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Feelders RA, Fleseriu M, Kadioglu P, Bex M, González-Devia D, Boguszewski CL, Yavuz DG, Patino H, Pedroncelli AM, Maamari R, Chattopadhyay A, Biller BMK, Pivonello R. Long-term efficacy and safety of subcutaneous pasireotide alone or in combination with cabergoline in Cushing's disease. Front Endocrinol (Lausanne) 2023; 14:1165681. [PMID: 37876540 PMCID: PMC10593462 DOI: 10.3389/fendo.2023.1165681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/11/2023] [Indexed: 10/26/2023] Open
Abstract
Objective This study evaluated short- and long-term efficacy and safety of the second-generation somatostatin receptor ligand pasireotide alone or in combination with dopamine agonist cabergoline in patients with Cushing's disease (CD). Study design This is an open-label, multicenter, non-comparative, Phase II study comprising 35-week core phase and an optional extension phase. All patients started with pasireotide, and cabergoline was added if cortisol remained elevated. Eligible patients had active CD, with or without prior surgery, were pasireotide naïve at screening or had discontinued pasireotide for reasons other than safety. Primary endpoint was proportion of patients with a mean urinary free cortisol (mUFC) level not exceeding the upper limit of normal (ULN) at week 35 with missing data imputed using last available post-baseline assessments. Results Of 68 patients enrolled, 26 (38.2%) received pasireotide monotherapy and 42 (61.8%) received pasireotide plus cabergoline during the core phase. Thirty-four patients (50.0%; 95% CI 37.6-62.4) achieved the primary endpoint, of whom 17 (50.0%) received pasireotide monotherapy and 17 (50.0%) received combination therapy. Proportion of patients with mUFC control remained stable during the extension phase up to week 99. Treatment with either mono or combination therapy provided sustained improvements in clinical symptoms of hypercortisolism up to week 99. Hyperglycemia and nausea (51.5% each), diarrhea (44.1%) and cholelithiasis (33.8%) were the most frequent adverse events. Conclusion Addition of cabergoline in patients with persistently elevated mUFC on maximum tolerated doses of pasireotide is an effective and well-tolerated long-term strategy for enhancing control of hypercortisolism in some CD patients. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT01915303, identifier NCT01915303.
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Affiliation(s)
- Richard A. Feelders
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Maria Fleseriu
- Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Pinar Kadioglu
- Division of Endocrinology, Metabolism and Diabetes, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Türkiye
| | - Marie Bex
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Deyanira González-Devia
- Departamento de Medicina Interna, Sección de Endocrinologia, Hospital Universitario Fundación Santa Fé de Bogotá, Bogota, Colombia
| | - Cesar Luiz Boguszewski
- Department of Internal Medicine, Endocrine Division (SEMPR), Federal University of Paraná, Curitiba, Parana, Brazil
| | - Dilek Gogas Yavuz
- Section of Endocrinology and Metabolism, Marmara University School of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Türkiye
| | - Heather Patino
- Global Medical Affairs, Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Alberto M. Pedroncelli
- Recordati AG, Basel, Switzerland
- Global Medical Affairs, Novartis Pharma AG, Basel, Switzerland
| | - Ricardo Maamari
- Global Medical Affairs, Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Arghya Chattopadhyay
- Global Medical Affairs, Novartis Healthcare Private Limited, Hyderabad, Telangana, India
| | - Beverly M. K. Biller
- Neuroendocrine & Pituitary Tumor Clinical Center, Massachusetts General Hospital, Boston, MA, United States
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
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Juric D, Turner N, Loi S, Andre F, Chia SK, Jhaveri K, Neven P, Dent R, Ciruelos E, Joshi M, Roux E, Patino H, Akdere M, Rugo H. Abstract P4-09-12: Baseline and End-of-Treatment Biomarkers in Patients With PIK3CA-Mutated, Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Advanced Breast Cancer From BYLieve Study Cohorts A and B. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-09-12] [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: 03/06/2023]
Abstract
Abstract
Introduction: Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) is mutated in ~40% of patients (pts) with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer (ABC). PIK3CA mutations are associated with resistance to endocrine therapy (ET) and worse overall survival. Alpelisib (ALP), an α-selective PI3K inhibitor and degrader, is indicated in combination with fulvestrant (FUL) for pts with PIK3CA-mutated (mut) HR+, HER2− ABC following progression on/after ET-based treatments. In the Phase 2, open-label, 3-cohort, noncomparative BYLieve study, clinical benefit of ALP in combination with ET was observed in the post-cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) setting in pts with PIK3CA-mut, HR+, HER2− ABC. Here we report the results of a biomarker analysis using paired baseline (Cycle 1 Day 1) and end-of-treatment (EOT) circulating tumor DNA (ctDNA) samples from pts in BYLieve Cohorts A and B.
