a goal dose of 50 mg with fixed bortezomib, then bortezomib was increased. Efficacy assessment occurred after each cycle using RECIST criteria. RESULTS Thirty patients were evaluable. During sunitinib escalation, DLTs of grade 4 thrombocytopenia (14%) and neutropenia (6%) at sunitinib 50 mg and bortezomib 1.3 mg m(-2) were seen. Subsequent experience showed tolerability and activity for sunitinib 37.5 mg and bortezomib 1.9 mg m(-2). Common grade 3/4 toxicities were neutropenia, thrombocytopenia, hypertension, and diarrhoea. The recommended doses for further study are bortezomib 1.9 mg m(-2) and sunitinib 37.5 mg. Four partial responses were seen. Stable disease >6 months was noted in an additional six patients. CONCLUSION Bortezomib and sunitinib are well tolerated and have anticancer activity, particularly in thyroid cancer. A phase 2 study of this combination in thyroid cancer patients is planned.
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Affiliation(s)
- R D Harvey
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.
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Kris MG, Johnson BE, Kwiatkowski DJ, Iafrate AJ, Wistuba II, Aronson SL, Engelman JA, Shyr Y, Khuri FR, Rudin CM, Garon EB, Pao W, Schiller JH, Haura EB, Shirai K, Giaccone G, Berry LD, Kugler K, Minna JD, Bunn PA. Identification of driver mutations in tumor specimens from 1,000 patients with lung adenocarcinoma: The NCI’s Lung Cancer Mutation Consortium (LCMC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.cra7506] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [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
CRA7506 Background: The ability to detect driver mutations like EGFR and EML4-ALK in tumor specimens from patients with lung cancer and administer agents targeting those molecular lesions has revolutionized the management of adenocarcinoma of the lung. The availability of multiplexed assays to detect mutations permits the identification of multiple driver mutations from tumors at diagnosis. The number of molecular lesions and new agents to target them continues to grow. To exploit this, we created the LCMC to determine 10 driver mutations in tumors from 1,000 patients and to give the results to clinicians for care and entry onto targeted therapeutic trials based on these findings. Methods: The 14 member LCMC is prospectively enrolling patients to test tumors from patients with lung adenocarcinoma in CLIA laboratories for KRAS, EGFR, HER2, BRAF, PIK3CA, AKT1, MEK1, and NRAS using standard multiplexed assays and fluorescence in situ hybridization (FISH) for ALK rearrangements and MET amplifications. All are stage IIIB/IV, PS 0-2, have available tissue, and signed consent. Results: 830 patients have been registered with 50 enrolling monthly. We detected a driver mutation in 60% (252/422, 95% CI 55 to 65%) of tumors thus far. Mutations found: KRAS 107 (25%, 95% CI 21 to 30%), EGFR 98 (23%, 95% CI 19 to 27%), ALK rearrangements 14 (6%, 95% CI 4 to11%), BRAF 12 (3%, 95% CI 1 to 5%), PIK3CA 11 (3%, 95% CI 1 to 5%), MET amplifications 4 (2%, 95% CI 0.5 to 5%), HER2 3, (1%, 95% CI 0.1 to 2%), MEK1 2 (0.4%, 95% CI 0.1 to 2%), NRAS 1 (0.2%, 95% CI 0.01 to 1%), AKT1 0 (0%, 95% CI 0 to 1%). 95% of molecular lesions were mutually exclusive. Conclusions: We detected an actionable driver mutation in 60% of tumors from prospectively studied patients with lung adenocarcinoma. Results of EGFR mutation testing are given to treating physicians to select erlotinib as initial treatment per NCCN and ASCO guidelines. Patients with other driver mutations are offered participation in LCMC-linked trials of agents targeting the mutation identified, e.g. crizotinib with EML4-ALK. At half of LCMC sites, multiplexed testing for all mutations is now routine practice in their pathology departments. Supported by 1RC2CA148394-01.
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Affiliation(s)
- M. G. Kris
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - B. E. Johnson
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - D. J. Kwiatkowski
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - A. J. Iafrate
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - I. I. Wistuba
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - S. L. Aronson
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - J. A. Engelman
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - Y. Shyr
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - F. R. Khuri
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - C. M. Rudin
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - E. B. Garon
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - W. Pao
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - J. H. Schiller
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - E. B. Haura
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - K. Shirai
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - G. Giaccone
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - L. D. Berry
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - K. Kugler
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - J. D. Minna
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
| | - P. A. Bunn
- Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA; University of Texas M. D. Anderson Cancer Center, Houston, TX; Partners Health Cancer Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Winship Cancer Institute of Emory University, Atlanta, GA; The Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; David
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Ellington CL, Kono SA, Owonikoko TK, Ramalingam SS, Khuri FR, Shin DM, Saba NF. Adenoid cystic carcinoma of the head and neck (ACCHN) incidence and survival trends. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5580] [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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Pentz RD, Farmer ZL, Green MJ, Daugherty C, Hlubocky FJ, Peterson SK, Sun CC, Lewis CM, Owonikoko TK, Khuri FR, Harvey RD. Assessing patients’ values when standard-of-care options are exhausted. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9108] [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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Behera M, Owonikoko TK, Chen Z, Kono SA, Khuri FR, Belani CP, Ramalingam SS. Single-agent maintenance therapy for advanced-stage non-small cell lung cancer: A meta-analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7553] [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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10
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Owonikoko TK, Behera M, Tran HN, Chen Z, Chowdry RP, Saba NF, Ramalingam SS, Khuri FR. Systematic comparative analysis of efficacy of EGFR tyrosine kinase inhibitors (TKIs) in the frontline versus salvage therapy of NSCLC. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7602] [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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11
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Kris MG, Johnson BE, Kwiatkowski DJ, Iafrate AJ, Wistuba II, Aronson SL, Engelman JA, Shyr Y, Khuri FR, Rudin CM, Garon EB, Pao W, Schiller JH, Haura EB, Shirai K, Giaccone G, Berry LD, Kugler K, Minna JD, Bunn PA. Identification of driver mutations in tumor specimens from 1,000 patients with lung adenocarcinoma: The NCI’s Lung Cancer Mutation Consortium (LCMC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.cra7506] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Sosa JA, Elisei R, Jarzab B, Bal CS, Koussis H, Gramza AW, Ben-Yosef R, Gitlitz BJ, Haugen B, Karandikar SM, Khuri FR, Licitra LF, Remick SC, Marur S, Lu C, Ondrey FG, Lu S, Balkissoon J. A randomized phase II/III trial of a tumor vascular disrupting agent fosbretabulin tromethamine (CA4P) with carboplatin (C) and paclitaxel (P) in anaplastic thyroid cancer (ATC): Final survival analysis for the FACT trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5502] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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13
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Chowdry RP, Bhimani C, Ramalingam SS, Khuri FR, Owonikoko TK. Salvage tyrosine kinase inhibitor therapy for differentiated and medullary thyroid cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e16036] [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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14
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Hossain S, Bhimani C, Chen Z, Ramalingam SS, Shin DM, Cohen C, Khuri FR, Waller E, Owonikoko TK. Comparison of native and adaptive immunity profiles of healthy volunteers and patients with well-differentiated thyroid cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5585] [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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15
