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Trout AT, Norris RE, de Blank PMK, Backus LR, Towbin AJ, Nash JM. Clinical trials: A plea to cooperative groups, consortia, pharmaceutical companies, and lead investigators for reasonable imaging protocols. Pediatr Blood Cancer 2023; 70:e30362. [PMID: 37057805 DOI: 10.1002/pbc.30362] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/15/2023]
Affiliation(s)
- Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Robin E Norris
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Peter M K de Blank
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lori R Backus
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jaylynn M Nash
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Mascia AE, Daugherty EC, Zhang Y, Lee E, Xiao Z, Sertorio M, Woo J, Backus LR, McDonald JM, McCann C, Russell K, Levine L, Sharma RA, Khuntia D, Bradley JD, Simone CB, Perentesis JP, Breneman JC. Proton FLASH Radiotherapy for the Treatment of Symptomatic Bone Metastases: The FAST-01 Nonrandomized Trial. JAMA Oncol 2023; 9:62-69. [PMID: 36273324 PMCID: PMC9589460 DOI: 10.1001/jamaoncol.2022.5843] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023]
Abstract
Importance To our knowledge, there have been no clinical trials of ultra-high-dose-rate radiotherapy delivered at more than 40 Gy/sec, known as FLASH therapy, nor first-in-human use of proton FLASH. Objectives To assess the clinical workflow feasibility and treatment-related toxic effects of FLASH and pain relief at the treatment sites. Design, Setting, and Participants In the FAST-01 nonrandomized trial, participants treated at Cincinnati Children's/UC Health Proton Therapy Center underwent palliative FLASH radiotherapy to extremity bone metastases. Patients 18 years and older with 1 to 3 painful extremity bone metastases and life expectancies of 2 months or more were eligible. Patients were excluded if they had foot, hand, and wrist metastases; metastases locally treated in the 2 weeks prior; metal implants in the treatment field; known enhanced tissue radiosensitivity; and implanted devices at risk of malfunction with radiotherapy. One of 11 patients who consented was excluded based on eligibility. The end points were evaluated at 3 months posttreatment, and patients were followed up through death or loss to follow-up for toxic effects and pain assessments. Of the 10 included patients, 2 died after the 2-month follow-up but before the 3-month follow-up; 8 participants completed the 3-month evaluation. Data were collected from November 3, 2020, to January 28, 2022, and analyzed from January 28, 2022, to September 1, 2022. Interventions Bone metastases were treated on a FLASH-enabled (≥40 Gy/sec) proton radiotherapy system using a single-transmission proton beam. This is consistent with standard of care using the same prescription (8 Gy in a single fraction) but on a conventional-dose-rate (approximately 0.03 Gy/sec) photon radiotherapy system. Main Outcome and Measures Main outcomes included patient time on the treatment couch, device-related treatment delays, adverse events related to FLASH, patient-reported pain scores, and analgesic use. Results A total of 10 patients (age range, 27-81 years [median age, 63 years]; 5 [50%] male) underwent FLASH radiotherapy at 12 metastatic sites. There were no FLASH-related technical issues or delays. The average (range) time on the treatment couch was 18.9 (11-33) minutes per patient and 15.8 (11-22) minutes per treatment site. Median (range) follow-up was 4.8 (2.3-13.0) months. Adverse events were mild and consistent with conventional radiotherapy. Transient pain flares occurred in 4 of the 12 treated sites (33%). In 8 of the 12 sites (67%) patients reported pain relief, and in 6 of the 12 sites (50%) patients reported a complete response (no pain). Conclusions and Relevance In this nonrandomized trial, clinical workflow metrics, treatment efficacy, and safety data demonstrated that ultra-high-dose-rate proton FLASH radiotherapy was clinically feasible. The treatment efficacy and the profile of adverse events were comparable with those of standard-of-care radiotherapy. These findings support the further exploration of FLASH radiotherapy in patients with cancer. Trial Registration ClinicalTrials.gov Identifier: NCT04592887.
