1
|
Aravind P, Popat S, Barwick TD, Soneji N, Lythgoe M, Sreter KB, Lozano-Kuehne JP, Bergqvist M, Patel N, Aboagye EO, Kenny LM. A Subset of Non-Small Cell Lung Cancer Patients Treated with Pemetrexed Show 18F-Fluorothymidine "Flare" on Positron Emission Tomography. Cancers (Basel) 2023; 15:3718. [PMID: 37509378 PMCID: PMC10377924 DOI: 10.3390/cancers15143718] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Thymidylate synthase (TS) remains a major target for cancer therapy. TS inhibition elicits increases in DNA salvage pathway activity, detected as a transient compensatory "flare" in 3'-deoxy-3'-[18F]fluorothymidine positron emission tomography (18F-FLT PET). We determined the magnitude of the 18F-FLT flare in non-small cell lung cancer (NSCLC) patients treated with the antifolate pemetrexed in relation to clinical outcome. METHOD Twenty-one patients with advanced/metastatic non-small cell lung cancer (NSCLC) scheduled to receive palliative pemetrexed ± platinum-based chemotherapy underwent 18F-FLT PET at baseline and 4 h after initiating single-agent pemetrexed. Plasma deoxyuridine (dUrd) levels and thymidine kinase 1 (TK1) activity were measured before each scan. Patients were then treated with the combination therapy. The 18F-FLT PET variables were compared to RECIST 1.1 and overall survival (OS). RESULTS Nineteen patients had evaluable PET scans at both time points. A total of 32% (6/19) of patients showed 18F-FLT flares (>20% change in SUVmax-wsum). At the lesion level, only one patient had an FLT flare in all the lesions above (test-retest borders). The remaining had varied uptake. An 18F-FLT flare occurred in all lesions in 1 patient, while another patient had an 18F-FLT reduction in all lesions; 17 patients showed varied lesion uptake. All patients showed global TS inhibition reflected in plasma dUrd levels (p < 0.001) and 18F-FLT flares of TS-responsive normal tissues including small bowel and bone marrow (p = 0.004 each). Notably, 83% (5/6) of patients who exhibited 18F-FLT flares were also RECIST responders with a median OS of 31 m, unlike patients who did not exhibit 18F-FLT flares (15 m). Baseline plasma TK1 was prognostic of survival but its activity remained unchanged following treatment. CONCLUSIONS The better radiological response and longer survival observed in patients with an 18F-FLT flare suggest the efficacy of the tracer as an indicator of the early therapeutic response to pemetrexed in NSCLC.
Collapse
Affiliation(s)
- Preetha Aravind
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK; (P.A.); (T.D.B.); (N.S.); (M.L.); (J.P.L.-K.); (N.P.)
| | - Sanjay Popat
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; (S.P.); (K.B.S.)
| | - Tara D. Barwick
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK; (P.A.); (T.D.B.); (N.S.); (M.L.); (J.P.L.-K.); (N.P.)
- Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
| | - Neil Soneji
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK; (P.A.); (T.D.B.); (N.S.); (M.L.); (J.P.L.-K.); (N.P.)
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; (S.P.); (K.B.S.)
- Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
| | - Mark Lythgoe
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK; (P.A.); (T.D.B.); (N.S.); (M.L.); (J.P.L.-K.); (N.P.)
| | - Katherina B. Sreter
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; (S.P.); (K.B.S.)
| | - Jingky P. Lozano-Kuehne
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK; (P.A.); (T.D.B.); (N.S.); (M.L.); (J.P.L.-K.); (N.P.)
| | | | - Neva Patel
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK; (P.A.); (T.D.B.); (N.S.); (M.L.); (J.P.L.-K.); (N.P.)
- Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
| | - Eric O. Aboagye
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK; (P.A.); (T.D.B.); (N.S.); (M.L.); (J.P.L.-K.); (N.P.)
| | - Laura M. Kenny
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK; (P.A.); (T.D.B.); (N.S.); (M.L.); (J.P.L.-K.); (N.P.)
- Department of Medical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
| |
Collapse
|
2
|
Aravind P, Popat S, Barwick TD, Soneji N, Lythgoe M, Lozano-kuehne J, Sreter KB, Bergqvist M, Patel NH, Aboagye EO, Kenny LM. [ 18F]Fluorothymidine(FLT)-PET imaging of thymidine kinase 1 pharmacodynamics in non-small cell lung cancer treated with pemetrexed. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3070 Background: Imaging of tumor proliferation has been studied with FLT-PET in various tumor types including NSCLC. Pemetrexed inhibits thymidylate synthase(TS), dihydrofolate reductase (DHFR), and glycinamide ribonucleotide formyltransferase (GARFT). TS inhibition upregulates the thymidine salvage pathway including relocalisation of ENT1 to membrane and TK1 activation as a transient “flare” response. We hypothesise that this can be detected as an increase in FLT tumoral uptake that subsequently decreases with reduced proliferation. This study was conducted to assess FLT uptake as an early pharmacodynamics(PD) marker of pemetrexed response. Methods: This was an open-label imaging study in 21 patients with Stage 3/4 NSCLC treated with pemetrexed and platinum-based chemotherapy. Patients underwent FLT PET/CT scan at baseline and 4h after administration of pemetrexed. Platinum component of treatment was administered on the day after second FLT scan for cycle 1. Plasma for TK1 activity expression were collected before each scan time point and analysed by ELISA. Percentage change in standardized uptake value (%ΔSUV) was calculated as [SUV(PET2) – SUV(PET1)]/ SUV(PET1)*100. Treatment response calculated by RECIST 1. 1 and survival data were collected. Results: 17 patients had evaluable PET/CT scans for pemetrexed response. Median percentage difference for SUVmean and SUVmax in tumour lesions increased by 3% and 10.3% respectively. 5 patients showed homogeneous FLT flare at 4h after pemetrexed, 2 patients had decrease, 10 patients had heterogeneous FLT response (regardless of platinum doublet). There was no significant correlation between plasma TK1 activity and FLT flare. At 9 weeks, 4 patients had partial response, 9 stable disease and 4 progressive disease. Baseline and weighted average ΔSUVmax were not associated with survival. The 5 patients with FLT flare in all lesions showed a median OS of 31 months, unlike the group with heterogenous or decrease uptake(15 months). FLT uptake in bone marrow and small bowel significantly increased at 4h (t test p = 0.004, p = 0.004, respectively) indicating increased thymidine salvage activity. Early FLT uptake was not predictive for tumour RECIST response or OS. In multivariable cox regression analysis, pre-treatment TK1 activity, adjusted for performance status, smoking history and age, independently affected survival in this group (p = 0.011). Conclusions: Early FLT flare at 4h was seen in NSCLC post pemetrexed administration indicating activation of thymidine salvage pathway. Median overall survival of patients with an FLT flare response was more than twice longer than patients with mixed or no response. However, the small sample size lacked power to show statistical significance in the OS comparison. Further studies should evaluate this and the relationship to other prognostic variables in a larger cohort of patients. Clinical trial information: NCRI UK badge 9249.
Collapse
Affiliation(s)
| | - Sanjay Popat
- Lung Cancer Unit, Department of Medicine, The Royal Marsden Hospital, London, United Kingdom
| | - Tara D. Barwick
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Soneji
- Imperial College NHS Trust, London, United Kingdom
| | | | | | | | | | - Neva H. Patel
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | | |
Collapse
|
3
|
Kenny LM, Gilbert FJ, Gopalakrishnan G, Aravind P, Barwick T, Patel N, Hiscock DROBERT, Boros I, Kealey S, Aigbirhio FI, Lozano-kuehne J, Cleator SJ, Fleming B, Riddle P, Ahmad R, Chua S, Johnston SR, Mansi J, Cook GJ, Aboagye EO. The HERPET study: Imaging HER2 expression in breast cancer with the novel PET tracer [ 18F]GE-226, a first-in-patient study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3069 Background: Over-expression the human epidermal growth factor receptor-2 (HER2) is seen in 20% of breast cancers; this is an adverse prognostic factor and used to guide therapy selection. At present HER2 expression can only be determined using biopsy material using immunohistochemistry or fluorescence in situ hybridisation. Heterogeneous expression of HER2 is now being recognised as a cause of treatment resistance but is difficult to characterise. A non-invasive method for determining HER2 expression could have several advantages and help select appropriate therapy for patients. GE-226 is a novel radiolabelled GE-Affibody radioligand which binds to the HER2 receptor with high affinity at a different epitope than trastuzumab. Methods: Patients with locally advanced or metastatic breast cancer were recruited and scanned for 65 mins after iv injection of 200MBq of GE-226 (mean activity injected for each patient 202MBq (range 164-223MBq, mean radiochemical purity 94%) of radioligand, over one bed position for dynamic imaging, followed by a half-body scan. Blood sampling was used to measure metabolism of the tracer. Safety was assessed. HER2-extracellular domain (ECD) domain was measured in blood. Tumoural uptake was quantified by semi-quantitative and fquantitative parameters in HER2 positive and HER2 negative tumours. Patients had routine baseline FDG imaging. Results: Twenty patients completed the study. GE-226 scans were well tolerated. There were no serious adverse events. GE-226 was slowly metabolised into a single metabolite in the liver; 97% of parent remained at 60 minutes post injection (range 82-100). There was a significant difference in tumoural radioligand uptake between biopsy proven HER2 positive and HER2 negative tumoural patients as measured by SUVmean and SUVmax (p < 0.001). Comparing HER2 positive to HER2 negative cases, there was also a significant difference between tumour to normal tissue uptake ratios SUVmean. Heterogeneous uptake was observed in three patients, two with interlesional uptake variation and one with intralesional heterogeneity. Tumoural uptake increased over time. Normal physiological uptake in salivary glands and the thyroid gland was noted. GE-226 was able to differentiate between lymphadenopathy due to sarcoidosis and cancer in one patient and was superior to FDG which had shown widespread uptake in the benign and malignant nodes. Conclusions: [18F]GE-226 imaging is well tolerated and shows promise for imaging of HER2 positive breast cancer. Further studies with this agent are now planned. Clinical trial information: NCT03827317.