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Saba NF, Kim HM, El-Rayes BF, Kono SA, Ramalingam SS, Owonikoko TK, Landry JC, Miller DL, Shin DM, Khuri FR, Goodman M. Survival outcomes of nonoperative therapy (NOT) alone versus NOT followed by surgery (NOTS) in patients with esophageal cancer (EC): SEER analysis 2000-2007. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14569] [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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16
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Khuri FR, Owonikoko TK, Subramanian J, Sica G, Behera M, Saba NF, Chen Z, Tighiouart M, Shin DM, Sun S, Fu R, Gal A, Govindan R, Ramalingam SS. Everolimus, an mTOR inhibitor, in combination with docetaxel for second- or third-line therapy of advanced-stage non-small cell lung cancer: A phase II study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13601] [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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17
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Campbell A, Reckamp KL, Camidge DR, Giaccone G, Gadgeel SM, Khuri FR, Engelman JA, Denis LJ, O'Connell JP, Janne PA. PF-00299804 (PF299) patient (pt)-reported outcomes (PROs) and efficacy in adenocarcinoma (adeno) and nonadeno non-small cell lung cancer (NSCLC): A phase (P) II trial in advanced NSCLC after failure of chemotherapy (CT) and erlotinib (E). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7596] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [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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Pakkala S, Chen Z, Rimland D, Owonikoko TK, Gunthel C, Brandes JC, Saba NF, Curran WJ, Khuri FR, Ramalingam SS. HIV-associated lung cancer in the era of highly active antiretroviral therapy (HAART): Correlation between CD4 count and outcome. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7632] [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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19
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Kauh JS, Harvey RD, Lawson DH, Owonikoko TK, Tighiouart M, Ramalingam SS, Shin DM, Lewis CM, El-Rayes BF, Khuri FR. Phase IB dose escalation study of bortezomib and sunitinib in patients with refractory solid tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2538] [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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20
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Harvey RD, Kauh JS, Ramalingam SS, Lewis CM, Chen Z, Lonial S, Blount IC, Shin DM, Khuri FR, Owonikoko TK. Combination therapy with sunitinib and bortezomib in adult patients with radioiodine refractory thyroid cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5589] [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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21
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Haddad RI, Tishler RB, Adkins D, Khuri FR, Clark J, Lorch JH, Wirth LJ, Sarlis NJ, Jaffa Z, Posner MR. The PARADIGM trial: A phase III study comparing sequential therapy (ST) to concurrent chemoradiotherapy (CRT) in locally advanced head and neck cancer (LAHNC): Preliminary toxicity report. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5563] [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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22
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Owonikoko TK, Ramalingam SS, Behera M, Brandes JC, Saba NF, Bhimani C, Harichand-Herdt S, Shin DM, Khuri FR, Ragin C. Survival impact of newly approved therapeutic agents in patients with advanced non-small cell lung cancer (NSCLC): A SEER-Medicare database analysis. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7633] [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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23
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Saba NF, Muller S, Chen AY, Grist W, Gibson K, Nannapaneni S, Yang CS, Khuri FR, Chen ZG, Shin DM. Chemoprevention with erlotinib and celecoxib in advanced premalignant lesions of the head and neck: Results of a phase I study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5535] [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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24
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Cockrell LM, Puckett MC, Goldman EH, Khuri FR, Fu H. Dual engagement of 14-3-3 proteins controls signal relay from ASK2 to the ASK1 signalosome. Oncogene 2009; 29:822-30. [PMID: 19935702 DOI: 10.1038/onc.2009.382] [Citation(s) in RCA: 30] [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: 12/24/2022]
Abstract
Faithful and efficient transmission of biological signals through mitogen-activated protein kinase (MAPK) pathways requires engagement of highly regulated cellular machinery in response to diverse environmental cues. Here, we report a novel mechanism controlling signal relay between two MAP3Ks, apoptosis signal-regulating kinase (ASK) 1 and ASK2. We show that ASK2 specifically interacts with 14-3-3 proteins through phosphorylated S964. Although a 14-3-3-binding defective mutant of ASK1 (S967A) has no effect on the ASK2/14-3-3 interaction, both overexpression of the analogous ASK2 (S964A) mutant and knockdown of ASK2 dramatically reduced the amount of ASK1 complexed with 14-3-3. These data suggest a dominant role of ASK2 in 14-3-3 control of ASK1 function. Indeed, ASK2 S964A-induced dissociation of 14-3-3 from ASK1 correlated with enhanced phosphorylation of ASK1 at T838 and increased c-Jun N-terminal kinase phosphorylation, the two biological readouts of ASK1 activation. Our results suggest a model in which upstream signals couple ASK2 S964 phosphorylation to the ASK1 signalosome through dual engagement of 14-3-3.
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Affiliation(s)
- L M Cockrell
- Program in Molecular and Systems Pharmacology of the Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA 30322, USA
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25
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Khuri FR, Harvey RD, Saba NF, Owonikoko TK, Kauh J, Shin DM, Sun SY, Browning KM, Tighiouart M, Ramalingam SS. Everolimus, an mTOR inhibitor, in combination with docetaxel for recurrent/refractory NSCLC: A phase I study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8060] [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
8060 Background: The mammalian target of rapamycin (mTOR) pathway is a key cell-signaling cascade that is aberrantly activated in non-small cell lung cancer (NSCLC). Everolimus (E), an mTOR inhibitor, is active as monotherapy for advanced NSCLC. Based on preclinical synergy between everolimus and docetaxel (D), we conducted a phase I and feasibility study with the combination. Methods: Patients with stage IIIB/IV NSCLC, progression following prior platinum-based chemotherapy and ECOG performance status (PS) of 0–2 were eligible. Sequential cohorts of patients were treated with increasing doses of D (day 1) and E (PO QD, days 1–19). Treatment cycles (C) were repeated every 3 weeks. A standard ‘up and down’ dose escalation scheme was utilized. The primary endpoint was determination of optimal dose of the two agents that can be administered in combination. Results: Twenty three patients were enrolled. Median age - 62 yrs; Females- 11; ECOG PS: 0–6; 1 -16; # of prior regimens: 1–12, 2–6, ≥3 -5. At dose level 1 (D- 60 mg/m2, E- 5mg), none of 6 patients had DLT. Four out of 12 patients at dose level 2 (D-75 mg/m2, E-5 mg) had fever with gr 3/4 neutropenia during cycle 1. At dose level 3 (D- 75 mg/m2, E- 7.5 mg), 2 of 3 pts had DLT (fever with neutropenia and grade 3 mucositis). Pharmacokinetic (PK) sampling was performed on days 1 (n=14), 8 (n=9), and 15 (n=10) of cycle 1. Mean E half-life (hr) on days 1, 8, and 15 were 9.66 (2–14), 12.6 (2.2–21.1), and 14.8 (2–21.2), respectively. E accumulation occurred and was greater than expected. In contrast to the mean predicted accumulation factor (R) based on AUC of 1.22 (1–1.44), actual R on day 8 and 15 were 1.78 (0.72–3.17) and 1.88 (0.37–3.3) respectively. Among 20 pts. evaluable for response, 1 had a partial response and 10 had disease stabilization. Six patients completed 6 cycles of combination therapy and continued on E as maintenance. Conclusions: The recommended doses of docetaxel and everolimus that can be administered as a combination are 60 mg/m2 and 5 mg PO QD respectively. The PK characteristics of everolimus appear unaffected by co-administration with docetaxel. Promising anti-cancer activity was noted with clinical benefit in 55% of the pts. A phase II study has been initiated with the combination in refractory NSCLC. Supported by NCI 5 P01 CA116676. [Table: see text]
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Affiliation(s)
| | | | | | | | - J. Kauh
- Emory University, Atlanta, GA
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26
