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Agnew S, Crawford M, MacPherson I, Shiramizu V, Fleming L. The impact of symptom clusters on endocrine therapy adherence in patients with breast cancer. Breast 2024; 75:103731. [PMID: 38599048 PMCID: PMC11017041 DOI: 10.1016/j.breast.2024.103731] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND When taken as prescribed, endocrine therapy is effective in reducing risk of recurrence and mortality in the treatment of patients with breast cancer. However, treatment side effects can act as a barrier to medication adherence. Existing research has not identified any specific side effects as consistent predictors of nonadherence. Our aim was to explore the influence of symptom clusters on self-reported adherence in patients with breast cancer. METHODS A cross-sectional online survey was conducted, including patients with breast cancer currently or previously prescribed endocrine therapy (N = 1051). This included measures of self-reported endocrine therapy adherence and common symptoms among this population (insomnia, depression, anxiety, fatigue, musculoskeletal, and vasomotor symptoms). RESULTS Unintentional nonadherence was higher than intentional nonadherence (50.8 % vs 31.01 %). The most troublesome symptom was insomnia (73.83 % displayed probable insomnia disorder). K-means cluster analysis identified 2 symptom clusters: overall High symptoms, and overall Low symptoms. Participants in the Low symptoms cluster were significantly more likely to be classed as adherent based on unintentional and intentional items. CONCLUSIONS Nonadherence was high in the current sample, and significantly more likely in participants reporting overall severe symptoms. Clinicians should be aware of the scale of common side effects and facilitate open conversation about potential barriers to adherence. Follow-up care should include assessment of common symptoms and signpost patients to appropriate support or treatment when required. Future research should explore potential for a central symptom to act as a target for intervention, to relieve overall side effect burden and facilitate better medication adherence.
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Affiliation(s)
- Sommer Agnew
- University of Strathclyde, 16 Richmond St, Glasgow, G1 1XQ, Scotland, UK.
| | - Megan Crawford
- University of Strathclyde, 16 Richmond St, Glasgow, G1 1XQ, Scotland, UK.
| | | | - Victor Shiramizu
- University of Strathclyde, 16 Richmond St, Glasgow, G1 1XQ, Scotland, UK.
| | - Leanne Fleming
- University of Strathclyde, 16 Richmond St, Glasgow, G1 1XQ, Scotland, UK.
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Lee J, Byrne CJ, Brennan PN, MacPherson I, Dow E, Dillon JF. Optimal ALT threshold for the automated diagnosis of MASLD: A population-based study using iLFT. Ann Hepatol 2024; 29:101280. [PMID: 38219950 DOI: 10.1016/j.aohep.2023.101280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION AND OBJECTIVES Early diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD), especially with advanced fibrosis, is crucial due to the increased risk of complications and mortality. Serum alanine aminotransferase (ALT) is commonly used; however, many patients have normal ranges (<55 U/L) who may remain undetected. We investigated the clinical implications of a lower ALT cut-off (>30 U/L) using intelligent liver function testing (iLFT) to identify MASLD patients with and without advanced fibrosis in primary care. MATERIALS AND METHODS All patients entering the iLFT diagnostic pathway had liver aetiological screening investigations if ALT >30 U/L. In those with MASLD the proportions with and without advanced fibrosis at different ALT thresholds: 31-41 U/L, 42-54 U/L and ≥55 U/L were compared. RESULTS 16,373 patients underwent iLFT between March 2016 to April 2022. 762 (5 %) patients had MASLD with abnormal fibrosis scores, while 908 (6 %) had MASLD with normal fibrosis scores. 428 (56 %) patients were assessed in liver clinics, where 169 (39 %) had evidence of fibrosis. Of these, 22 (13 %) had ALT 31-41 U/L, 31 (18 %) had ALT 42-54 U/L and 116 (69 %) had ALT ≥55 U/L. 145 (86 %) patients had advanced fibrosis or cirrhosis, where 20 (14 %) had ALT 31-41 U/L, 28 (19 %) had ALT 42-54 U/L and 97 (67 %) had ALT ≥55 U/L. CONCLUSIONS 33 % of MASLD patients with advanced fibrosis or cirrhosis had ALT 31-54 U/L, who would have been missed using the conventional ALT range. This suggests that lowering the ALT cut-off improves diagnosis of MASLD with advanced fibrosis in primary care.
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Affiliation(s)
- Jeremy Lee
- School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
| | - Christopher J Byrne
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK; Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK
| | - Paul N Brennan
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK; Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, UK
| | - Iain MacPherson
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Eleanor Dow
- Department of Blood Sciences, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - John F Dillon
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK; Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
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Fleming L, Agnew S, Peddie N, Crawford M, Dixon D, MacPherson I. The impact of medication side effects on adherence and persistence to hormone therapy in breast cancer survivors: A quantitative systematic review. Breast 2022; 64:63-84. [PMID: 35609380 PMCID: PMC9130570 DOI: 10.1016/j.breast.2022.04.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hormone Therapy (HT) is recommended for most women with HR-positive primary breast cancer. When taken as intended, HT reduces breast cancer recurrence by 40% and mortality by one-third. The recommended duration of treatment ranges from 5 to 10 years depending on risk of recurrence and the specific HT regimen. However, recent data indicates that rates of HT non-adherence are high and research suggests this may be due to the impact of HT side effects. The contribution of side effects to non-adherence and non-persistence behaviours has rarely been systematically explored, thereby hindering the implementation of targeted intervention strategies. Our aim is to identify, evaluate and summarise the relationship between HT side effects and patterns of adherence and persistence. METHODS Electronic searches were conducted from inception and were completed by September 2021, utilising Cochrane CENTRAL, Medline, Embase, Web of Science and PsycINFO databases. Searches included a combination of terms related to breast cancer, adherence, hormone therapy and side effects. RESULTS Sixty-two eligible papers were identified and study quality varied by study type. Most observational and cross-sectional studies were rated good quality, whereas most controlled intervention studies were rated fair quality. Three studies were rated poor quality. The most frequently measured side effects were pain, low mood, hot flashes, insomnia, anxiety, fatigue, weight gain, concentration/memory problems. CONCLUSIONS This review identified a lack of consistency in the measurement of adherence and the definition of persistence across studies. The instruments used to measure side effects also varied significantly. This variation and lack of consistency makes it difficult to evaluate and summarise the role of HT side effects in HT adherence and persistence behaviour.
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Affiliation(s)
| | - Sommer Agnew
- University of Strathclyde, George Street, Glasgow, UK
| | - Nicola Peddie
- University of Strathclyde, George Street, Glasgow, UK
| | | | - Diane Dixon
- University of Aberdeen, Kings College, Aberdeen, UK
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Winter M, Coleman R, Kendall J, Palmieri C, Twelves C, Howell S, MacPherson I, Wilson C, Purohit K, Gath J, Taylor C, Eastell R, Murden G, Brown SR, Rathbone E, Brown J. A phase IB and randomised phase IIA trial of CApecitabine plus Radium-223 (Xofigo™) in breast cancer patients with BONe metastases: CARBON trial results. J Bone Oncol 2022; 35:100442. [PMID: 35800293 PMCID: PMC9253642 DOI: 10.1016/j.jbo.2022.100442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Approximately 70% of patients with metastatic breast cancer (MBC) develop bone metastases. Despite advances in systemic treatment options and the use of bone targeted agents in the management of bone metastases to reduce skeletal morbidity, there remains an unmet need for further treatment options. Radium-223 (Ra223) is an alpha-emitting radiopharmaceutical that is preferentially taken up into bone at sites of increased osteoblastic activity where it emits high-energy, short-range alpha-particles that could provide a targeted anti-tumour effect on bone metastases. Here we evaluate the safety, feasibility and efficacy findings of the combination of Ra223 with capecitabine chemotherapy in patients with MBC with bone involvement. Methods CARBON is a multi-centre, open-label phase IB/IIA study evaluating the combination of Ra223 (55 kBq/kg day 1 given on 6 weekly schedule) and capecitabine (1000 mg/m2 bd days 4-17 every 21 days) in patients with bone metastases from MBC (± other disease sites). Other eligibility criteria included ECOG performance status 0-2, ≤2 lines of chemotherapy for MBC and current bisphosphonate or denosumab use for ≥ 6 weeks. The phase IB part of the trial (6 patients) was conducted to provide preliminary feasibility and safety of capecitabine + Ra223. Thereafter, 28 patients were randomised (2:1) to capecitabine + Ra223 or capecitabine alone to further characterise the safety profile and evaluate efficacy, the primary efficacy endpoint being the bone turnover marker (urinary n-telopeptide of type I collagen) change from baseline to end of cycle 5 and secondary endpoints of time to first symptomatic skeletal event, and disease progression at extra-skeletal and bone disease. Results In addition to bone metastases, 10/23 [44%] and 13/23 [57%] capecitabine + Ra223 and 2/11 [18%] and 9/11 [82%] capecitabine alone patients had soft tissue and visceral disease sites respectively. More capecitabine + Ra223 patients had received prior chemotherapy for MBC: 11/23 [48%] vs 2/11 [18%]. The analysis populations comprise 34 patients (23 capecitabine + Ra223, 11 capecitabine); 2 patients randomised to capecitabine + Ra223 received capecitabine alone and are included in the capecitabine arm. Median number of cycles received was 8.5 in capecitabine + Ra223 (range 3-12) and 12 in the capecitabine arm (range 1-12). 94/95 prescribed Ra223 cycles were administered. No dose limiting toxicities were seen in phase IB and no patients developed grade ≥ III diarrhoea. Gastrointestinal, haematological and palmer-planter erthyrodysesthesia adverse events were similar in both arms. Although formal statistical comparisons were not made, changes in bone turnover markers, the times to extra-skeletal progression and bone disease progression, and the frequency of symptomatic skeletal events were similar across the two treatment arms. Conclusion Capecitabine + Ra223 at the planned dose was safe and feasible in MBC patients with bone metastases. However, no efficacy signals were seen that might suggest greater efficacy of the combination over capecitabine alone clinically or biochemically.