Collapse
Affiliation(s)
| | - Fiona J Gilbert
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | | | | | - Tara Barwick
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neva Patel
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Istvan Boros
- University of Cambridge, Cambridge, United Kingdom
| | | | | | | | | | - Ben Fleming
- Imperial College London, London, United Kingdom
| | | | - Rizvana Ahmad
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sue Chua
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Janine Mansi
- Department of Medical Oncology, London, United Kingdom
| | | | | |
Collapse
|
4
|
Coombes C, Howell SJ, Krebs MG, Lord S, Kenny LM, Bahl A, Clack G, Ainscow E, Dickinson PA, Fostea R, Mansi J, Palmieri C, Bertelli G, Jeselsohn R, Mitri Z, Gradishar WJ, Sardesai S, O'Shaughnessy J, Ward P, Chalasani P, Lehnert M, Ali S, McIntosh S. Abstract GS3-10: Study of samuraciclib (CT7001), a first-in-class, oral, selective inhibitor of CDK7, in combination with fulvestrant in patients with advanced hormone receptor positive HER2 negative breast cancer (HR+BC). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs3-10] [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: CDK7 inhibition is a promising therapeutic strategy in cancer; acting as a regulator of the cell cycle, transcription and endocrine receptor signalling [1]. Patients with HR+BC post CDK4/6 inhibitor treatment have a poor prognosis; median progression free survival (mPFS) of ~ 8 weeks for fulvestrant post CDK4/6i in HR+BC [2,3]. Pre-clinical HR+BC models indicate the potential for synergy when the CDK7 inhibitor samuraciclib is combined with the Selective Estrogen Receptor Degrader fulvestrant [4]Materials and Methods: This single arm cohort assessed the tolerability and efficacy of samuraciclib in combination with standard dose fulvestrant in patients with advanced HR+BC; all patients had previously received an aromatase inhibitor and a CDK4/6i for advanced disease.Results: 31 patients with HR+BC received the combination of standard dose with fulvestrant and samuraciclib. 6 patients received samuraciclib dose of 240mg once daily (QD) and 25 patients a dose of 360mg QD. The combination treatment was generally well tolerated, with adverse drug reactions (AE) of note being G1-2 nausea, vomiting and diarrhoea; the majority of patients staying on treatment until disease progression.RECIST evaluation indicates evidence of reduction in tumor disease burden, including a partial response in one patient who has been on treatment for ~ 1 year.Graphic illustrations of data, including ‘waterfall’ and ‘swimmer’ plots, will be presented along with stratification data based on demographic factors such as hepatic involvement and cfDNA analysis (ESR1m, PI3Km).Conclusions: Samuraciclib has demonstrated an acceptable safety profile with evidence of anti-tumour activity in combination with fulvestrant for patients with advanced HR+BC who have progressed on their prior CDK4/6i.References:1.Patel et al., Mol Cancer Therap. 20182.Juric et al., SABCS 20183.Lindeman et al., JCO 20214.Jeselsohn et al., SABCS 2019
Citation Format: Charles Coombes, Sasha J Howell, Matthew G Krebs, Simon Lord, Laura M Kenny, Ash Bahl, Glen Clack, Edward Ainscow, Paul A Dickinson, Raluca Fostea, Janine Mansi, Carlo Palmieri, Gianflippo Bertelli, Rinath Jeselsohn, Zahi Mitri, William J Gradishar, Sagar Sardesai, Joyce O'Shaughnessy, Patrick Ward, Pavani Chalasani, Manfred Lehnert, Simak Ali, Stuart McIntosh. Study of samuraciclib (CT7001), a first-in-class, oral, selective inhibitor of CDK7, in combination with fulvestrant in patients with advanced hormone receptor positive HER2 negative breast cancer (HR+BC) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS3-10.
Collapse
Affiliation(s)
| | - Sasha J Howell
- The University of Manchester, Manchester, United Kingdom
| | - Matthew G Krebs
- The Christie NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| | - Simon Lord
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Ash Bahl
- Carrick Therapeutics, Dublin, Ireland
| | | | | | - Paul A Dickinson
- SEDA Pharmaceutical Development Services, Stockport, United Kingdom
| | | | - Janine Mansi
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Zahi Mitri
- Oregon Health & Science University, Portland, OR
| | | | | | | | | | | | | | - Simak Ali
- Imperial College, London, United Kingdom
| | | |
Collapse
|
5
|
Howell SJ, Kenny LM, Lord S, Krebs MG, Arkenau T, Baird R, MacPherson IR, Bahl A, Clack G, Ainscow E, Barrett AGM, Dickinson PA, Fuchter MJ, Lehnert M, Ali S, McIntosh S, Coombes C. Abstract P1-18-10: A clinical study of samuraciclib (CT7001), a first-in-class, oral, selective inhibitor of CDK7, in patients with advanced triple negative breast cancer (TNBC). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-18-10] [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: CDK7 inhibition is a promising therapeutic strategy in cancer. CDK7 is a key kinase, regulating cell division, transcription and nuclear receptor function [1]. Although recent advances have been made in the treatment of TNBC this disease is still one of significant unmet need. Materials and Methods: Tolerability and efficacy of Samuraciclib were assessed in a TNBC expansion cohort of the first in human study of Samuraciclib. These patients had metastatic or locally advanced TNBC and had received prior taxane and anthracycline therapy including at least one line of chemotherapy for metastatic or locally advanced disease. Results: From 29th January 2019 to 12th April 2021, 23 women with advanced TNBC were recruited and dosed with Samuraciclib 360mg OD. Treatment has generally been well tolerated with all patients remaining on treatment until disease progression. The most common adverse drug reactions (AE) were: G1-2 Nausea (96%), Vomiting (52%) and Diarrhea (91%). There were 4 dose reductions to manage upper GI adverse events of nausea and/or vomiting. G3 events were as follows: 2 Grade 3 Diarrhea, 1 Grade 3 Vomiting, 1 Grade 3 Fatigue, 1 Grade 3 Stomatitis, 1 Grade 3 Anaemia and 1 Grade 4 Thrombocytopenia21 patients have had follow-up evaluations for assessment of efficacy. Stable disease was achieved in 14 patients, 1 with partial response (being on treatment for 72 weeks) and 7 patients with progressive disease; two additional patients remain on compassionate use treatment, following disease progression by RECIST. 5 patients have been on treatment for at least 24 weeks of whom 3 have exceeded 1 year. Conclusions: Samuraciclib demonstrated an acceptable safety and tolerability profile with evidence of antitumour activity in advanced TNBC. References1.Patel et al. ICEC0942, an Orally Bioavailable Selective Inhibitor of CDK7 for Cancer Treatment. Mol Cancer Ther. 2018. doi: 10.1158/1535-7163.MCT-16-0847. PMID:29545334.
Citation Format: Sacha J Howell, Laura M Kenny, Simon Lord, Matthew G Krebs, Tobias Arkenau, Richard Baird, Iain R MacPherson, Ash Bahl, Glen Clack, Edward Ainscow, Anthony GM Barrett, Paul A Dickinson, Matthew J Fuchter, Manfred Lehnert, Simak Ali, Stuart McIntosh, Charles Coombes. A clinical study of samuraciclib (CT7001), a first-in-class, oral, selective inhibitor of CDK7, in patients with advanced triple negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-10.
Collapse
Affiliation(s)
- Sacha J Howell
- The University of Manchester, Manchester, United Kingdom
| | | | - Simon Lord
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Matthew G Krebs
- The Christie NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| | | | - Richard Baird
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Ash Bahl
- Carrick Therapeutics, Dublin, Ireland
| | | | | | | | - Paul A Dickinson
- SEDA Pharmaceutical Development Services, Stockport, United Kingdom
| | | | | | - Simak Ali
- Imperial College, London, United Kingdom
| | | | | |
Collapse
|
6
|
Kenny LM, Gopalakrishnan GS, Barwick TD, Vaja V, McDevitt SH, Punjani R, Patel NH, Ramakrishnan R, Patel NR, Johnston S, Mansi J, Cook GJ, Gilbert FJ, Aigbirhio FI, Hiscock D, Aboagye EO. Abstract PD6-09: Herpet study- PET imaging of HER2 expression in breast cancer using the novel Affibody tracer [18F]GE-226, a first in patient study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd6-09] [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 20% of breast cancers have over-expression of the human epidermal growth factor receptor-2 (HER2), which is an adverse prognostic factor and used to guide therapy selection. At present HER2 expression can only be determined using biopsy material which is then analysed using immunohistochemistry or fluorescence in situ hybridisation. GE-226 is a radiolabelled Affibody® tracer which binds to the HER2 receptor with high affinity at a different epitope than trastuzumab. Heterogeneous expression does exist but the impact this has on treatment response has not been well assessed. A non-invasive method for determining HER2 expression could have several advantages and help select appropriate therapy for patients.
Trial DesignPatients with locally advanced or metastatic breast cancer were recruited and scanned for 65 mins after iv injection of 200MBq (mean activity injected for each patient 198 MBq (range 164-219MBq), mean radiochemical purity 94.6%) of tracer, with one dynamic bed position, and then a half-body scan was performed. Blood sampling was used to measure metabolism of the tracer. Safety was recorded. HER2-extracellular domain (ECD) domain was measured in blood. The original accrual target was 16 patients. Tumoural uptake was quantified by semi-quantitative and fully quantitative parameters in HER2 positive and HER2 negative tumours.
ResultsThirteen patients were recruited. Scans were well tolerated. There were no serious adverse events. GE-226 was metabolised into a single metabolite in the liver. 96.8 % parent remained at 60 minutes post injection. There was a significant difference between HER2 positive and HER2 negative tumoural uptake of tracer as measured by SUVmean and SUVmax (p<0.05). Comparing HER2 positive to HER2 negative cases, there was also a significant difference between tumour to normal tissue uptake ratios (p<0.05). Heterogeneous uptake was observed in the same patient. Tumoural uptake increased over time. Uptake in salivary glands and the thyroid gland was noted. In one patient GE-226 was able to differentiate between lymphadenopathy due to sarcoidosis and cancer and was superior to FDG which had shown widespread uptake in the same patient.
Conclusions[18F]GE-226 imaging is well tolerated and shows promise for imaging of HER2 positive breast cancer. Further studies with this agent are now planned.
Citation Format: Laura M. Kenny, Gosala S. Gopalakrishnan, Tara D. Barwick, Vijay Vaja, S. Hope McDevitt, Robert Punjani, Neva H. Patel, Rathi Ramakrishnan, Naina R. Patel, Stephen Johnston, Janine Mansi, Gary J. Cook, Fiona J. Gilbert, Franklin I. Aigbirhio, Duncan Hiscock, Eric O. Aboagye. Herpet study- PET imaging of HER2 expression in breast cancer using the novel Affibody tracer [18F]GE-226, a first in patient study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD6-09.