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Saba NF, Gaultney J, Edelman S, Tighiouart M, Davis LW, Khuri FR, Chen A, Grist W, Shin DM. Concurrent platinum-based chemotherapy with intensity modulated radiation therapy (IMRT) for locally advanced squamous cell carcinoma of the head and neck (SCCHN): A retrospective single institution analysis. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.16511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16511 Background: Randomized clinical and meta-analysis data support the use of concurrent chemoradiation for treatment of locally advanced (SCCHN). IMRT is increasingly being used in treating SCCHN. We present outcome data from Emory University Winship Cancer Institute (WCI) with concurrent platinum based chemotherapy and IMRT, and analyze results according to primary site and nodal status. Methods: Between February 2003, and November 2005, 87 patients with locally advanced SCCHN underwent concurrent IMRT and platinum based chemotherapy. A total of 62 patients were treated with Cisplatin 100 mg/m2 d1,21,43, while 19 were treated with paclitaxel and carboplatin weekly for 7 weeks. Five patients were treated with other platinum based regimens. Follow up was documented in all cases with a median of 520 days (range 107 - 1269 days). Results: Patients were distributed among primary sites as follows: Hypopharynx (HP) 7 (8.0%), Larynx (L) 11(12.4%), Nasopharynx (NP) 13 (14.6%), and Oropharynx (OP) 56 (63.0%). T stage distribution was: T1: 16 patients (18.0%); lesions more advanced than T1 (>T1): 68 (76.4%). N stage distribution was, N0 :16 patients (18.0%), N1: 8 (9.0 %),nodal stage N2a or higher: 61 (68.5%). Median age was 57 years (range 32–75), and 63 patients (71.0%) were male. The median overall survival (OS) and disease-free survival (DFS) post-therapy was not reached. The 3 year OS rate for the entire cohort was 86% (L 82%, NP 89 %, OP 86 % HP 80%). The 3 year DFS rate for the entire cohort was 74%, (L 85%, NP 60%, and OP 75%, HP 76%). There was no correlation between OS and T or N stage (p=0.143 and 0.44 respectively), or between DFS and T-stage (p=0.4). A significant correlation was found between DFS and N stage (p=0.008). Conclusion: With moderate follow up, this retrospective analysis reveals an excellent outcome for patients with locally advanced SCCHN treated with chemotherapy and IMRT concurrently, supporting concurrent therapy as the current standard of care. The significant correlation of DFS and nodal status suggests a possible greater impact future approaches such as induction therapy may have on patients with advanced nodal disease. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | | | | | | | - A. Chen
- Emory University, Atlanta, GA
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27
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Kim KB, Faderl S, Hwang CS, Khuri FR. Chronic myelomonocytic leukaemia after platinum-based therapy for non-small cell lung cancer: case report and review of the literature. J Clin Pharm Ther 2006; 31:401-6. [PMID: 16882113 DOI: 10.1111/j.1365-2710.2006.00748.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic myelomonocytic leukaemia (CMML) is a preleukaemic condition with myeloproliferative features, and classified as a part of myelodysplastic syndrome (MDS). Other than alkylating agents and topoisomerase II inhibitors, there is less evidence that chemotherapeutic drugs are associated with therapy-related CMML, acute leukaemia or MDS. We present a patient who developed CMML within 2 years of platinum-based chemotherapy for a metastatic non-small cell lung cancer. He received a cumulative dose of 240 mg/m(2) of cisplatin, and 1123 mg/m(2) of carboplatin before developing CMML. The cytogenetic study revealed trisomy 8. This is the first reported case that links platinum-based therapy with development of CMML with trisomy 8. Although the relationship between platinum therapy and the development of CMML is difficult to assess due to combinational nature of therapy in most cases, physicians should consider the possibility of CMML in patients with symptoms or signs suggestive of haematologic malignancy after platinum therapy.
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Affiliation(s)
- K B Kim
- Department of Melanoma Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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28
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Klass CM, Chen ZG, Zhang X, Lonial S, Khuri FR, Shin DM. Antitumor effects of combined bortezomib and tipifarnib in head and neck squamous cell carcinoma (HNSCC) cells. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
5581 Background: The dysregulation of the NF-κB and Ras/PI3K/AKT pathways in HNSCC supports our hypothesis that combined treatment with the proteasome inhibitor (PI) bortezomib (B) and the farnesyl transferase inhibitor (FTI) tipifarnib (T) leads to synergistic growth inhibition of HNSCC cells. Methods: Growth inhibitory effects of single agents (B 2.5–100 nM; T 0.625–5μM), combination (B+T) (B 12.5–17.5 nM; T 0.625–5 μM) or sequential treatment (B→T after 2h or T→B) were examined in three HNSCC lines (Tu212, 686LN and Sqcc/Y1) using a sulforrhodamine B assay after 72 h of drug exposure. Combination effect in cells treated concomitantly or sequentially was assessed using the combination index (C.I.: < 1.0, synergy; >1.0, antagonism; ≈1.0, additivity). Apoptosis was measured by flow cytometry. Relevant protein markers were evaluated by Western blot. Cell cycle analysis after flow cytometry used FlowJo software. Statistical analysis was done using a two-sided t-test. Results: Growth inhibition by B alone is very effective in all three lines (IC50 = 9–22nM). T used alone is active only in μM range (IC50 = 0.625–5 μM). The inhibitory effects of B and T were sequence dependent. Simultaneous treatment with 12.5 nM B and 5μM T showed synergistic growth inhibition in all 3 lines [C.I., 0.281–0.54]. B→T showed synergistic effects in all three cell lines [C.I., 0.36–0.76]. However, T→B was less synergistic in two of the three lines [Sqcc/Y1 C.I. = 0.404; Tu212 C.I. = 0.748]. Apoptosis was also sequence dependent with B+T or B→T treatment showing significantly more apoptosis than T→B (p = 0.03). Apoptosis induced by T→B was not different from treatment with single agent B (p = 0.22). Sqcc/Y1 cells treated with B and T showed accumulation in G2M phase and an increased percentage of cells in sub-G1. The observed synergistic inhibitory effect of B+T was associated with downregulation of p-AKT. Conclusions: We conclude that treatment with B+T and B→T synergistically enhances HNSCC growth inhibition and results in both significantly increased apoptosis and G2M arrest. These studies strongly support the clinical development of the sequential combination of a PI and a FTI. (Supported by Millenium Pharm. and the Georgia Cancer Coalition). [Table: see text]
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Affiliation(s)
| | | | - X. Zhang
- Winship Cancer Institute, Atlanta, GA
| | - S. Lonial
- Winship Cancer Institute, Atlanta, GA
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29
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Zhang X, Choe MS, Lee JE, Muller S, Tighiouart M, Rogatko A, Glisson BS, Chen Z, Khuri FR, Shin DM. GRIM-19 expression and its correlation with clinical outcomes of an induction chemotherapy for patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5519] [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)
- X. Zhang
- Winship Cancer Institute, Emory Univ, Atlanta, GA; Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - M. S. Choe
- Winship Cancer Institute, Emory Univ, Atlanta, GA; Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - J. E. Lee
- Winship Cancer Institute, Emory Univ, Atlanta, GA; Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - S. Muller
- Winship Cancer Institute, Emory Univ, Atlanta, GA; Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - M. Tighiouart
- Winship Cancer Institute, Emory Univ, Atlanta, GA; Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - A. Rogatko
- Winship Cancer Institute, Emory Univ, Atlanta, GA; Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - B. S. Glisson
- Winship Cancer Institute, Emory Univ, Atlanta, GA; Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - Z. Chen
- Winship Cancer Institute, Emory Univ, Atlanta, GA; Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - F. R. Khuri
- Winship Cancer Institute, Emory Univ, Atlanta, GA; Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - D. M. Shin
- Winship Cancer Institute, Emory Univ, Atlanta, GA; Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
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Yang CH, Kies MS, Glisson B, Burke BJ, Ginsberg LE, Truong MT, Sugrue MM, Hong WK, Khuri FR, Kim ES. A phase II study of lonafarnib (SCH66336) in patients with chemo-refractory advanced head and neck squamous cell carcinoma (HNSCC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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. H. Yang
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - M. S. Kies