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Affiliation(s)
- Matthew Winter
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Rob Coleman
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Jessica Kendall
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Carlo Palmieri
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK. University of Liverpool, Liverpool, UK
| | - Chris Twelves
- University of Leeds, St James’s University Hospital and NIHR Clinical Research Facility, Leeds, UK
| | - Sacha Howell
- The Christie NHS Foundation Trust, Manchester, UK
| | - Iain MacPherson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Caroline Wilson
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kash Purohit
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jacqui Gath
- Consumer Research Forum, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christine Taylor
- Consumer Research Forum, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Richard Eastell
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Geraldine Murden
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sarah R. Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Emma Rathbone
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Janet Brown
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
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Gray E, Figueroa JD, Oikonomidou O, MacPherson I, Urquhart G, Cameron DA, Hall PS. Variation in chemotherapy prescribing rates and mortality in early breast cancer over two decades: a national data linkage study. ESMO Open 2021; 6:100331. [PMID: 34864502 PMCID: PMC8649669 DOI: 10.1016/j.esmoop.2021.100331] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background Regional variation in clinical practice may identify differences in care, reveal inequity in access, and explain inequality in outcomes. The study aim was to measure geographical variation in Scotland for adjuvant chemotherapy use and mortality in early-stage breast cancer. Patients and methods In this retrospective cohort study using population cancer registry-based data linkage, patients with surgically treated early breast cancer between 2001 and 2018 were identified from the Scottish Cancer Registry. Geographical regions considered were based on NHS Scotland organisational structure including 14 territorial Health Boards as well as three regional Cancer Networks. Regional variation in the proportion receiving chemotherapy, breast cancer mortality and all-cause mortality was investigated. Inter-regional comparisons of chemotherapy use were adjusted for differences in case mix using logistic regression. Comparison of breast cancer-specific mortality and all-cause mortality used regression with a parametric survival model. Time trends were assessed using moving average plots. Results Chemotherapy use ranged from 35% to 46% of patients across Health Boards without adjustment. Variation reduced between 2001 and 2018. Following adjustment for clinical case mix, variation between cancer networks was within 3 percentage points, but up to 10 percentage points from the national average in some Health Boards. Differences in breast cancer mortality and all-cause mortality between cancer networks were modest, with hazard ratios of between 0.933 (95% confidence interval 0.893-0.975) and 1.041 (1.002-1.082) compared with the national average. Survival improved over the time period studied. Conclusion With adequate case mix adjustment, variation in adjuvant chemotherapy use for early breast cancer in Scotland is small, with a trend towards greater convergence in practice and improved mortality outcomes in more recent cohorts. This suggests very limited regional inequity in access and convergence of clinical practice towards risk-stratified treatment recommendations. Outliers require assessment to understand the reasons for variance. A cohort study including the Scottish population of surgically treated early breast cancer patients from 2001 to 2018. With adequate case mix adjustment, regional variation in adjuvant chemotherapy use was small, but with notable outliers. Over time there was a trend towards greater convergence in practice towards risk-stratified treatment recommendations.
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Affiliation(s)
- E Gray
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - J D Figueroa
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - O Oikonomidou
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK; Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK
| | - I MacPherson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK; The Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - D A Cameron
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK; Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK
| | - P S Hall
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK; Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK.
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Krebs M, Lord S, Kenny L, Baird R, MacPherson I, Bahl A, Clack G, Ainscow E, Barrett A, Dickinson P, Fuchter M, Lehnert M, Ali S, Mcintosh S, Coombes R. 230MO First in human, modular study of samuraciclib (CT7001), a first-in-class, oral, selective inhibitor of CDK7, in patients with advanced solid malignancies. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Peddie N, Agnew S, Crawford M, Dixon D, MacPherson I, Fleming L. The impact of medication side effects on adherence and persistence to hormone therapy in breast cancer survivors: A qualitative systematic review and thematic synthesis. Breast 2021; 58:147-159. [PMID: 34049260 PMCID: PMC8165559 DOI: 10.1016/j.breast.2021.05.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Hormone Therapy (HT) reduces the risk of breast cancer recurrence and mortality in women with breast cancer. Despite these clinical benefits, rates of HT non-adherence and non-persistence are high. Research suggests this may be due to the impact of HT side effects. However, little research has explored the individual contribution of side effects to non-adherence and non-persistence behaviours, thereby hindering the implementation of targeted intervention strategies. Our aim is to review the published literature on breast cancer survivors' lived experiences of HT side effects and explore how these may be related to non-adherence and non-persistence behaviour. METHODS Electronic searches were conducted from inception to May 2020, utilising Cochrane CENTRAL, Medline, Embase, Web of Science and PsycINFO databases. Searches included a combination of terms related to breast cancer, adherence, hormone therapy and side effects. RESULTS Sixteen eligible papers were identified, and study quality was high. Data were thematically synthesised into four analytical themes, which encompassed 13 descriptive sub-themes: 'Daily impact of side-effects', 'Role of Health Care Professionals', 'Managing HT side-effects', and 'Weighing up the pros and cons'. CONCLUSIONS HT side effects significantly impact breast cancer survivor's quality of life. A lack of support from healthcare providers leads to self-management strategies, which negatively affects adherence and persistence behaviour.
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Kingston B, Cutts R, Beaney M, Walsh-Crestani G, Hrebien S, Kilburn L, Kernaghan S, Moretti L, Wilkinson K, MacPherson I, Baird R, Roylance R, Reis-Filho J, Hubank M, Faull I, Banks K, Garcia-Murillas I, Bliss J, Ring A, Turner N. 99P Analysis of ctDNA in advanced breast cancer reveals polyclonal disease associated with adverse outcome. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.214] [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: 10/21/2022] Open
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Winter M, Kendall J, Brown S, Rathbone E, Wilson C, Howell S, Twelves C, Palmieri C, Anand A, MacPherson I, Coleman R, Brown J. Abstract PS14-02: A randomised phase IB/IIA study of CApecitabine plus Radium-223 in breast cancer patients with BONe metastases (CARBON) - Safety and preliminary efficacy findings. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps14-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Bone metastases (BMs) occur in approximately 70% of patients (pts) with metastatic breast cancer (MBC). Despite significant advances in the management of BMs with bone-targeted agents and the associated reduction in skeletal-related events, there remains an unmet need for further treatment options to improve median overall survival beyond 2-3 years. Radium-223 [R] dichloride is an alpha-emitting radiopharmaceutical that is avidly taken up, like calcium, into the bone where it emits high-energy, short-range alpha-particles resulting in a targeted anti-tumour effect on BMs. Combining R with current systemic therapy could potentially enhance efficacy in MBC with BMs. Methods: CARBON is a UK, open-label, multi-centre phase IB/IIA study evaluating the combination of capecitabine [C] (1000mg/m2 bd days 4-17, 12x21 day cycles) with R 55kBq/kg day 1 given on a 6-weekly schedule in pts with BMs from MBC (+/- other sites of disease) with ≥2 bone lesions on radionuclide bone scan and/or ≥1 lesion confirmed on plain radiographs, CT or MRI. Other eligibility criteria included ECOG PS 0-2, ≤ 2 lines of chemotherapy for MBC and current use of a bisphosphonate / denosumab for ≥6 weeks. To establish the feasibility and safety of C+R the phase IB opened in August 2016 registering 6 pts; the primary endpoint was dose-limiting toxicities (DLTs), defined as ≥grade 3 gastrointestinal toxicity lasting >48 hours or ≥grade 4 haematological toxicity lasting >7 days. Subsequently, between April 2017 and March 2019 28 pts were randomised (2:1) to C+R vs C in phase IIa to further characterise the safety profile, with frequency of CTC grade 3-4 toxicities and diarrhoea as primary endpoints. Preliminary evaluation of efficacy through assessment of bone turnover marker changes from baseline to end of cycle 5 and time to progression in bone and overall was made. Results: Baseline clinico-pathologic characteristics and prior treatments were well balanced between the arms; 13 C+R and 9 C pts had visceral metastases. There were 0 DLTs in the 6 phase IB pts, therefore the same C+R dose and schedule was studied in phase IIA. 2 pts randomised to C+R received C alone and are included in the C arm. The safety population consists of 34 pts (23 C+R, 11 C). Median number of cycles received was 8.5 (range 3-12) in C+R arm and 12 (range 1-12) in C arm. 38/307 (12%) treatment cycles were delayed (25 [13%] C+R arm, 13 [12%] C arm). 11 (48%) C+R and 6 (55%) C pts had a permanent C dose reduction. 94/95 (99%) prescribed R cycles were administered. 9 (39%) C+R and 9 (82%) C pts completed all 12 cycles. Other reasons for discontinuation were: progressive disease in 12 (52%) C+R and 0 in C pts; toxicity in 1 (4%) C+R and 1 (9%) C pt; clinician decision in 1 (9%) C pt; progressive disease and toxicity in 1 (4%) C+R pt. Only 25/575 (4%) reported AEs were grade 3-4 (n=21 in 11 [48%] C+R pts, n=4 in 4 [36%] C pts) with 0 episodes of grade 3-4 diarrhoea. Table 1 shows maximum grades of diarrhoea and haematological AEs experienced by arm. 18 SAEs occurred (n=11 in 8 C+R pts, n=7 in 2 C pts). 8 (44%) SAEs were grade 3 (C+R: 6, C: 2); none were related to diarrhoea. There were 0 SUSARs. Conclusion: In the first completed trial evaluating R with chemotherapy in MBC pts, the combination of C+R is safe and well-tolerated. Preliminary efficacy analyses including bone markers are ongoing and will be presented at the meeting. The creation of the data was supported in part by Bayer Plc and Yorkshire Cancer Research.