Collapse
Affiliation(s)
| | | | - Tara D. Barwick
- 2Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Vijay Vaja
- 1Imperial College London, London, United Kingdom
| | | | | | - Neva H. Patel
- 2Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | | | | | - Janine Mansi
- 4Guys and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | |
Collapse
|
7
|
Robertson JFR, Evans A, Henschen S, Kirwan CC, Jahan A, Kenny LM, Dixon JM, Schmid P, Kothari A, Mohamed O, Fasching PA, Cheung KL, Wuerstlein R, Carroll D, Klinowska T, Lindemann JPO, MacDonald A, Mather R, Maudsley R, Moschetta M, Nikolaou M, Roudier MP, Sarvotham T, Schiavon G, Zhou D, Zhou L, Harbeck N. A Randomized, Open-label, Presurgical, Window-of-Opportunity Study Comparing the Pharmacodynamic Effects of the Novel Oral SERD AZD9496 with Fulvestrant in Patients with Newly Diagnosed ER + HER2 - Primary Breast Cancer. Clin Cancer Res 2020; 26:4242-4249. [PMID: 32234755 DOI: 10.1158/1078-0432.ccr-19-3387] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/04/2020] [Accepted: 03/26/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Fulvestrant, the first-in-class selective estrogen receptor (ER) degrader (SERD), is clinically effective in patients with ER+ breast cancer, but it has administration and pharmacokinetic limitations. Pharmacodynamic data suggest complete ER degradation is not achieved at fulvestrant's clinically feasible dose. This presurgical study (NCT03236974) compared the pharmacodynamic effects of fulvestrant with AZD9496, a novel, orally bioavailable, nonsteroidal, potent SERD, in treatment-naïve patients with ER+ HER2- primary breast cancer awaiting curative intent surgery. PATIENTS AND METHODS Patients were randomized 1:1 to receive AZD9496 250 mg twice daily from day 1 for 5-14 days, or fulvestrant 500 mg on day 1. On-treatment imaging-guided core tumor biopsies were taken between day 5 and 14 and compared with pretreatment diagnostic biopsies. The primary objective was to compare the effects of AZD9496 and fulvestrant on ER expression. Secondary objectives included changes in progesterone receptor (PR) and Ki-67 pharmacokinetic/pharmacodynamic relationships and safety. RESULTS Forty-six women received treatment (AZD9496 n = 22; fulvestrant n = 24); 35 paired biopsies were evaluable (AZD9496 n = 15; fulvestrant n = 20). The least square mean estimate for ER H-score reduction was 24% after AZD9496 versus 36% after fulvestrant treatment (P = 0.86). AZD9496 also reduced PR H-scores (-33.3%) and Ki-67 levels (-39.9%) from baseline, but was also not superior to fulvestrant (PR: -68.7%, P = 0.97; Ki-67: -75.4%, P = 0.98). No new safety findings were identified. CONCLUSIONS This was the first presurgical study to demonstrate that an oral SERD affects its key biological targets. However, AZD9496 was not superior to fulvestrant at the dose tested.
Collapse
Affiliation(s)
| | | | | | | | - Ali Jahan
- King's Mill Hospital, Mansfield, United Kingdom
| | - Laura M Kenny
- Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Ashutosh Kothari
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Omar Mohamed
- Johannes Wesling General Hospital, Minden, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | | | - Rachel Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center, University of Munich (LMU), Munich, Germany
| | - Danielle Carroll
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Teresa Klinowska
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Justin P O Lindemann
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Alexander MacDonald
- Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Richard Mather
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Rhiannon Maudsley
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Michele Moschetta
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Myria Nikolaou
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Martine P Roudier
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Tinnu Sarvotham
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Gaia Schiavon
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Diansong Zhou
- Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Li Zhou
- Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center, University of Munich (LMU), Munich, Germany
| |
Collapse
|
8
|
Varghese V, Magnani L, Harada-Shoji N, Mauri F, Szydlo RM, Yao S, Lam EWF, Kenny LM. FOXM1 modulates 5-FU resistance in colorectal cancer through regulating TYMS expression. Sci Rep 2019; 9:1505. [PMID: 30728402 PMCID: PMC6365533 DOI: 10.1038/s41598-018-38017-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 10/07/2018] [Indexed: 12/11/2022] Open
Abstract
Resistance to 5-Fluoruracil (5-FU) has been linked to elevated expression of the main target, thymidylate synthase (TYMS), which catalyses the de novo pathway for production of deoxythymidine monophosphate. The potent oncogenic forkhead box transcription factor, FOXM1 is is regulated by E2F1 which also controls TYMS. This study reveals a significant role of FOXM1 in 5-FU resistance. Overexpression and knock-down studies of FOXM1 in colon cancer cells suggest the importance of FOXM1 in TYMS regulation. ChIP and global ChIP-seq data also confirms that FOXM1 can also potentially regulate other 5-FU targets, such as TYMS, thymidine kinase 1 (TK-1) and thymidine phosphorylase (TYMP). In human colorectal cancer tissue specimens, a strong correlation of FOXM1 and TYMS staining was observed. Elevated FOXM1 and TYMS expression was also observed in acquired 5-FU resistant colon cancer cells (HCT116 5-FU Res). A synergistic effect was observed following treatment of CRC cells with an inhibitor of FOXM1, thiostrepton, in combination with 5-FU. The combination treatment decreased colony formation and migration, and induced cell cycle arrest, DNA damage, and apoptosis in CRC cell lines. In summary, this research demonstrated that FOXM1 plays a pivotal role in 5-FU resistance at least partially through the regulation of TYMS.
Collapse
Affiliation(s)
- Vidhya Varghese
- Department of Surgery and Cancer, Imperial College London, London, USA
| | - Luca Magnani
- Department of Surgery and Cancer, Imperial College London, London, USA
| | | | - Francesco Mauri
- Imperial College Healthcare NHS Trust, Imperial College London, London, USA
| | | | - Shang Yao
- Department of Surgery and Cancer, Imperial College London, London, USA
| | - Eric W-F Lam
- Department of Surgery and Cancer, Imperial College London, London, USA.
| | - Laura M Kenny
- Department of Surgery and Cancer, Imperial College London, London, USA.
| |
Collapse
|
9
|
Palmieri C, Szydlo R, Miller M, Barker L, Patel NH, Sasano H, Barwick T, Tam H, Hadjiminas D, Lee J, Shaaban A, Nicholas H, Coombes RC, Kenny LM. IPET study: an FLT-PET window study to assess the activity of the steroid sulfatase inhibitor irosustat in early breast cancer. Breast Cancer Res Treat 2017; 166:527-539. [PMID: 28795252 PMCID: PMC5668341 DOI: 10.1007/s10549-017-4427-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 05/08/2017] [Accepted: 07/26/2017] [Indexed: 10/24/2022]
Abstract
BACKGROUND Steroid sulfatase (STS) is involved in oestrogen biosynthesis and irosustat is a first generation, irreversible steroid sulfatase inhibitor. A pre-surgical window-of-opportunity study with irosustat was undertaken in estrogen receptor-positive (ER+) breast cancer to assess the effect of irosustat on tumour cell proliferation as measured by 3'-deoxy-3'-[18F] fluorothymidine uptake measured by PET scanning (FLT-PET) and Ki67. METHODS Postmenopausal women with untreated ER+ early breast cancer were recruited, and imaged with FLT-PET at baseline and after at least 2 weeks treatment with irosustat, 40 mg once daily orally. The primary endpoint was changed in FLT uptake; secondary endpoints included safety and tolerability of irosustat, changes in tumoral Ki67 and steroidogenic enzymes expression and circulating steroid hormone levels. RESULTS Thirteen women were recruited, and ten started irosustat for 2 weeks, followed by repeat FLT-PET scans in eight. Defining response as decreases of ≥20% in standardized uptake value (SUV) or ≥30% in Ki, 1 (12.5% (95% CI 2-47%, p = 0.001)) and 3 (43% (95% CI 16-75%, p = <0.001) patients, respectively, responded. 6 out of 7 patients had a Ki67 reduction (range = -19.3 to 76.4%), and median percentage difference in Ki67 was 52.3% (p = 0.028). In one patient with a low baseline STS expression, a 19.7% increase in Ki67 was recorded. STS decreases were seen in tumours with high basal STS expression, significant decreases were also noted in aromatase, and 17β-hydroxysteroid dehydrogenase type 1 and 2. Irosustat was generally well tolerated with all adverse event CTCAE Grade ≤2. CONCLUSIONS Irosustat resulted in a significant reduction in FLT uptake and Ki67, and is well tolerated. These data are the first demonstrating clinical activity of irosustat in early breast cancer. Baseline expression of STS may be a biomarker of sensitivity to irosustat.
Collapse
Affiliation(s)
- Carlo Palmieri
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, L69 3BX, UK.
- Liverpool & Merseyside Breast Academic Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK.
- Academic Department of Medical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, CH63 4JY, UK.
| | - Richard Szydlo
- Centre for Haematology, Imperial College London, London, W12 0NN, UK
| | - Marie Miller
- Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
| | - Laura Barker
- Department of Medical Oncology, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Neva H Patel
- Radiological Sciences Unit and Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
- Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
| | - Hironobu Sasano
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Tara Barwick
- Department of Radiology, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Henry Tam
- Department of Radiology, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Dimitri Hadjiminas
- Department of Surgery, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Jasmin Lee
- Department of Pathology, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Abeer Shaaban
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Hanna Nicholas
- Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
| | - R Charles Coombes
- Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
- Department of Medical Oncology, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Laura M Kenny
- Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
- Department of Medical Oncology, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| |
Collapse
|
10
|
Saleem A, Searle GE, Kenny LM, Huiban M, Kozlowski K, Waldman AD, Woodley L, Palmieri C, Lowdell C, Kaneko T, Murphy PS, Lau MR, Aboagye EO, Coombes RC. Erratum to: Lapatinib access into normal brain and brain metastases in patients with Her-2 overexpressing breast cancer. EJNMMI Res 2017; 7:74. [PMID: 28887806 PMCID: PMC5591177 DOI: 10.1186/s13550-017-0323-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/25/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Azeem Saleem
- Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, Burlington Danes Building, Du Cane Road, London, W12 0NN, UK.