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - B. Glisson
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - B. J. Burke
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - L. E. Ginsberg
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - M. T. Truong
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - M. M. Sugrue
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - W. K. Hong
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - F. R. Khuri
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
| | - E. S. Kim
- Univ of Texas MD Anderson Cancer Ctr, Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Winship Cancer Institute of Emory Univ, Atlanta, GA
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Choe MS, Tighiouart M, Rogatko A, Muller S, Shin HJ, Francisco M, Papadimitrakopoulou VA, Khuri FR, Hong WK, Chen Z, Shin DM. Role of cyclooxygenase-2 (COX-2) expression in tumor progression and survival in the squamous cell carcinoma of the head and neck (HNSCC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5508] [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)
- M. S. Choe
- Emory University, Winship Cancer Inst, Atlanta, GA; Univ of Texas, M. D. Anderson Cancer Ctr, Houston, TX
| | - M. Tighiouart
- Emory University, Winship Cancer Inst, Atlanta, GA; Univ of Texas, M. D. Anderson Cancer Ctr, Houston, TX
| | - A. Rogatko
- Emory University, Winship Cancer Inst, Atlanta, GA; Univ of Texas, M. D. Anderson Cancer Ctr, Houston, TX
| | - S. Muller
- Emory University, Winship Cancer Inst, Atlanta, GA; Univ of Texas, M. D. Anderson Cancer Ctr, Houston, TX
| | - H. J. Shin
- Emory University, Winship Cancer Inst, Atlanta, GA; Univ of Texas, M. D. Anderson Cancer Ctr, Houston, TX
| | - M. Francisco
- Emory University, Winship Cancer Inst, Atlanta, GA; Univ of Texas, M. D. Anderson Cancer Ctr, Houston, TX
| | - V. A. Papadimitrakopoulou
- Emory University, Winship Cancer Inst, Atlanta, GA; Univ of Texas, M. D. Anderson Cancer Ctr, Houston, TX
| | - F. R. Khuri
- Emory University, Winship Cancer Inst, Atlanta, GA; Univ of Texas, M. D. Anderson Cancer Ctr, Houston, TX
| | - W. K. Hong
- Emory University, Winship Cancer Inst, Atlanta, GA; Univ of Texas, M. D. Anderson Cancer Ctr, Houston, TX
| | - Z. Chen
- Emory University, Winship Cancer Inst, Atlanta, GA; Univ of Texas, M. D. Anderson Cancer Ctr, Houston, TX
| | - D. M. Shin
- Emory University, Winship Cancer Inst, Atlanta, GA; Univ of Texas, M. D. Anderson Cancer Ctr, Houston, TX
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Heymach JV, Johnson DH, Khuri FR, Safran H, Schlabach LL, Yunus F, DeVore RF, De Porre PM, Richards HM, Jia X, Zhang S, Johnson BE. Phase II study of the farnesyl transferase inhibitor R115777 in patients with sensitive relapse small-cell lung cancer. Ann Oncol 2004; 15:1187-93. [PMID: 15277257 DOI: 10.1093/annonc/mdh315] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND R115777 (tipifarnib, Zarnestra) is a farnesyl transferase inhibitor that blocks the farnesylation of proteins involved in signal transduction pathways critical for cell proliferation and survival. This multicenter phase II study was conducted to determine the efficacy, tolerability and pharmacokinetics of R115777 in patients with relapsed small-cell lung cancer (SCLC). PATIENTS AND METHODS Patients who had a partial or complete response to their initial chemotherapy regimen, followed by at least 3 months off treatment before relapse (sensitive relapse) were eligible. R115777 was administered in 3-week cycles at a dose of 400 mg orally twice daily for 14 consecutive days followed by 7 days off treatment. RESULTS Twenty-two patients were enrolled. The median progression-free survival was 1.4 months and median overall survival was 6.8 months. Non-hematological toxicities were predominantly grade 1-2 and included nausea (64%) and fatigue (60%). Grade 3-4 granulocytopenia and thrombocytopenia occurred in 27% and 23% of patients, respectively. Febrile neutropenia was not observed. Pharmacokinetic studies demonstrated peak plasma concentrations of R115777 2.6-4.5 h after oral dosing and no significant drug accumulation. The trial was terminated because no objective responses were observed in 20 patients evaluable for response. CONCLUSIONS R115777 showed no significant antitumor activity as a single agent in sensitive-relapse SCLC.
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Affiliation(s)
- J V Heymach
- Dana Farber Cancer Institute and Massachusetts General Hospital, Boston, MA 02115, USA
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Kies MS, Lewin JS, Diaz EM, Gillenwater AM, Glisson BS, Ginsberg LE, Clayman GL, Taylor S, Gillaspy KA, Khuri FR. Definitive treatment of intermediate stage laryngeal squamous cell (SCC/L) cancer with chemotherapy (CT). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5533] [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)
- M. S. Kies
- U Texas M. D. Anderson Cancer Center, Houston, TX; Winship Cancer Institute, Atlanta, GA
| | - J. S. Lewin
- U Texas M. D. Anderson Cancer Center, Houston, TX; Winship Cancer Institute, Atlanta, GA
| | - E. M. Diaz
- U Texas M. D. Anderson Cancer Center, Houston, TX; Winship Cancer Institute, Atlanta, GA
| | - A. M. Gillenwater
- U Texas M. D. Anderson Cancer Center, Houston, TX; Winship Cancer Institute, Atlanta, GA
| | - B. S. Glisson
- U Texas M. D. Anderson Cancer Center, Houston, TX; Winship Cancer Institute, Atlanta, GA
| | - L. E. Ginsberg
- U Texas M. D. Anderson Cancer Center, Houston, TX; Winship Cancer Institute, Atlanta, GA
| | - G. L. Clayman
- U Texas M. D. Anderson Cancer Center, Houston, TX; Winship Cancer Institute, Atlanta, GA
| | - S. Taylor
- U Texas M. D. Anderson Cancer Center, Houston, TX; Winship Cancer Institute, Atlanta, GA
| | - K. A. Gillaspy
- U Texas M. D. Anderson Cancer Center, Houston, TX; Winship Cancer Institute, Atlanta, GA
| | - F. R. Khuri
- U Texas M. D. Anderson Cancer Center, Houston, TX; Winship Cancer Institute, Atlanta, GA
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Abstract
The ras family of proto-oncogenes are upstream mediators of several essential cellular signal transduction pathways involved in cell proliferation and survival. Point mutations of ras oncogenes result in constitutively active Ras and have been shown to be oncogenic. However, ras activation can occur in the absence of ras mutations secondary to upstream receptor activation. The first important step in Ras activation is farnesylation by farnesyl transferase, and inhibitors of this enzyme have been demonstrated to inhibit Ras signaling, and have anti-tumor effects. However, it is now clear that farnesyl transferase inhibitors (FTIs) have activity independent of Ras, most likely due to effects on prenylated proteins downstream of Ras, which explains their activity in several malignancies, including breast cancer, where ras mutations are rare. Several FTIs are in clinical development for the treatment of solid tumors. Preclinical evidence suggests that FTIs can inhibit breast cancers in vitro and in vivo, and a phase II trial of the FTI, R115777, in patients with advanced breast cancer produced encouraging results. Based on prior successful outcomes with agents targeting the estrogen and epidermal growth factor receptor pathways in breast cancer, the FTIs, used alone or more likely with other agents, may be the next exciting targeted therapy in breast cancer.
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Affiliation(s)
- R M O'Regan
- Department of Hematology and Medical Oncology at the Winship Cancer Center, Emory University, Atlanta, Georgia 30322, USA.
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35
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Abstract
The findings presented contribute to quality of life (QOL) research by highlighting the significance of factors affecting the communication by patients with primary-stage squamous cell carcinoma of the head and neck cancer (SCCHN) of their experiences of suffering after treatment to their clinicians. Qualitative research methodology based on open-ended interviews with 18 survivors of American Joint Committee on Cancer primary stage I and II SCCHN were used. The interviews were transcribed verbatim and thematically analyzed. Three important themes emerged: (1). a diminished self (2). fears of addiction, and (3). hopelessness and the loss of meaning in life after SCCHN. The findings indicate that SCCHN patients under-report their experiences mainly due to fear. As a consequence, and perhaps due to a failure on the part of clinicians and patients to adequately address such fears, SCCHN patients may experience greater psychological morbidity, becoming increasingly fatalistic about biomedicine's ability to restore them to health after cancer despite being "cured", or to relieve related symptoms. This qualitative study provides a perspective as to why such under-reporting occurs, thereby potentially enhancing clinician-patient communication and the QOL of SCCHN patients who present with curable disease.