Table 1: Maximum CTCAE grade (G) experienced - diarrhoea and haematological AEs.C+R (n=23)C (n=11)Not experiencedG1G2G3G4Not experiencedG1G2G3G4Diarrhoea7 (30%)14 (61%)2 (9%)006 (55%)4 (36%)1 (9%)00Neutropenia18 (78%)02 (9%)3 (13%)010 (91%)01 (9%)00Thrombocytopenia21 (91%)1 (4%)1 (4%)009 (82%)1 (9%)1 (9%)00Anaemia21 (91%)2 (9%)0008 (73%)1 (9%)2 (18%)00
Citation Format: Matthew Winter, Jessica Kendall, Sarah Brown, Emma Rathbone, Caroline Wilson, Sacha Howell, Chris Twelves, Carlo Palmieri, Anjana Anand, Iain MacPherson, Rob Coleman, Janet Brown. A randomised phase IB/IIA study of CApecitabine plus Radium-223 in breast cancer patients with BONe metastases (CARBON) - Safety and preliminary efficacy findings [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS14-02.
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Affiliation(s)
- Matthew Winter
- 1Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Sarah Brown
- 2CTRU, University of Leeds, Leeds, United Kingdom
| | - Emma Rathbone
- 3Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom
| | - Caroline Wilson
- 1Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Sacha Howell
- 4The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Chris Twelves
- 5St James’s University Hospital, Leeds, United Kingdom
| | - Carlo Palmieri
- 6Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Anjana Anand
- 7Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Iain MacPherson
- 8Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Rob Coleman
- 9The University of Sheffield, Sheffield, United Kingdom
| | - Janet Brown
- 9The University of Sheffield, Sheffield, United Kingdom
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Malorni L, Tyekucheva S, Hilbers FS, Ignatiadis M, Neven P, Colleoni M, Henry S, Ballestrero A, Bonetti A, Jerusalem G, Papadimitriou K, Bernardo A, Duhoux F, MacPherson I, Thomson A, Davies DM, Bergqvist M, Benelli M, McCartney A, De Swert H, Ruepp B, Rabaglio M, Maibach R, Piccart M, Regan MM. Abstract PS5-05: Serum thymidine kinase activity in patients with luminal metastatic breast cancer treated with palbociclib and fulvestrant within the PYTHIA trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps5-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The CDK4/6 inhibitor palbociclib (P) plus fulvestrant (F) is approved for the treatment of patients (pts) with luminal metastatic breast cancer (MBC) progressed on prior endocrine therapy (ET). Despite clinical activity, a significant proportion of pts in this setting show primary resistance to P+F, with treatment failure within 3-6 months of initiation. To date there is no validated biomarker to identify such pts. Thymidine kinase 1 is a cancer proliferation marker downstream of the CDK4/6 pathway, whose activity can be measured in serum as a readout of tumour proliferation. Circulating thymidine kinase activity (TKa) is a potential prognostic and monitoring marker in pts treated with ET alone or in combination with P for MBC. However, the prognostic value of early changes in TKa during P+F treatment and its role in identifying pts with primary resistance are not yet defined. Here we prospectively investigated the role of serum TKa measured at different timepoints in pts treated with P+F within the PYTHIA trial (IBCSG 53-14/BIG 14-04; NCT02536742), a downstream trial of the AURORA platform (BIG 14-01; NCT02102165).
Methods: PYTHIA is a biomarker discovery phase II trial including pts (Aug ‘16 to Jun ’19) with ET-resistant luminal MBC who received P+F at standard schedule and dose with 3-monthly imaging. Serum samples were collected at baseline (D0; n=122), on-treatment at day 11-16 of cycle 1 (D15; n=108), and during the one week off P before initiating cycle 2 (D28: Day 24-37 of Cycle 1; n=108). TKa was measured with DiviTum®, a refined ELISA-based assay. Complete TKa response (CTR) was defined as TKa below the limit of detection (LOD; 20 Du/L) at D15. Cox models evaluated association of log-transformed TKa measurements with progression-free survival (PFS; from initiation of therapy until progression by RECIST criteria or death). Kaplan-Meier method estimated median, 3 and 6 months (95% CI) PFS in groups of patients defined by dichotomizing TKa as “high” or “low” at the median or by CTR. A sample size of 120 provided 80% power to detect a hazard ratio of 2.0 for biomarker with 30-50% prevalence (two-sided α=0.05) after ≥80 events.
Results: A total of 122 pts were enrolled. About half had received one prior line of ET for MBC, and 18% had received one prior line of chemotherapy. 48% had visceral metastases and 31% had bone-only disease. TKa at D0 was not associated with clinical characteristics. Median TKa (mTKa) at D0 was 87 Du/L. Overall, 82 pts experienced progression, with a median PFS (mPFS) of 11 months (95% CI: 8.6 - 16). P+F dramatically suppressed mTKa levels at D15, with 90/108 (83%) pts achieving CTR. At D28, TKa showed some rebound in most pts. At each timepoint, higher TKa was significantly and consistently associated with shorter PFS (each p<0.001). The effect of TKa on PFS remained statistically significant after adjusting for clinical variables. At 6 months, the largest difference between PFS probabilities was observed between patients with CTR versus no CTR at D15.
Conclusions: TKa is an independent prognostic biomarker in pts treated with P+F. High baseline TKa and incomplete suppression of TKa during treatment may identify pts with poor prognosis and primary resistance to P+F. TKa may represent a novel biomarker to select pts for alternative treatment modalities. These results warrant further investigation in prospective comparative trials.
TimepointBaseline (D0)D151D28TK median value (Du/L) (range)87 (<20 - 14,510)<20 (<20 - 7,060)52 (<20 - 3,533)Sample sizeHigh TKa611854Low TKa619054mPFS (months) (95% CI)High TKa7.4 m (5.5 - 8.7)4.9 m (2.8 - 5.9)8.3 m (5.6 - 11)Low TKa17.0 m (14 - NR2)16.0 m (11 - 30)19.0 m (17 - NR2)PFS at 3 months(95% CI)High Tka79% (43% - 68%)61% (42% - 88%)78% (67% - 90%)Low TKa93% (87% - 100%)92% (87% - 98%)96% (91% - 100%)PFS at 6 months(95% CI)High TKa54% (43% - 68%)17% (6% - 47%)56% (44% - 71%)Low TKa88% (81% - 97%)85% (78% - 93%)92% (86% - 100%)1For D15 High/Low TKa correspond to no CTR/CTR; 2 NR = not reached
Citation Format: Luca Malorni, Svitlana Tyekucheva, Florentine S Hilbers, Michail Ignatiadis, Patrick Neven, Marco Colleoni, Stéphanie Henry, Alberto Ballestrero, Andrea Bonetti, Guy Jerusalem, Konstantinos Papadimitriou, Antonio Bernardo, Francois Duhoux, Iain MacPherson, Alastair Thomson, David Mark Davies, Mattias Bergqvist, Matteo Benelli, Amelia McCartney, Heidi De Swert, Barbara Ruepp, Manuela Rabaglio, Rudolf Maibach, Martine Piccart, Meredith M Regan. Serum thymidine kinase activity in patients with luminal metastatic breast cancer treated with palbociclib and fulvestrant within the PYTHIA trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS5-05.
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Affiliation(s)
- Luca Malorni
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Svitlana Tyekucheva
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Florentine S Hilbers
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Michail Ignatiadis
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Patrick Neven
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Marco Colleoni
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Stéphanie Henry
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Alberto Ballestrero
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Andrea Bonetti
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Guy Jerusalem
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Konstantinos Papadimitriou
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Antonio Bernardo
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Francois Duhoux
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Iain MacPherson
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Alastair Thomson
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - David Mark Davies
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Mattias Bergqvist
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Matteo Benelli
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Amelia McCartney
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Heidi De Swert
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Barbara Ruepp
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Manuela Rabaglio
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Rudolf Maibach
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Martine Piccart
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
| | - Meredith M Regan
- PYTHIA collaborators, International Breast Cancer Study Group and Breast International Group, Bern, Switzerland
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11
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Chow DC, Mau M, Hodis HN, Kewcharoen J, Li Y, Siriwardhana C, Souza SA, Mitchell BI, Bowler S, SahBandar I, Gangcuangco LMA, MacPherson I, Ndhlovu LC, Shikuma CM. Short Communication: Carotid Artery Plaque Burden in HIV Is Associated with Soluble Mediators and Monocytes. AIDS Res Hum Retroviruses 2020; 36:1020-1023. [PMID: 32862657 DOI: 10.1089/aid.2020.0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Maximum carotid plaque thickness (MCPT) measures the largest plaque thickness in the carotid artery and reflects atherosclerosis plaque burden. MCPT may be a better predictor of cardiovascular disease than carotid artery intima-media thickness (cIMT) because it identifies potential unstable arterial atherosclerosis plaques. We assessed the relationships of monocyte and T cell populations and plasma soluble mediators with MCPT measures. We performed a cross-sectional and small follow-up analysis in people living with HIV (PLWH) aged >40 years on stable antiretroviral therapy (ART) >6 months. MCPT was acquired by high-resolution B-mode ultrasound. Existing monocyte subsets and T cell activation frequencies were determined by flow cytometry and plasma mediators of inflammation and apolipoproteins were measured by Luminex assay. One hundred twenty-five ART-treated PLWH, 88% male, 55% Caucasian, with a median age of 51 years, median CD4 count of 477 cells/μL (Q1: 325, Q3: 612), 84% undetectable plasma HIV RNA (<50 copies/mL). Twenty-five PLWH had detectable carotid plaque. MCPT correlated with monocyte chemoattractant protein-1 (MCP-1; r = 0.487, p = .016), tumor necrosis factor-α (TNF-α; r = 0.474 p = .019), soluble vascular cell adhesion molecule-1 (sVCAM-1; r = 0.472, p = .020), apolipoprotein B6 (ApoB6; r = -0.473, p = .019), and interleukin-6 (IL-6; r = 0.455, p = .025). In a multivariable regression model, MCP-1, TNF-α, and sVCAM-1 remained significant after adjustment for age. Carotid plaque burden was associated with increased inflammatory, monocyte, and endothelial measures, including MCP-1, TNF-α, and sVCAM-1 levels. Further investigation on the evolution or severity of plaque burden in this population is warranted.