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Affiliation(s)
- Anthony E. Mascia
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
- Department of Radiation Oncology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Emily C. Daugherty
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
- Department of Radiation Oncology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Yongbin Zhang
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
- Department of Radiation Oncology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Eunsin Lee
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
- Department of Radiation Oncology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Zhiyan Xiao
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
- Department of Radiation Oncology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mathieu Sertorio
- Department of Radiation Oncology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jennifer Woo
- Varian Medical Systems, Siemens Healthineers, Palo Alto, California
| | - Lori R. Backus
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Julie M. McDonald
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Claire McCann
- Varian Medical Systems, Siemens Healthineers, Palo Alto, California
| | - Kenneth Russell
- Varian Medical Systems, Siemens Healthineers, Palo Alto, California
| | - Lisa Levine
- Varian Medical Systems, Siemens Healthineers, Palo Alto, California
| | - Ricky A. Sharma
- Varian Medical Systems, Siemens Healthineers, Palo Alto, California
| | - Dee Khuntia
- Varian Medical Systems, Siemens Healthineers, Palo Alto, California
| | - Jeffrey D. Bradley
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Charles B. Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - John P. Perentesis
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - John C. Breneman
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
- Department of Radiation Oncology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Streby KA, Geller JI, Currier MA, Warren PS, Racadio JM, Towbin AJ, Vaughan MR, Triplet M, Ott-Napier K, Dishman DJ, Backus LR, Stockman B, Brunner M, Simpson K, Spavin R, Conner J, Cripe TP. Intratumoral Injection of HSV1716, an Oncolytic Herpes Virus, Is Safe and Shows Evidence of Immune Response and Viral Replication in Young Cancer Patients. Clin Cancer Res 2017; 23:3566-3574. [PMID: 28495911 PMCID: PMC10546618 DOI: 10.1158/1078-0432.ccr-16-2900] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [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: 11/17/2016] [Revised: 12/22/2016] [Accepted: 01/13/2017] [Indexed: 02/04/2023]
Abstract
Purpose: HSV1716 is an oncolytic herpes simplex virus-1 (HSV-1) studied in adults via injection into the brain and superficial tumors. To determine the safety of administering HSV1716 to pediatric patients with cancer, we conducted a phase I trial of image-guided injection in young patients with relapsed or refractory extracranial cancers.Experimental Design: We delivered a single dose of 105 to 107 infectious units of HSV1716 via computed tomography-guided intratumoral injection and measured tumor responses by imaging. Patients were eligible for up to three more doses if they achieved stable disease. We monitored HSV-1 serum titers and shedding by PCR and culture.Results: We administered a single dose of HSV1716 to eight patients and two doses to one patient. We did not observe any dose-limiting toxicities. Adverse events attributed to virus included low-grade fever, chills, and mild cytopenias. Six of eight HSV-1 seronegative patients at baseline showed seroconversion on day 28. Six of nine patients had detectable HSV-1 genomes by PCR in peripheral blood appearing on day +4 consistent with de novo virus replication. Two patients had transient focal increases in metabolic activity on 18fluorine-deoxyglucose PET, consistent with inflammatory reactions. In one case, the same geographic region that flared later appeared necrotic on imaging. No patient had an objective response to HSV1716.Conclusions: Intratumoral HSV1716 is safe and well-tolerated without shedding in children and young adults with late-stage, aggressive cancer. Viremia consistent with virus replication and transient inflammatory reactions hold promise for future HSV1716 studies. Clin Cancer Res; 23(14); 3566-74. ©2017 AACR.
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Affiliation(s)
- Keri A Streby
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
- Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital Research Institute, Columbus, Ohio
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Mark A Currier
- Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital Research Institute, Columbus, Ohio
| | - Patrick S Warren
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - John M Racadio
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michele R Vaughan
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Melinda Triplet
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Kristy Ott-Napier
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Devon J Dishman
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Lori R Backus
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Beth Stockman
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Marianne Brunner
- Translational Research Trials Office, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Robert Spavin
- Virttu Biologics Ltd, Biocity, Scotland, United Kingdom
| | - Joe Conner
- Virttu Biologics Ltd, Biocity, Scotland, United Kingdom
| | - Timothy P Cripe
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
- Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital Research Institute, Columbus, Ohio
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