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Affiliation(s)
- R J Moore
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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36
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Abstract
The findings presented in this discussion seek to make a contribution to quality of life (QOL) research, by highlighting the import of factors affecting the communication of primary stage head and neck cancer patient's experiences of suffering after treatments by their clinicians. Qualitative research methodology based on open-ended interviews with 18 survivors of American Joint Committee on Cancer (AJCC) Stage I and Stage II, squamous cell carcinoma of the head and neck (SCCHN) were used. The interviews were transcribed verbatim and thematically analysed. In this preliminary analysis, three important themes emerged: (1) a self diminished by cancer; (2) the fear of addiction to pain medications; and (3) hopelessness and the loss of meaning in life after SCCHN. Our present findings indicate that SCCHN patients understand their experiences of cancer and under-report their experiences of suffering mainly because of fear. These include fears of: being further diminished by SCCHN, fears of addiction, and an inability to cope with the additional losses associated with SCCHN. As a consequence, and perhaps, because of a failure the part of clinicians and patients to adequately address these fears, SCCHN patients may also experience greater psychological morbidity, becoming fatalistic about biomedicine's ability to restore them to health after cancer, or related symptoms, including pain, despite being 'cured.' This study provides a perspective on why this under-reporting occurs, thereby potentially enhancing clinician-patient communication and the QOL of SCCHN patients who present with curable disease.
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Affiliation(s)
- R J Moore
- Departments of Epidemiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Tseng JE, Glisson BS, Khuri FR, Shin DM, Myers JN, El-Naggar AK, Roach JS, Ginsberg LE, Thall PF, Wang X, Teddy S, Lawhorn KN, Zentgraf RE, Steinhaus GD, Pluda JM, Abbruzzese JL, Hong WK, Herbst RS. Phase II study of the antiangiogenesis agent thalidomide in recurrent or metastatic squamous cell carcinoma of the head and neck. Cancer 2002. [PMID: 11745292 DOI: 10.1002/1097-0142(20011101)92:9<2364::aid-cncr1584>3.0.co;2-p] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Thalidomide has been shown to have antiangiogenic effects in preclinical models as well as a significant antitumor effect in hematologic tumors such as multiple myeloma. The authors performed this Phase II study to determine the activity, toxicity profile, and antiangiogenic effect of thalidomide in patients with locoregionally recurrent or metastatic squamous cell carcinoma of the head and neck. METHODS Twenty-one patients with recurrent or metastatic squamous cell carcinoma of the head and neck were treated with single-agent thalidomide. All patients had received radiation therapy, and most had undergone surgery (95%) and/or chemotherapy (90%). Thalidomide was initiated at 200 mg;3>daily and increased to a target dose of 1000 mg daily. Patients continued treatment until disease progression, unacceptable toxicity, or death occurred. RESULTS All 21 patients eventually developed progressive disease. Median time to progression was 50 days (95% confidence interval, 28-70), with median overall survival time of 194 days (95% lower confidence boundary, 151), similar to the progression and survival times reported for this patient group with other agents. Thalidomide was generally well tolerated, with few patients experiencing Grades 3 to 4 toxicities. Serum vascular endothelial growth factor and basic fibroblast growth factor levels increased in six of seven patients, for whom paired serum samples were available and all of whom had progressive disease. CONCLUSIONS In this heavily pretreated population of patients with advanced squamous cell carcinoma of the head and neck, thalidomide does not appear to have single-agent antitumor activity. Further evaluation of the mechanism of action of thalidomide is indicated. Potentially, future evaluations of thalidomide may be performed in combination with other antiangiogenic or cytotoxic agents in patients with earlier stage disease or in patients with minimal residual disease.
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Affiliation(s)
- J E Tseng
- Department of Thoracic and Head and Neck Medical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Kim ES, Lu C, Khuri FR, Tonda M, Glisson BS, Liu D, Jung M, Hong WK, Herbst RS. A phase II study of STEALTH cisplatin (SPI-77) in patients with advanced non-small cell lung cancer. Lung Cancer 2001; 34:427-32. [PMID: 11714540 DOI: 10.1016/s0169-5002(01)00278-1] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cisplatin-based chemotherapy improves survival in appropriately selected patients with stage IV non-small cell lung cancer (NSCLC). However, cisplatin-based regimens have well-known dose-related toxicities, particularly renal insufficiency and neurotoxicity. On the basis of prior preclinical and phase I studies, we initiated a phase II study of SPI-77 (STEALTH) Liposomal Cisplatin) in patients with stage IIIB and IV NSCLC who failed previous treatment with platinum. Disease in all subjects had progressed during therapy, failed to respond, or progressed within 3 months after discontinuing the platinum-based chemotherapy. Between January and June 1999, 13 patients were enrolled at our institution. Patient characteristics included: seven women, six men; median age, 61 years; median Karnofsky performance status, 80%; median number of prior chemotherapy regimens, two (range, 1-3). All patients had adequate hepatic and renal function. SPI-77 was administered at a dose of 260 mg/m(2) IV every 3 weeks. A median of two cycles (range 1-6) were given; the total number of cycles was 35. Among the 12 patients evaluable for response, two had (17%) stable disease and ten (83%) had progressive disease. The median survival was 24.3 weeks, and the median follow-up was 43.9 weeks. Toxicity could be evaluated in all subjects. Moderate anemia (46% of cycles, <or=grade 2; 3% of cycles, >or=grade 3) with minimal granulocytopenia and thrombocytopenia (26% of cycles grade 1; 0% of cycles, >or=grade 2) were the most notable manifestations of myelosuppression. Grade 3 nonhematological toxicities included dyspnea (8%), fatigue (8%), and pain (8%). There were no grade 4 toxicities. These data suggest that this liposomal cisplatin formulation does not have appreciable activity in this population of patients with NSCLC who had received prior platinum-based chemotherapy. The lack of encouraging results from SPI-77 use in other phase I and II studies resulted in early closure of this trial by the manufacturer.
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Affiliation(s)
- E S Kim
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX 77030-4009, USA
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39
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Tseng JE, Glisson BS, Khuri FR, Shin DM, Myers JN, El-Naggar AK, Roach JS, Ginsberg LE, Thall PF, Wang X, Teddy S, Lawhorn KN, Zentgraf RE, Steinhaus GD, Pluda JM, Abbruzzese JL, Hong WK, Herbst RS. Phase II study of the antiangiogenesis agent thalidomide in recurrent or metastatic squamous cell carcinoma of the head and neck. Cancer 2001; 92:2364-73. [PMID: 11745292 DOI: 10.1002/1097-0142(20011101)92:9<2364::aid-cncr1584>3.0.co;2-p] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [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
BACKGROUND Thalidomide has been shown to have antiangiogenic effects in preclinical models as well as a significant antitumor effect in hematologic tumors such as multiple myeloma. The authors performed this Phase II study to determine the activity, toxicity profile, and antiangiogenic effect of thalidomide in patients with locoregionally recurrent or metastatic squamous cell carcinoma of the head and neck. METHODS Twenty-one patients with recurrent or metastatic squamous cell carcinoma of the head and neck were treated with single-agent thalidomide. All patients had received radiation therapy, and most had undergone surgery (95%) and/or chemotherapy (90%). Thalidomide was initiated at 200 mg;3>daily and increased to a target dose of 1000 mg daily. Patients continued treatment until disease progression, unacceptable toxicity, or death occurred. RESULTS All 21 patients eventually developed progressive disease. Median time to progression was 50 days (95% confidence interval, 28-70), with median overall survival time of 194 days (95% lower confidence boundary, 151), similar to the progression and survival times reported for this patient group with other agents. Thalidomide was generally well tolerated, with few patients experiencing Grades 3 to 4 toxicities. Serum vascular endothelial growth factor and basic fibroblast growth factor levels increased in six of seven patients, for whom paired serum samples were available and all of whom had progressive disease. CONCLUSIONS In this heavily pretreated population of patients with advanced squamous cell carcinoma of the head and neck, thalidomide does not appear to have single-agent antitumor activity. Further evaluation of the mechanism of action of thalidomide is indicated. Potentially, future evaluations of thalidomide may be performed in combination with other antiangiogenic or cytotoxic agents in patients with earlier stage disease or in patients with minimal residual disease.
