1
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Johansson H, Guerrieri-Gonzaga A, Gandini S, Bertelsen BE, Macis D, Serrano D, Mellgren G, Lazzeroni M, Thomas PS, Crew KD, Kumar NB, Briata IM, Galimberti V, Viale G, Vornik LA, Aristarco V, Buttiron Webber T, Spinaci S, Brown PH, Heckman-Stoddard BM, Szabo E, Bonanni B, DeCensi A. Alternative dosing regimen of exemestane in a randomized presurgical trial: the role of obesity in biomarker modulation. NPJ Breast Cancer 2024; 10:7. [PMID: 38238336 PMCID: PMC10796398 DOI: 10.1038/s41523-024-00616-8] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
In a 3-arm presurgical trial, four-six weeks exemestane 25 mg three times/week (TIW) was non-inferior to 25 mg/day (QD) in suppressing circulating estradiol in postmenopausal women with ER-positive breast cancer. Since obesity may decrease exemestane efficacy, we analyzed changes in sex steroids, adipokines, Ki-67, and drug levels in relation to obesity. Postmenopausal women with early-stage ER-positive breast cancer were randomized to either exemestane 25 mg QD (n = 57), 25 mg TIW (n = 57), or 25 mg/week (QW, n = 62) for 4-6 weeks before breast surgery. Serum and tissue pre- and post-treatment biomarkers were stratified by body mass index (BMI)< or ≥30 kg/m2. Post-treatment median exemestane and 17-OH exemestane levels were 5-6 times higher in the QD arm compared to the TIW arm. For obese women, TIW maintained comparable reductions to QD in systemic estradiol levels, although the reduction in estrone was less with the TIW regimen. There was less suppression of SHBG with the TIW versus the QD dose schedule in obese women which should result in less systemic bioavailable estrogens. Metabolically, the effect of the TIW regimen was similar to the QD regimen for obese women in terms of leptin suppression and increase in the adiponectin-leptin ratio. Reduction in tissue Ki-67 was less for obese women on the TIW regimen than QD, although changes were similar for non-obese women. Our findings suggest that TIW exemestane should be explored further for primary cancer prevention in both normal weight and obese cohorts.
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Affiliation(s)
| | | | - Sara Gandini
- IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Bjørn-Erik Bertelsen
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Debora Macis
- IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Gunnar Mellgren
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | | | | | - Nagi B Kumar
- Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | | | | | | | - Lana A Vornik
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Powel H Brown
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Eva Szabo
- Division of Cancer Prevention, NCI Bethesda, MD, USA
| | | | - Andrea DeCensi
- E.O. Galliera Hospital, Genoa, Italy
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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2
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O’Shea AE, Clifton GT, Qiao N, Heckman-Stoddard BM, Wojtowicz M, Dimond E, Bedrosian I, Weber D, Garber JE, Husband A, Pastorello R, Lee JJ, Hernandez M, Liu DD, Vornik LA, Brown PH, Alatrash G, Peoples GE, Mittendorf EA. Phase II Trial of Nelipepimut-S Peptide Vaccine in Women with Ductal Carcinoma In Situ. Cancer Prev Res (Phila) 2023; 16:333-341. [PMID: 37259799 PMCID: PMC10903526 DOI: 10.1158/1940-6207.capr-22-0388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/31/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
NeuVax is a vaccine comprised of the HER2-derived MHC class I peptide E75 (nelipepimut-S, NPS) combined with GM-CSF. We completed a randomized trial of preoperative vaccination with NeuVax versus GM-CSF alone in patients with ductal carcinoma in situ (DCIS). The primary objective was to evaluate for NPS-specific cytotoxic T lymphocyte (CTL) responses. Patients with human leukocyte antigen (HLA)-A2-positive DCIS were enrolled and randomized 2:1 to NeuVax versus GM-CSF alone and received two inoculations prior to surgery. The number of NPS-specific CTL was measured pre-vaccination, at surgery, and 1 and 3 to 6 months post-operation by dextramer assay. Differences in CTL responses between groups and between pre-vaccination and 1-month post-operation were analyzed using a two-sample t test or Wilcoxon rank sum test. The incidence and severity of adverse events were compared between groups. Overall, 45 patients were registered; 20 patients were HLA-A2 negative, 7 declined participation, 1 withdrew, and 4 failed screening for other reasons. The remaining 13 were randomized to NeuVax (n = 9) or GM-CSF alone (n = 4). Vaccination was well-tolerated with similar treatment-related toxicity between groups with the majority (>89%) of adverse events being grade 1. The percentage of NPS-specific CTLs increased in both arms between baseline (pre-vaccination) and 1-month post-operation. The increase was numerically greater in the NPS+GM-CSF arm, but the difference was not statistically significant. NPS+GM-CSF is safe and well-tolerated when given preoperatively to patients with DCIS. In patients with HLA-A2-positive DCIS, two inoculations with NPS+GM-CSF can induce in vivo immunity and a continued antigen-specific T-cell response 1-month postsurgery. PREVENTION RELEVANCE This trial showed that vaccination of patients with HLA-A2-positive DCIS with NeuVax in the preoperative setting can induce a sustained antigen-specific T-cell response. This provides proof of principle that vaccination in the preoperative or adjuvant setting may stimulate an adaptive immune response that could potentially prevent disease recurrence.
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Affiliation(s)
- Anne E. O’Shea
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX, USA
| | - Guy T. Clifton
- Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX, USA
| | - Na Qiao
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Eileen Dimond
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane Weber
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Judy E. Garber
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alexander Husband
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ricardo Pastorello
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - J. Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mike Hernandez
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane D. Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lana A. Vornik
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Powel H. Brown
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gheath Alatrash
- Department of Stem Cell Transplant and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Elizabeth A. Mittendorf
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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3
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Serrano D, Gandini S, Thomas P, Crew KD, Kumar NB, Vornik LA, Lee JJ, Veronesi P, Viale G, Guerrieri-Gonzaga A, Lazzeroni M, Johansson H, D’Amico M, Guasone F, Spinaci S, Bertelsen BE, Mellgren G, Bedrosian I, Weber D, Castile T, Dimond E, Heckman-Stoddard BM, Szabo E, Brown PH, DeCensi A, Bonanni B. Efficacy of Alternative Dose Regimens of Exemestane in Postmenopausal Women With Stage 0 to II Estrogen Receptor-Positive Breast Cancer: A Randomized Clinical Trial. JAMA Oncol 2023; 9:664-672. [PMID: 36951827 PMCID: PMC10037202 DOI: 10.1001/jamaoncol.2023.0089] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/06/2022] [Indexed: 03/24/2023]
Abstract
Importance Successful therapeutic cancer prevention requires definition of the minimal effective dose. Aromatase inhibitors decrease breast cancer incidence in high-risk women, but use in prevention and compliance in adjuvant settings are hampered by adverse events. Objective To compare the noninferiority percentage change of estradiol in postmenopausal women with estrogen receptor-positive breast cancer given exemestane, 25 mg, 3 times weekly or once weekly vs a standard daily dose with a noninferiority margin of -6%. Design, Setting, and Participants This multicenter, presurgical, double-blind phase 2b randomized clinical trial evaluated 2 alternative dosing schedules of exemestane. Postmenopausal women with estrogen receptor-positive breast cancer who were candidates for breast surgery were screened from February 1, 2017, to August 31, 2019. Blood samples were collected at baseline and final visit; tissue biomarker changes were assessed from diagnostic biopsy and surgical specimen. Biomarkers were measured in different laboratories between April 2020 and December 2021. Interventions Exemestane, 25 mg, once daily, 3 times weekly, or once weekly for 4 to 6 weeks before surgery. Main Outcomes and Measures Serum estradiol concentrations were measured by solid-phase extraction followed by liquid chromatography-tandem mass spectrometry detection. Toxic effects were evaluated using the National Cancer Institute terminology criteria, and Ki-67 was assessed by immunohistochemistry. Results A total of 180 women were randomized into 1 of the 3 arms; median (IQR) age was 66 (60-71) years, 63 (60-69) years, and 65 (61-70) years in the once-daily, 3-times-weekly, and once-weekly arms, respectively. In the intention-to-treat population (n = 171), the least square mean percentage change of serum estradiol was -89%, -85%, and -60% for exemestane once daily (n = 55), 3 times weekly (n = 56), and once weekly (n = 60), respectively. The difference in estradiol percentage change between the once-daily and 3-times-weekly arms was -3.6% (P for noninferiority = .37), whereas in compliant participants (n = 153), it was 2.0% (97.5% lower confidence limit, -5.6%; P for noninferiority = .02). Among secondary end points, Ki-67 and progesterone receptor were reduced in all arms, with median absolute percentage changes of -7.5%, -5.0%, and -4.0% for Ki-67 in the once-daily, 3-times-weekly, and once-weekly arms, respectively (once daily vs 3 times weekly, P = .31; once daily vs once weekly, P = .06), and -17.0%, -9.0%, and -7.0% for progesterone receptor, respectively. Sex hormone-binding globulin and high-density lipoprotein cholesterol had a better profile among participants in the 3-times-weekly arm compared with once-daily arm. Adverse events were similar in all arms. Conclusions and Relevance In this randomized clinical trial, exemestane, 25 mg, given 3 times weekly in compliant patients was noninferior to the once-daily dosage in decreasing serum estradiol. This new schedule should be further studied in prevention studies and in women who do not tolerate the daily dose in the adjuvant setting. Trial Registration ClinicalTrials.gov Identifier: NCT02598557; EudraCT: 2015-005063-16.