Methods: In the BYLieve study, pts with PIK3CA-mut, HR+, HER2− ABC had CDK4/6i + aromatase inhibitor (Cohort A; N=127) or CDK4/6i + FUL (Cohort B; N=126) as treatment immediately prior to receiving ALP + FUL and ALP + letrozole, respectively. In this biomarker analysis, gene alterations were detected in ctDNA at baseline and EOT using next-generation sequencing (PanCancer V2 panel). Pts included in this interim analysis had confirmed PIK3CA mutations and matched baseline/EOT samples with enough sequencing coverage and ctDNA fraction to detect mutations at both time points. ctDNA fractions, tumor mutation burden (TMB) distributions, genomic landscapes, gain/loss of PIK3CA and estrogen receptor 1 (ESR1), chromosome 8/11 amplification profiles, and alterations in PI3K pathway and potential CDK4/6i resistance markers were assessed across time points. Sample sizes were small; results should thus be interpreted with caution.
Results: Forty-three pts were included in the Cohort A biomarker population and 40 pts were included in Cohort B. ctDNA fraction was numerically higher at EOT compared with baseline in both cohorts; further analyses will be presented. In Cohort A, no significant differences were observed in TMB at EOT compared with baseline (P=0.21). In Cohort B, TMB was higher at EOT compared with baseline (P=0.053). Chromosome 8/11 amplifications were consistent between baseline and EOT for both cohorts. Small variations were observed in ESR1/PIK3CA mutations between baseline and EOT on both cohorts (Table). The status of potential CDK4/6i resistance markers was relatively unchanged at EOT (Table). Loss-of-function mutations in PTEN, a known PI3K inhibitor resistance marker, increased from 9% at baseline to 14% at EOT in Cohort A and from 12% at baseline to 22% at EOT in Cohort B.
Conclusions: Between baseline and EOT, only small variations in gene alterations in PIK3CA-mutated HR+, HER2– ABC were observed in the post-CDK4/6i setting. As the disease progressed, increases in loss-of-function mutations in PTEN at EOT in both Cohorts A and B suggested loss of PTEN in PI3K pathway may drive resistance to ALP. Early intervention with ALP, when the tumor is particularly driven by PIK3CA oncogenic mutations and before it develops more genomic complexity, may potentially provide better clinical outcomes.
Table. Gene Alteration Gain/Loss at Baseline/EOT Across Cohorts A and B
Citation Format: Dejan Juric, Nicholas Turner, Sherene Loi, Fabrice Andre, Stephen K. Chia, Komal Jhaveri, Patrick Neven, Rebecca Dent, Eva Ciruelos, Mukta Joshi, Estelle Roux, Heather Patino, Murat Akdere, Hope Rugo. Baseline and End-of-Treatment Biomarkers in Patients With PIK3CA-Mutated, Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Advanced Breast Cancer From BYLieve Study Cohorts A and B [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-09-12.