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Affiliation(s)
- J E Tseng
- Department of Thoracic and Head and Neck Medical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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40
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Abstract
Treatment of solid tumors despite improved techniques in detection, surgery, radiation therapy, and chemotherapy remains difficult. Therefore, strategies to improve efficacy in accord with safety are needed. Many epithelial cancers have been found to overexpress the receptor to epidermal growth factor (EGFR), including head and neck, breast, colon, lung, prostate, kidney, ovary, brain, pancreas, and bladder. Because overexpression of EGFR has been associated with an overall poor prognosis in patients with cancer, a number of strategies to block or downregulate EGFR have been developed to inhibit tumor proliferation and improve overall clinical outcome. These include monoclonal antibodies to the EGFR, tyrosine kinase inhibitors, ligand-linked toxins, and antisense approaches. Antibodies such as IMC-C225 specifically target EGF receptors, whereas tyrosine kinase inhibition by many small molecules is less specific. Ultimately, IMC-C225 may prove to become a valuable contributor in the treatment of cancer. This report will focus on IMC-C225, a novel monoclonal antibody that targets the EGFR.
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Affiliation(s)
- E S Kim
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas, USA.
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Herbst RS, Khuri FR, Fossella FV, Glisson BS, Kies MS, Pisters KM, Riddle JR, Terry KA, Lee JS. ZD1839 (Iressa™) In Non–Small-Cell Lung Cancer. Clin Lung Cancer 2001; 3:27-32. [PMID: 14656386 DOI: 10.3816/clc.2001.n.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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]
Abstract
The epidermal growth factor receptor (EGFR) signaling pathway plays an important role in a number of processes that are key to tumor progression, including cell proliferation, angiogenesis, metastatic spread, and inhibition of apoptosis. EGFR is expressed or overexpressed in non-small-cell lung cancer (NSCLC), and EGFR-mediated growth has been associated with advanced disease and poor prognosis in NSCLC patients. ZD1839 (Iressa) is an orally active, selective EGFR-tyrosine kinase inhibitor that blocks EGFR signal transduction. In preclinical studies using NSCLC cell lines, ZD1839 has been shown to inhibit tumor cell growth. In addition, ZD1839, as monotherapy and in combination with commonly used cytotoxic agents, has produced growth delay in NSCLC human xenografts. Preliminary results from phase I trials in patients with advanced disease have shown that ZD1839 has excellent bioavailability, an acceptable tolerability profile, and promising clinical activity in patients with a variety of tumor types, particularly in NSCLC. ZD1839 is currently in phase III clinical development for the treatment of advanced NSCLC.
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Affiliation(s)
- R S Herbst
- Department of Thoracic/Head and Neck Medical Oncology, UT M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Moore RJ, Doherty DA, Do KA, Chamberlain RM, Khuri FR. Racial disparity in survival of patients with squamous cell carcinoma of the oral cavity and pharynx. Ethn Health 2001; 6:165-177. [PMID: 11696928 DOI: 10.1080/13557850120078099] [Citation(s) in RCA: 50] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND This study was designed to determine if race and age are independent prognostic factors for survival in patients treated for squamous cell carcinoma of the oral cavity and pharynx. METHODS Retrospective study. RESULTS Out of 909 patients registered, 815 (90%) were white and 94 (10%) were African-American. The median age was 60 years (range 19-93). The African-American patients had a significantly lower 5 year survival rate of 27.6% (95% CI 19.9-38.3) compared with white patients with a survival rate of 52.0% (95% CI 48.7-55.6) (P < 0.001). The greatest racial disparities in survival were observed in patients under 60 years of age [29.2% (95% CI 19.5-43.6) vs 60.9% (95% CI 56.3-66.0) for African-American and white patients, respectively, P < 0.001], and in African-American men compared with white men [20.2% (95% CI 12.6-30.2) vs 51.0% (95% CI 46.7-53.0), P < 0.001]. A multivariate Cox model, stratified according to stage of disease, indicated that race, age, and type of treatment were statistically significant predictors of survival. After adjusting for race and treatment received, African-American patients had a relative risk of dying of 1.61 (95% CI 1.23-2.10) compared with white patients. All patients 60 years of age and older had a higher risk of dying 1.59 (95% CI 1.31-1.92). Compared with surgical treatment alone, radiotherapy and other treatments were both associated with increased risk of dying with respective relative risks of 1.34 (95% CI 1.01-1.76) and 1.94 (95% CI 1.52-1.48). CONCLUSIONS African-American patients had poorer survival outcomes, with race and age emerging as significant independent predictors of survival after treatment for oral and pharyngeal cancer, compared with their white counterparts. Primary and secondary prevention programs that target younger patients at high risk might reduce environmental risk factors such as smoking and alcohol consumption, which may play a greater role in the acquired susceptibility for oral and pharyngeal cancer in African-American males.
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Affiliation(s)
- R J Moore
- Department of Epidemiology, Box 189, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
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Khuri FR, Kim ES, Lee JJ, Winn RJ, Benner SE, Lippman SM, Fu KK, Cooper JS, Vokes EE, Chamberlain RM, Williams B, Pajak TF, Goepfert H, Hong WK. The impact of smoking status, disease stage, and index tumor site on second primary tumor incidence and tumor recurrence in the head and neck retinoid chemoprevention trial. Cancer Epidemiol Biomarkers Prev 2001; 10:823-9. [PMID: 11489748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Second primary tumors (SPTs) develop at an annual rate of 3-7% in patients with head and neck squamous cell cancer (HNSCC). In a previous Phase III study, we observed that high doses of 13-cis-retinoic acid reduced the SPT rate in this disease. In 1991, we launched an intergroup, placebo-controlled, double-blind study to evaluate the efficacy of low-dose 13-cis-retinoic acid in the prevention of SPTs in patients with stage I or II squamous cell carcinoma of the larynx, oral cavity, or pharynx who had been previously successfully treated with surgery, radiotherapy, or both, and whose diagnoses had been established within 36 months of study entry. As of September 16, 1999, the Retinoid Head and Neck Second Primary (HNSP) Trial had completed accrual with 1384 registered patients and 1191 patients randomized and eligible. All of the patients were followed for survival, SPT development, and index cancer recurrence. Smoking status was assessed at study entry and during study. Smoking cessation was confirmed biochemically by measurement of serum cotinine levels. The annual rate of SPT development was analyzed in terms of smoking status and tumor stage. As of May 1, 2000, SPTs have developed in 172 patients. Of these, 121 (70.3%) were tobacco-related SPTs, including 113 in the aerodigestive tract (57 lung SPTs, 50 HNSCC SPTs, and 6 esophageal SPTs) and 8 bladder SPTs. The remaining 51 cases included 23 prostate adenocarcinomas, 8 gastrointestinal malignancies, 6 breast cancers, 3 melanomas, and 11 other cancers. The annual rate of SPT development observed in our study has been 5.1%. SPT development related to smoking status was marginally significant (active versus never, 5.7% versus 3.5%; P = 0.053). Significantly different smoking-related SPT development rates were observed in current, former, and never smokers (annual rate = 4.2%, 3.2%, and 1.9%, respectively, overall P = 0.034; current versus never smokers, P = 0.018). Stage II HNSCC had a higher overall annual rate of SPT development (6.4%) than did stage I disease (4.3%; P = 0.004). When evaluating the development of smoking-related SPTs, stage was also highly significant (4.8% for stage II versus 2.7% for stage I; P = 0.001). Smoking-related SPT incidence was significant for site as well (larynx versus oral cavity, P = 0.015; larynx versus pharynx, P = 0.011). Primary tumors recurred at an annual rate of 2.8% in a total of 97 patients. The rate of recurrence was higher in patients with stage II disease (4.1% versus 2.2%, P = 0.004) as well as oral cavity site when compared with larynx (P = 0.002). This is the first large-scale prospective chemoprevention study evaluating smoking status and its impact on SPT development and recurrence rate in HNSCC. The results indicate significantly higher SPT rates in active smokers versus never smokers and significantly higher smoking-related SPT rates in active smokers versus never smokers, with intermediate rates for former smokers.