| | - Graham E Searle
- Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, Burlington Danes Building, Du Cane Road, London, W12 0NN, UK
| | - Laura M Kenny
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Mickael Huiban
- Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, Burlington Danes Building, Du Cane Road, London, W12 0NN, UK
| | - Kasia Kozlowski
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Adam D Waldman
- Division of Brain Sciences, Imperial College Department of Imaging, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Laura Woodley
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
| | - Carlo Palmieri
- Department of Molecular and Clinical Cancer Medicine, Duncan Building, Daulby Street, Liverpool, L69 3GA, UK
| | - Charles Lowdell
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Tomomi Kaneko
- GlaxoSmithKline Oncology, Stockley Park West, Uxbridge, Middlesex, UB11 1BT, UK
| | - Philip S Murphy
- Clinical Imaging and Medicines Development, GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK
| | - Mike R Lau
- Clinical Imaging and Medicines Development, GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK
| | - Eric O Aboagye
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Raoul C Coombes
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| |
Collapse
|
11
|
Cysouw MCF, Kramer GM, Frings V, De Langen AJ, Wondergem MJ, Kenny LM, Aboagye EO, Kobe C, Wolf J, Hoekstra OS, Boellaard R. Baseline and longitudinal variability of normal tissue uptake values of [ 18F]-fluorothymidine-PET images. Nucl Med Biol 2017; 51:18-24. [PMID: 28528264 DOI: 10.1016/j.nucmedbio.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/22/2017] [Revised: 04/14/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE [18F]-fluorothymidine ([18F]-FLT) is a PET-tracer enabling in-vivo visualization and quantification of tumor cell proliferation. For qualitative and quantitative analysis, adequate knowledge of normal tissue uptake is indispensable. This study aimed to quantitatively investigate baseline tracer uptake of blood pool, lung, liver and bone marrow and their precision, and to assess the longitudinal effect of systemic treatment on biodistribution. METHODS 18F-FLT-PET(/CT) scans (dynamic or static) of 90 treatment-naïve oncological patients were retrospectively evaluated. Twenty-three patients received double baseline scans, and another 39 patients were also scanned early and late during systemic treatment with a tyrosine kinase inhibitor. Reproducible volume of interest were placed in blood pool, lung, liver, and bone marrow. For semi-quantitative analysis, SUVmean, SUVmax, and SUVpeak with several normalizations were derived. RESULTS SUVs of basal lung, liver, and bone marrow were not significantly different between averaged dynamic and static images, in contrast with blood pool and apical lung. Highest repeatability was seen for liver and bone marrow, with repeatability coefficients of 18.6% and 20.4% when using SUVpeak. Systemic treatment with TKIs both increased and decreased normal tissue tracer uptake at early and late time points during treatment. CONCLUSION Simultaneous evaluation of liver and bone marrow uptake in longitudinal response studies may be used to assess image quality, where changes in uptake outside repeatability limits should trigger investigators to perform additional quality control on individual PET images. ADVANCES IN KNOWLEDGE For [18F]-FLT PET images, liver and bone marrow have low intra-patient variability when quantified with SUVpeak, but may be affected by systemic treatment. IMPLICATIONS FOR PATIENT CARE In [18F]-FLT-PET response monitoring trials, liver and bone marrow uptake may be used for quality control of [18F]-FLT PET images.
Collapse
Affiliation(s)
- Matthijs C F Cysouw
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - Gerbrand M Kramer
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Virginie Frings
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Adrianus J De Langen
- Department of Pulmonary diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Mariëlle J Wondergem
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Laura M Kenny
- Imperial College London, and Hammersmith Hospital NHS Trust, London, UK
| | - Eric O Aboagye
- Imperial College London, and Hammersmith Hospital NHS Trust, London, UK
| | - Carsten Kobe
- Department of Nuclear Medicine, Center for Integrated Oncology Köln Bonn, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, University Hospital of Cologne, Cologne, Germany
| | - Otto S Hoekstra
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
12
|
Redana S, Papadimitraki E, Okonji DO, Khabra K, Thanopoulou E, Chiramel J, Papanastasopoulos P, Wardley AM, Hogg MS, Howell SJ, Zucchini G, Kenny LM, Ring AE, Johnston SRD. Real-world experience of exemestane-everolimus (EXE-EVE) in elderly patients with hormone-receptor positive (HR+) metastatic breast cancer (MBC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Stefania Redana
- The Royal Marsden Hospital NHS Foundation Trust, London & Surrey, United Kingdom
| | | | | | - Komel Khabra
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | | | | | | | - Alistair E. Ring
- The Royal Marsden Hospital NHS Foundation Trust, London & Surrey, United Kingdom
| | | |
Collapse
|
13
|
Palmieri C, Szydlo R, Miller M, Woodley-Barker L, Patel N, Berwick T, Tam H, Hadjiminas D, Lee J, Shaaban A, Reed S, Nicholas H, Coombes C, Kenny LM. The effects of the first in class steroid sulfatase inhibitor Irosustat on FLT uptake and Ki67 in estrogen receptor positive early breast cancer: Results of the perioperative IPET study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e23140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Carlo Palmieri
- Institute of Translational Medicine, Liverpool, United Kingdom
| | | | | | | | - Neva Patel
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Tara Berwick
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Henry Tam
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Jasmin Lee
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Abeer Shaaban
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Sadie Reed
- Imperial College London, London, United Kingdom
| | | | | | | |
Collapse
|
14
|
Kenny LM, Adam A. Image guided therapy and the importance of local tumour control. Eur J Surg Oncol 2016; 42:588-90. [PMID: 26935446 DOI: 10.1016/j.ejso.2016.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/19/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- L M Kenny
- School of Medicine, University of Queensland, Australia; Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Central Integrated Regional Cancer Service, Queensland Health, Queensland, Australia
| | - A Adam
- King's College London, UK.
| |
Collapse
|
15
|
Brown T, Banks M, Hughes BGM, Lin C, Kenny LM, Bauer JD. New radiotherapy techniques do not reduce the need for nutrition intervention in patients with head and neck cancer. Eur J Clin Nutr 2015; 69:1119-24. [PMID: 26306565 DOI: 10.1038/ejcn.2015.141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/15/2015] [Accepted: 07/21/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Since 2007, our institution has used validated guidelines for the insertion of proactive gastrostomy feeding tubes in patients with head and neck cancer. Helical intensity-modulated radiotherapy (H-IMRT) delivered by Tomotherapy, is an advanced radiotherapy technique introduced at our centre in 2010. This form of therapy reduces long-term treatment-related toxicity to normal tissues. The aim of this study is to compare weight change and need for tube feeding following H-IMRT (n=53) with patients that would have previously been treated with three-dimensional conformal radiotherapy (n=134). SUBJECTS/METHODS Patients with head and neck cancer assessed as high nutritional risk with recommendation for proactive gastrostomy were identified from cohorts from 2007 to 2008 and 2010 to 2011. Retrospective data were collected on clinical factors, weight change from baseline to completion of treatment, incidence of severe weight loss (⩾ 10%) and tube feeding. Statistical analyses to compare outcomes between the two treatments included χ(2)-test, Fisher's exact and two-sample Wilcoxon tests (P<0.05). RESULTS The H-IMRT cohort had higher proportions of patients with definitive chemoradiotherapy (P=0.032) and more advanced N stage (P<0.001). Nutrition outcomes were not significantly different between H-IMRT and conformal radiotherapy, respectively: need for proactive gastrostomy (n=49, 92% versus n=115, 86%, P=0.213), median percentage weight change (-7.2% versus -7.3%, P=0.573) and severe weight loss incidence (28% versus 27%, P=0.843). CONCLUSIONS Both groups had median weight loss >5% and high incidences of tube feeding and severe weight loss. Nutrition intervention remains critical in this patient population, despite advances in radiotherapy techniques, and no changes to current management are recommended.
Collapse
Affiliation(s)
- T Brown
- Centre for Dietetics Research (C-DIET-R), School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - M Banks
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - B G M Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - C Lin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - L M Kenny
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - J D Bauer
- Centre for Dietetics Research (C-DIET-R), School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
| |
Collapse
|
16
|
Harada N, Varghese V, Xie L, Kenny LM. Abstract P1-08-03: Targeting lactate metabolism as a novel therapeutic target in platinum-resistant triple negative breast cancer (TNBC). Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p1-08-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction TNBC is a heterogeneous disease and is often associated with expression of a stem cell signature (CD44+, CD24-). Recently platinum agents have been shown to improve the pathological response rates in the neo-adjuvant setting; however a significant proportion of patients with TNBC will relapse. The study objective was to evaluate the potential of targeting glycolysis, mitochondrial function and lactate metabolism in platinum resistant TNBC cell lines.
Methods Stem cell signature and glycolytic phenotyping: CD44 and CD24 antibodies were used to measure the percentage of stem cells in each of the cell lines using flow cytometry(FACS). Protein expression of hexokinase, Glut1 transporter, lactate dehydrogenase A/B(LDHA and LDHB), and monocarboxylic transporter 1 and 4 (MCT1 and MCT4) was determined in MCF7(control), MDA-MB231, MDA-MB468, and HCC38 cells. Proliferation and apoptosis assays: IC50s for platinum, metformin, and MCT1 inhibitor AR-C155858, Tocris (MCT1I) were calculated by the sulforhodamine B (SRB) assay. Propidium iodide and AnnexinV staining intensity used to measure apoptosis by FACS. Metabolic analysis: The change in lactate and glucose levels in culture media post-treatment with metformin and MCT1I was quantified by 1H NMR. Intracellular lactate and ATP concentrations were determined by lactate(BioVision) and ATP determination assays(Invitrogen). Mitochondrial membrane potential and Reactive oxygen species (ROS) were measured by MitoTracker Red and MitoSOX Red. 2NBDG was used to assess cell glucose uptake. Combination index SRBs: Cells were treated with increasing concentrations of MCT1I and metformin for 72h. The combination index values were calculated using CalcuSyn® software.
Results MDA-MB231 and HCC38 cells were resistant to cisplatin and associated with a stem cell signature (CD44+, CD24-) which was not detected in the other cell lines. MCT1 was highly expressed in HCC38 cells but not at all in MDA-MB231. In contrast, MCT4 was abundantly expressed MDA-MB231 but minimally in HCC38 cells.
In these two cell lines, only MDA-MB231 was sensitive to metformin which reduced ATP production, induced ROS generation, and increased the percentage of apoptotic cells. HCC38 also produced ROS, but ATP production and apoptosis were unaffected.
HCC38 cells were more sensitive to MCT1I than other cells, which was associated with increased intracellular lactate.
The NMR data showed significant increases in lactate in culture media following treatment with metformin in MDA-MB231 and HCC38. Only HCC38 had increased 2NBDG uptake and reduced of glucose levels in culture medium by metformin.
Metformin significantly enhanced the anticancer efficacy of MCT1I in HCC38 cells, as a synergistic effect of the two agents was observed across the range of different concentrations; whilst an antagonistic effect was shown in MDA-MB231 cells with almost all concentrations.
Conclusions Targeting lactate metabolism selectively inhibits a platinum-resistant stem cell population of TNBC, this effect is enhanced when combined with metformin.
The inhibition of glycolysis and lactate metabolism may represent a new therapeutic strategy for this population and warrants further study.
Citation Format: Narumi Harada, Vidhya Varghese, Lingmin Xie, Laura M Kenny. Targeting lactate metabolism as a novel therapeutic target in platinum-resistant triple negative breast cancer (TNBC) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-08-03.