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Affiliation(s)
- Dominic C. Chow
- Hawai'i Center for AIDS, Department of Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
| | - Makoa Mau
- Hawai'i Center for AIDS, Department of Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
| | - Howard N. Hodis
- Atherosclerosis Research Unit, University of Southern California, Los Angeles, California, USA
| | - Jakrin Kewcharoen
- Hawai'i Center for AIDS, Department of Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
| | - Yanjie Li
- Atherosclerosis Research Unit, University of Southern California, Los Angeles, California, USA
| | - Chathura Siriwardhana
- Department of Tropical Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
| | - Scott A. Souza
- Hawai'i Center for AIDS, Department of Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
- Queen's Medical Center, Honolulu, Hawai'i, USA
| | - Brooks I. Mitchell
- Hawai'i Center for AIDS, Department of Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
| | - Scott Bowler
- Hawai'i Center for AIDS, Department of Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
| | - Ivo SahBandar
- Hawai'i Center for AIDS, Department of Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
- Department of Tropical Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Louie Mar A. Gangcuangco
- Hawai'i Center for AIDS, Department of Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
| | - Iain MacPherson
- Hawai'i Center for AIDS, Department of Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
| | - Lishomwa C. Ndhlovu
- Hawai'i Center for AIDS, Department of Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
- Department of Tropical Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Cecilia M. Shikuma
- Hawai'i Center for AIDS, Department of Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, Hawai'i, USA
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12
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Awada A, Cortes J, Slater S, MacPherson I, Csoszi T, Bertrand JB, Clermont AS, Pollard R, Chrestia-Blanchine R, Biswas-Baldwin N, Youssoufian H, El-Hariry I. Abstract OT1-08-02: TRYbeCA-2: A randomized phase 2/3 study of eryaspase in combination with gemcitabine and carboplatin chemotherapy versus chemotherapy alone as first-line treatment in patients with metastatic or locally recurrent triple-negative breast cancer (NCT03674242). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-ot1-08-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Triple Negative Breast Cancer (TNBC) represents approximately 15% of all breast cancer. It confers a poorer prognosis relative to the other breast cancer subtypes, with an increased likelihood of recurrence and death within 5 years of diagnosis. There is no standard of care specifically for patients presenting with TNBC.
Altered amino acid metabolism have been shown to play a role in TNBC. Eryaspase, asparaginase (ASNase) encapsulated in red blood cells (RBCs) is an investigational product under development. Following infusion, asparagine and glutamine are actively transported into RBCs where they are hydrolyzed by the encapsulated ASNase. In a recent randomized Phase 2b study, eryaspase has demonstrated evidence of improved overall survival (OS) and progression free survival (PFS) and acceptable safety when combined with gemcitabine or FOLFOX therapy in patients with advanced pancreatic cancer whose disease progressed following first-line treatment (NCT02195180). The demonstration of ASNase activity of eryaspase in combination with chemotherapy including DNA-damaging agents in both preclinical and clinical settings provide a rationale to further test combination in TNBC.
Methods: TRYbeCA-2 is an international, randomized, open-label Phase 2/3 trial (N=64 for Phase 2) of eryaspase combined with chemotherapy in patients with locally recurrent or metastatic TNBC who have not received prior systemic therapy for locally recurrent or metastatic disease. Patients are randomized in a 1:1 ratio to receive gemcitabine/carboplatin with or without eryaspase, administered as IV infusion on Day 1 and Day 8 of each 3-week cycle.
Key eligibility criteria include measurable lesion(s), performance status 0 or 1, and adequate organ function. The primary endpoint is the objective response rate (ORR) as determined by an independent radiological review. Key secondary endpoints include ORR as determined by the investigator’s assessment, clinical benefit rate, overall survival, progression-free survival, safety, biomarker research, pharmacokinetics and pharmacodynamics.
A steering committee will be established to review safety at regular intervals and to review safety and efficacy data at the end of the Phase 2 to determine whether or not to proceed to Phase 3. The study is planned in European countries. Several sites have already been initiated and at least one patient was enrolled at the time of submitting this abstract.
Citation Format: Ahmad Awada, Javier Cortes, Sarah Slater, Iain MacPherson, Tibor Csoszi, Jean-Baptiste Bertrand, Anne-Sophie Clermont, Rachel Pollard, Romain Chrestia-Blanchine, Nigel Biswas-Baldwin, Hagop Youssoufian, Iman El-Hariry. TRYbeCA-2: A randomized phase 2/3 study of eryaspase in combination with gemcitabine and carboplatin chemotherapy versus chemotherapy alone as first-line treatment in patients with metastatic or locally recurrent triple-negative breast cancer (NCT03674242) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT1-08-02.
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Affiliation(s)
| | | | - Sarah Slater
- 3Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Iain MacPherson
- 3Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Tibor Csoszi
- 4Jasz-Nagykun-Szolnok Megyei Hetenyi Geza Korhaz-Rendelointezet, Szolnok, Hungary
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13
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Coleman R, Brown J, Rathbone E, Flanagan L, Reid A, Kendall J, Howell S, Twelves C, Palmieri C, Anand A, MacPherson I, Brown S. CApecitabine plus Radium-223 (Xofigo™) in breast cancer patients with BONe metastases (CARBON): study protocol for a phase IB/IIA randomised controlled trial. Trials 2020; 21:89. [PMID: 31941523 PMCID: PMC6961242 DOI: 10.1186/s13063-019-3643-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background A substantial proportion of breast cancer patients develop metastatic disease, with over 450,000 deaths globally per year. Bone is the most common first site of metastatic disease accounting for 40% of all first recurrence and 70% of patients with advanced disease develop skeletal involvement. Treatment of bone metastases currently focusses on symptom relief and prevention and treatment of skeletal complications. However, there remains a need for further treatment options for patients with bone metastases. Combining systemic therapy with a bone-targeted agent, such as radium-223, may provide an effective treatment with minimal additional side effects. Methods/design CARBON is a UK-based, open-label, multi-centre study which comprises an initial safety phase to establish the feasibility and safety of combining radium-223 given on a 6-weekly schedule in combination with orally administered capecitabine followed by a randomised extension phase to further characterise the safety profile and provide preliminary estimation of efficacy. Discussion The CARBON study is important as the results will be the first to assess radium-223 with chemotherapy in advanced breast cancer. If the results find acceptable rates of toxicity with a decrease in bone turnover markers, further work will be necessary in a phase II/III setting to assess the efficacy and clinical benefit. Trial registration ISRCTN, ISRCTN92755158, Registered on 17 February 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3643-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Emma Rathbone
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Louise Flanagan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amber Reid
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jessica Kendall
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Sacha Howell
- The Christie NHS Foundation Trust, Manchester, UK
| | - Chris Twelves
- St James's University Hospital, Leeds, UK.,Leeds Institute of Cancer Studies and Pathology, University of Leeds, Leeds, UK
| | - Carlo Palmieri
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Anjana Anand
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Iain MacPherson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Sarah Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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14
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Saura C, Thistlethwaite F, Banerji U, Lord S, Moreno V, MacPherson I, Boni V, Rolfo CD, de Vries EG, Van Herpen CM, Rottey S, Geenen JJ, Eskens F, Gil Martin M, Mommers E, Koper NP, Mulder R, Aftimos PG. A phase I expansion cohorts study of SYD985 in heavily pretreated patients with HER2-positive or HER2-low metastatic breast cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1014] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Cristina Saura
- Medical Oncology Department, Breast Cancer Group, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Fiona Thistlethwaite
- The Christie NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Simon Lord
- Early Phase Clinical Trials Unit, Oxford University NHS Trust, Oxford, United Kingdom
| | - Victor Moreno