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Affiliation(s)
- Dejan Juric
- 1Massachusetts General Hospital Cancer Center, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Sherene Loi
- 3Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Stephen K. Chia
- 5British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Patrick Neven
- 7Universitair Ziekenhuis Leuven, Leuven, Vlaams-Brabant, Belgium
| | | | - Eva Ciruelos
- 9SOLTI Breast Cancer Research Group, Barcelona, Spain/Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mukta Joshi
- 10Novartis Institutes for BioMedical Research, Cambridge, MA
| | | | | | | | - Hope Rugo
- 14University of California San Francisco, San Francisco, CA
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Heil JR, McCarthy KL, German JB, McCarthy MJ, Patino H. Use of Magnetic Resonance Imaging for Evaluation of Beer Foam Characteristics. Journal of the American Society of Brewing Chemists 2018. [DOI: 10.1094/asbcj-48-0119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- J. R. Heil
- Department of Food Science and Technology, University of California, Davis, 95616
| | - K. L. McCarthy
- Department of Food Science and Technology, University of California, Davis, 95616
| | - J. B. German
- Department of Food Science and Technology, University of California, Davis, 95616
| | - M. J. McCarthy
- Department of Food Science and Technology, University of California, Davis, 95616
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Hachem RY, Langston AA, Graybill JR, Perfect JR, Pedicone LD, Patino H, Raad II. Posaconazole as salvage treatment of invasive fungal infections in patients with underlying renal impairment. J Antimicrob Chemother 2008; 62:1386-91. [DOI: 10.1093/jac/dkn401] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Langston A, Lipton J, Brundage T, Patino H, Ullmann A. 208: Impact of posaconazole (POS) vs fluconazole (FLU) on cyclosporine (CsA) and tacrolimus (TAC) dosing in hematopoietic stem cell transplant (HSCT) recipients with graft-vs-host disease (GVHD). Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Durrant S, Vesole D, Langston A, Lipton J, Patino H, Pedicone L, Ullmann A. Posaconazole (POS) vs fluconazole (FLU) for prophylaxis of invasive fungal infections (IFIs) in allogeneic hematopoietic stem cell transplant (HSCT) recipients with graft-versus-host disease (GVHD): A multicenter trial. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.412] [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: 11/30/2022]
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Patino H. Baseball hardness as a risk factor for eye injuries. J Oral Maxillofac Surg 1999. [DOI: 10.1016/s0278-2391(99)90888-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Patino H. Functional laryngeal dyskinesia in children and adults. J Oral Maxillofac Surg 1999. [DOI: 10.1016/s0278-2391(99)90100-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Patino H. Effects of hemimandibulectomy on quality of life. J Oral Maxillofac Surg 1999. [DOI: 10.1016/s0278-2391(99)90104-0] [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: 11/16/2022]
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Patino H. Hyperbaric oxygen for the management of radionecrosis of bone and cartilage. J Oral Maxillofac Surg 1999. [DOI: 10.1016/s0278-2391(99)90306-3] [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: 12/01/2022]
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Patino H. The failing flap in facial plastic and reconstructive surgery: Role of the medicinal leech. J Oral Maxillofac Surg 1999. [DOI: 10.1016/s0278-2391(99)90308-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Patino H. Increased risk of salivary gland tumors after low-dose irradiation. J Oral Maxillofac Surg 1999. [DOI: 10.1016/s0278-2391(99)90258-6] [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: 12/01/2022]
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Patino H. Intraorbital metallic foreign body. J Oral Maxillofac Surg 1999. [DOI: 10.1016/s0278-2391(99)90248-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Patino H. Plaque radiation therapy for recurrent conjunctival pyogenic granuloma. J Oral Maxillofac Surg 1999. [DOI: 10.1016/s0278-2391(99)90644-4] [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: 11/24/2022]
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Patino H. Avulsion of the optic nerve head after orbital trauma. J Oral Maxillofac Surg 1998. [DOI: 10.1016/s0278-2391(98)90626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Patino H. Stevens-Johnson syndrome induced by methazolamide treatment. J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0278-2391(97)90670-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Patino H. Mullerian mixed tumor metastatic to the iris and ciliary body. J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0278-2391(97)90099-9] [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: 11/29/2022]
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Patino H. Subperiosteal orbital hemorrhage from retrobulbar injection resulting in blindness. J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0278-2391(97)90369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Patino H. Reducing confirmation bias in clinical decision-making. J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0278-2391(97)90505-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Patino H. Bilateral enophthalmos associated with hydrocephalus and ventriculoperitoneal shunting. J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0278-2391(97)90147-6] [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: 11/25/2022]
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Patino H. Endoscopic sympathectomy treatment for craniofacial hyperhidrosis. J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0278-2391(97)90158-0] [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: 11/29/2022]
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Patino H. Market forces driving health care reform. J Oral Maxillofac Surg 1996. [DOI: 10.1016/s0278-2391(96)90325-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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