Collapse
|
17
|
Saleem A, Searle GE, Kenny LM, Huiban M, Kozlowski K, Waldman AD, Woodley L, Palmieri C, Lowdell C, Kaneko T, Murphy PS, Lau MR, Aboagye EO, Coombes RC. Lapatinib access into normal brain and brain metastases in patients with Her-2 overexpressing breast cancer. EJNMMI Res 2015; 5:30. [PMID: 25977884 PMCID: PMC4424224 DOI: 10.1186/s13550-015-0103-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain metastases are common in human epidermal growth factor receptor (Her)-2-positive breast cancer. Drug access to brain metastases and normal brain is key to management of cranial disease. In this study, positron emission tomography (PET) scanning after administration of radiolabelled lapatinib was used to obtain direct evidence of cranial drug access. METHODS Patients with Her-2+ metastatic breast cancer either with at least one 1-cm diameter brain metastasis or without brain metastases underwent dynamic carbon-11 radiolabelled lapatinib ([(11)C]lapatinib)-PET. Less than 20 μg of [(11)C]lapatinib was administered before and after 8 days of oral lapatinib (1,500 mg once daily). Radial arterial blood sampling was performed throughout the 90-min scan. The contribution of blood volume activity to the tissue signal was excluded to calculate lapatinib uptake in normal brain and metastases. Partitioning of radioactivity between plasma and tissue (V T) was calculated and the tissue concentration of lapatinib derived. Plasma lapatinib levels were measured and adverse events noted. RESULTS Six patients (three with brain metastases) were recruited. About 80% plasma radioactivity corresponded to intact [(11)C]lapatinib after 60 min. PET signal in the brain corresponded to circulating radioactivity levels, with no [(11)C]lapatinib uptake observed in normal brain tissue. In contrast, radioactivity uptake in cranial metastases was significantly higher (p = 0.002) than that could be accounted by circulating radioactivity levels, consistent with [(11)C]lapatinib uptake in brain metastases. There was no difference in lapatinib uptake between the baseline and day 8 scans, suggesting no effect of increased drug access by inhibition of the drug efflux proteins by therapeutic doses of lapatinib. CONCLUSIONS Increased lapatinib uptake was observed in brain metastases but not in normal brain. TRIAL REGISTRATION ClinicalTrials.gov: NCT01290354.
Collapse
Affiliation(s)
- Azeem Saleem
- Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, Burlington Danes Building, Du Cane Road, London, W12 0NN UK
| | - Graham E Searle
- Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, Burlington Danes Building, Du Cane Road, London, W12 0NN UK
| | - Laura M Kenny
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
| | - Mickael Huiban
- Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, Burlington Danes Building, Du Cane Road, London, W12 0NN UK
| | - Kasia Kozlowski
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
| | - Adam D Waldman
- Division of Brain Sciences, Imperial College Department of Imaging, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
| | - Laura Woodley
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0NN UK
| | - Carlo Palmieri
- Department of Molecular and Clinical Cancer Medicine, Duncan Building, Daulby Street, Liverpool, L69 3GA UK
| | - Charles Lowdell
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, W6 8RF London, UK
| | - Tomomi Kaneko
- GlaxoSmithKline Oncology, Stockley Park West, Uxbridge, Middlesex, UB11 1BT UK
| | - Philip S Murphy
- Clinical Imaging and Medicines Development, GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire SG1 2NY UK
| | - Mike R Lau
- Clinical Imaging and Medicines Development, GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire SG1 2NY UK
| | - Eric O Aboagye
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
| | - Raoul C Coombes
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
| |
Collapse
|
18
|
Hoyng LL, Frings V, Hoekstra OS, Kenny LM, Aboagye EO, Boellaard R. Metabolically active tumour volume segmentation from dynamic [(18)F]FLT PET studies in non-small cell lung cancer. EJNMMI Res 2015; 5:26. [PMID: 25932353 PMCID: PMC4409618 DOI: 10.1186/s13550-015-0102-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Positron emission tomography (PET) with (18)F-3'-deoxy-3'-fluorothymidine ([(18)F]FLT) can be used to assess tumour proliferation. A kinetic-filtering (KF) classification algorithm has been suggested for segmentation of tumours in dynamic [(18)F]FLT PET data. The aim of the present study was to evaluate KF segmentation and its test-retest performance in [(18)F]FLT PET in non-small cell lung cancer (NSCLC) patients. METHODS Nine NSCLC patients underwent two 60-min dynamic [(18)F]FLT PET scans within 7 days prior to treatment. Dynamic scans were reconstructed with filtered back projection (FBP) as well as with ordered subsets expectation maximisation (OSEM). Twenty-eight lesions were identified by an experienced physician. Segmentation was performed using KF applied to the dynamic data set and a source-to-background corrected 50% threshold (A50%) was applied to the sum image of the last three frames (45- to 60-min p.i.). Furthermore, several adaptations of KF were tested. Both for KF and A50% test-retest (TRT) variability of metabolically active tumour volume and standard uptake value (SUV) were evaluated. RESULTS KF performed better on OSEM- than on FBP-reconstructed PET images. The original KF implementation segmented 15 out of 28 lesions, whereas A50% segmented each lesion. Adapted KF versions, however, were able to segment 26 out of 28 lesions. In the best performing adapted versions, metabolically active tumour volume and SUV TRT variability was similar to those of A50%. KF misclassified certain tumour areas as vertebrae or liver tissue, which was shown to be related to heterogeneous [(18)F]FLT uptake areas within the tumour. CONCLUSIONS For [(18)F]FLT PET studies in NSCLC patients, KF and A50% show comparable tumour volume segmentation performance. The KF method needs, however, a site-specific optimisation. The A50% is therefore a good alternative for tumour segmentation in NSCLC [(18)F]FLT PET studies in multicentre studies. Yet, it was observed that KF has the potential to subsegment lesions in high and low proliferative areas.
Collapse
Affiliation(s)
- Lieke L Hoyng
- />Department of Radiology & Nuclear Medicine, VU University Medical Center (VUmc), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Virginie Frings
- />Department of Radiology & Nuclear Medicine, VU University Medical Center (VUmc), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Otto S Hoekstra
- />Department of Radiology & Nuclear Medicine, VU University Medical Center (VUmc), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Laura M Kenny
- />Comprehensive Cancer Imaging Centre, Imperial College London, Hammersmith Hospital, W12 0NN London, UK
| | - Eric O Aboagye
- />Comprehensive Cancer Imaging Centre, Imperial College London, Hammersmith Hospital, W12 0NN London, UK
| | - Ronald Boellaard
- />Department of Radiology & Nuclear Medicine, VU University Medical Center (VUmc), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| |
Collapse
|
19
|
Kenny LM, Tomasi G, Turkheimer F, Larkin J, Gore M, Brock CS, Mangar S, Aboagye EO. Preliminary clinical assessment of the relationship between tumor alphavbeta3 integrin and perfusion in patients studied with [(18)F]fluciclatide kinetics and [ (15)O]H 2O PET. EJNMMI Res 2014; 4:30. [PMID: 26055935 PMCID: PMC4884000 DOI: 10.1186/s13550-014-0030-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 04/10/2014] [Accepted: 05/20/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND [(18)F]fluciclatide, a peptide ligand with high affinity for αvβ3/αvβ5 integrins, is a proposed biomarker of tumor angiogenesis. The study rationale was to perform a preliminary evaluation of the relationship between tumor [(18)F]fluciclatide uptake and perfusion by [(15)O]H2O PET. METHODS Patients with non-small cell lung cancer and melanoma underwent dynamic imaging with arterial sampling following injection of [(15)O]H2O and [(18)F]fluciclatide. Quantification was performed using a one-tissue compartmental model for [(15)O]H2O and a two-tissue model for [(18)F]fluciclatide at volume-of-interest level, and SUV at voxel level. RESULTS Tumor binding potential (k 3/k 4 ratio) of [(18)F]fluciclatide tumor was 5.39 ± 1.46, consistent with previous studies in breast cancer metastases. Voxel-by-voxel maps of [(18)F]fluciclatide delivery strongly correlated with [(15)O]H2O-based perfusion (p < 10(-4) tumor, 1,794 ± 1,331 voxels). Interestingly, this correlation was lost when retention of [(18)F]fluciclatide at late time-points was compared with perfusion (p > 0.15). CONCLUSIONS Our study suggests tumor [(18)F]fluciclatide retention is unrelated to tumor perfusion, supporting use of late (60-min) imaging protocols in patients.
Collapse
Affiliation(s)
- Laura M Kenny
- />Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
- />Department of Medical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Giampaolo Tomasi
- />Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| | - Federico Turkheimer
- />Centre for Neuroimaging, Institute of Psychiatry, King’s College London, London UK
| | | | | | - Cathryn S Brock
- />Department of Medical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Stephen Mangar
- />Department of Medical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Eric O Aboagye
- />Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
| |
Collapse
|
20
|
Varghese V, Magnani L, Harada N, Mauri FA, Lam EW, Kenny LM. Abstract LB-220: Forkhead box transciption factor M1 (FOXM1) plays a critical role in colorectal cancer resistance by regulating thymidylate synthase (TS). Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-lb-220] [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: Tumor resistance to chemotherapy is a major challenge in cancer therapeutics today. 5-Fluorouracil (5-FU) is one of the most commonly used cancer therapeutic agents. The Forkhead box transcription factor M1 (FOXM1) has been shown to play vital roles in cell cycle progression, apoptosis, and cell survival. FOXM1 is over expressed in many types of cancers, including colorectal carcinoma and has been implicated in drug resistance in breast cancer. Thymidylate synthase (TS) enzyme is an important precursor in DNA synthesis. The mechanism of action of 5-FU has been associated with TS. High TS expression levels in tumors are generally related to 5-FU resistance. In this study we investigated the role of FOXM1 in 5-FU resistance and the therapeutic potential of the FOXM1 inhibitor thiostrepton (a thiazole antibiotic) in combination with 5-FU in colorectal cancer. We further analyzed the relation between TS and FOXM1 gene expressions in colorectal cancer.
Methods and Results: HCT116, DLD1, and HT29 cells were treated with 5-FU to detect the protein, mRNA expression of FOXM1 and TS. This resulted in a decrease in TS and FOXM1 expression in p53 wild type HCT116 cells but not in p53 mutant DLD1 or HT29. We also observed that FOXM1 expression was significantly correlated with TS expression by thiostrepton treatment. The IC50 of 5-FU was determined by SRB assay and was found to be 0.92ug/mL, 0.45ug/mL and 2.8ug/mL, while thiostrepton IC50 was found to be 0.60uM, 1.07uM, and 3.54uM, in HCT116, DLD1, and HT29 cells respectively. Combination of 5-FU and thiostrepton showed synergistic effect in all 3 colorectal cancer cells. Chromatin immunoprecipitation (ChIP) was performed in HCT116 and DLD1 cells to determine if FOXM1 binds to the TS promoter region (0 - 2000bp upstream of the TS transcription start site). Three negative primers were designed further to 2000bp upstream region. ChIP data revealed enrichment for FOXM1 at the TS promoter (0 - 1500 bp upstream) and no enrichment observed in the negative control. Inhibition of FOXM1 by thiostrepton led to a decrease in enrichment in the TS promoter region. These results confirmed the role of FOXM1 in TS regulation. Chip Sequencing (ChIP-seq) was then performed to study further FOXM1 targets and binding sites of FOXM1 to other well-known 5-FU targets such as thymidine phosphorylase (TP) and thymidine kinase 1 (TK1). The FOXM1 specific ChIP-seq libraries and corresponding input controls were sequenced on the Illumina Hi Seq 2000. ChIP-seq confirmed that FOXM1 significantly binds to both these factors. FOXM1 binding to cell cycle regulatory genes E2F1, E2F2 and E2F3 was also shown in both cell lines.