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Affiliation(s)
| | - Sara Gandini
- European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Nagi B. Kumar
- Moffitt Cancer Center, University of South Florida, Tampa
| | - Lana A. Vornik
- The University of Texas MD Anderson Cancer Center, Houston
| | - J. Jack Lee
- The University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | | | | | | | | | | | - Bjørn-Erik Bertelsen
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Mellgren
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Diane Weber
- The University of Texas MD Anderson Cancer Center, Houston
| | - Tawana Castile
- The University of Texas MD Anderson Cancer Center, Houston
| | - Eileen Dimond
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | | | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Powel H. Brown
- The University of Texas MD Anderson Cancer Center, Houston
| | - Andrea DeCensi
- Ospedali Galliera, Genoa, Italy
- Wolfson Institute of Population Health, Queen Mary University of London, London, England, United Kingdom
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4
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Faraoni EY, Singh K, Chandra V, Le Roux O, Dai Y, Sahin I, O'Brien BJ, Strickland LN, Li L, Vucic E, Warner AN, Pruski M, Clark T, Van Buren G, Thosani NC, Bynon JS, Wray CJ, Bar-Sagi D, Poulsen KL, Vornik LA, Savage MI, Sei S, Mohammed A, Zhao Z, Brown PH, Mills T, Eltzschig HK, McAllister F, Bailey-Lundberg JM. CD73-Dependent Adenosine Signaling through Adora2b Drives Immunosuppression in Ductal Pancreatic Cancer. Cancer Res 2023; 83:1111-1127. [PMID: 36720042 PMCID: PMC10071819 DOI: 10.1158/0008-5472.can-22-2553] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Received: 08/15/2022] [Revised: 01/04/2023] [Accepted: 01/27/2023] [Indexed: 02/02/2023]
Abstract
The microenvironment that surrounds pancreatic ductal adenocarcinoma (PDAC) is profoundly desmoplastic and immunosuppressive. Understanding triggers of immunosuppression during the process of pancreatic tumorigenesis would aid in establishing targets for effective prevention and therapy. Here, we interrogated differential molecular mechanisms dependent on cell of origin and subtype that promote immunosuppression during PDAC initiation and in established tumors. Transcriptomic analysis of cell-of-origin-dependent epithelial gene signatures revealed that Nt5e/CD73, a cell-surface enzyme required for extracellular adenosine generation, is one of the top 10% of genes overexpressed in murine tumors arising from the ductal pancreatic epithelium as opposed to those rising from acinar cells. These findings were confirmed by IHC and high-performance liquid chromatography. Analysis in human PDAC subtypes indicated that high Nt5e in murine ductal PDAC models overlaps with high NT5E in human PDAC squamous and basal subtypes, considered to have the highest immunosuppression and worst prognosis. Multiplex immunofluorescent analysis showed that activated CD8+ T cells in the PDAC tumor microenvironment express high levels of CD73, indicating an opportunity for immunotherapeutic targeting. Delivery of CD73 small-molecule inhibitors through various delivery routes reduced tumor development and growth in genetically engineered and syngeneic mouse models. In addition, the adenosine receptor Adora2b was a determinant of adenosine-mediated immunosuppression in PDAC. These findings highlight a molecular trigger of the immunosuppressive PDAC microenvironment elevated in the ductal cell of origin, linking biology with subtype classification, critical components for PDAC immunoprevention and personalized approaches for immunotherapeutic intervention. SIGNIFICANCE Ductal-derived pancreatic tumors have elevated epithelial and CD8+GZM+ T-cell CD73 expression that confers sensitivity to small-molecule inhibition of CD73 or Adora2b to promote CD8+ T-cell-mediated tumor regression. See related commentary by DelGiorno, p. 977.
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Affiliation(s)
- Erika Y. Faraoni
- Department of Anesthesiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Kanchan Singh
- Department of Anesthesiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Vidhi Chandra
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
- The Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, and The University of Texas Health Science Center at Houston, Houston, Texas
| | - Olivereen Le Roux
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yulin Dai
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Ismet Sahin
- Department of Engineering, Texas Southern University, Houston, Texas
| | - Baylee J. O'Brien
- Department of Anesthesiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Lincoln N. Strickland
- Department of Anesthesiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Le Li
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emily Vucic
- Departments of Biochemistry and Molecular Pharmacology and Medicine, NYU Langone School of Medicine, New York, New York
| | - Amanda N. Warner
- Department of Anesthesiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- The Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, and The University of Texas Health Science Center at Houston, Houston, Texas
| | - Melissa Pruski
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Trent Clark
- Department of Anesthesiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - George Van Buren
- Division of Surgical Oncology, Baylor College of Medicine, Houston, Texas
| | - Nirav C. Thosani
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - John S. Bynon
- Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Curtis J. Wray
- Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Dafna Bar-Sagi
- Department of Engineering, Texas Southern University, Houston, Texas
| | - Kyle L. Poulsen
- Department of Anesthesiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- Center for Perioperative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Lana A. Vornik
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle I. Savage
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shizuko Sei
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Altaf Mohammed
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Zhongming Zhao
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Powel H. Brown
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tingting Mills
- Department of Biochemistry, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Holger K. Eltzschig
- Department of Anesthesiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- Center for Perioperative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Florencia McAllister
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
- The Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, and The University of Texas Health Science Center at Houston, Houston, Texas
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer M. Bailey-Lundberg
- Department of Anesthesiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- The Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, and The University of Texas Health Science Center at Houston, Houston, Texas
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- Center for Interventional Gastroenterology at UTHealth (iGUT), McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- Center for Perioperative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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5
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Thomas PS, Patel AB, Lee JJ, Liu DD, Hernandez M, Muzzio M, Contreras A, Sepeda V, Mays C, Weber D, Vornik LA, Khan SA, Dimond E, Heckman-Stoddard BM, Perloff M, Brown PH. Phase I Dose Escalation Study of Topical Bexarotene in Women at High Risk for Breast Cancer. Cancer Prev Res (Phila) 2023; 16:47-55. [PMID: 36228112 PMCID: PMC10391360 DOI: 10.1158/1940-6207.capr-22-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/30/2022] [Accepted: 10/11/2022] [Indexed: 01/11/2023]
Abstract
PREVENTION RELEVANCE Bexarotene is a rexinoid that has been shown to prevent mammary tumors in mouse models but oral dosing has toxicities. This phase I study evaluates topical bexarotene, as a potential chemoprevention agent, for safety and toxicity in high-risk women for breast cancer.
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Affiliation(s)
- Parijatham S Thomas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anisha B Patel
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mike Hernandez
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Alejandro Contreras
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Valerie Sepeda
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carrie Mays
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Weber
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lana A Vornik
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seema A Khan
- Department of Surgery, Northwestern University, Chicago, Illinois
| | | | | | | | - Powel H Brown
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
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6
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Kwan SY, Slayden AN, Coronado AR, Marquez RC, Chen H, Wei P, Savage MI, Vornik LA, Fox JT, Sei S, Liang D, Stevenson HL, Wilkerson GK, Gagea M, Brown PH, Beretta L. Treatment Strategies and Mechanisms Associated with the Prevention of NASH-Associated HCC by a Toll-like Receptor 4 Inhibitor. Cancer Prev Res (Phila) 2023; 16:17-28. [PMID: 36162136 PMCID: PMC9812917 DOI: 10.1158/1940-6207.capr-22-0332] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/22/2022] [Indexed: 01/12/2023]
Abstract
We evaluated the cancer preventive efficacy of TAK-242, an inhibitor of Toll-like receptor 4 (TLR4), in a mouse model of hepatocellular carcinoma (HCC) occurring in the context of nonalcoholic steatohepatitis (NASH). We also assessed the cellular events associated with the preventive treatment efficacy. We tested oral administration of TAK-242, at clinically relevant but toxicity-reducing doses and scheduling, in mice with hepatocyte-specific deletion of Pten (HepPten-). The optimal dose and oral gavage formulation of TAK-242 were determined to be 30 mg/kg in 5% DMSO in 30% 2-hydroxypropyl-β-cyclodextrin. Daily oral administration of 30 mg/kg TAK-242 over 18 weeks was well tolerated and resulted in reduced development of tumors (lesions > 7.5 mm3) in HepPten- mice. This effect was accompanied by reduced macrovesicular steatosis and serum levels of alanine aminotransferase. In addition, 30 mg/kg TAK-242 daily treatment of small preexisting adenomas (lesions < 7.5 mm3) over 18 weeks, significantly reduced their progression to HCC. RNA sequencing identified 220 hepatic genes significantly altered upon TAK-242 treatment, that significantly correlated with tumor burden. Finally, cell deconvolution analysis revealed that TAK-242 treatment resulted in reduced hepatic populations of endothelial cells and myeloid-derived immune cells (Kupffer cells, Siglec-H high dendritic cells, and neutrophilic granule protein high neutrophils), while the proportion of mt-Nd4 high hepatocytes significantly increased, suggesting a decrease in hepatic inflammation and concomitant increase in mitochondrial function and oxidative phosphorylation upon TLR4 inhibition. In conclusion, this study identified treatment strategies and novel molecular and cellular mechanisms associated with the prevention of HCC in the context of NASH that merit further investigations. PREVENTION RELEVANCE Means to prevent development of HCC or progression of small adenomas to HCC in patients with NASH are urgently needed to reduce the growing mortality due to HCC. We characterized the chemopreventive effect of oral administration of the TLR4 inhibitor TAK-242 in a model of NASH-associated HCC.