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Affiliation(s)
- F R Khuri
- University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Lee JJ, Liu D, Lee JS, Kurie JM, Khuri FR, Ibarguen H, Morice RC, Walsh G, Ro JY, Broxson A, Hong WK, Hittelman WN. Long-term impact of smoking on lung epithelial proliferation in current and former smokers. J Natl Cancer Inst 2001; 93:1081-8. [PMID: 11459869 DOI: 10.1093/jnci/93.14.1081] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [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 Lung cancer risk remains elevated for many years after quitting smoking. To assess using proliferation indices in bronchial tissues as an intermediate endpoint biomarker in lung cancer chemoprevention trials, we determined the relationship between the extent, intensity, and cessation of tobacco smoking and proliferative changes in bronchial epithelial biopsy specimens. METHODS Bronchial biopsy specimens were obtained from up to six epithelial sites in 120 current smokers (median pack-years, 42) and 207 former smokers (median pack-years, 40; median quit-years, 8.1). Sections from the paraffin-embedded specimens were stained with hematoxylin--eosin to determine the metaplasia index and with an antibody to Ki-67 to determine the proliferative (labeling) index for the basal and parabasal (Ki-67 PLI) layers. All statistical tests were two-sided. RESULTS Biopsy sites with metaplasia had statistically significantly higher Ki-67-labeling indices than those without metaplasia (P<.001) in both current and former smokers. Increased proliferation was observed in multiple biopsy sites, with the average Ki-67 PLI of the subject strongly correlating with the metaplasia index (r =.72 for current smokers; P<.001), even in sites without metaplasia (r =.23 for current smokers; P<.001). In current smokers, the Ki-67 PLI was associated with the number of packs smoked/day (P =.02) but not with smoking years or pack-years. In subjects who had quit smoking, the Ki-67 PLI dropped statistically significantly within 1 year (P =.008) but remained detectable for more than 20 years, even in the absence of squamous metaplasia. CONCLUSION Smoking appears to elicit a dose-related proliferative response in the bronchial epithelia of active smokers. Although the proliferative response decreased gradually in former smokers, a subset of individuals had detectable proliferation for many years and may benefit from targeted chemoprevention. Bronchial epithelial proliferation, measured by Ki-67, may provide a useful biomarker in the assessment of lung cancer risk and in the response to chemopreventive interventions.
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Affiliation(s)
- J J Lee
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
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Shin DM, Khuri FR, Murphy B, Garden AS, Clayman G, Francisco M, Liu D, Glisson BS, Ginsberg L, Papadimitrakopoulou V, Myers J, Morrison W, Gillenwater A, Ang KK, Lippman SM, Goepfert H, Hong WK. Combined interferon-alfa, 13-cis-retinoic acid, and alpha-tocopherol in locally advanced head and neck squamous cell carcinoma: novel bioadjuvant phase II trial. J Clin Oncol 2001; 19:3010-7. [PMID: 11408495 DOI: 10.1200/jco.2001.19.12.3010] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Retinoids and interferons (IFNs) have single-agent and synergistic combined effects in modulating cell proliferation, differentiation, and apoptosis in vitro and clinical activity in vivo in the head and neck and other sites. Alpha-tocopherol has chemopreventive activity in the head and neck and may decrease 13-cis-retinoic acid (13-cRA) toxicity. We designed the present phase II adjuvant trial to prevent recurrence or second primary tumors (SPTs) using 13-cRA, IFN-alpha, and alpha-tocopherol in locally advanced-stage head and neck cancer. PATIENTS AND METHODS After definitive local treatment with surgery, radiotherapy, or both, patients with locally advanced SCCHN were treated with 13-cRA (50 mg/m(2)/d, orally, daily), IFN-alpha (3 x 10(6) IU/m(2), subcutaneous injection, three times a week), and alpha-tocopherol (1,200 IU/d, orally, daily) for 12 months, with a dose modification. Screening for recurrence or SPTs was performed every 3 months. RESULTS Tumors of 11 (24%) of the 45 treated patients were stage III, and 34 (76%) were stage IV. Thirty-eight (86%) of 44 patients completed the full 12-month treatment (doses modified as needed). Toxicity generally was consistent with previous IFN and 13-cRA reports and included mild to moderate mucocutaneous and flu-like symptoms; occasional significant fatigue (grade 3 in 7% of patients), mild to moderate hypertriglyceridemia in 30% of patients who continued treatment along with antilipid therapy, and mild hematologic side effects. Six patients did not complete the planned treatment because of intolerable toxicity or social problems. At a median 24-months of follow-up, our clinical end point rates were 9% for local/regional recurrence (four patients), 5% for local/regional recurrence and distant metastases (two patients), and 2% for SPT (one patient), which was acute promyelocytic leukemia (ie, not of the upper aerodigestive tract). Median 1- and 2-year rates of overall survival were 98% and 91%, respectively, and of disease-free survival were 91% and 84%, respectively. CONCLUSION The novel biologic agent combination of IFN-alpha, 13-cRA, and alpha-tocopherol was generally well tolerated and promising as adjuvant therapy for locally advanced squamous cell carcinoma of the head and neck. We are currently conducting a phase III randomized study of this combination (v no treatment) to confirm these phase II study results.
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Affiliation(s)
- D M Shin
- Departments of Thoracic/Head and Neck Medical Oncology, Diagnostic Imaging, Head and Neck Surgery, Biostatistics, Radiation Oncology, and Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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Abstract
Lung cancer remains the single most devastating cause of cancer-related death with approximately 1.5 million cases of lung cancer expected worldwide and more than 1.3 million cancer-related deaths in 2001. In the United States alone, of 164,100 news cases expected in the year 2000, about 70,000 will be metastatic disease (stage IV), and another 70,000 will be locally advanced (stages IIIA and IIIB). Therefore, the five-year survival rate for lung cancer has improved only incrementally from 5% in the late 1950s to 14% by 1994. While advances in combined modality therapy have led to significant progress against locally advanced disease, it was only a decade ago that few believed that the treatment of stage IV non-small-cell lung cancer was justifiable. However, multiple randomized trials in the 1980s and 1990s have changed the role of chemotherapy in lung cancer, such that by the middle of the next decade, it may be that only patients with stage IA non-small-cell lung cancer are not considered as candidates for chemotherapy.
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Affiliation(s)
- F R Khuri
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
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47
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Abstract
Therapeutic outcomes of the currently used chemotherapeutic agents for recurrent or advanced head and neck squamous cell carcinoma, such as methotrexate or a combination of 5-fluorouracil and cisplatin, are far beyond satisfaction. New chemotherapeutic agents, such as taxanes, paclitaxel and docetaxel, are among the most active drugs for head and neck cancer and a number of multidrug regimens containing a taxane and cisplatin have produced equivalent or higher response rates than conventional regimens. In addition, early clinical trials of novel molecular-targeted agents, such as epidermal growth factor receptors, tyrosine kinase inhibitors and gene targeted therapy, have shown encouraging results. Further clinical trials will be needed to optimally combine the biologic agents with chemotherapy and assess their effects on long-term control of cancer.