- START Madrid-FJD, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | | | | | | | - Sylvie Rottey
- Ghent University Hospital, Heymans Institute of Pharmacology, Ghent, Belgium
| | - Jill J.J. Geenen
- Netherlands Cancer Institute, department of molecular pathology, Amsterdam, Netherlands
| | - Ferry Eskens
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Marta Gil Martin
- Institut Català D'Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Roel Mulder
- Synthon Biopharmaceuticals BV, Nijmegen, Netherlands
| | - Philippe Georges Aftimos
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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15
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Gligorov J, Ataseven B, Verrill M, De Laurentiis M, Jung K, Azim H, Al-Sakaff N, Lauer S, Shing M, Pivot X, Koroveshi D, Bouzid K, Casalnuovo M, Cascallar D, Korbenfeld EP, Bastick P, Beith J, Colosimo M, Friedlander M, Ganju V, Green M, Patterson K, Redfern A, Richardson G, Ceric T, Gordana K, Beato CA, Ferrari M, Hegg R, Helena V, Ismael GF, Lessa AE, Mano M, Morelle A, Nogueira JA, Timcheva K, Tomova A, Tsakova M, Zlatareva-Petrova A, Asselah J, Assi H, Brezden-Masley C, Chia S, Freedman O, Harb M, Joy AA, Kulkarni S, Prady C, Gaete AAA, Matamala L, Torres R, Yanez E, Franco S, Urrego M, Gugić D, Vrbanec D, Melichar B, Prausová J, Vyzula R, Pilarte RG, León MI, Muñoz R, Ramos G, Azeem HA, Aziz AA, El Zawahry H, Osegueda FR, Alexandre J, Artignan X, Barletta H, Beguier E, Berdah JF, Marty CB, Bollet M, Bourgeois H, Bressac C, Burki F, Campone M, Coeffic D, Cojocarasu OZ, Dagada C, Dalenc F, Del Piano F, Desauw C, Desmoulins I, Dohollou N, Egreteau J, Ferrero JM, Foa C, Garidi R, Gasnault L, Gligorov J, Guardiola E, Hamizi S, Jarcau R, Jacquin JP, Jaubert D, Jolimoy G, Mineur HL, Largillier R, Leduc B, Martin P, Melis A, Monge J, Moullet I, Mousseau M, Nguyen S, Orfeuvre H, Petit T, Pivot X, Priou F, Bach IS, Simon H, Stefani L, Uwer L, Youssef A, Aktas B, von der Assen A, Augustin D, Balser C, Bauer LE, Bechtner C, Beyer G, Brucker C, Bückner U, Busch S, Christensen B, Deryal M, Farrokh A, Faust E, Friedrichs K, Graf H, Griesshammer M, Grischke EM, Hänle C, Heider A, Henschen S, Hesse T, Jackisch C, Kisro J, Köhler A, Kuemmel S, Lampe D, Lantzsch T, Latos K, Lex B, Liedtke C, Luedders D, Maintz C, Müller V, Overkamp F, Park-Simon TW, Paul M, Prechtl A, Ringsdorf U, Runnebaum I, Ruth S, Salat C, Scheffen I, Schilling J, Schmatloch S, Schmidt M, Schneeweiss A, Schrader I, Seipelt G, Simon E, Stefek A, Stickeler E, Thill M, Tio J, Tuczek A, Warm M, Weigel M, Wischnik A, Wojcinski S, Ziegler-Löhr K, Aravantinos G, Ardavanis A, Fountzilas G, Gogas H, Kakolyris S, Mavroudis D, Papadimitriou C, Papandreou C, Papazisis K, Castro H, Hernandez-Monroy CE, Ngan R, Yeo W, Bittner N, Boer K, Csejtei A, Horvath Z, Kocsis J, Mangel LC, Mezei K, Nagy Z, Szanto J, Atmakusuma D, Fadjari H, Kurnianda D, Prayogo N, Tanggo EH, Coate L, Hennessy B, Kelly C, Martin M, Nasim S, O'Connor M, Aieta M, Allegrini G, Amadori D, Bidoli P, Biti G, Bordonaro R, Bottini A, Carterni G, Cavanna L, Cazzaniga M, Cognetti F, Contu A, Cruciani G, Donadio M, Falcone A, Farci D, Forcignanò RC, Frassoldati A, Gaion F, Gamucci T, Giotta F, de Laurentiis M, Livi L, Lorusso V, Maiello E, Marchetti P, Mariani G, Mion M, Moscetti L, Musolino A, Pazzola A, Pedrazzoli P, Pigi A, de Placido S, Caremoli ER, Santoro A, Tienghi A, Ahn JS, Jung KH, Lee KS, Lee SH, Seo JH, Sohn JH, Cesas A, Juozaityte E, Cheah NLC, Chong FLT, Devi BC, Phua V, Teoh D, Ching LW, Yusof M, Corona J, Dominguez A, Mendoza RLG, Hernandez CA, Ramiro AJ, Santos JM, Espinosa PM, Villarreal Garza CM, Errihani H, Bakker S, van den Berkmortel F, Blaisse R, Huinink DTB, van den Bosch J, Braun J, Dercksen M, Droogendijk H, Erdkamp F, Haringhuizen A, de Jongh F, Kok T, Los M, Madretsma S, Terwogt JMM, van der Padt A, van Rossum-Schornagel QC, Smilde T, de Valk B, van der Velden A, van Warmerdam L, van de Wouw A, North R, Kersten C, Mjaaland I, Wist E, Aziz Z, Masood N, Rashid K, Shah M, Alcedo JC, Aleman D, Neciosup S, Reategui R, Valdiviezo N, Vera L, Fernando G, Roque F, Strebel HM, Krzemieniecki K, Litwiniuk M, Mruk A, Pienkowski T, Sawrycki P, Slomian G, Tomczak P, Afonso N, Cardoso F, Damasceno M, Nave M, Badulescu F, Ciule L, Curescu S, Eniu A, Filip D, Grecea D, Jinga DC, Lungulescu D, Oprean CM, Stanculeanu DL, Turdean M, Dvornichenko V, Emelyanov S, Lichinitser M, Manikhas A, Sakaeva D, Shirinkin V, Stroyakovskiy D, Abulkhair O, Zekri J, Filipovic S, Kovcin V, Nedovic J, Pesic J, Vasovic S, Ng R, Bystricky B, Leskova J, Mardiak J, Mišurová E, Wagnerova M, Takač I, Demetriou GS, Dreosti L, Govender P, Jordaan JP, Veersamy P, Romero JLA, Lopez NB, Arias CC, Chacon J, Aramburo AF, Morales LAF, Garcia M, Estevez LG, Garcia-Palomo Perez A, Garcia Saenz JA, Garcia Sanchis L, Cubells LG, Cortijo LG, Santiago SG, De Aranguiz BHF, Mañas JJI, Gallego PJ, Cussac AL, Ferrandiz CL, Garrido ML, Alvarez PL, Vega JML, Del Prado PM, Jañez NM, Murillo SM, Rosales AM, Jaso LM, Fernandez IP, Martorell AP, Carrion RP, Simon SP, Alcibar AP, Lorenzo JP, Garcia VQ, Asensio TRYC, Maicas MDT, Villanueva Silva MJ, Killander F, Svensson JH, Fehr M, Hauser N, Müller A, Pagani O, Passmann-Kegel H, Popescu R, Rabaglio M, Rauch D, Schlatter C, Zaman K, Chang TW, Huang CS, Wang HC, Yu JC, Bandidwattanawong C, Maneechavakajorn J, Seetalarom K, Dejthevaporn T(S, Somwangprasert A, Vongsaisuwon M, Akbulut H, Altundag K, Arican A, Bozcuk H, Eralp Y, Idris M, Isikdogan A, Senol CH, Sevinc A, Uygun K, Yucel E, Yucel I, Yumuk F, Shparyk Y, Voitko N, Jaloudi M, Adams J, Agrawal R, Ahmed S, Alhasso A, Allerton R, Anwar S, Archer C, Ashford R, Barraclough L, Bertelli G, Bishop J, Branson T, Butt M, Chakrabarti A, Chakraborti P, Churn M, Crowley C, Davis R, Dhadda A, Eldeeb H, Fraser J, Hall J, Hickish T, Hogg M, Howe T, Joffe J, Kelleher M, Kelly S, Kendall A, Kristeleit H, Lumsden G, Macmillan C, MacPherson I, Malik Z, Mithal N, Neal A, Panwar U, Proctor A, Proctor SJ, Raj S, Rehman S, Sandri I, Scatchard K, Sherwin E, Sims E, Singer J, Smith S, Tahir S, Taylor W, Tsalic M, Verrill M, Wardley A, Waters S, Wheatley D, Wright K, Yuille F, Alonso I, Artagaveytia N, Rodriguez R, Arbona E, Garcia Y, Lion L, Marcano D, Van Thuan T. Safety and tolerability of subcutaneous trastuzumab for the adjuvant treatment of human epidermal growth factor receptor 2-positive early breast cancer: SafeHer phase III study's primary analysis of 2573 patients. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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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Hernández-Fernaud JR, Ruengeler E, Casazza A, Neilson L, Pulleine E, MacPherson I, Blyth K, Yin H, Mazzone M, Norman J, Zanivan S. Abstract PR01: CLIC3 is secreted by CAFs and enhances angiogenesis and tumor cell invasion by cooperating with TGM2. Mol Cancer Ther 2015. [DOI: 10.1158/1538-8514.tumang15-pr01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Cancer-associated fibroblasts (CAFs) play a central role in tumor progression through the mechanical remodeling of the stroma. Indeed CAFs secrete a plethora of extracellular matrix (ECM) components and ECM modifiers which contribute to generate stiff and dense tumors. Increased tumor stiffness induces endothelial cell (EC) sprouting and tumor cell invasion. Moreover, excessive stiffness represents a critical barrier to therapy because it blocks perfusion thus preventing diffusion of drugs and favoring hypoxia. Tuning tumor stiffness has therefore the potential to contribute to improve the efficacy of conventional anti-cancer therapies. Our study aims at using unbiased proteomics approach to identify CAF proteins which alter the tumor stroma, and investigating their functional role.
We have established mass spectrometry-based proteomics approach to accurately and in-depth analyze secretomes of cells in culture, and used it to compare cell lines of human mammary normal (iNF) and myofibroblasts-like cancer-associated (iCAF) fibroblasts. Unexpectedly, we detected the chloride intracellular channel protein 3 (CLIC3), which so far was known as an intracellular regulator of receptor trafficking in tumor cells, amongst the most up-regulated proteins in the ECM generated by iCAF. Highlighting the relevance of CLIC3 in a clinical context, high levels of CLIC3 were also measured in CAFs isolated from patient samples. Notably, CLIC3 silencing reduces the pro-angiogenic and pro-invasive activity of CAFs in vitro. To investigate the role of secreted CLIC3, we have generated the recombinant protein (rCLIC3) and the mutant for the active site (rCLIC3mut) and show that rCLIC3 induces angiogenesis in vitro and in vivo, and tumor cell invasion in vitro and that its active site is required for this activity. Furthermore, we show that rCLIC3 is used by iCAF to increase the stiffness of the ECM that they produce. Using gene silencing and specific inhibitors in combination with functional assays in vitro and in vivo, we show that rCLIC3 exerts its functions through the cooperation with the ECM remodeling enzyme transglutaminase 2 (TGM2). Importantly, TGM2 is highly abundant in many tumors. In a clinical context, CLIC3 staining of various TMAs shows that this protein is expressed in the stroma of some tumors and that it is particularly abundant in the stroma of ovarian cancers. Preliminary analysis of ovarian TMAs shows that the stroma of aggressive and highly vascularized tumors strongly stains for CLIC3.