Conclusion: FOXM1 plays a critical role in 5-FU drug resistance by regulating 5-FU target genes such as TS, TK1. Inhibition of FOXM1 acts synergistically with 5-FU in colorectal cancer and warrants further investigation as a new treatment strategy.
Citation Format: Vidhya Varghese, Luca Magnani, Narumi Harada, Francesco A. Mauri, Eric W. Lam, Laura M. Kenny. Forkhead box transciption factor M1 (FOXM1) plays a critical role in colorectal cancer resistance by regulating thymidylate synthase (TS). [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr LB-220. doi:10.1158/1538-7445.AM2014-LB-220
Collapse
Affiliation(s)
| | | | | | - Francesco A. Mauri
- 2Imperial College Healthcare, NHS Trust, Hammersmith Hospital, London, United Kingdom
| | | | | |
Collapse
|
21
|
Abstract
Over recent years, there has been a rapid expansion in our knowledge of the factors that regulate tumor growth; this has resulted in the identification of new therapeutic targets and improvements in the long-term survival of cancer patients. New noninvasive biomarkers of drug targets and pathway modulation in vivo are needed to guide therapy selection and detect drug resistance early so that alternative, more effective treatments can be offered. The translation of new therapeutics into the clinic is disappointingly slow, expensive, and subject to high rates of attrition often occurring at late stages (phase 3) of development. In an attempt to mitigate these delays and failures, there has been resurgence in the development of new molecular imaging probes for studies with positron emission tomography (PET) to characterize tumor biology. In the assessment of therapeutic effects, PET allows imaging of entire tumor burden in a noninvasive repeatable manner. This chapter focuses on the clinical translation of PET imaging agents from bench to bedside. New probes are being used to study a diverse range of processes such as angiogenesis, apoptosis, fatty acid metabolism, and growth factor receptor expression. In the future, validation of these novel imaging probes could allow more innovative therapies to be adapted earlier in the clinic leading to improved patient outcomes.
Collapse
Affiliation(s)
- Laura M Kenny
- Comprehensive Cancer Imaging Centre, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Eric O Aboagye
- Comprehensive Cancer Imaging Centre, Department of Surgery & Cancer, Imperial College London, London, United Kingdom.
| |
Collapse
|
22
|
Monteiro LJ, Khongkow P, Kongsema M, Morris JR, Man C, Weekes D, Koo CY, Gomes AR, Pinto PH, Varghese V, Kenny LM, Coombes RC, Freire R, Medema RH, Lam EWF. The Forkhead Box M1 protein regulates BRIP1 expression and DNA damage repair in epirubicin treatment. Oncogene 2013; 32:4634-45. [PMID: 23108394 PMCID: PMC3874579 DOI: 10.1038/onc.2012.491] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [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: 05/25/2012] [Revised: 08/29/2012] [Accepted: 09/07/2012] [Indexed: 01/25/2023]
Abstract
FOXM1 is implicated in genotoxic drug resistance but its role and mechanism of action remain unclear. Here, we establish that γH2AX foci, indicative of DNA double-strand breaks (DSBs), accumulate in a time-dependent manner in the drug-sensitive MCF-7 cells but not in the resistant counterparts in response to epirubicin. We find that FOXM1 expression is associated with epirubicin sensitivity and DSB repair. Ectopic expression of FOXM1 can increase cell viability and abrogate DSBs sustained by MCF-7 cells following epirubicin, owing to an enhancement in repair efficiency. Conversely, alkaline comet and γH2AX foci formation assays show that Foxm1-null cells are hypersensitive to DNA damage, epirubicin and γ-irradiation. Furthermore, we find that FOXM1 is required for DNA repair by homologous recombination (HR) but not non-homologous end joining (NHEJ), using HeLa cell lines harbouring an integrated direct repeat green fluorescent protein reporter for DSB repair. We also identify BRIP1 as a direct transcription target of FOXM1 by promoter analysis and chromatin-immunoprecipitation assay. In agreement, depletion of FOXM1 expression by small interfering RNA downregulates BRIP1 expression at the protein and mRNA levels in MCF-7 and the epirubicin-resistant MCF-7 Epi(R) cells. Remarkably, the requirement for FOXM1 for DSB repair can be circumvented by reintroduction of BRIP1, suggesting that BRIP1 is an important target of FOXM1 in DSB repair. Indeed, like FOXM1, BRIP1 is needed for HR. These data suggest that FOXM1 regulates BRIP1 expression to modulate epirubicin-induced DNA damage repair and drug resistance.
Collapse
Affiliation(s)
- Lara J. Monteiro
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
| | - Pasarat Khongkow
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
| | - Mesayamas Kongsema
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
| | - Joanna R. Morris
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Cornelia Man
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Daniel Weekes
- Department of Medical and Molecular Genetics, King’s College London, Guy’s Hospital, London, UK
| | - Chuay-Yeng Koo
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
| | - Ana R. Gomes
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
| | - Paola H. Pinto
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
| | - Vidhya Varghese
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
| | - Laura M. Kenny
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
| | - R. Charles Coombes
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
| | - Raimundo Freire
- Unidad de Investigación, Hospital Universitario de Canarias, Instituto de Tecnologías Biomédicas, Ofra s/n, La Laguna, Tenerife, Spain
| | - René H. Medema
- Division of Cell Biology, the Netherlands Cancer Institute, Amsterdam, 1066 CX, the Netherlands
| | - Eric W.-F. Lam
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
| |
Collapse
|
23
|
Kenny LM. 18F-FDG PET/CT for Early Prediction of Response to Neoadjuvant Lapatinib, Trastuzumab, and Their Combination in HER2-Positive Breast Cancer: Results from Neo-ALTTO. J Nucl Med 2013; 54:1855-6. [DOI: 10.2967/jnumed.113.126342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
24
|
Challapalli A, Kenny LM, Hallett WA, Kozlowski K, Tomasi G, Gudi M, Al-Nahhas A, Coombes RC, Aboagye EO. 18F-ICMT-11, a caspase-3-specific PET tracer for apoptosis: biodistribution and radiation dosimetry. J Nucl Med 2013; 54:1551-6. [PMID: 23949910 DOI: 10.2967/jnumed.112.118760] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
UNLABELLED Effective anticancer therapy induces tumor cell death through apoptosis. Noninvasive monitoring of apoptosis during therapy may provide predictive outcome information and help tailor treatment. A caspase-3-specific imaging radiotracer, (18)F-(S)-1-((1-(2-fluoroethyl)-1H-[1,2,3]-triazol-4-yl)methyl)-5-(2(2,4-difluorophenoxymethyl)-pyrrolidine-1-sulfonyl)isatin ((18)F-ICMT-11), has been developed for use in PET studies. We report the safety, biodistribution, and internal radiation dosimetry profiles of (18)F-ICMT-11 in 8 healthy human volunteers. METHODS (18)F-ICMT-11 was intravenously administered as a bolus injection (mean ± SD, 159 ± 2.75 MBq; range, 154-161 MBq) to 8 healthy volunteers (4 men, 4 women). Whole-body (vertex to mid thigh) PET/CT scans were acquired at 6 time points, up to 4 h after tracer injection. Serial whole blood, plasma, and urine samples were collected for radioactivity measurement and radiotracer stability. In vivo (18)F activities were determined from quantitative analysis of the images, and time-activity curves were generated. The total numbers of disintegrations in each organ normalized to injected activity (residence times) were calculated as the area under the curve of the time-activity curve, normalized to injected activities and standard values of organ volumes. Dosimetry calculations were then performed using OLINDA/EXM 1.1. RESULTS Injection of (18)F-ICMT-11 was well tolerated in all subjects, with no serious tracer-related adverse events reported. The mean effective dose averaged over both men and women was estimated to be 0.025 ± 0.004 mSv/MBq (men, 0.022 ± 0.004 mSv/MBq; women, 0.027 ± 0.004 mSv/MBq). The 5 organs receiving the highest absorbed dose (mGy/MBq), averaged over both men and women, were the gallbladder wall (0.59 ± 0.44), small intestine (0.12 ± 0.05), upper large intestinal wall (0.08 ± 0.07), urinary bladder wall (0.08 ± 0.02), and liver (0.07 ± 0.01). Elimination was both renal and via the hepatobiliary system. CONCLUSION (18)F-ICMT-11 is a safe PET tracer with a dosimetry profile comparable to other common (18)F PET tracers. These data support the further development of (18)F-ICMT-11 for clinical imaging of apoptosis.
Collapse
Affiliation(s)
- Amarnath Challapalli
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Saleem A, Searle G, Kenny LM, Huiban M, Waldman A, Downie L, Lau M, Murphy PS, Kozlowski K, Lewis Y, Woodley L, Hill S, Kamalakaran A, Hirschberg S, Kaneko T, Aboagye E, Marini L, Coombes RC. Brain and tumor penetration of carbon-11–labeled lapatinib ([11C]Lap) in patients (pts) with HER2-overexpressing metastatic breast cancer (MBC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
635 Background: About a third of HER2-overexpressing (HER2+) breast cancer pts will develop brain metastases in the course of their disease. Drug access to normal brain and brain metastases is therefore key to prevention and treatment of cerebral metastases. To provide direct evidence of Lap drug access and evaluate whether therapeutic doses of Lap act as a substrate for efflux transporters, thereby increasing Lap concentrations, we performed positron emission tomography (PET) studies with [11C]Lap. Methods: Pts with HER2+ MBC with an ECOG of <3 were grouped into 2 cohorts: with at least one 1-cm diameter brain metastasis or without brain metastases and underwent 90-minute dynamic cranial PET-CT scans after IV administration of a microdose (<1 mg) of [11C]Lap before and after 8 days of oral Lap (1500 mg once daily). Arterial blood samples were performed to assess [11C]Lap radioactivity contribution in blood and plasma, and the fraction of plasma [11C] radioactivity corresponding to metabolites. Tissue time-radioactivity curves (TACs) were generated and [11C]Lap exposure (AUC; area under TAC) derived for normal brain and brain metastases. Signal dissection of the total image activity was performed to remove the contribution of blood volume to the image and the actual tissue contribution due to [11C]Lap obtained. Results: 6 pts (3 with brain metastasis) were recruited. Arterial plasma analysis revealed that [11C]Lap contributed to >80% of activity in plasma at 60 minutes. Tissue data revealed [11C]Lap signal in normal brain was low with no appreciable uptake observed when corrected for blood volume contribution. [11C]Lap uptake was higher in brain metastases compared with normal brain and appreciable, even after correction for tissue blood volume contribution. Uptake was also observed in extra-cranial normal tissue. There was no difference in [11C]Lap uptake in normal brain and metastases between treatment-naïve and post-treatment scans. Conclusions: [11C]Lap uptake in brain metastases was higher than in normal brain. [11C]Lap drug access to brain metastases might therefore indicate possible efficacy against HER2+ brain metastases. Clinical trial information: NCT01290354.