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Affiliation(s)
- Suet-Ying Kwan
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alyssa N. Slayden
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aubrey R. Coronado
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rosamaria C. Marquez
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Huiqin Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michelle I. Savage
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lana A. Vornik
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer T. Fox
- Chemopreventive Agent Development Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland, USA
| | - Shizuko Sei
- Chemopreventive Agent Development Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland, USA
| | - Dong Liang
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas, USA
| | - Heather L. Stevenson
- Department of Pathology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Gregory K. Wilkerson
- Keeling Center for Comparative Medicine and Research, University of Texas, MD Anderson Cancer Center, Bastrop, Texas, USA
| | - Mihai Gagea
- Department of Veterinary Medicine & Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Powel H. Brown
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laura Beretta
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Mazumdar A, Tahaney WM, Hill JL, Zhang Y, Ramachandran S, Kawedia J, Qian J, Contreras A, Savage MI, Vornik LA, Sei S, Mohammed A, Brown PH. Targeting the mTOR Pathway for the Prevention of ER-Negative Breast Cancer. Cancer Prev Res (Phila) 2022; 15:791-802. [PMID: 35981902 PMCID: PMC9762336 DOI: 10.1158/1940-6207.capr-22-0106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/08/2022] [Revised: 07/18/2022] [Accepted: 08/15/2022] [Indexed: 01/31/2023]
Abstract
PREVENTION RELEVANCE Our results show that everolimus delays mammary tumor formation in multiple mouse models, suggesting that mTOR inhibitors will be useful for the prevention of ER-negative and triple-negative breast cancer in humans. See related Spotlight, p. 787.
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Affiliation(s)
- Abhijit Mazumdar
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Corresponding Author: Abhijit Mazumdar, Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030. E-mail:
| | - William M. Tahaney
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
| | - Jamal L. Hill
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yun Zhang
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sumankalai Ramachandran
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jitesh Kawedia
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Qian
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alejandro Contreras
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle I. Savage
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lana A. Vornik
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shizuko Sei
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Altaf Mohammed
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Powel H. Brown
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
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Trivedi MS, Arber N, Friedman E, Garber JE, Holcomb K, Horowitz NS, Wright JD, Lee JJ, Vornik LA, Abutaseh S, Castile T, Sauter ER, Dimond E, Heckman-Stoddard BM, House M, Samimi G, Brown PH, Crew KD. Lessons from the Failure to Complete a Trial of Denosumab in Women With a Pathogenic BRCA1/2 Variant Scheduling Risk-Reducing Salpingo-Oophorectomy. Cancer Prev Res (Phila) 2022; 15:721-726. [PMID: 36001346 PMCID: PMC10441620 DOI: 10.1158/1940-6207.capr-22-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/19/2022] [Accepted: 07/26/2022] [Indexed: 01/31/2023]
Abstract
Female carriers of pathogenic/likely pathogenic (P/LP) BRCA1/2 variants are at increased risk of developing breast and ovarian cancer. Currently, the only effective strategy for ovarian cancer risk reduction is risk-reducing bilateral salpingo-oophorectomy (RR-BSO), which carries adverse effects related to early menopause. There is ongoing investigation of inhibition of the RANK ligand (RANKL) with denosumab as a means of chemoprevention for breast cancer in carriers of BRCA1 P/LP variants. Through the NCI Division of Cancer Prevention (DCP) Early Phase Clinical Trials Prevention Consortia, a presurgical pilot study of denosumab was developed in premenopausal carriers of P/LP BRCA1/2 variants scheduled for RR-BSO with the goal of collecting valuable data on the biologic effects of denosumab on gynecologic tissue. The study was terminated early due to the inability to accrue participants. Challenges which impacted the conduct of this study included a study design with highly selective eligibility criteria and requirements and the COVID-19 pandemic. It is critical to reflect on these issues to enhance the successful completion of future prevention studies in individuals with hereditary cancer syndromes.
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Affiliation(s)
| | - Nadir Arber
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eitan Friedman
- Chaim Sheba Medical Center, Tel-Aviv University Medical School, Tel Aviv, Israel
| | | | | | | | - Jason D. Wright
- Columbia University Irving Medical Center, New York, New York
| | - J. Jack Lee
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lana A. Vornik
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Saba Abutaseh
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tawana Castile
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edward R. Sauter
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Eileen Dimond
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | | | - Margaret House
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Goli Samimi
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Powel H. Brown
- University of Texas MD Anderson Cancer Center, Houston, Texas
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Singh K, Chandra V, Ballew L, Mills T, Faraoni EY, Clark T, Vornik LA, Savage MI, Eltzschig HK, Mohammed A, Sei S, Brown PH, McAllister F, Bailey-Lundberg J. Abstract 719: Preclinical testing of CD73 inhibitors for pancreatic cancer immunoprevention. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-719] [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: Pancreatic ductal adenocarcinoma (PDAC) is characterized by a profoundly immunosuppressive microenvironment. Innovative therapeutic strategies are urgently needed to stop the progression of precancerous lesions into aggressive PDAC, which remains a lethal malignancy. The goal of this research project is to test the immunopreventive strategies by targeting the ectonucleotidase CD73, one of the gatekeeper enzymes responsible for adenosine production and the formation of immunosuppressive tumor microenvironment in this malignancy. We hypothesize that inhibition of CD73 will prevent pancreatic intraepithelial neoplasia (PanIN) formation and progression to PDAC by reversing immunosuppression.
Materials and methods: A syngeneic PDAC mouse model was employed by injecting 100k murine pancreatic cancer (KPC) cells in flanks of C57BL/6 female mice. Oral gavage of AB680 (small molecule CD73 inhibitor) was given three days/week at 10mg/kg starting the day after KPC injections and tumor sizes were measured weekly. Toxicity was analyzed by serum ALT analysis. At the time of death 6 weeks post-KPC inoculation, tumor volume and mass were recorded. In another experiment, AB680 was administered 3 days/week at 10mg/kg for 5 weeks. CyTOF immunoprofiling of digested tumors from control and AB680 treated mice and HPLC analysis on serum from the time of death were performed.
Results: In experiment 1, by week three of the study, there was a significant difference in tumor volume between the control and AB680 treated groups (P=0.02). However, in weeks 4-5 AB680 reduced tumor growth compared to vehicle controls, but the grouped statistical analysis was not significant. When observing individual tumors, there was a reduction in tumor size in 30% of the AB680 treated mice between weeks 3-5, but the difference was not statistically different. ALT analysis determined AB680 does not induce liver toxicity. For experiment 2 (3x/week treatment with AB680), there was a significant reduction in tumor growth. Activated CD8-positive T cells, dendritic cells, and macrophages were significantly increased in the syngeneic tumors from AB680 treated mice. The intratumoral adenosine levels were significantly decreased in AB680 treated mice compared to vehicle treated mice.
Conclusion: We conclude oral gavage delivery of CD73 inhibitor AB680 at 10mg/kg (6x/week) reduces tumor growth in KPC syngeneic tumor bearing mice. Treatment with AB680 at 10mg/kg 3x/week significantly increases tumor doubling time, significantly alters intratumoral immune cell populations, and results in a significant decrease in intratumoral adenosine levels. In addition, we observed a significant increase in infiltration of activated CD8-positive T cells indicating oral gavage delivery using AB680 reverses immunosuppression in vivo. [Supported by NCI 75N91019D00021/75N91020F00002]
Citation Format: Kanchan Singh, Vidhi Chandra, Lincoln Ballew, Tingting Mills, Erika Y. Faraoni, Trent Clark, Lana A. Vornik, Michelle I. Savage, Holger K. Eltzschig, Altaf Mohammed, Shizuko Sei, Powel H. Brown, Florencia McAllister, Jennifer Bailey-Lundberg. Preclinical testing of CD73 inhibitors for pancreatic cancer immunoprevention [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 719.
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Affiliation(s)
- Kanchan Singh
- 1The University of Texas Health Science Center at Houston, Houston, TX
| | - Vidhi Chandra
- 2The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lincoln Ballew
- 1The University of Texas Health Science Center at Houston, Houston, TX
| | - Tingting Mills
- 1The University of Texas Health Science Center at Houston, Houston, TX
| | - Erika Y. Faraoni
- 1The University of Texas Health Science Center at Houston, Houston, TX
| | - Trent Clark
- 1The University of Texas Health Science Center at Houston, Houston, TX
| | - Lana A. Vornik
- 2The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Powel H. Brown
- 2The University of Texas MD Anderson Cancer Center, Houston, TX
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Guerrieri-Gonzaga A, Serrano D, Thomas P, Crew KD, Kumar NB, Gandini S, Vornik LA, Lee J, Cagnacci S, Vicini E, Accornero CA, D'Amico M, Guasone F, Spinaci S, Webber TB, Brown PH, Szabo E, Heckman-Stoddard B, Bonanni B. Alternative dosing of exemestane in postmenopausal women with ER-positive breast cancer. Design and methods of a randomized presurgical trial. Contemp Clin Trials 2021; 107:106498. [PMID: 34216815 PMCID: PMC8429140 DOI: 10.1016/j.cct.2021.106498] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/16/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
Introduction: Aromatase inhibitors are effective in lowering breast cancer incidence among postmenopausal women, but adverse events represent a barrier to their acceptability and adherence as a preventive treatment. This study aims to assess whether lowering exemestane schedule may retain biological activity while improving tolerability in breast cancer patients. Methods/design: We are conducting a, pre-surgical, non-inferiority phase IIb study in postmenopausal women with newly diagnosed estrogen receptor-positive breast cancer. Participants are randomized to receive either exemestane 25 mg/day or 25 mg/three times-week or once a week for 4 to 6 weeks prior to surgery. The primary endpoint is the percentage change of serum estradiol concentration between baseline and surgery comparing the three arms. Sample size of 180 women was calculated assuming a 6% non-inferiority of the percent change of estradiol in the lower dose arms compared with the 80% decrease predicted in the full dose arm, with 80% power and using a one-sided 5% significance level and a two-sample t-test. Main secondary outcomes are: safety; change in Ki-67 in cancer and adjacent pre-cancer tissue, circulating sex hormones, adipokines, lipid profile, insulin and glucose changes, in correlation with drug and metabolites concentrations. Results and discussion: The present paper is focused on methodology and operational aspects of the study. A total of 180 participants have ben enrolled. The trial is still blinded, and the analyses are ongoing. Despite the short term duration, results may have relevant implications for clinical management of women at increased risk of developing a ER positive breast cancer.