In conclusion, our work has discovered a completely unexpected function for CLIC3, which we have now characterized as a stromal protein which is secreted and alters the ECM stiffness cooperating with TGM2, thus enhancing the pro-angiogenic and pro-invasive properties of the CAFs. CLIC3 is therefore a promising candidate to be further investigated for its role in tumor progression and as a target to improve current anti-cancer therapy.
Citation Format: Juan Ramon Hernández-Fernaud, Elena Ruengeler, Andrea Casazza, Lisa Neilson, Ellie Pulleine, Iain MacPherson, Karen Blyth, Huabing Yin, Massimiliano Mazzone, Jim Norman, Sara Zanivan. CLIC3 is secreted by CAFs and enhances angiogenesis and tumor cell invasion by cooperating with TGM2. [abstract]. In: Proceedings of the AACR Special Conference: Tumor Angiogenesis and Vascular Normalization: Bench to Bedside to Biomarkers; Mar 5-8, 2015; Orlando, FL. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl):Abstract nr PR01.
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Affiliation(s)
| | | | | | - Lisa Neilson
- 1CRUK Beatson Institute, Glasgow, United Kingdom,
| | | | | | - Karen Blyth
- 1CRUK Beatson Institute, Glasgow, United Kingdom,
| | - Huabing Yin
- 3University of Glasgow, Glasgow, United Kingdom
| | | | - Jim Norman
- 1CRUK Beatson Institute, Glasgow, United Kingdom,
| | - Sara Zanivan
- 1CRUK Beatson Institute, Glasgow, United Kingdom,
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Marshall A, MacPherson I, Currie G, Chalmers G. P275 Ebus Or Eus In The Diagnosis Of Sarcoidosis? Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.393] [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: 11/03/2022]
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Macagno JP, Diaz Vera J, Yu Y, MacPherson I, Sandilands E, Palmer R, Norman JC, Frame M, Vidal M. FAK acts as a suppressor of RTK-MAP kinase signalling in Drosophila melanogaster epithelia and human cancer cells. PLoS Genet 2014; 10:e1004262. [PMID: 24676055 PMCID: PMC3967952 DOI: 10.1371/journal.pgen.1004262] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 02/10/2014] [Indexed: 11/18/2022] Open
Abstract
Receptor Tyrosine Kinases (RTKs) and Focal Adhesion Kinase (FAK) regulate multiple signalling pathways, including mitogen-activated protein (MAP) kinase pathway. FAK interacts with several RTKs but little is known about how FAK regulates their downstream signalling. Here we investigated how FAK regulates signalling resulting from the overexpression of the RTKs RET and EGFR. FAK suppressed RTKs signalling in Drosophila melanogaster epithelia by impairing MAPK pathway. This regulation was also observed in MDA-MB-231 human breast cancer cells, suggesting it is a conserved phenomenon in humans. Mechanistically, FAK reduced receptor recycling into the plasma membrane, which resulted in lower MAPK activation. Conversely, increasing the membrane pool of the receptor increased MAPK pathway signalling. FAK is widely considered as a therapeutic target in cancer biology; however, it also has tumour suppressor properties in some contexts. Therefore, the FAK-mediated negative regulation of RTK/MAPK signalling described here may have potential implications in the designing of therapy strategies for RTK-driven tumours.
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Affiliation(s)
- Juan Pablo Macagno
- Cancer Research UK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
| | - Jesica Diaz Vera
- Cancer Research UK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
| | - Yachuan Yu
- Cancer Research UK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
| | - Iain MacPherson
- Cancer Research UK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
| | - Emma Sandilands
- Edinburgh Cancer Research UK Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
| | - Ruth Palmer
- Department of Molecular Biology, Umeå University, Umeå, Sweden
| | - Jim C. Norman
- Cancer Research UK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
| | - Margaret Frame
- Edinburgh Cancer Research UK Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
| | - Marcos Vidal
- Cancer Research UK Beatson Institute, Garscube Estate, Glasgow, United Kingdom
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Awada A, Spector N, El-Hariry I, Rodriguez AA, Erban JK, Cortes J, Gomez H, Kong A, Hickish T, Fein L, Vahdat L, MacPherson I, Canon JL, Mansoor S, Giovanne A, McAdam K, Vukovic VM, Yalcin I, Bradley R, Proia D, Mano MS, Perez EA, Cameron DA. Abstract P2-16-23: The ENCHANT-1 trial (NCT01677455): An open label multicenter phase 2 proof of concept study evaluating first line ganetespib monotherapy in women with metastatic HER2 positive or triple negative breast cancer (TNBC). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-16-23] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
Abstract
Background: Hsp90 is a molecular chaperone protein required for the stabilization and activation of many proteins, referred to as Hsp90 ‘clients’, such as HER2, HIF1-a, EGFR, ER, PI3K, AKT, P53 and VEGFR. The drug candidate, ganetespib is a novel triazolone inhibitor of Hsp90, with over 700 patients treated to date. Ganetespib has shown activity in preclinical models of HER2+, ER+/PR+ and TNBC. Early clinical trials documented ganetespib single agent activity in heavily pretreated HER2+ and TNBC patients. Ganetespib has been well tolerated in clinical trials with a favorable safety profile. This efficacy-screening study is designed to provide further evidence of ganetespib activity and identify potentially predictive biomarkers in metastatic breast cancer (BC).
Methods: The ENCHANT-1 Trial is an international, first-line 2-cohort Phase 2 study in BC patients: Cohort A, HER2 amplified (n = 35), and Cohort B, TNBC (n = 35). Patients who present with previously untreated metastatic disease are eligible for treatment with ganetespib at 150 mg/m2 twice weekly on 3 out of 4 wks, for a total of up to 12 wks. Primary endpoint: ORR assessed using RECIST1.1 criteria. Key secondary endpoints include metabolic response as assessed by PET/CT at wk 3 utilizing modified EORTC criteria. Disease progression (PD) at wk 3 by PET imaging indicates discontinuation of study therapy, and is performed to quickly offer patients with metabolic PD a standard of care treatment.
The study is designed as Simon 2-stage requiring at least one OR in 15 patients for the respective cohort to expand to 35 patients. A Steering Committee is established to oversee the overall study and review the interim results.
Results: The study was initiated in 23 centers globally. At the time of submission, a total of 17 patients had been enrolled; TNBC (n = 15) and HER2 (n = 2). Here we report the interim analysis in the TNBC cohort. The median age was 54 years (range 30 -77) with ECOG PS 0 (n = 7/15). Most patients (n = 9) presented with de novo metastatic disease. 5 patients were not evaluable for PET assessment (3 had not yet reached wk 3 and 2 withdrawn before wk 3 for clinical progression), and 9 patients were not evaluable for objective response at wk 6 (3 withdrawn before or at wk 3 for clinical progression and 6 had not yet reached wk 6 evaluation). In the 10 patients with evaluable PET imaging, 9 patients achieved metabolic (m) response (2 mPR, 4 mSD with dominant tumor shrinkage and 3 SD) and one patient with mPD. In the 6 patients evaluable for OR at wk 6, one patient achieved PR, 2 SD and 3 PD. Treatment with ganetespib was well tolerated; the most common AEs were mild or moderate diarrhea (8/15, 53%), fatigue (5/15, 33%), decreased appetite (4/15, 27%), insomnia (4/15, 27%), and nausea (4/15, 27%).
Conclusion: Ganetespib single agent was generally well tolerated and showed anti-tumor activity TNBC patients as early as 3 weeks following treatment. PET seems to be a good tool to screen antitumor activity of new agents in early settings rather that in heavily pretreated patients. The TNBC cohort has met the protocol criteria for proceeding to stage 2.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-16-23.
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Affiliation(s)
- A Awada
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - N Spector
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - I El-Hariry
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - AA Rodriguez
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - JK Erban
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - J Cortes
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - H Gomez
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - A Kong
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - T Hickish
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - L Fein
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - L Vahdat
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - I MacPherson
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - J-L Canon
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - S Mansoor
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - A Giovanne
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - K McAdam
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - VM Vukovic
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - I Yalcin
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - R Bradley
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - D Proia
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - MS Mano
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - EA Perez
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
| | - DA Cameron
- Jules Bordet Institute, Brussels, Belgium; Duke University Medical Center, Durham; Synta Pharmaceuticals Inc, Lexington; The Methodist Hospital Research Institute, Houston; Tufts Medical Center, Boston; Vall d'Hebron University Hospital, Barcelona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; Churchill Hospital, Oxford University Hospitals NHS Trust and University of Oxford, Oxford, United Kingdom; The Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom; Centro Oncológico de Rosario, Rosario Santa Fe, Argentina; Weill Cornell Medical College, New York; The Beatson Institute for Cancer Research, Glasgow, United Kingdom; Grand Hôpital de Charleroi, Charleroi, Belgium; Georgia Cancer Specialists, Atlanta; Hospital Central de la Fuerza Aérea del Perú, Lima, Peru; Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom; Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; Mayo Clinic, Jacksonville; Edinburgh University, Edinburgh, United Kingdom
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Dozynkiewicz M, Jamieson N, MacPherson I, Grindlay J, van den Berghe P, von Thun A, Morton J, Gourley C, Timpson P, Nixon C, McKay C, Carter R, Strachan D, Anderson K, Sansom O, Caswell P, Norman J. Rab25 and CLIC3 collaborate to promote integrin recycling from late endosomes/lysosomes and drive cancer progression. Dev Cell 2012; 22:131-45. [PMID: 22197222 PMCID: PMC3507630 DOI: 10.1016/j.devcel.2011.11.008] [Citation(s) in RCA: 242] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 08/31/2011] [Accepted: 11/18/2011] [Indexed: 01/12/2023]
Abstract
Here we show that Rab25 permits the sorting of ligand-occupied, active-conformation α5β1 integrin to late endosomes/lysosomes. Photoactivation and biochemical approaches show that lysosomally targeted integrins are not degraded but are retrogradely transported and recycled to the plasma membrane at the back of invading cells. This requires CLIC3, a protein upregulated in Rab25-expressing cells and tumors, which colocalizes with active α5β1 in late endosomes/lysosomes. CLIC3 is necessary for release of the cell rear during migration on 3D matrices and is required for invasion and maintenance of active Src signaling in organotypic microenvironments. CLIC3 expression predicts lymph node metastasis and poor prognosis in operable cases of pancreatic ductal adenocarcinoma (PDAC). The identification of CLIC3 as a regulator of a recycling pathway and as an independent prognostic indicator in PDAC highlights the importance of active integrin trafficking as a potential drive to cancer progression in vivo.