Collapse
Affiliation(s)
- Azeem Saleem
- Imanova Centre for Imaging Sciences, London, United Kingdom
| | - Graham Searle
- Imanova Centre for Imaging Sciences, London, United Kingdom
| | | | - Mickael Huiban
- Imanova Centre for Imaging Sciences, London, United Kingdom
| | - Adam Waldman
- Department of Imaging, Imperial College, London, United Kingdom
| | | | - Mike Lau
- GlaxoSmithKline, Oncology, Uxbridge, United Kingdom
| | | | | | - Yvonne Lewis
- Imanova Centre for Imaging Sciences, London, United Kingdom
| | | | - Sam Hill
- Imanova Centre for Imaging Sciences, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
26
|
Willaime JMY, Turkheimer FE, Kenny LM, Aboagye EO. Quantification of intra-tumour cell proliferation heterogeneity using imaging descriptors of 18F fluorothymidine-positron emission tomography. Phys Med Biol 2012; 58:187-203. [PMID: 23257054 DOI: 10.1088/0031-9155/58/2/187] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intra-tumour heterogeneity is a characteristic shared by all cancers. We explored the use of texture variables derived from images of [(18)F]fluorothymidine-positron emission tomography (FLT-PET), thus notionally assessing the heterogeneity of proliferation in individual tumours. Our aims were to study the range of textural feature values across tissue types, verify the repeatability of these image descriptors and further, to explore associations with clinical response to chemotherapy in breast cancer patients. The repeatability of 28 textural descriptors was assessed in patients who had two FLT-PET scans prior to therapy using relative differences and the intra-class correlation coefficient (ICC). We tested associations between features at baseline and clinical response measured in 11 patients after three cycles of chemotherapy, and explored changes in FLT-PET at one week after the start of therapy. A subset of eight features was characterized by low variations at baseline (<±30%) and high repeatability (0.7 ≤ ICC ≤ 1). The intensity distribution profile suggested fewer highly proliferating cells in lesions of non-responders compared to responders at baseline. A true increase in CV and homogeneity was measured in four out of six responders one week after the start of therapy. A number of textural features derived from FLT-PET are altered following chemotherapy in breast cancer, and should be evaluated in larger clinical trials for clinical relevance.
Collapse
Affiliation(s)
- J M Y Willaime
- Comprehensive Cancer Imaging Centre, Imperial College London, Hammersmith Hospital, London, UK
| | | | | | | |
Collapse
|
27
|
Aboagye EO, Gilbert FJ, Fleming IN, Beer AJ, Cunningham VJ, Marsden PK, Visvikis D, Gee AD, Groves AM, Kenny LM, Cook GJ, Kinahan PE, Myers M, Clarke L. Recommendations for measurement of tumour vascularity with positron emission tomography in early phase clinical trials. Eur Radiol 2012; 22:1465-78. [DOI: 10.1007/s00330-011-2311-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/08/2011] [Accepted: 09/27/2011] [Indexed: 12/22/2022]
|
28
|
Contractor KB, Kenny LM, Coombes CR, Turkheimer FE, Aboagye EO, Rosso L. Evaluation of limited blood sampling population input approaches for kinetic quantification of [18F]fluorothymidine PET data. EJNMMI Res 2012; 2:11. [PMID: 22444834 PMCID: PMC3340309 DOI: 10.1186/2191-219x-2-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 03/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantification of kinetic parameters of positron emission tomography (PET) imaging agents normally requires collecting arterial blood samples which is inconvenient for patients and difficult to implement in routine clinical practice. The aim of this study was to investigate whether a population-based input function (POP-IF) reliant on only a few individual discrete samples allows accurate estimates of tumour proliferation using [18F]fluorothymidine (FLT). METHODS Thirty-six historical FLT-PET data with concurrent arterial sampling were available for this study. A population average of baseline scans blood data was constructed using leave-one-out cross-validation for each scan and used in conjunction with individual blood samples. Three limited sampling protocols were investigated including, respectively, only seven (POP-IF7), five (POP-IF5) and three (POP-IF3) discrete samples of the historical dataset. Additionally, using the three-point protocol, we derived a POP-IF3M, the only input function which was not corrected for the fraction of radiolabelled metabolites present in blood. The kinetic parameter for net FLT retention at steady state, Ki, was derived using the modified Patlak plot and compared with the original full arterial set for validation. RESULTS Small percentage differences in the area under the curve between all the POP-IFs and full arterial sampling IF was found over 60 min (4.2%-5.7%), while there were, as expected, larger differences in the peak position and peak height.A high correlation between Ki values calculated using the original arterial input function and all the population-derived IFs was observed (R2 = 0.85-0.98). The population-based input showed good intra-subject reproducibility of Ki values (R2 = 0.81-0.94) and good correlation (R2 = 0.60-0.85) with Ki-67. CONCLUSIONS Input functions generated using these simplified protocols over scan duration of 60 min estimate net PET-FLT retention with reasonable accuracy.
Collapse
Affiliation(s)
- Kaiyumars B Contractor
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
| | | | | | | | | | | |
Collapse
|
29
|
Contractor K, Challapalli A, Barwick T, Winkler M, Hellawell G, Hazell S, Tomasi G, Al-Nahhas A, Mapelli P, Kenny LM, Tadrous P, Coombes RC, Aboagye EO, Mangar S. Use of [11C]choline PET-CT as a noninvasive method for detecting pelvic lymph node status from prostate cancer and relationship with choline kinase expression. Clin Cancer Res 2011; 17:7673-83. [PMID: 22038995 DOI: 10.1158/1078-0432.ccr-11-2048] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the accuracy and biological basis for [(11)C]choline-PET-CT in the nodal staging of high risk localized prostate cancer patients. EXPERIMENTAL DESIGN Twenty-eight patients underwent dynamic [(11)C]choline-PET-CT of the pelvis and lower abdomen prior to extended laparoscopic pelvic lymph node dissection (eLPL). The sensitivity and specificity of [(11)C]choline PET, [(11)C]choline PET-CT, and MRI for nodal detection were calculated. Average and maximal standardized uptake values (SUV(ave), SUV(max)) were compared with choline kinase alpha (CHKα) and Ki67 immunohistochemistry scores. RESULTS Four hundred and six lymph nodes (LN), in 26 patients, were assessable. Twenty-seven (6.7%) involved pelvic nodes at eLPL were detected in 9 patients. Seventeen of the 27 involved nodes were subcentimeter. The sensitivity and specificity on a per nodal basis were 18.5% and 98.7%, 40.7% and 98.4%, and 51.9% and 98.4% for MRI, [(11)C]choline PET, and [(11)C]choline PET-CT, respectively. Sensitivity was higher for [(11)C]choline PET-CT compared with MRI (P = 0.007). A higher nodal detection rate, including subcentimeter nodes, was seen with [(11)C]choline PET-CT than MRI. Malignant lesions showed CHKα expression in both cytoplasm and nucleus. SUV(ave) and SUV(max) strongly correlated with CHKα staining intensity (r = 0.68, P < 0.0001 and r = 0.63, P = 0.0004, respectively). In contrast, Ki67 expression was generally low in all tumors. CONCLUSION This study establishes the relationship between [(11)C]choline PET-CT uptake with choline kinase expression in prostate cancer and allows it to be used as a noninvasive means of staging pelvic LNs, being highly specific and more sensitive than MRI, including the detection of subcentimeter disease.
Collapse
Affiliation(s)
- Kaiyumars Contractor
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Contractor KB, Kenny LM, Stebbing J, Rosso L, Ahmad R, Jacob J, Challapalli A, Turkheimer F, Al-Nahhas A, Sharma R, Coombes RC, Aboagye EO. [18F]-3'Deoxy-3'-fluorothymidine positron emission tomography and breast cancer response to docetaxel. Clin Cancer Res 2011; 17:7664-72. [PMID: 22028493 DOI: 10.1158/1078-0432.ccr-11-0783] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [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
PURPOSE To establish biomarkers indicating clinical response to taxanes, we determined whether early changes in [(18)F]-3'deoxy-3'-fluorothymidine positron emission tomography (FLT-PET) can predict benefit from docetaxel therapy in breast cancer. EXPERIMENTAL DESIGN This was a prospective unblinded study in 20 patients with American Joint Committee on Cancer (AJCC) stage II-IV breast cancer unresponsive to first-line chemotherapy or progressing on previous therapy. Individuals underwent a baseline dynamic FLT-PET scan followed by a scan 2 weeks after initiating the first or second cycle of docetaxel. PET variables were compared with anatomic response midtherapy (after 3 cycles). RESULTS Average and maximum tumor standardized uptake values at 60 minutes (SUV(60,av) and SUV(60,max)) normalized to body surface area ranged between 1.7 and 17.0 and 5.6 and 26.9 × 10(-5) m(2)/mL, respectively. Docetaxel treatment resulted in a significant decrease in FLT uptake (P = 0.0003 for SUV(60,av) and P = 0.0002 for SUV(60,max)). Reduction in tumor SUV(60,av) was associated with target lesion size changes midtherapy (Pearson R for SUV(60,av) = 0.64; P = 0.004) and predicted midtherapy target lesion response (0.85 sensitivity and 0.80 specificity). Decreases in SUV(60,av) in responders were due, at least in part, to reduced net intracellular trapping of FLT (rate constant, K(i)). Docetaxel significantly reduced K(i) by 51.1% (±28.4%, P = 0.0009). CONCLUSION Changes in tumor proliferation assessed by FLT-PET early after initiating docetaxel chemotherapy can predict lesion response midtherapy with good sensitivity warranting prospective trials to assess the ability to stop therapy in the event of non-FLT-PET response.