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Affiliation(s)
| | | | | | | | - Nagi B Kumar
- Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Sara Gandini
- European Institute of Oncology IRCCS, Milan, Italy
| | - Lana A Vornik
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Lee
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Elisa Vicini
- European Institute of Oncology IRCCS, Milan, Italy
| | | | | | | | | | | | - Powel H Brown
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Eva Szabo
- Division of Cancer Prevention, NCI, Bethesda, MD, USA
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11
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Trivedi MS, Samimi G, Wright JD, Holcomb K, Garber JE, Horowitz NS, Arber N, Friedman E, Wenham RM, House M, Parnes H, Lee JJ, Abutaseh S, Vornik LA, Heckman-Stoddard BM, Brown PH, Crew KD. Abstract OT2-09-01: Pilot study of denosumab in BRCA1/2 mutation carriers scheduling for risk-reducing salpingo-oophorectomy. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-09-01] [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: Denosumab is a monoclonal antibody that inhibits RANKL and is approved for the prevention of fractures in patients with osteoporosis or bone metastases. The RANKL signaling pathway is also involved in BRCA1-associated mammary tumorigenesis via a progesterone-induced paracrine effect of RANKL on luminal progenitor cells. Pre-clinical studies have demonstrated that RANKL inhibition resulted in reduced proliferation of mammary tumors. Early findings from an ongoing pre-surgical study demonstrated that denosumab treatment resulted in decreased Ki67 proliferation index in benign breast tissue. Based on these data, denosumab is being pursued as a potential preventive agent for breast cancer in BRCA1 mutation carriers. While promising, the effect of RANKL inhibition on gynecologic tissues such as the ovaries and fallopian tubes, in which progesterone has a protective effect, is unknown.
Trial design: We will conduct a multicenter, open-label randomized pilot study of presurgical administration of denosumab versus no treatment in premenopausal women with BRCA1/2 mutations undergoing risk-reducing salpingo-oophorectomy (RRSO). A total of 60 women will be randomized 1:1 to Arm 1) 3-4 doses of 120 mg denosumab subcutaneously every 4 weeks or Arm 2) No treatment. Participants will be stratified by 1) BRCA1 versus BRCA2 mutation status and 2) Use of hormonal contraceptives within the past 3 months (yes/no). Assuming a 10% unevaluable rate, we expect to have 54 evaluable participants (27 per arm).
Eligibility criteria: 1) Premenopausal women (defined as < 3 months since last menstrual period OR serum follicle-stimulating hormone (FSH) < 20 mIU/mL), age > 18 years; 2) Documented germline pathogenic mutation or likely pathogenic variant in the BRCA1 or BRCA2 gene; 3) Plan for RRSO with or without hysterectomy; 4) ECOG performance status ≤ 1 (Karnofsky ≥ 70%); 5) Normal organ and marrow function; 6) Negative pregnancy test and use of adequate contraception; 7) Willingness to take supplemental oral calcium and vitamin D3; 8) Dental examination within 6 months of enrollment and no evidence of active dental issues; 9) Ability to understand and willingness to provide informed consent.
Specific aims: Our primary objective is to compare the effect of denosumab to no treatment on Ki67 expression in the fimbrial end of the fallopian tube. Secondary objectives are to assess Ki67 in ovary and endometrium; cleaved caspase-3, RANK/RANKL, ER/PR, CD44, and STAT3/pSTAT3 expression in fallopian tube, ovary, and endometrium; gene expression profiling in the fallopian tube and ovary; serum markers (progesterone, estradiol, C-terminal telopeptide) and denosumab levels; and toxicity.
Statistical methods: The primary endpoint is post-treatment Ki67 expression in the fimbrial end of the fallopian tube in the denosumab arm compared to the no treatment arm. Assuming a standard deviation of 5.0%, we will have 82% power to detect a 4.0% absolute difference (or effect size of 0.8) in Ki67 proliferation index between the denosumab and no treatment groups by applying a 2-sample t-test at a 0.05 significance level.
Target accrual: 60 participants, to be activated in Summer 2018.
Citation Format: Trivedi MS, Samimi G, Wright JD, Holcomb K, Garber JE, Horowitz NS, Arber N, Friedman E, Wenham RM, House M, Parnes H, Lee JJ, Abutaseh S, Vornik LA, Heckman-Stoddard BM, Brown PH, Crew KD. Pilot study of denosumab in BRCA1/2 mutation carriers scheduling for risk-reducing salpingo-oophorectomy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-09-01.
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Affiliation(s)
- MS Trivedi
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - G Samimi
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - JD Wright
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - K Holcomb
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - JE Garber
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - NS Horowitz
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - N Arber
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - E Friedman
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - RM Wenham
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - M House
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - H Parnes
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - JJ Lee
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Abutaseh
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - LA Vornik
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - BM Heckman-Stoddard
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - PH Brown
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
| | - KD Crew
- Columbia University Medical Center, New York, NY; National Cancer Institute, NIH, Bethesda, MD; Weill Cornell Medical Center, New York, NY; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Chaim Sheba Medical Center, Tel-Hashomer, Israel; Moffitt Cancer Center, Tampa, FL; University of Texas MD Anderson Cancer Center, Houston, TX
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Thomas PS, Patel AB, Contreras A, Liu DD, Lee JJ, Khan S, Vornik LA, Dimond EP, Perloff M, Heckman-Stoddard BM, Brown PH. Abstract OT2-09-02: A phase I dose escalation study of topical bexarotene in women at high risk for breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-09-02] [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: Breast cancer prevention with anti-estrogens, including tamoxifen, raloxifene, and exemestane, has been shown to reduce the incidence of hormone receptor-positive breast cancer. However, agents that can reduce the incidence of hormone receptor negative breast cancer are currently lacking. Rexinoids such as bexarotene are vitamin A analogues that have been shown to be involved in cell differentiation, growth, and apoptosis. In preclinical mouse models that develop ER-negative breast cancers, bexarotene showed a significant reduction in mammary tumor development. Oral bexarotene has been evaluated in BRCA mutation carriers and significant decreases in cyclin D1 were noted in breast cells suggesting biological activity of bexarotene on breast tissue. Systemic side effects of hyperlipidemia and hypothyroidism were also found. Data from chemoprevention studies with topical 4-hydroxytamoxifen support the concept of topical agents penetrating into the breast tissue and exhibiting biological activity in the tissue. We hypothesize that topical bexarotene can be applied to the breast as a chemoprevention agent with penetration to the breast tissue without subsequent systemic side effects and toxicity as seen with oral bexarotene.
Trial Design: Women at high risk for breast cancer will be recruited and assigned to one of three different dose levels: 10mg (1ml) every other day, 10mg (1ml) daily, 20mg (2ml) daily to one unaffected breast for 4 weeks. The primary endpoint of the study is to determine the recommended phase II dose of topical bexarotene 1% gel for evaluation in healthy at-risk women. Dose Limiting Toxicity (DLT) is defined as a grade 2 skin adverse event that persists for at least 6 days or any grade 3 or greater adverse event related to the study drug. A grade 2 skin adverse event that recurs and persists for at least 3 days is also a DLT. The Maximum Tolerated Dose (MTD) will be defined as the highest dose level at which no more than 2 participants experience a DLT among 10 participants treated. A conservative modification of the standard “3+3” design will be applied. The first three participants will be assigned to the lowest dose level. New cohorts of 3-4 participants will not be treated until toxicity has been fully evaluated for all current participants through 4 weeks. Once the MTD has been determined, an expansion cohort of an additional 10 patients will be recruited at the MTD to further evaluate safety and toxicity at this dose level as well bexarotene concentration in the breast tissue. Secondary endpoints include serum bexarotene level, tissue bexarotene levels, and changes in thyroid function tests, lipid profile, and calcium. The planned accrual for this study if maximally accrued to all dose levels and the dose expansion cohort will be 40 participants.
Citation Format: Thomas PS, Patel AB, Contreras A, Liu DD, Lee JJ, Khan S, Vornik LA, Dimond EP, Perloff M, Heckman-Stoddard BM, Brown PH. A phase I dose escalation study of topical bexarotene in women at high risk for breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-09-02.
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Affiliation(s)
- PS Thomas
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - AB Patel
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - A Contreras
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - DD Liu
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - JJ Lee
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - S Khan
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - LA Vornik
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - EP Dimond
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - M Perloff
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - BM Heckman-Stoddard
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - PH Brown
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
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Thomas PS, Contreras A, Pruthi S, Krontiras H, Rimawi M, Garber J, Wang T, Hilsenbeck SG, Vornik LA, Gilmer T, Friedman R, Heckman-Stoddard BM, Dunn B, Kuerer H, Brown PH. Abstract PD3-07: A phase II pre-surgical trial of lapatinib for the treatment of women with HER2 positive or EGFR positive ductal carcinoma in situ. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd3-07] [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: Estrogen receptor (ER)-negative tumors and human epidermal growth factor 2-Neu (HER2) positive breast cancers are known to be more clinically aggressive subtypes of breast cancer and account for 30% of all breast cancers. Women with HER2 + breast cancers, whether ER+ or ER -, require cytotoxic chemotherapy with a HER2-targeting agent, and often have adverse outcomes. Thus, preventive agents are needed to reduce the incidence of these subtypes of aggressive breast cancer. Lapatinib, a dual tyrosine kinase inhibitor, inhibits epidermal growth factor receptors (EGFR) and HER2 kinases and has shown to decrease breast cell proliferation in invasive breast cancer and adjacent premalignant lesions. Therefore, we conducted a multi-institutional randomized Phase II clinical trial to study the effects of the signal transduction inhibitor lapatinib in women with HER2-positive or EGFR-positive ductal carcinoma in situ (DCIS).