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Affiliation(s)
| | - Nigel B. Jamieson
- Centre for Oncology and Applied Pharmacology, Division of Cancer Sciences and Molecular Pathology, University of Glasgow, Glasgow G61 1BD, UK
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | - Iain MacPherson
- Beatson Institute for Cancer Research, Garscube Estate, Glasgow G61 1BD, UK
| | - Joan Grindlay
- Beatson Institute for Cancer Research, Garscube Estate, Glasgow G61 1BD, UK
| | | | - Anne von Thun
- Beatson Institute for Cancer Research, Garscube Estate, Glasgow G61 1BD, UK
| | - Jennifer P. Morton
- Beatson Institute for Cancer Research, Garscube Estate, Glasgow G61 1BD, UK
| | - Charlie Gourley
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XR, UK
| | - Paul Timpson
- Beatson Institute for Cancer Research, Garscube Estate, Glasgow G61 1BD, UK
| | - Colin Nixon
- Beatson Institute for Cancer Research, Garscube Estate, Glasgow G61 1BD, UK
| | - Colin J. McKay
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | - Ross Carter
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | - David Strachan
- Beatson Institute for Cancer Research, Garscube Estate, Glasgow G61 1BD, UK
| | - Kurt Anderson
- Beatson Institute for Cancer Research, Garscube Estate, Glasgow G61 1BD, UK
| | - Owen J. Sansom
- Beatson Institute for Cancer Research, Garscube Estate, Glasgow G61 1BD, UK
| | - Patrick T. Caswell
- Beatson Institute for Cancer Research, Garscube Estate, Glasgow G61 1BD, UK
- Wellcome Trust Centre for Cell-Matrix Research, Faculty of Life Sciences, University of Manchester, Manchester M13 9PT, UK
| | - Jim C. Norman
- Beatson Institute for Cancer Research, Garscube Estate, Glasgow G61 1BD, UK
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Chalmers CR, Mallon EA, Touqan N, Horgan KJ, MacPherson I, Doughty JC. P1-12-05: Complete Pathological Response of Ductal Carcinoma In Situ after Treatment with Neoadjuvant Herceptin. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-12-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The introduction of neo-adjuvant herceptin has led to pathological complete response rates of up to 60% in patients with breast cancer. The traditional (NSABP) definition of pathological complete response includes cases demonstrating residual DCIS and little is known about the effects of neo-adjuvant herceptin in this situation. Current evidence suggests that DCIS is chemo-resistant, but it has also been shown that DCIS is more likely to be HER-2 positive than primary cancer.
Results: We describe six patients who received neo-adjuvant chemotherapy and herceptin for biopsy-proven, node-positive, large breast cancers either with an extensive component of concomitant DCIS or a separate DCIS focus. Neo-adjuvant treatment did not result in any changes in the pattern of mammographic calcification seen pre-operatively (Figure 1 a-c), however histopathology of all six specimens showed ductal spaces containing macrophages and calcification but no residual lining epithelium, features consistent with pathological complete response of the DCIS component (Figure 1d). Figure 1: Pathologically complete response of DCIS after neo-adjuvant treatment with herceptin. (a) Pre-treatment mammogram (b) Post neo-adjuvant chemotherapy and herceptin mammogram showing resolution of the mass effect of the primary cancer and unchanged residual mammographic calcification associated with the extensive DCIS component (c) Wire-localised specimen demonstrating excision of calcification (d) Histopathology of the same specimen showing calcium-filled ducts and no residual lining epithelium. Discussion: In conclusion, neo-adjuvant herceptin is associated with complete pathological response of both breast cancer and DCIS. The presence of unchanged persistent mammographic calcification in known regions of DCIS after treatment complicates any role of mammographic surveillance in this group and raises the question of optimal surgical management in the future management of these individuals.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-12-05.
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Affiliation(s)
- CR Chalmers
- 1The Western Infirmary, Glasgow, Scotland, United Kingdom; Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - EA Mallon
- 1The Western Infirmary, Glasgow, Scotland, United Kingdom; Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - N Touqan
- 1The Western Infirmary, Glasgow, Scotland, United Kingdom; Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - KJ Horgan
- 1The Western Infirmary, Glasgow, Scotland, United Kingdom; Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - I MacPherson
- 1The Western Infirmary, Glasgow, Scotland, United Kingdom; Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
| | - JC Doughty
- 1The Western Infirmary, Glasgow, Scotland, United Kingdom; Leeds General Infirmary, Leeds, Yorkshire, United Kingdom
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Barnett AL, Ding S, Murray C, Lee DN, Plummer S, Evans TRJ, MacPherson I, Bissett D, Elcombe CR, Wolf CR. Abstract 3566: Anti-tumor activity of CXR1002, a novel anti-cancer compound that induces ER stress: Human tumor xenograft efficacy and in vitro mode of action. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-3566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Summary: CXR1002 is an ammonium salt of perfluorooctanoic acid. It has a unique pharmacokinetic, pharmacologic and toxicity profile and induces cell death in a wide range of human tumor cells in vitro and in vivo. CXR1002 causes an ER stress response, acts as a fatty acid mimetic, and binds to PPARs in both an agonistic and antagonistic manner. The aim of this study was to explore further its mechanism of action in vitro, and to determine its cytotoxicity both in vitro and in vivo. Methods: In vitro cytotoxicity of CXR1002 was determined using an ATP depletion assay, alone and and in combination with 12 other drugs in a panel of tumor cell lines. The mode of action was examined using microarray analysis (followed by analysis using the Ingenuity system), transactivation assays and western blots. Four CXR1002 xenograft studies (25 mg/kg p.o. 3x per week) were performed in nu/nu mice. Results: CXR1002 was cytotoxic to a wide range of human tumor cells, including pancreatic and ovarian carcinoma and sarcoma. The IC50 value was lower after 7 days vs 2 days exposure (range 229 - 625 μM vs 300 - >1000 μM), suggesting potency was linked to duration of exposure. IC50 values were comparable to the plasma concentrations achieved with a non-toxic dose in an on-going Phase I trial. Drug combination studies with 12 anti-cancer drugs in 11 human cancer cell lines indicated that CXR1002 was synergistic with other anti-tumor drugs, particularly doxorubicin, gemcitabine, geldanamycin, MAPK inhibitors and AKT/PI3K inhibitors, but it was antagonistic when combined with rapamycin. In transactivation assays CXR1002 was an agonist of PPARα, and to a lesser extent PPARγ, but it demonstrated antagonist activity against PPARδ, in the presence of bezafibrate. Microarray studies in the pancreatic cell line PANC-1 treated with an IC15 dose of CXR1002 showed 4996 gene changes. Representation analysis of the 4996 signature list identified a number of pathways that were over-represented, in particular, genes in the ER stress pathway, including the ATF family of transcription factors. Western blot analysis of PANC-1 cells using PCNA and cleaved PARP antibodies showed that PCNA was reduced and cleaved PARP increased 24 hr after treatment with 450 μM CXR1002, suggesting a pro-apoptotic/anti-proliferative outcome. CXR1002 was active in all 4 human xenograft (i.e. pancreatic, liver, prostate and colon) models examined with best absolute tumor volume as a % of control of 50.13%, 77.05%, 19.14% and 49.22% respectively. Conclusions: CXR1002 is a unique potential anti-cancer therapy that exhibits unique pharmacokinetics and a wide spectrum of biological activities. CXR1002 appears to act in part by its ability to induce ER stress. A Phase I human trial is on-going.
Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3566.
