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O'Connor OA, Özcan M, Jacobsen ED, Roncero JM, Trotman J, Demeter J, Masszi T, Pereira J, Ramchandren R, Beaven A, Caballero D, Horwitz SM, Lennard A, Turgut M, Hamerschlak N, d'Amore FA, Foss F, Kim WS, Leonard JP, Zinzani PL, Chiattone CS, Hsi ED, Trümper L, Liu H, Sheldon-Waniga E, Ullmann CD, Venkatakrishnan K, Leonard EJ, Shustov AR. Randomized Phase III Study of Alisertib or Investigator's Choice (Selected Single Agent) in Patients With Relapsed or Refractory Peripheral T-Cell Lymphoma. J Clin Oncol 2019; 37:613-623. [PMID: 30707661 PMCID: PMC6494247 DOI: 10.1200/jco.18.00899] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this open-label, first-in-setting, randomized phase III trial was to evaluate the efficacy of alisertib, an investigational Aurora A kinase inhibitor, in patients with relapsed/refractory peripheral T-cell lymphoma (PTCL). PATIENTS AND METHODS Adult patients with relapsed/refractory PTCL—one or more prior therapy—were randomly assigned 1:1 to receive oral alisertib 50 mg two times per day (days 1 to 7; 21-day cycle) or investigator-selected single-agent comparator, including intravenous pralatrexate 30 mg/m2 (once per week for 6 weeks; 7-week cycle), or intravenous gemcitabine 1,000 mg/m2 or intravenous romidepsin 14 mg/m2 (days 1, 8, and 15; 28-day cycle). Tumor tissue (disease subtype) and imaging were assessed by independent central review. Primary outcomes were overall response rate and progression-free survival (PFS). Two interim analyses and one final analysis were planned. RESULTS Between May 2012 and October 2014, 271 patients were randomly assigned (alisertib, n = 138; comparator, n = 133). Enrollment was stopped early on the recommendation of the independent data monitoring committee as a result of the low probability of alisertib achieving PFS superiority with full enrollment. Centrally assessed overall response rate was 33% for alisertib and 45% for the comparator arm (odds ratio, 0.60; 95% CI, 0.33 to 1.08). Median PFS was 115 days for alisertib and 104 days for the comparator arm (hazard ratio, 0.87; 95% CI, 0.637 to 1.178). The most common adverse events were anemia (53% of alisertib-treated patients v 34% of comparator-treated patients) and neutropenia (47% v 31%, respectively). A lower percentage of patients who received alisertib (9%) compared with the comparator (14%) experienced events that led to study drug discontinuation. Of 26 on-study deaths, five were considered treatment related (alisertib, n = 3 of 11; comparator, n = 2 of 15). Two-year overall survival was 35% for each arm. CONCLUSION In patients with relapsed/refractory PTCL, alisertib was not statistically significantly superior to the comparator arm.
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Affiliation(s)
| | - Muhit Özcan
- 2 Ankara University Medical School, Ankara, Turkey
| | | | | | - Judith Trotman
- 5 Concord Repatriation General Hospital, Concord, New South Wales, Australia.,6 University of Sydney, New South Wales, Australia
| | - Judit Demeter
- 7 Semmelweis Egyetem Általános Orvostudományi Kar, Budapest, Hungary
| | - Tamás Masszi
- 8 St. István and St. László Hospital, Budapest, Hungary.,9 Semmelweis University, Budapest, Hungary
| | - Juliana Pereira
- 10 Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Anne Beaven
- 12 Duke University Health System, Durham, NC
| | | | | | - Anne Lennard
- 15 Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | | | | | | | - Francine Foss
- 19 Smilow Cancer Hospital at Yale New Haven, New Haven, CT
| | - Won-Seog Kim
- 20 Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | - Lorenz Trümper
- 25 University Medical Center Göttingen, Göttingen, Germany
| | - Hua Liu
- 26 Millennium Pharmaceuticals, Cambridge, MA
| | | | | | | | | | - Andrei R Shustov
- 27 University of Washington, Seattle Cancer Care Alliance, Seattle, WA
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Pérez-García A, Osca G, Bosch-Vizcaya A, Kelleher N, Santos NY, Rodríguez R, González Y, Roncero JM, Coll R, Serrando M, Lloveras N, Tuset E, Gallardo D. Kinetics of the CTLA-4 isoforms expression after T-lymphocyte activation and role of the promoter polymorphisms on CTLA-4 gene transcription. Hum Immunol 2013; 74:1219-24. [PMID: 23756164 DOI: 10.1016/j.humimm.2013.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 05/09/2013] [Accepted: 05/29/2013] [Indexed: 11/27/2022]