Methods: Randomized participants received either lapatinib (750mg, 1000mg, or 1500mg) or placebo daily for 2-6 weeks prior to their surgery. After minimal accrual, the trial was later amended to lapatinib 1000mg or placebo. Pre-treatment breast tissue was obtained from initial diagnostic core biopsy and post-treatment breast tissue was obtained from surgical excision specimen. Blood was obtained prior to surgery to assess serum lapatinib level. Participants kept a daily symptom assessment log and had a cardiac assessment at baseline and prior to surgery. Patients were instructed to take drug up to and including the day before surgery. The dual primary endpoint for this study was change in proliferation in pre- versus post-treatment biopsies between the two treatment arms, as measured by Ki67 as well as toxicity assessment. Secondary endpoints included incidence of DCIS at surgery and modulation of tissue biomarker expression in growth factor receptors (EGFR, ErbB2); phosphorylated growth factor receptor (phospho-ErbB2); signal transduction markers (MAPK, phospho-MAPK); hormone receptors (ER, PR); and p27.
Results:Twenty-two women (mean age: 51; range: 32-66) with HER2+ or EGFR+ DCIS were treated with lapatinib (1,000 or 1,500 mg) or placebo for 2–6 weeks prior to surgical excision. Ki67 expression was significantly decreased in the lapatinib treatment arms compared to placebo (p=0.0122). Diarrhea, fatigue, and skin reactions were notable adverse events that occurred predominately in the lapatinib arm compared to placebo. No grade 3 or 4 events related to the study drug were noted during the study. No changes were noted in cardiac function. DCIS was present in all surgical specimens in both arms. Invasive breast cancer was noted in 1 patient on lapatinib 1000mg and 3 patients on placebo. No statistically significant changes were noted in signal transduction biomarkers
Conclusion:These results demonstrate the effectiveness of lapatinib in reducing proliferation in women with EGFR+ or HER2+ DCIS. Even low-grade toxicities can deter use of an agent in the prevention setting. This and the lack of a risk model for HER2+ and triple negative breast cancer make the development of larger scale clinical prevention trials of lapatinib for the prevention a challenge.
Citation Format: Thomas PS, Contreras A, Pruthi S, Krontiras H, Rimawi M, Garber J, Wang T, Hilsenbeck SG, Vornik LA, Gilmer T, Friedman R, Heckman-Stoddard BM, Dunn B, Kuerer H, Brown PH. A phase II pre-surgical trial of lapatinib for the treatment of women with HER2 positive or EGFR positive ductal carcinoma in situ [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD3-07.
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Affiliation(s)
- PS Thomas
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - A Contreras
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - S Pruthi
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - H Krontiras
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - M Rimawi
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - J Garber
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - T Wang
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - SG Hilsenbeck
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - LA Vornik
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - T Gilmer
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - R Friedman
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - BM Heckman-Stoddard
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - B Dunn
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - H Kuerer
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
| | - PH Brown
- University of Texas at MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN; University of Alabama Medical Center, Birmingham, AL; Baylor College of Medicine, Houston, TX; Dana Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; Glaxo Smith Kline, Durham, NC
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14
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Uribe LR, Lin R, Stoffel EM, Samadder NJ, Lynch P, Kanth P, Milne G, Marnett LJ, Sepeda V, Liu DD, You YN, Vornik LA, Lee JJ, Richmond E, Umar A, Perloff M, Lipkin SM, Brown PH, Vilar-Sanchez E. Abstract CT065: A phase Ib biomarker trial of naproxen in patients at risk for DNA mismatch repair deficient colorectal cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-ct065] [Citation(s) in RCA: 1] [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: Patients diagnosed with Lynch Syndrome (LS) have an approximately 70% lifetime risk of colorectal cancer (CRC) due to the presence of germline mutations in the mismatch repair (MMR) genes. Cyclooxygenases (COX) are key enzymes in the metabolism of Prostaglandins (PGs) being COX-2 induced at sites of inflammation as well as in ~85% of CRC and 50% of premalignant adenomas. Non-steroidal anti-inflammatory drugs (NSAIDs) such as Aspirin and Naproxen exert their therapeutic effects through the inhibition of both COX-1 and COX-2, which causes a reduction in PGs. However, other known non-canonical effects include inhibition of cell growth, induction of cell cycle arrest, and apoptosis. Aspirin has demonstrated chemopreventive properties in LS patients at high doses. Naproxen is widely used for the treatment of pain with an excellent safety profile. In addition, pre-clinical in vivo data using a genetically-engineered mouse model of Lynch Syndrome (Villin-Cre;Msh2LoxP/LoxP) has demonstrated that Naproxen is the most effective NSAID in preventing colorectal tumors and has shown to be superior to Aspirin. The present clinical trial was designed to assess the safety and tolerability of long-term chemoprevention with Naproxen in LS and also to discover novel biomarkers of drug activity.
Methods: LS patients at 4 participating sites (The University of Texas MD Anderson Cancer Center, Dana Farber Cancer Institute, The University of Michigan Comprehensive Cancer Center, and Huntsman Cancer Institute) were randomly assigned to Naproxen 440 mg, 220 mg, or placebo once daily for 6 months. To determine the safety profile and tolerability of Naproxen, adverse events (AEs) were reported using CTCAE V4.03. To assess the activity of the drug intervention we measured Prostaglandin E2 (PGE2) levels in normal colorectal mucosa, its metabolite in urine (PGE-M), levels of Naproxen in plasma and colorectal mucosa at baseline and 6 months after treatment. Response to treatment was defined as 30% reduction in PGE2 levels. Results: A total of 86 patients were registered to this study, 28 randomized to Placebo, 25 to Naproxen 440 mg, and 27 to Naproxen 220 mg. Mean age was 44.6 years, 64% of the patients were females, 53% were unaffected carriers, and MLH1 and MSH2 were the most frequently mutated genes. Fifty-eight completed the study (67%). A total of 183 AEs were recorded in 61 patients, 77% were unrelated or unlikely related to the treatment, only 8 were reported as grade 3 AEs and none of these were related to Naproxen. In the group that received Naproxen at 440 mg, the levels of Naproxen in plasma and normal colorectal mucosa were the highest and the levels of PGE2 and PGE-M were significantly lower when compared to patients in the Placebo arm (P=0.027). In addition, the response rate was the highest among patients receiving Naproxen at 440 mg daily compared to Naproxen at 220 mg and Placebo (87.5% vs 75% vs 13%, respectively).
Conclusions: The tolerance and safety of long-term chemoprevention with Naproxen at a dose of 440 mg for 6 months was excellent. There was evidence of decreased inflammatory activity among LS patients treated with high dose Naproxen compared to Placebo. Biomarker studies to discover novel non-canonical effects of Naproxen via modulation of miRNA and mRNA profiles using next-generation sequencing approaches are currently ongoing.
Citation Format: Laura Reyes Uribe, Ramona Lin, Elena M. Stoffel, N. Jewel Samadder, Patrick Lynch, Priyanka Kanth, Ginger Milne, Lawrence J. Marnett, Valerie Sepeda, Diane D Liu, Y. Nancy You, Lana A. Vornik, J. Jack Lee, Ellen Richmond, Asad Umar, Marjorie Perloff, Steven M. Lipkin, Powel H. Brown, Eduardo Vilar-Sanchez. A phase Ib biomarker trial of naproxen in patients at risk for DNA mismatch repair deficient colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT065.