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Affiliation(s)
| | | | | | | | | | - TR Jeffry Evans
- 2The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Iain MacPherson
- 2The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
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Anthoney DA, MacPherson I, Twelves C, Crawford D, Siller C, Nemat S, Abe M, Miwa M, Evans J. Phase I study of TP300 in patients (pts) with advanced solid tumors. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2563] [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
2563 Background: TP300 (CH4556300) is a synthetic camptothecin analogue and potent topoisomerase I inhibitor designed to have superior efficacy, tolerability and pharmacokinetic (PK) characteristics compared to current inhibitors. Intravenous (i/v) TP300 undergoes rapid chemical conversion to the active compound CH0793076, then enzymatic conversion to an active metabolite, CH0793011. The objectives of this study were to determine the dose-limiting toxicities (DLTs), maximum-tolerated dose (MTD) and PK profiles of TP300; antitumor activity and pharmacodynamics (PD) were also evaluated. Methods: Eligible pts with refractory, advanced solid tumors who had adequate PS, hematologic, renal, and hepatic function were recruited into this open-label, modified- Fibonacci dose escalation (“3 + 3” pts/dose level, with expansion at the MTD) study. TP300 was given as a 1-hour i/v infusion 3-weekly; the starting dose was 1 mg/m2. The MTD was defined as the dose level below that where > 2 of 3–6 pts experienced DLT. PK profiles of TP300, CH0793076 and CH0793011 were analysed; DNA strand breaks in peripheral blood mononuclear cells (PBMCs) were measured with the comet assay as a PD marker. Results: 32 pts (m=20; f=12), median age 58 (range 31–72), received TP300 at doses of 1, 2, 4, 8, 12, then 10mg/m2. The MTD was 10mg/m2; DLTs seen at 12mg/m2 (2/4 pts) and 10mg/m2 (3/12 pts) included anaemia, thrombocytopenia and febrile neutropenia. Other grade 3/4 toxicities included lethargy, chills and lower back pain. Diarrhoea was uncommon. Seven pts, all previously treated with irinotecan, had disease stabilisation for 1.5–5 months. CH0793076 PK (AUC and Cmax) were linear from 1 to 10mg/m2. There was a strong PD relationship between CH0793076 AUC and fall in neutrophils, the threshold AUC for DLT neutropenia being 5 hr.umol/L. DNA strand breaks were detected consistently in PBMCs on completion of TP300 infusion . Conclusions: The Phase II starting dose will be 8mg/m2 because hematologic toxicity was seen in cycle 1 at the MTD. As the AUC of CH0793076 at MTD is substantially greater than that of SN38 in pts treated with irinotecan, and CH0793076 is almost equipotent to SN38 pre-clinically, a PK advantage for TP300 is confirmed. Further investigation is warranted. [Table: see text]
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Affiliation(s)
- D. A. Anthoney
- St James's Institute of Oncology, West Yorkshire, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; Chugai Pharma Europe, London, United Kingdom; Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - I. MacPherson
- St James's Institute of Oncology, West Yorkshire, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; Chugai Pharma Europe, London, United Kingdom; Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - C. Twelves
- St James's Institute of Oncology, West Yorkshire, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; Chugai Pharma Europe, London, United Kingdom; Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - D. Crawford
- St James's Institute of Oncology, West Yorkshire, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; Chugai Pharma Europe, London, United Kingdom; Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - C. Siller
- St James's Institute of Oncology, West Yorkshire, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; Chugai Pharma Europe, London, United Kingdom; Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - S. Nemat
- St James's Institute of Oncology, West Yorkshire, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; Chugai Pharma Europe, London, United Kingdom; Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - M. Abe
- St James's Institute of Oncology, West Yorkshire, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; Chugai Pharma Europe, London, United Kingdom; Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - M. Miwa
- St James's Institute of Oncology, West Yorkshire, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; Chugai Pharma Europe, London, United Kingdom; Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - J. Evans
- St James's Institute of Oncology, West Yorkshire, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; Chugai Pharma Europe, London, United Kingdom; Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
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Wijma HJ, MacPherson I, Farver O, Tocheva EI, Pecht I, Verbeet MP, Murphy MEP, Canters GW. Effect of the methionine ligand on the reorganization energy of the type-1 copper site of nitrite reductase. J Am Chem Soc 2007; 129:519-25. [PMID: 17227014 DOI: 10.1021/ja064763j] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 11/29/2022]
Abstract
Copper-containing nitrite reductase harbors a type-1 and a type-2 Cu site. The former acts as the electron acceptor site of the enzyme, and the latter is the site of catalytic action. The effect of the methionine ligand on the reorganization energy of the type-1 site was explored by studying the electron-transfer kinetics between NiR (wild type (wt) and the variants Met150Gly and Met150Thr) with Fe(II)EDTA and Fe(II)HEDTA. The mutations increased the reorganization energy by 0.3 eV (30 kJ mol-1). A similar increase was found from pulse radiolysis experiments on the wt NIR and three variants (Met150Gly, Met150His, and Met150Thr). Binding of the nearby Met62 to the type-1 Cu site in Met150Gly (under influence of an allosteric effector) lowered the reorganization energy back to approximately the wt value. According to XRD data the structure of the reduced type-1 site in Met150Gly NiR in the presence of an allosteric effector is similar to that in the reduced wt NiR (solved to 1.85 A), compatible with the similarity in reorganization energy.
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Affiliation(s)
- Hein J Wijma
- Leiden Institute of Chemistry, Leiden University, P.O. Box 9502, 2300 RA Leiden, The Netherlands
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25
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Morgan J, Demetri G, Wang D, MacPherson I, LoRusso P, van den Abbeele A, Brunton V, Luo R, Voi M, Evans T. 383 POSTER A Phase I Study of dasatinib, a Src and multi-kinase inhibitor, in patients (pts) with GIST and other solid tumors. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70388-3] [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: 11/28/2022] Open
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Fortin PD, MacPherson I, Neau DB, Bolin JT, Eltis LD. Directed evolution of a ring-cleaving dioxygenase for polychlorinated biphenyl degradation. J Biol Chem 2005; 280:42307-14. [PMID: 16227200 DOI: 10.1074/jbc.m510456200] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
DoxG, an extradiol dioxygenase involved in the aerobic catabolism of naphthalene, possesses a weak ability to cleave 3,4-dihydroxybiphenyls (3,4-DHB), critical polychlorinated biphenyl metabolites. A directed evolution strategy combining error-prone PCR, saturation mutagenesis, and DNA shuffling was used to improve the polychlorinated biphenyl-degrading potential of DoxG. Screening was facilitated through analysis of filtered, digital imaging of plated colonies. A simple scheme, which is readily adaptable to other activities, enabled the screening of >10(5) colonies/h. The best variant, designated DoxGSMA2, cleaved 3,4-DHB with an apparent specificity constant of 2.0 +/- 0.3 x 10(6) m(-1) s(-1), which is 770 times that of wild-type (WT) DoxG. The specificities of DoxGSMA2 for 1,2-DHN and 2,3-DHB were increased by 6.7-fold and reduced by 2-fold, respectively, compared with the WT enzyme. DoxGSMA2 contained three substituted residues with respect to the WT enzyme: L190M, S191W, and L242S. Structural data indicate that the side chains of residues 190 and 242 occur on opposite walls of the substrate binding pocket and may interact directly with the distal ring of 3,4-DHB or influence contacts between this substrate and other residues. Thus, the introduction of two bulkier residues on one side of the substrate binding pocket and a smaller residue on the other may reshape the binding pocket and alter the catalytically relevant interactions of 3,4-DHB with the enzyme and dioxygen. Kinetic analyses reveal that the substitutions are anti-cooperative.
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Affiliation(s)
- Pascal D Fortin
- Department of Microbiology and Biochemistry, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
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27
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McKie L, MacPherson I. Health issues in remote and rural areas. Health Bull (Edinb) 1997; 55:296-8. [PMID: 11769108] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
In March 1996 a conference on the theme health issues in remote and rural areas was held in Inverness. Sponsored by the Scottish Office, Highland Health Board and the Department of General Practice and Primary Care, University of Aberdeen, participants included representatives from the Scottish Office, the seven Health Boards with areas designated as remote and rural, the Health Education Board for Scotland, The Royal College of General Practitioners, voluntary sector organisations and academics. In this paper we introduce the theme and outline the debates detailed in the following three papers.
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Affiliation(s)
- L McKie
- Department of General Practice and Primary Care, Primary Care University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY
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Abstract
General practitioners have a central role to play in relation to planning and delivery of primary and community care services. This paper reports the experience of one health board in using a postal survey to ascertain the views of local GPs concerning services for people suffering from dementia. The survey was sent out once only and had a 41% response rate. Non-responding GPs were surveyed to ascertain reasons for failure to respond initially to the survey. The commonest reason given was that GPs felt they were being swamped with questionnaires. The paper discusses the problems of accessig GP opinion when time and resources are limited, the alternative strategies that could have been employed and the way forward in the light of the experience.
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Affiliation(s)
- I MacPherson
- Department of General Practice, University of Aberdeen, Foresterhill Health Centre, UK
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Abstract
The results on referral to and assessment for nursing homes, taken from a national survey of all registered private nursing homes in Scotland, are reported in this paper. The findings challenge the view that nursing homes do little by way of assessing potential candidates and that what is done is somehow at variance with the type of assessments carried out in the public long-stay sector. The implications for the future of the traditional view of which professionals should be involved in the assessment of candidates for nursing homes are discussed as are the criteria they might use to make their assessments.
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Affiliation(s)
- I MacPherson
- Department of Public Health, University of Aberdeen, Foresterhill
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Williamson P, MacPherson I, Barbour J. Creating common purpose. Health Serv J 1990; 100:1700. [PMID: 10108368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Hunter D, MacPherson I, McKeganey N. General practitioners. Juggling act with the elderly. Health Soc Serv J 1985; 95:1236-7. [PMID: 10274468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Alexander DJ, Allan WH, Biggs PM, Bracewell CD, Darbyshire JH, Dawson PS, Harris AH, Jordan FT, MacPherson I, McFerran JB, Randall CJ, Stuart JC, Swarbrick O, Wilding GP. A standard technique for haemagglutination inhibition tests for antibodies to avian infectious bronchitis virus. Vet Rec 1983; 113:64. [PMID: 6310847 DOI: 10.1136/vr.113.3.64-a] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
We studied the properties of two morphologically reverted cell clones isolated as chromosomal segregants from a "hybrid" clone of BHK 21/13 hamster fibroblasts, transformed with polyoma virus. Both clones were less tumorigenic than control transformed cells. They contained no detectable polyoma-specific complement-fixing antigen. Induced transplantation antigen also appeared to be lost or reduced. Both clones could be retransformed with polyoma virus, suggesting that their reversion is due to the loss of viral genes from the transformed cell.
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Montagnier L, MacPherson I, Jarrett O. An epithelioid variant of the BHK21 hamster fibroblast line and its transformation by polyoma virus. J Natl Cancer Inst 1966; 36:503-512. [PMID: 18630324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
An epithelioid variant, which forms characteristic colonies in soft agar medium, has been isolated from the BHK21/13 line of hamster fibroblasts. After infection with a high multiplicity of polyoma virus, a fraction of the cells is morphologically transformed. Transformation may be demonstrated in two ways: 1) When infected cells are grown on glass, dense colonies of transformed cells develop from the confluent monolayer of untransformed cells in which multiplication has stopped because of their contiguity. 2) In agar, colonies derived from transformed cells are larger and morphologically distinct from those formed by the untransformed cells. The variant cells produce tumors in hamsters. Their transplantability is increased by polyoma transformation. Transformed cells possess a new polyoma-specific cell antigen.
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Affiliation(s)
- L Montagnier
- Medical Research Council Experimental Virus Research Unit, Institute of Virology, University of Glasgow, Scotland
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