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Affiliation(s)
- K B Kim
- Head and Neck Cancer Program, Univ. of Pittsburgh Cancer Institute, 200 Lothrop Street, N755, UPMC, Montefiore, Pittsburgh, PA 15213-2582, USA
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Khuri FR, Rigas JR, Figlin RA, Gralla RJ, Shin DM, Munden R, Fox N, Huyghe MR, Kean Y, Reich SD, Hong WK. Multi-Institutional Phase I/II Trial of Oral Bexarotene in Combination With Cisplatin and Vinorelbine in Previously Untreated Patients With Advanced Non–Small-Cell Lung Cancer. J Clin Oncol 2001; 19:2626-37. [PMID: 11352954 DOI: 10.1200/jco.2001.19.10.2626] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Bexarotene (Targretin; Ligand Pharmaceuticals, Inc, San Diego, CA) is a retinoid-X-receptor (RXR)-selective retinoid with preclinical antitumor activity in squamous cell cancers. In this phase I/II trial, we combined bexarotene with cisplatin and vinorelbine in the treatment of patients with non–small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Forty-three patients who had stage IIIB NSCLC with pleural effusion or stage IV NSCLC and had received no prior therapy received bexarotene in combination with cisplatin (100 mg/m2) and vinorelbine (alternating doses of 30 mg/m2 and 15 mg/m2). In the phase I portion, the daily dose of bexarotene was escalated in cohorts of three patients from 150 mg/m2 to 600 mg/m2, beginning 1 week before the start of the cisplatin-vinorelbine regimen. Once the maximum-tolerated dose (MTD) of bexarotene was determined, the study entered the phase II portion. Response rate was the primary end point; median survival time and 1-year survival rate were secondary end points. RESULTS: In the phase I portion, the daily MTD of bexarotene was determined to be 400 mg/m2. Eight of 43 patients exhibited major responses. Seven (25%) of the 28 patients in the phase II portion responded to treatment. The median survival time in the phase II portion was 14 months; nine (32%) of the 28 patients were still alive at a minimum follow-up of 2 years. One-year and projected 3-year survival rates were 61% and 30%, respectively. The most common grade 3 and 4 adverse events were hyperlipemia, leukopenia, nausea, vomiting, pneumonia, dyspnea, anemia, and asthenia. Grade 3 and 4 laboratory abnormalities with incidences greater than 5% were decreased hemoglobin levels and WBC, absolute neutrophil, and absolute lymphocyte counts and increased prothrombin time and creatinine and amylase levels. Of the two cases of pancreatitis, one required hospitalization and both were associated with increased triglyceride levels. There was one death secondary to renal insufficiency unrelated to bexarotene treatment. CONCLUSION: In patients with advanced NSCLC, bexarotene with cisplatin and vinorelbine yielded acceptable phase II response rates (25%) and was associated with better-than-expected survival (14-month median survival time; 61% 1-year, 32% 2-year, and 30% projected 3-year survival rates). The regimen should be studied in larger clinical trials.
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Affiliation(s)
- F R Khuri
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Shin DM, Donato NJ, Perez-Soler R, Shin HJ, Wu JY, Zhang P, Lawhorn K, Khuri FR, Glisson BS, Myers J, Clayman G, Pfister D, Falcey J, Waksal H, Mendelsohn J, Hong WK. Epidermal growth factor receptor-targeted therapy with C225 and cisplatin in patients with head and neck cancer. Clin Cancer Res 2001; 7:1204-13. [PMID: 11350885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
C225, a human-mouse chimerized monoclonal antibody directed against the epidermal growth factor receptor (EGFr), has a synergistic effect with cisplatin in xenograft models. To determine the tumor EGFr saturation dose with C225 and the fate of infused C225, we conducted a Phase Ib study with C225 in combination with cisplatin in patients with recurrent squamous cell carcinoma of the head and neck. Using tumor samples, we assessed tumor EGFr saturation by antibody using immunohistochemistry studies, the EGFr tyrosine kinase assay, and detection of the EGFr/C225 complex formation by immunoblot. Potential candidates were screened for EGFr expression in their tumors, and 12 patients who had high levels of EGFr expression and tumors easily accessible for repeated biopsies (pretherapy, 24 h after first C225 infusion, 24 h before third C225 infusion) were entered at three different dose levels of C225 with a fixed dose of cisplatin. The median value of tumor EGFr saturation increased to 95% at the higher dose levels. EGFr tyrosine kinase activity was significantly reduced after C225 infusion, and EGFr/C225 complexes were also detected at higher doses of C225. The loading dose of C225 at 400 mg/m(2) with a maintenance dose at 250 mg/m(2) achieved a high percentage of saturation of EGFr in tumor tissue, and these doses were recommended for Phases II or III clinical trials. Six (67%) of nine evaluable patients achieved major responses, including two (22%) complete responses. Mild to moderate degrees of allergic reaction and folliculitis-like skin reactions were demonstrated. We conclude that infused C225 binds and significantly saturates tumor EGFr, which may render a high degree of antitumor activity, and provides a novel mechanism for targeting cancer therapy for patients who have EGFr expression in their tumors.
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Affiliation(s)
- D M Shin
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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50
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Lippman SM, Lee JJ, Karp DD, Vokes EE, Benner SE, Goodman GE, Khuri FR, Marks R, Winn RJ, Fry W, Graziano SL, Gandara DR, Okawara G, Woodhouse CL, Williams B, Perez C, Kim HW, Lotan R, Roth JA, Hong WK. Randomized phase III intergroup trial of isotretinoin to prevent second primary tumors in stage I non-small-cell lung cancer. J Natl Cancer Inst 2001; 93:605-18. [PMID: 11309437 DOI: 10.1093/jnci/93.8.605] [Citation(s) in RCA: 259] [Impact Index Per Article: 11.3] [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: 12/19/2022] Open
Abstract
BACKGROUND Promising data have suggested that retinoid chemoprevention may help to control second primary tumors (SPTs), recurrence, and mortality of stage I non-small-cell lung cancer (NSCLC) patients. METHODS We carried out a National Cancer Institute (NCI) Intergroup phase III trial (NCI #I91-0001) with 1166 patients with pathologic stage I NSCLC (6 weeks to 3 years from definitive resection and no prior radiotherapy or chemotherapy). Patients were randomly assigned to receive a placebo or the retinoid isotretinoin (30 mg/day) for 3 years in a double-blind fashion. Patients were stratified at randomization by tumor stage, histology, and smoking status. The primary endpoint (time to SPT) and the secondary endpoints (times to recurrence and death) were analyzed by log-rank test and the Cox proportional hazards model. All statistical tests were two-sided. RESULTS After a median follow-up of 3.5 years, there were no statistically significant differences between the placebo and isotretinoin arms with respect to the time to SPTs, recurrences, or mortality. The unadjusted hazard ratio (HR) of isotretinoin versus placebo was 1.08 (95% confidence interval [CI] = 0.78 to 1.49) for SPTs, 0.99 (95% CI = 0.76 to 1.29) for recurrence, and 1.07 (95% CI = 0.84 to 1.35) for mortality. Multivariate analyses showed that the rate of SPTs was not affected by any stratification factor. Rate of recurrence was affected by tumor stage (HR for T(2) versus T(1) = 1.77 [95% CI = 1.35 to 2.31]) and a treatment-by-smoking interaction (HR for treatment-by-current-versus-never-smoking status = 3.11 [95% CI = 1.00 to 9.71]). Mortality was affected by tumor stage (HR for T(2) versus T(1) = 1.39 [95% CI = 1.10 to 1.77]), histology (HR for squamous versus nonsquamous = 1.31 [95% CI = 1.03 to 1.68]), and a treatment-by-smoking interaction (HR for treatment-by-current-versus-never-smoking = 4.39 [95% CI = 1.11 to 17.29]). Mucocutaneous toxicity (P<.001) and noncompliance (40% versus 25% at 3 years) were higher in the isotretinoin arm than in the placebo arm. CONCLUSIONS Isotretinoin treatment did not improve the overall rates of SPTs, recurrences, or mortality in stage I NSCLC. Secondary multivariate and subset analyses suggested that isotretinoin was harmful in current smokers and beneficial in never smokers.
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Affiliation(s)
- S M Lippman
- Department of Clinical Cancer Prevention, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 236, Houston, TX 77030-4095, USA.
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