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Affiliation(s)
- Laura Reyes Uribe
- 1Department of Clinical Cancer Prevention, MD Anderson Cancer Center, Houston, TX
| | - Ramona Lin
- 2Gastroenterology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
| | - Elena M. Stoffel
- 3Gastroenterology, Cancer Genetics, University of Michigan Health system, Ann Harbor, MI
| | - N. Jewel Samadder
- 4Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Patrick Lynch
- 5Department of Gastroenterology, MD Anderson Cancer Center, Houston, TX
| | - Priyanka Kanth
- 6Division of Gastroenterologym, Huntsman Cancer Institute at The University of Utah, Salt Lake City, UT
| | - Ginger Milne
- 7Research Associate Professor of Medicine and Pharmacology and Director, Eicosanoid Core Laboratory, Vanderbilt University Medical Center, Nashville, TN
| | - Lawrence J. Marnett
- 8Biochemistry, Chemistry and Pharmacology, Vanderbilt Institute of Chemical Biology, Nashville, TN
| | - Valerie Sepeda
- 1Department of Clinical Cancer Prevention, MD Anderson Cancer Center, Houston, TX
| | - Diane D Liu
- 9Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Y. Nancy You
- 10Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX
| | - Lana A. Vornik
- 1Department of Clinical Cancer Prevention, MD Anderson Cancer Center, Houston, TX
| | - J. Jack Lee
- 11Department of Biostatistics. University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ellen Richmond
- 12Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Asad Umar
- 12Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Marjorie Perloff
- 12Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Steven M. Lipkin
- 13Division of Gastroenterology/Hepatology, Weill Cornell Medical College (WCMC), New York, NY
| | - Powel H. Brown
- 1Department of Clinical Cancer Prevention, MD Anderson Cancer Center, Houston, TX
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15
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Gucalp A, Zhou XK, Cook ED, Garber JE, Crew KD, Nangia JR, Bhardwaj P, Giri DD, Elemento O, Verma A, Wang H, Lee JJ, Vornik LA, Mays C, Weber D, Sepeda V, O'Kane H, Krasne M, Williams S, Morris PG, Heckman-Stoddard BM, Dunn BK, Hudis CA, Brown PH, Dannenberg AJ. A Randomized Multicenter Phase II Study of Docosahexaenoic Acid in Patients with a History of Breast Cancer, Premalignant Lesions, or Benign Breast Disease. Cancer Prev Res (Phila) 2018; 11:203-214. [PMID: 29453232 DOI: 10.1158/1940-6207.capr-17-0354] [Citation(s) in RCA: 12] [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: 11/02/2017] [Revised: 01/02/2018] [Accepted: 02/02/2018] [Indexed: 12/12/2022]
Abstract
Obesity, a cause of subclinical inflammation, is a risk factor for the development of postmenopausal breast cancer and is associated with poorer cancer outcomes. Docosahexaenoic acid (DHA), an omega-3 fatty acid, possesses anti-inflammatory properties. We hypothesized that treatment with DHA would reduce the expression of proinflammatory genes and aromatase, the rate-limiting enzyme for estrogen biosynthesis, in benign breast tissue of overweight/obese women. A randomized, placebo-controlled, double-blind phase II study of DHA given for 12 weeks to overweight/obese women with a history of stage I-III breast cancer, DCIS/LCIS, Paget's disease, or proliferative benign breast disease was carried out. In this placebo controlled trial, the primary objective was to determine whether DHA (1,000 mg by mouth twice daily) reduced breast tissue levels of TNFα. Secondary objectives included evaluation of the effect of DHA on breast tissue levels of COX-2, IL1β, aromatase, white adipose tissue inflammation, and gene expression by RNA-seq. Red blood cell fatty acid levels were measured to assess compliance. From July 2013 to November 2015, 64 participants were randomized and treated on trial (32 women per arm). Increased levels of omega-3 fatty acids in red blood cells were detected following treatment with DHA (P < 0.001) but not placebo. Treatment with DHA did not alter levels of TNFα (P = 0.71), or other biomarkers including the transcriptome in breast samples. Treatment with DHA was overall well-tolerated. Although compliance was confirmed, we did not observe changes in the levels of prespecified biomarkers in the breast after treatment with DHA when compared with placebo. Cancer Prev Res; 11(4); 203-14. ©2018 AACRSee related editorial by Fabian and Kimler, p. 187.
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Affiliation(s)
- Ayca Gucalp
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. .,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Xi K Zhou
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Elise D Cook
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Judy E Garber
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Katherine D Crew
- Departments of Medicine/Epidemiology, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Julie R Nangia
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Priya Bhardwaj
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Dilip D Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Olivier Elemento
- Departments of Physiology and Biophysics/Computational Biomedicine, Weill Cornell Medical College, New York, New York
| | - Akanksha Verma
- Departments of Physiology and Biophysics/Computational Biomedicine, Weill Cornell Medical College, New York, New York
| | - Hanhan Wang
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - J Jack Lee
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lana A Vornik
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carrie Mays
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Weber
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Valerie Sepeda
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Holly O'Kane
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Margaret Krasne
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samantha Williams
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Patrick G Morris
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Barbara K Dunn
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Clifford A Hudis
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,American Society of Clinical Oncology, Alexandria, Virginia
| | - Powel H Brown
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
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16
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Kim J, Davis JW, Klein EA, Magi-Galluzzi C, Lotan Y, Ward JF, Pisters LL, Basler JW, Pettaway CA, Stephenson A, Li Ning Tapia EM, Efstathiou E, Wang X, Do KA, Lee JJ, Gorlov IP, Vornik LA, Hoque AM, Prokhorova IN, Parnes HL, Lippman SM, Thompson IM, Brown PH, Logothetis CJ, Troncoso P. Tissue Effects in a Randomized Controlled Trial of Short-term Finasteride in Early Prostate Cancer. EBioMedicine 2016; 7:85-93. [PMID: 27322462 PMCID: PMC4909608 DOI: 10.1016/j.ebiom.2016.03.047] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/21/2016] [Accepted: 03/31/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In the Prostate Cancer Prevention Trial, finasteride selectively suppressed low-grade prostate cancer and significantly reduced the incidence of prostate cancer in men treated with finasteride compared with placebo. However, an apparent increase in high-grade disease was also observed among men randomized to finasteride. We aimed to determine why and hypothesized that there is a grade-dependent response to finasteride. METHODS From 2007 to 2012, we randomized dynamically by intranet-accessible software 183 men with localized prostate cancer to receive 5mg finasteride or placebo daily in a double-blind study during the 4-6weeks preceding prostatectomy. As the primary end point, the expression of a predefined molecular signature (ERβ, UBE2C, SRD5A2, and VEGF) differentiating high- and low-grade tumors in Gleason grade (GG) 3 areas of finasteride-exposed tumors from those in GG3 areas of placebo-exposed tumors, adjusted for Gleason score (GS) at prostatectomy, was compared. We also determined androgen receptor (AR) levels, Ki-67, and cleaved caspase 3 to evaluate the effects of finasteride on the expression of its downstream target, cell proliferation, and apoptosis, respectively. The expression of these markers was also compared across grades between and within treatment groups. Logistic regression was used to assess the expression of markers. FINDINGS We found that the predetermined molecular signature did not distinguish GG3 from GG4 areas in the placebo group. However, AR expression was significantly lower in the GG4 areas of the finasteride group than in those of the placebo group. Within the finasteride group, AR expression was also lower in GG4 than in GG3 areas, but not significantly. Expression of cleaved caspase 3 was significantly increased in both GG3 and GG4 areas in the finasteride group compared to the placebo group, although it was lower in GG4 than in GG3 areas in both groups. INTERPRETATION We showed that finasteride's effect on apoptosis and AR expression is tumor grade dependent after short-term intervention. This may explain finasteride's selective suppression of low-grade tumors observed in the PCPT.
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Affiliation(s)
- Jeri Kim
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | - Yair Lotan
- Department of Urology, The University of Texas Southwestern Medical School, Dallas, TX 75390, USA
| | - John F Ward
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Louis L Pisters
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joseph W Basler
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Andrew Stephenson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Elsa M Li Ning Tapia
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eleni Efstathiou
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kim-Anh Do
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ivan P Gorlov
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lana A Vornik
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Ashraful M Hoque
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ina N Prokhorova
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Howard L Parnes
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA
| | - Scott M Lippman
- Moores Cancer Center, University of California, San Diego, San Diego, CA 92093, USA
| | - Ian M Thompson
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Powel H Brown
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christopher J Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Patricia Troncoso
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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17
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Guerrieri-Gonzaga A, Veronesi G, Fiore PPD, Lazzeroni M, Bellomi M, Szabo E, Vornik LA, Brown PH, Bonanni B. Abstract C49: A randomized phase II trial of low-dose aspirin versus placebo in high-risk individuals with CT screen-detected subsolid lung nodules. Cancer Prev Res (Phila) 2013. [DOI: 10.1158/1940-6215.prev-13-c49] [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
Lung cancer screening by spiral low-dose CT scan (ld-CT) is a noninvasive test with low radiation exposure and no contrast medium and offers the opportunity to serially examine the peripheral lung for the first time, albeit with the limitation that small lesions cannot be biopsied, leaving their identity unknown. However, the incidence of undetermined nodules detected with ld-CT is more than 50% in high-risk individuals. The nature of these nodules remains uncertain but some of them could represent precancerous lesions. Particularly, ground glass opacities (GGO), compared with solid nodules, can represent localized bronchioloalveolar carcinoma without foci of active fibroblastic proliferation or atypical adenomatous hyperplasia, a putative adenocarcinoma precursor lesion.
Two screening programs with annual ld-CT in current and former smokers are run at the EIO and they may represent suitable cohorts of at-risk subjects to be enrolled in a chemopreventive study.
Aspirin, the first nonsteroidal anti-inflammatory drug (NSAID) identified, may have anti-cancer properties, especially for diseases whose etiology implicates chronic inflammation including lung cancer. The anti-inflammatory effect of NSAIDs operates through inhibition of prostaglandins via suppression of cyclooxygenase-1 (COX-1) and COX-2. Evidence of this effect is derived from several recently published meta-analyses of aspirin in the prevention of cardiovascular events showing that daily aspirin reduced the incidence of several cancers and reduced metastases. In 2011, Rothwell et al. pooled data from 8 double-blind randomized controlled trials of daily aspirin and analyzed the effect of aspirin on cancer mortality as secondary endpoints. The 20-year risk of death due to all cancers was lower in the aspirin than in the control group and the benefit increased with treatment duration. Lung cancer-specific mortality rates were reduced by 29% (95% CI, 11-42) in the aspirin group in the 20-year period after the trial commenced. No trend with dose (above 75 mg/day) was observed, but the effect on all cancers was more evident in adenocarcinomas and was present in both smokers and nonsmokers. Several further observational studies have been published confirming a lower lung cancer risk in aspirin users.
Based on the growing evidence on the potential preventive effect of Aspirin on lung cancer, we will conduct a monoinstitutional, double-blind, placebo-controlled phase IIb study in which 128 participants enrolled in a ld-CT annual screening program will be randomized to receive either low dose Aspirin (100 mg/day) or placebo for 12 month.
The primary endpoint will be the shrinkage of GGO and partially solid nodules after one-year treatment in a per-lesion and per-subject analysis.
Secondary endpoints will be the modulation of biological markers and their potential correlation with modification of lung nodules shrinkage. In particular, we will evaluate the effect of Aspirin on a signature of serum miRNA correlated to subsolid nodules. Other secondary endpoints will be the evaluation of lung nodule density before and after treatment and the number and size of non-target lesions. Additional circulating biomarkers will include the modulation of hs-CRP as a marker of inflammation, the evaluation of urinary cotinine as marker of tobacco exposure and investigation of the potential effect of aspirin according to its concentration, the measurement of urinary prostaglandin metabolites (PGEM) and urine LTE4. Tolerability of low dose Aspirin will be also evaluated.