Collapse
Affiliation(s)
- Kaiyumars B Contractor
- Departments of Surgery and Cancer, Neuroscience, and Nuclear Medicine, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith and Charing Cross Hospitals, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Kenny LM, Lam EWF. Review: lapatinib in metastatic colorectal cancer-another strategy for disease control? Clin Adv Hematol Oncol 2011; 9:500-501. [PMID: 21841752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Laura M Kenny
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, United Kingdom
| | | |
Collapse
|
32
|
Hatt M, Cheze-Le Rest C, Aboagye EO, Kenny LM, Rosso L, Turkheimer FE, Albarghach NM, Metges JP, Pradier O, Visvikis D. Reproducibility of 18F-FDG and 3′-Deoxy-3′-18F-Fluorothymidine PET Tumor Volume Measurements. J Nucl Med 2010; 51:1368-76. [DOI: 10.2967/jnumed.110.078501] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
33
|
Kenny LM, Contractor KB, Hinz R, Stebbing J, Palmieri C, Jiang J, Shousha S, Al-Nahhas A, Coombes RC, Aboagye EO. Reproducibility of [11C]Choline-Positron Emission Tomography and Effect of Trastuzumab. Clin Cancer Res 2010; 16:4236-45. [DOI: 10.1158/1078-0432.ccr-10-0468] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
34
|
Gray KR, Contractor KB, Kenny LM, Al-Nahhas A, Shousha S, Stebbing J, Wasan HS, Coombes RC, Aboagye EO, Turkheimer FE, Rosso L. Kinetic filtering of [18F]Fluorothymidine in positron emission tomography studies. Phys Med Biol 2010; 55:695-709. [DOI: 10.1088/0031-9155/55/3/010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
35
|
Contractor KB, Kenny LM, Stebbing J, Al-Nahhas A, Palmieri C, Sinnett D, Lewis JS, Hogben K, Osman S, Shousha S, Lowdell C, Coombes RC, Aboagye EO. [11C]choline positron emission tomography in estrogen receptor-positive breast cancer. Clin Cancer Res 2009; 15:5503-10. [PMID: 19706823 DOI: 10.1158/1078-0432.ccr-09-0666] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Novel radiotracers could potentially allow the identification of clinically aggressive tumor phenotypes. As choline metabolism increases during malignant transformation and progression of human mammary epithelial cells, we examined the ability of [(11)C]choline (CHO) positron emission tomography imaging to detect clinically aggressive phenotype in patients with estrogen receptor (ER)-positive breast cancer in vivo. EXPERIMENTAL DESIGN CHO positron emission tomography was done in 32 individuals with primary or metastatic ER-positive breast cancer. Semiquantitative (standardized uptake value) and fully quantitative (net irreversible transfer rate constant of CHO, Ki) estimates of CHO uptake in the tumors were calculated and compared with tumor grade, size, involved nodes, and also ER, progesterone receptor, Ki-67, and human epidermal growth factor receptor-2 scores. RESULTS Breast tumors were well visualized in 30 of 32 patients with good tumor background ratios. A wide range of uptake values were observed in primary and metastatic tumors. CHO uptake variables correlated well with tumor grade. For most imaging variables, a poor association was found with tumor size, ER, progesterone receptor, human epidermal growth factor receptor-2, Ki-67, and nodal status. CONCLUSIONS CHO showed good uptake in most breast cancers and merits further investigation as a breast cancer imaging agent.
Collapse
|
36
|
Abstract
OBJECTIVE To determine the effectiveness of vitamin D therapy in patients with asymptomatic, prostate-specific antigen (PSA)-progression of prostate cancer. PATIENTS AND METHODS Twenty-six patients with locally advanced or metastatic prostate cancer were treated with vitamin D. Vitamin D therapy was discontinued on disease progression as assessed by symptoms or serum PSA increase. The response to therapy was judged from changes in PSA level from the pretreatment baseline to 3 months after starting vitamin D therapy. RESULTS Of the 26 patients, five (20%) responded to vitamin D; the mean (range) reduction in PSA level was 45.3 (15.9-95.1)%, and mean duration of response was 4-5 months. Patients in whom the PSA level was stabilized, but not reduced, after vitamin D treatment had a duration of response of up to 36 months. Treatment was well tolerated and was not associated with elevation of serum calcium levels. There was no significant correlation between response to therapy and stage of disease, Gleason grade, previous treatments or PSA level at diagnosis or initiation of vitamin D therapy. CONCLUSION Vitamin D therapy is an effective and well tolerated treatment for patients with asymptomatic progressive prostate cancer, and is a useful addition to the therapeutic options.
Collapse
|
37
|
McParland BJ, Miller MP, Spinks TJ, Kenny LM, Osman S, Khela MK, Aboagye E, Coombes RC, Hui AM, Cohen PS. The biodistribution and radiation dosimetry of the Arg-Gly-Asp peptide 18F-AH111585 in healthy volunteers. J Nucl Med 2008; 49:1664-7. [PMID: 18794263 DOI: 10.2967/jnumed.108.052126] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [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] Open
Abstract
UNLABELLED We report the safety, biodistribution, and internal radiation dosimetry of a new PET tracer, (18)F-AH111585, a peptide with a high affinity for the alpha(v)beta(3) integrin receptor involved in angiogenesis. METHODS PET scans of 8 healthy volunteers were acquired at time points up to 4 h after a bolus injection of (18)F-AH111585. (18)F activity in whole blood and plasma and excreted urine were measured up to 4 h after injection. In vivo (18)F activities in up to 12 source regions were determined from quantitative analysis of the images. The cumulated activities subsequently calculated were then used to determine the internal radiation dosimetry, including the effective dose. RESULTS Injection of (18)F-AH111585 was well tolerated in all subjects, with no serious or drug-related adverse events reported. The main route of (18)F excretion was renal (37%), and the 3 highest initial uptakes were by liver (15%); combined walls of the small, upper large, and lower large intestines (11%); and kidneys (9%). The 3 highest absorbed doses were received by the urinary bladder wall (124 microGy/MBq), kidneys (102 microGy/MBq), and cardiac wall (59 microGy/MBq). The effective dose was 26 microGy/MBq. CONCLUSION (18)F-AH111585 is a safe PET tracer with a dosimetry profile comparable to other common (18)F PET tracers.
Collapse
Affiliation(s)
- Brian J McParland
- Medical Diagnostics, GE Healthcare Ltd., Amersham, Buckinghamshire, England.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Kenny LM, Coombes RC, Oulie I, Contractor KB, Miller M, Spinks TJ, McParland B, Cohen PS, Hui AM, Palmieri C, Osman S, Glaser M, Turton D, Al-Nahhas A, Aboagye EO. Phase I trial of the positron-emitting Arg-Gly-Asp (RGD) peptide radioligand 18F-AH111585 in breast cancer patients. J Nucl Med 2008; 49:879-86. [PMID: 18483090 DOI: 10.2967/jnumed.107.049452] [Citation(s) in RCA: 226] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
UNLABELLED The integrin alpha v beta3 receptor is upregulated on tumor cells and endothelium and plays important roles in angiogenesis and metastasis. Arg-Gly-Asp (RGD) peptide ligands have high affinity for these integrins and can be radiolabeled for PET imaging of angiogenesis or tumor development. We have assessed the safety, stability, and tumor distribution kinetics of a novel radiolabeled RGD-based integrin peptide-polymer conjugate, 18F-AH111585, and its feasibility to detect tumors in metastatic breast cancer patients using PET. METHODS The biodistribution of 18F-AH111585 was assessed in 18 tumor lesions from 7 patients with metastatic breast cancer by PET, and the PET data were compared with CT results. The metabolic stability of 18F-AH111585 was assessed by chromatography of plasma samples. Regions of interest (ROIs) defined over tumor and normal tissues of the PET images were used to determine the kinetics of radioligand binding in tissues. RESULTS The radiopharmaceutical and PET procedures were well tolerated in all patients. All 18 tumors detected by CT were visible on the 18F-AH111585 PET images, either as distinct increases in uptake compared with the surrounding normal tissue or, in the case of liver metastases, as regions of deficit uptake because of the high background activity in normal liver tissue. 18F-AH111585 was either homogeneously distributed in the tumors or appeared within the tumor rim, consistent with the pattern of viable peripheral tumor and central necrosis often seen in association with angiogenesis. Increased uptake compared with background (P = 0.002) was demonstrated in metastases in lung, pleura, bone, lymph node, and primary tumor. CONCLUSION 18F-AH111585 designed to bind the alpha v beta3 integrin is safe, metabolically stable, and retained in tumor tissues and detects breast cancer lesions by PET in most anatomic sites.
Collapse
Affiliation(s)
- Laura M Kenny
- Department of Oncology, Imperial College Faculty of Medicine, Hammersmith Hospital, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Kenny LM, Ngan S, Waxman J. 'Time, gentlemen, please' for watchful waiting in prostate cancer? BJU Int 2007; 100:244-6. [PMID: 17550409 DOI: 10.1111/j.1464-410x.2007.07063.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laura M Kenny
- Department of Oncology, Imperial College London, London, UK
| | | | | |
Collapse
|
40
|
Kenny LM, Vigushin DM, Al-Nahhas A, Osman S, Luthra SK, Shousha S, Coombes RC, Aboagye EO. Quantification of Cellular Proliferation in Tumor and Normal Tissues of Patients with Breast Cancer by [18F]Fluorothymidine-Positron Emission Tomography Imaging: Evaluation of Analytical Methods. Cancer Res 2005; 65:10104-12. [PMID: 16267037 DOI: 10.1158/0008-5472.can-04-4297] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is an unmet need to develop imaging methods for the early and objective assessment of breast tumors to therapy. 3'-Deoxy-3'-[18F]fluorothymidine ([18F]FLT)-positron emission tomography represents a new approach to imaging thymidine kinase activity, and hence, cellular proliferation. We compared graphical, spectral, and semiquantitative analytic methodologies for quantifying [18F]FLT kinetics in tumor and normal tissue of patients with locally advanced and metastatic breast cancer. The resultant kinetic parameters were correlated with the Ki-67 labeling index from tumor biopsies. [18F]FLT accumulation was detected in primary tumor, nodal disease, and lung metastasis. In large tumors, there was substantial heterogeneity in regional radiotracer uptake, reflecting heterogeneity in cellular proliferation; radiotracer uptake in primary tumors also differed from that of metastases. [18F]FLT was metabolized in patients to a single metabolite [18F]FLT-glucuronide. Unmetabolized [18F]FLT accounted for 71.54 +/- 1.50% of plasma radioactivity by 90 minutes. The rate constant for the metabolite-corrected net irreversible uptake of [18F]FLT (Ki) ranged from 0.6 to 10.4 x 10(-4) and from 0 to 0.6 x 10(-4) mL plasma cleared/s/mL tissue in tumor (29 regions, 15 patients) and normal tissues, respectively. Tumor Ki and fractional retention of radiotracer determined by spectral analysis correlated with Ki-67 labeling index (r = 0.92, P < 0.0001 and r = 0.92, P < 0.0001, respectively). These correlations were superior to those determined by semiquantitative methods. We conclude that [18F]FLT-positron emission tomography is a promising clinical tool for imaging cellular proliferation in breast cancer, and is most predictive when analyzed by graphical and spectral methods.
Collapse
Affiliation(s)
- Laura M Kenny
- Molecular Therapy and PET Oncology Research Group, Hammersmith Hospital, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
Tumour-cell proliferation is a hallmark of the malignant phenotype. Positron emission tomography (PET) offers a unique method of imaging biological and biochemical changes in vivo. Radiolabelled thymidine and thymidine analogues are currently in development as PET tracers. By studying the uptake and kinetics of such compounds using PET, a measure of DNA synthesis and hence cell proliferation can be obtained. Molecular imaging of cellular proliferation with PET is now possible, and has the potential to play an important role in the evaluation of efficacy of new anti-cancer agents.
Collapse
Affiliation(s)
- L M Kenny
- Molecular Therapy Group and PET Oncology Group, Hammersmith Hospital, London, UK
| | | | | |
Collapse
|