Abstract
Cytotoxic T lymphocyte antigen 4 (CTLA-4) plays a key inhibitory role during T lymphocyte activation. The CTLA4 gene is translated into two proteic isoforms: a full-length protein (flCTLA-4) and a soluble counterpart. We explored the expression of both isoforms on healthy subjects. Whereas in non-stimulated cells the flCTLA-4 isoform is predominant, after stimulation the expression of the soluble form rapidly increases, reaching its maximum 24h after and falling again to the basal levels 72 h after stimulation. In contrast, the flCTLA-4 mRNA levels increase is slower, reaching the maximum level 72 h after stimulation. The presence of the T allele in the promoter positions -1722 and -318 is associated with an increased transcriptional activity and this effect seems to be synergic. We conclude that the kinetics of CTLA-4 isoform expression are sequential, and that the promoter polymorphisms -1722(C/T) and -318(C/T) are involved in the control of the CTLA4 transcription.
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Affiliation(s)
- Arianne Pérez-García
- Hematology Department, Institut Català d'Oncologia, Hospital Josep Trueta, IDIBGi, Girona, Spain
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Delgado J, Espinet B, Oliveira AC, Abrisqueta P, de la Serna J, Collado R, Loscertales J, Lopez M, Hernandez-Rivas JA, Ferra C, Ramirez A, Roncero JM, Lopez C, Aventin A, Puiggros A, Abella E, Carbonell F, Costa D, Carrio A, Gonzalez M. Chronic lymphocytic leukaemia with 17p deletion: a retrospective analysis of prognostic factors and therapy results. Br J Haematol 2012; 157:67-74. [PMID: 22224845 DOI: 10.1111/j.1365-2141.2011.09000.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients with chronic lymphocytic leukaemia (CLL) whose tumour cells harbour a 17p deletion (17p-) are universally considered to have a poor prognosis. The deletion can be detected at diagnosis or during the evolution of the disease, particularly in patients who have received chemotherapy. We sought to evaluate the natural history of patients with 17p- CLL, identify predictive factors within this prognostic subgroup, and evaluate the results of different therapeutic approaches. Data from 294 patients with 17p- CLL followed up at 20 different institutions was retrospectively collected and analysed. Median age was 68 (range 27-98) years at the time of fluorescence in situ hybridization analysis. After 17p- documentation, 52% received treatment, achieving an overall response rate of 50%. Median overall survival was 41 months, and was significantly shorter in patients with elevated beta(2)-microglobulin concentration (P < 0·001), B symptoms (P = 0·016), higher percentage of cells with deletion (P < 0·001), and acquired deletions (P = 0·012). These findings suggest that patients with 17p- CLL have a variable prognosis that can be refined using simple clinical and laboratory features, including 17p- clone size, beta2-microglobulin concentration, presence of B symptoms and type of deletion (de novo versus acquired).
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Affiliation(s)
- Julio Delgado
- Department of Haematology, Institute of Haematology and Oncology, Hospital Clinic, IDIBAPS, University of Barcelona, C/Villaroel 170, Barcelona, Spain.
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Bosch-Vizcaya A, Pérez-García A, Brunet S, Solano C, Buño I, Guillem V, Martínez-Laperche C, Sanz G, Barrenetxea C, Martínez C, Tuset E, Lloveras N, Coll R, Guardia R, González Y, Roncero JM, Bustins A, Gardella S, Fernández C, Buch J, Gallardo D. Donor CTLA-4 Genotype Influences Clinical Outcome after T Cell-Depleted Allogeneic Hematopoietic Stem Cell Transplantation from HLA-Identical Sibling Donors. Biol Blood Marrow Transplant 2012; 18:100-5. [DOI: 10.1016/j.bbmt.2011.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 05/23/2011] [Indexed: 01/08/2023]
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