The study is expected to start by December 2013.
Supported by NCI, DCP Contract HHSN261201200034I to the UT MD Anderson Cancer Prevention Agent Development Program: Early Phase Clinical Research
Citation Format: Aliana Guerrieri-Gonzaga, Giulia Veronesi, Pier Paolo Di Fiore, Matteo Lazzeroni, Massimo Bellomi, Eva Szabo, Lana A. Vornik, Powel H. Brown, Bernardo Bonanni. A randomized phase II trial of low-dose aspirin versus placebo in high-risk individuals with CT screen-detected subsolid lung nodules. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C49.
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Affiliation(s)
| | | | | | | | | | - Eva Szabo
- 2National Cancer Institute, Bethesda, MD,
| | - Lana A. Vornik
- 3The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Powel H. Brown
- 3The University of Texas MD Anderson Cancer Center, Houston, TX
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Kim J, Davis JW, Klein EA, Magi-Galluzzi C, Lotan Y, Ward JF, Pisters LL, Basler JW, Pettaway CA, Li Ning Tapia EM, Wang X, Do KA, Lee J, Vornik LA, Tangrea J, Parnes HL, Lippman SM, Thompson IM, Brown PH, Troncoso P, Logothetis CJ. Abstract LB-195: A double-blind randomized controlled multisite trial evaluating tissue effects of preoperative finasteride in clinically organ-confined prostate cancer: Pathologic outcomes. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-lb-195] [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: The Prostate Cancer Prevention Trial (PCPT) showed a relative reduction of 24.8% in cumulative incidence of prostate cancer (PC) in finasteride-treated men (18.4 v 24.4%; p<.001). However, high-grade cancers (Gleason score [GS] ≥7) were more commonly detected in men receiving finasteride than placebo (6.4 v 5.1%; p=.005), an effect of uncertain significance. We therefore undertook a study to determine differences between finasteride-exposed and -unexposed (placebo/control) cancers in the expression of a preselected molecular signature shown to distinguish Gleason grade (GG) 3 from GG 4 untreated tumors.
Methods: This 4-site presurgical trial was in men with clinically organ-confined PC (cT1c/T2; GS 6 or 7; prostate-specific antigen [PSA] <10 ng/mL) randomly assigned to treatment with 5 mg finasteride or placebo daily for 4-6 wk prior to prostatectomy. At baseline and at surgery, PSA, testosterone (T), dihydrotestosterone (DHT), estrone (E1), and estradiol (E2) levels were measured in men who opted to donate blood for research. We used a standard method to handle radical prostatectomy (RP) specimens, including mapping of tumor foci to document relevant morphologic data.
Results: In all, 210 patients consented, 204 were randomized, 183 were evaluable for detailed pathologic outcomes, and 163 were evaluable for PSA and hormone levels. Median age was 60 (45-73) yr. Median treatment time was 28 (10-43) days. Median prostate total tumor volume (TV) was 0.9 (0-10.4) cc, and peripheral zone TV, 0.6 (0-9.3) cc. Biopsy (Bx) GS, GS upgrade between Bx and RP, specimen GS/GG, total cancer foci, zonal origin of dominant cancer, and median total and PZ TV were similar in the 2 treatment arms (A v B). Post-treatment, median PSA was significantly lower (3.2 v 5.2 ng/mL; p<.001); testosterone, significantly higher (391 v 325 ng/dL; p=.021); and DHT, significantly lower (10 v 27 ng/dL; p<.001) in arm A than in arm B. No differences were noted in E1 and E2 levels. Biomarker analysis of a preselected molecular signature is under way; unblinding awaits completion of biomarker analysis.
Conclusions: No significant difference in GS distribution was observed between the two groups after short-term exposure to finasteride or placebo. Modulation of PSA, T, and DHT levels occurred in a statistically significant uneven distribution by study arm. Molecular signature characterization has been completed, and the planned analysis of associations is under way. The findings are expected to provide insight into the reported grade effect attributed to finasteride. (This work was supported in part by NCI contract N01-CN-35159.)
Citation Format: Jeri Kim, John W. Davis, Eric A. Klein, Cristina Magi-Galluzzi, Yair Lotan, John F. Ward, Louis L. Pisters, Joseph W. Basler, Curtis A. Pettaway, Elsa M. Li Ning Tapia, Xuemei Wang, Kim-Anh Do, Jack Lee, Lana A. Vornik, Joe Tangrea, Howard L. Parnes, Scott M. Lippman, Ian M. Thompson, Powel H. Brown, Patricia Troncoso, Christopher J. Logothetis. A double-blind randomized controlled multisite trial evaluating tissue effects of preoperative finasteride in clinically organ-confined prostate cancer: Pathologic outcomes. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-195. doi:10.1158/1538-7445.AM2013-LB-195
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Affiliation(s)
- Jeri Kim
- 1UT MD Anderson Cancer Ctr., Houston, TX
| | | | | | | | - Yair Lotan
- 3UT Southwestern Medical Center, Dallas, TX
| | | | | | | | | | | | | | - Kim-Anh Do
- 1UT MD Anderson Cancer Ctr., Houston, TX
| | - Jack Lee
- 1UT MD Anderson Cancer Ctr., Houston, TX
| | | | - Joe Tangrea
- 5National Cancer Institute, Division of Cancer Prevention, Bethesda, MD
| | - Howard L. Parnes
- 5National Cancer Institute, Division of Cancer Prevention, Bethesda, MD
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Arun B, Gong Y, Liu D, Litton J, Gutierrez-Barrera A, Sajan B, Lee JJ, Vornik LA, Cornelison T, Hortobagyi GN, Lippman S, Brown PH, Sneige N. Abstract B17: Phase I prevention study of atorvastatin in women at increased risk for breast cancer. Cancer Prev Res (Phila) 2012. [DOI: 10.1158/1940-6207.prev-12-b17] [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: Currently FDA approved chemopreventive agents for breast cancer risk reduction include the selective estrogen receptor modulators (SERMs) tamoxifen and raloxifen. However, acceptance amongst high risk women is low due to side effects that include thromboembolic events, uterine cancer and menopausal symptoms. Furthermore, SERMs only reduce the incidence of estrogen receptor (ER) negative breast cancer. Therefore, agents with a favorable toxicity profile that reduce incidence of ER negative and ER positive breast cancer are urgently needed. Atorvastatin is a statin that inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMGcoA) reductase. Observational studies have demonstrated a decreased incidence of cancers among users of HMG CoA reductase inhibitors and a reduced risk of recurrence among statin users diagnosed with early stage breast cancer. In animal models, statins have been shown to be also effective against ER negative breast cancer. The aim of this study was to evaluate atorvastatin's potential chemopreventive effect by first demonstrating changes in breast cancer risk biomarkers in women at increased risk for breast cancer.
Methods: High risk patients were randomized 1:1:1:1 to daily 10mg, 20mg, or 40mg Atorvastatin for 3 months, or to no treatment. High risk was defined as having a previous history of ductal carcinoma insitu (DCIS), lobular carcinoma insitu (LCIS), or atypical hyperplasia, or life time breast cancer risk greater than 20% by models including Gail, Claus, Tyrer-Cuzick, Boadicea, or BRCAPRO. All patients underwent baseline and 3 months blood collection and fine needle aspiration (FNA) of the breast for analysis of modulation in biomarkers. Biomarkers to be examined included in the blood: CRP, lipid profile, levels of atorvastatin, HMGcoA genotype and in breast FNA samples: Cytology, Ki 67, EGFR, bcl-2, CC3, and LXR evaluated by immunohistochemistry.
Results: Between 2008 and 2012, 66 high risk women were randomized and 60 completed the study. Mean age was 51.8 years (range 27-69). One patient in the 20 mg arm experienced grade 3 toxicity (myalgia) that was not study drug related; 5 patients in the control arm, 6 in the 10mg, 9 in the 20mg and 4 in the 40 mg arm experienced grade 2 toxicity; only minority of them related to the study drug (arthraligia, myalgia, skin rash); 2 patients in the control arm, 3 in the 10 mg, 4 in the 20mg and 12 in the 40mg arm experienced grade 1 toxicity; only 10% of them possibly related to the study drug (arthralgia, myalgia, diarrhea, skin rash).
Conclusion: Compliance during our atorvastatin phase I biomarker modulation study was very good. Atorvastatin was well tolerated with minority of the patients experiencing side effects, most of which were not related to the study drug. Biomarker analysis is ongoing and will be presented. This study was supported by the NCI N01CN35159 award.
Citation Format: Banu Arun, Yun Gong, Diane Liu, Jennifer Litton, Angelica Gutierrez-Barrera, Blessy Sajan, Jack j. Lee, Lana A. Vornik, Terri Cornelison, Gabriel N. Hortobagyi, Scott Lippman, Powel H. Brown, nour Sneige. Phase I prevention study of atorvastatin in women at increased risk for breast cancer. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B17.
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Affiliation(s)
- Banu Arun
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
| | - Yun Gong
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
| | - Diane Liu
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
| | - Jennifer Litton
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
| | - Angelica Gutierrez-Barrera
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
| | - Blessy Sajan
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
| | - Jack j. Lee
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
| | - Lana A. Vornik
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
| | - Terri Cornelison
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
| | - Gabriel N. Hortobagyi
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
| | - Scott Lippman
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
| | - Powel H. Brown
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
| | - nour Sneige
- 1University of Texas MD Anderson Cancer Cenetr, Houston, TX, 2National Cancer Institute, Bethesda, MD, 3University of California San Diego, San Diego, CA
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Abstract
OBJECTIVE Depressive disorders are common in asthma. Despite the high prevalence, antidepressant therapy in asthma patients with depression remains under-investigated. The objective of this pilot study was to investigate the use of bupropion for depression and anxiety in depressed asthma patients. METHOD We conducted a 12-week open-label study of bupropion in 18 depressed asthma patients. Participants were assessed with the Hamilton Rating Scale for Depression (HAM-D-17), Hamilton Rating Scale for Anxiety (HAM-A), Inventory of Depressive Symptomatology--Self-Report (IDS-SR), Asthma Control Questionnaire (ACQ) and spirometry at baseline and weeks 1, 2, 4, 8, and 12. RESULTS Significant baseline to exit improvements were observed on the HAM-D-17 (mean change = 4.72, SD = 7.78, p = 0.02) and the HAM-A (mean change = 2.12, SD = 3.97, p = 0.04). Based on the HAM-D-17 scores, 27.8% of the patients were responders and 16.7% were remitters. Significant correlations were found between changes in ACQ score and HAM-D-17 r = 0.73, p = 0.001), ACQ score and IDS-SR r = 0.58, = 0.012), and FEV1% Predicted and HAM-D-17 r = -0.66, p = 0.006). CONCLUSIONS Bupropion treatment was associated with significant improvements in depression and anxiety symptoms in asthma patients. Improvements in asthma correlated significantly with improvements in depression.
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Affiliation(s)
- E Sherwood Brown
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 75390-8849, USA.
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Vornik LA, Brown ES. Management of comorbid bipolar disorder and substance abuse. J Clin Psychiatry 2006; 67 Suppl 7:24-30. [PMID: 16961421] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Bipolar disorder is a severe and often chronic disorder with lifetime prevalence rates of bipolar spectrum disorders of up to 6.5% in the general population. Patients with bipolar disorder frequently report co-occurring substance use disorders, and the rates of alcohol and other substance use disorders are significantly higher in persons with bipolar disorder than in the general population. The present review discusses why people with bipolar disorder use substances, provides an overview of the impact of alcohol and other substance use on the course of bipolar disorder, and outlines the treatment options currently available to patients with co-occurring bipolar disorder and substance abuse. Our aim is to summarize the existing data on the pharmacologic treatment options and to include the most recent published data whenever possible. Three randomized, placebo-controlled studies of dual-diagnosis patients treated with carbamazepine, lithium, and valproate are discussed. The results are generally positive and support the use of these agents in dual-diagnosis patients. Open-label studies are also presented, and the need for controlled data is outlined. The review also briefly discusses the psychotherapeutic approaches to patients with comorbid bipolar and substance use disorders.
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Affiliation(s)
- Lana A Vornik
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Perlis RH, Welge JA, Vornik LA, Hirschfeld RMA, Keck PE. Atypical antipsychotics in the treatment of mania: a meta-analysis of randomized, placebo-controlled trials. J Clin Psychiatry 2006; 67:509-16. [PMID: 16669715 DOI: 10.4088/jcp.v67n0401] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Randomized, controlled trials have demonstrated efficacy for atypical antipsychotics in the treatment of mania in bipolar disorder, either as monotherapy or adjunctive treatment. However, there are no published comparisons of individual atypical antipsychotics for mania. DATA SOURCES AND STUDY SELECTION We conducted a systematic review and meta-analysis of randomized, placebo-controlled monotherapy and adjunctive therapy trials of atypical antipsychotics for acute bipolar mania. Studies published through 2004 were identified using searches of PubMed/MEDLINE with the search terms mania, placebo, and each of the atypical antipsychotics, limited to randomized, controlled clinical trials; review of abstracts from the 2003 meetings of the American College of Neuropsychiatry, American Psychiatric Association, and International Conference on Bipolar Disorder; and consultations with study investigators and representatives of pharmaceutical companies that market atypical antipsychotics. DATA EXTRACTION Analyses were performed on the changes in Young Mania Rating Scale or Mania Rating Scale total scores from baseline to endpoint, using last observation carried forward and computing the difference in change scores between each drug and its corresponding placebo arm. A random-effects model with fixed drug effects was used to combine the studies and make comparisons of the antipsychotics to each other and to placebo. DATA SYNTHESIS Data from 12 placebo-controlled monotherapy and 6 placebo-controlled adjunctive therapy trials involving a total of 4304 subjects (including 1750 placebo-treated subjects) with bipolar mania were obtained. Aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone all demonstrated significant efficacy in monotherapy (i.e., all confidence intervals exclude zero). However, after adjusting for multiple comparisons, pairwise comparisons of individual effects identified no significant differences in efficacy among antipsychotics. Magnitude of improvement was similar whether the antipsychotic was utilized as monotherapy or adjunctive therapy. CONCLUSIONS The 5 newer atypical antipsychotics were all superior to placebo in the treatment of bipolar mania. For monotherapy and add-on therapy, cross-trial comparisons suggest that differences in acute efficacy between the drugs, if any, are likely to be small.
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Affiliation(s)
- Roy H Perlis
- Bipolar Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Vornik LA, Hirschfeld RMA. Bipolar disorder: quality of life and the impact of atypical antipsychotics. Am J Manag Care 2005; 11:S275-80. [PMID: 16232010] [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: 05/04/2023]
Abstract
This article reviews the impact of bipolar disorder on the quality of life of affected individuals. In particular, the impact of atypical antipsychotics on the quality of life of individuals with bipolar disorder is addressed. Among atypical antipsychotics, olanzapine has been studied most with regard to quality of life. In general, symptomatic improvements have been associated with improvements in quality of life.
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Affiliation(s)
- Lana A Vornik
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Calveston, Texas, USA
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Hirschfeld RMA, Vornik LA. Bipolar disorder--costs and comorbidity. Am J Manag Care 2005; 11:S85-90. [PMID: 16097719] [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: 05/03/2023]
Abstract
Not only is bipolar disorder a chronic, severe psychiatric disorder, it is also expensive to treat and expensive to society. An estimate of the total cost of bipolar disorder made more than a decade ago was as high as 45 billion dollars per year. Most of this cost is accounted for by indirect costs related to reduced functional capacity and lost work. Patients with bipolar disorder have higher rates of utilization of healthcare resources compared with the general population and compared with patients with other types of psychiatric conditions. Comorbidity contributes to the heavy burden that bipolar disorder imposes on society. Bipolar disorder frequently occurs together with other psychiatric disorders, especially anxiety disorders and substance abuse. In addition, bipolar disorder has been associated with a variety of general medical conditions, which further complicate management of the psychiatric disorder.
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Affiliation(s)
- Robert M A Hirschfeld
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA
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Hirschfeld RMA, Vornik LA. Recognition and diagnosis of bipolar disorder. J Clin Psychiatry 2005; 65 Suppl 15:5-9. [PMID: 15554789] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Bipolar disorder is a serious, recurrent, and sometimes chronic psychiatric illness that is far more prevalent than many physicians realize. It often is unrecognized and misdiagnosed, particularly in patients presenting with depression. The consequences of misdiagnosis and mistreatment as unipolar depression may be disastrous. The rate of recognition may be improved by asking patients about bipolar symptoms and by screening for bipolar disorder using the Mood Disorder Questionnaire.
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Affiliation(s)
- Robert M A Hirschfeld
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX 77550-0188, USA
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Hirschfeld RMA, Vornik LA. Newer antidepressants: review of efficacy and safety of escitalopram and duloxetine. J Clin Psychiatry 2004; 65 Suppl 4:46-52. [PMID: 15046541] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND Two antidepressants with different mechanisms of action, escitalopram and duloxetine, have recently been developed for the treatment of major depressive disorder. This article reviews the available controlled data on these agents with regard to efficacy, safety, and tolerability. METHOD We identified four 8-week, double-blind, placebo-controlled studies of escitalopram in the acute treatment of major depression. Three of the studies involved an active comparator, citalopram. We identified 6 placebo-controlled studies of duloxetine in major depressive disorder. Two of the studies included fluoxetine as an active comparator, and 2 included paroxetine as an active comparator. RESULTS A review of the data from the controlled studies supports the efficacy of both escitalopram and duloxetine in the treatment of patients with major depression. Three of the 4 escitalopram studies were positive, and 1 was a failed study. Four of the 6 duloxetine studies were positive. Both escitalopram and duloxetine performed better than at least 1 selective serotonin reuptake inhibitor comparator. The safety and tolerability profiles of both drugs are quite benign. The reported incidence of treatment-emergent adverse events was somewhat lower with escitalopram than with duloxetine, with the possible exception of sexual dysfunction. Discontinuations due to adverse events were lower for escitalopram than for duloxetine, although rates were comparable with higher doses of escitalopram (20 mg/day). CONCLUSION Both escitalopram and duloxetine are useful in the treatment of major depressive disorder.
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Affiliation(s)
- Robert M A Hirschfeld
- Department of Psychiatry and Behavioral Sciences, University of Texas-Medical Branch, Galveston 77555-0188, USA.
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Abstract
We investigated whether the sociolinguistic information delivered by spoken, accented postevent narratives would influence the misinformation effect. New Zealand subjects listened to misleading postevent information spoken in either a New Zealand (NZ) or North American (NA) accent. Consistent with earlier research, we found that NA accents were seen as more powerful and more socially attractive. We found that accents per se had no influence on the misinformation effect but sociolinguistic factors did: both power and social attractiveness affected subjects' susceptibility to misleading postevent suggestions. When subjects rated the speaker highly on power, social attractiveness did not matter; they were equally misled. However, when subjects rated the speaker low on power, social attractiveness did matter: subjects who rated the speaker high on social attractiveness were more misled than subjects who rated it lower. There were similar effects for confidence. These results have implications for our understanding of social influences on the misinformation effect.
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