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Cristea MC, Stewart D, Synold T, Ruel N, Mortimer J, Wang E, Jung A, Wilczynski S, Konecny GE, Eng M, Kilpatrick L, Han E, Dellinger T, Hakim A, Lee S, Morgan RJ, Wakabayashi MT, Frankel PH. A phase I study of Mirvetuximab Soravtansine and gemcitabine in patients with FRα-positive recurrent ovarian, primary peritoneal, fallopian tube, or endometrial cancer, or triple negative breast cancer. Gynecol Oncol 2024; 182:124-131. [PMID: 38262235 DOI: 10.1016/j.ygyno.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Platinum-resistant epithelial ovarian cancer (EOC), recurrent endometrial cancer (EC), and triple negative breast cancer (TNBC) are difficult to treat after failing standard therapies. This phase I study evaluated mirvetuximab soravtansine (MIRV) and gemcitabine in patients with recurrent FRα-positive EOC, EC, or TNBC to determine the maximum tolerated dose (MTD)/recommended phase 2 dose (RP2D) (primary endpoint). METHODS FRα-positive patients with platinum-resistant EOC, EC, or TNBC with ≤4 prior chemotherapy regimens (2 for EC) were enrolled. FRα expression requirement varied among eligible tumors and changed during the study. RESULTS Twenty patients were enrolled; 17 were evaluable for DLT. Half the patients received ≥3 prior chemotherapy lines. Most EOC and EC patients (78%) were medium (50-74%) or high(75-100%) FRα expressors. TNBC patients were low (25-49%) FRα expressors. The MTD/RP2D was MIRV 6 mg/kg AIBW D1 and gemcitabine 800 mg/m2 IV, D1 and D8, every 21 days (Dose Level [DL] 3), where 5/7 patients demonstrated a partial response (PR) as their best response, including 2 confirmed ovarian responses whose time-to-progression and duration of response were 7.9/5.4 and 8.0/5.7 months respectively. Most common treatment-related adverse events at MTD were anemia and neutropenia (3/7 each, 43%), diarrhea, hypophosphatemia, thrombocytopenia, and leukopenia (2/7 each, 29%). DLTs were thrombocytopenia (DL1), oral mucositis (DL4) and diarrhea (DL4). Nine of 20 patients (45%; 95% CI: 21.1-68.9%) achieved PR as their best response, with 3/20 patients or 15% (95%CI, 0-32.1%) confirmed PR. CONCLUSION MIRV and gemcitabine demonstrate promising activity in platinum resistant EOC at RP2D, but frequent hematologic toxicities.
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Affiliation(s)
- Mihaela C Cristea
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center (COH), Duarte, CA, USA
| | - Daphne Stewart
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center (COH), Duarte, CA, USA
| | - Timothy Synold
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center (COH), Duarte, CA, USA
| | - Nora Ruel
- Department of Computational and Quantitative Medicine, Beckman Research Institute, Duarte, CA, USA
| | - Joanne Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center (COH), Duarte, CA, USA
| | - Edward Wang
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center (COH), Duarte, CA, USA
| | | | | | - Gottfried E Konecny
- Department of Medical Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Melissa Eng
- Clinical Trials Office, COH, Duarte, CA, USA
| | | | - Ernest Han
- Department of Surgery, COH, Duarte, CA, USA
| | | | - Amy Hakim
- Department of Surgery, COH, Duarte, CA, USA
| | | | - Robert J Morgan
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center (COH), Duarte, CA, USA
| | | | - Paul H Frankel
- Department of Computational and Quantitative Medicine, Beckman Research Institute, Duarte, CA, USA.
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Raoof M, Whelan RL, Sullivan KM, Ruel C, Frankel PH, Cole SE, Tinsley R, Eng M, Fakih M, Chao J, Lim D, Woo Y, Paz IB, Lew M, Cristea M, Rodriguez-Rodriguez L, Fong Y, Thomas RM, Chang S, Deperalta D, Merchea A, Dellinger TH. ASO Visual Abstract: Safety and Efficacy of Oxaliplatin Pressurized Intraperitoneal Aerosolized Chemotherapy (PIPAC) in Colorectal and Appendiceal Cancer with Peritoneal Metastases: Results of a Multicenter Phase I Trial in the United States. Ann Surg Oncol 2023; 30:7869-7870. [PMID: 37598124 DOI: 10.1245/s10434-023-14109-8] [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: 08/21/2023]
Affiliation(s)
- Mustafa Raoof
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
| | | | - Kevin M Sullivan
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Christopher Ruel
- Department of Computation and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Paul H Frankel
- Department of Computation and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Sarah E Cole
- Department of Clinical Protocol Development, City of Hope National Medical Center, Duarte, CA, USA
| | - Raechelle Tinsley
- Clinical Trials Office, City of Hope National Medical Center, Duarte, CA, USA
| | - Melissa Eng
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Joseph Chao
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Dean Lim
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Yanghee Woo
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Isaac B Paz
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Michael Lew
- Department of Anesthesiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Michaela Cristea
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Lorna Rodriguez-Rodriguez
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Yuman Fong
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Sue Chang
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Amit Merchea
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Thanh H Dellinger
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
- Division of Gynecologic Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
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Raoof M, Whelan RL, Sullivan KM, Ruel C, Frankel PH, Cole SE, Tinsley R, Eng M, Fakih M, Chao J, Lim D, Woo Y, Paz IB, Lew M, Cristea M, Rodriguez-Rodriguez L, Fong Y, Thomas RM, Chang S, Deperalta D, Merchea A, Dellinger TH. Safety and Efficacy of Oxaliplatin Pressurized Intraperitoneal Aerosolized Chemotherapy (PIPAC) in Colorectal and Appendiceal Cancer with Peritoneal Metastases: Results of a Multicenter Phase I Trial in the USA. Ann Surg Oncol 2023; 30:7814-7824. [PMID: 37501051 PMCID: PMC10562297 DOI: 10.1245/s10434-023-13941-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) is a laparoscopic locoregional treatment for peritoneal metastases (PM) from colorectal cancer (CRC) or appendiceal cancer (AC) in patients who cannot undergo cytoreductive surgery (CRS). While PIPAC has been studied in Europe and Asia, it has not been investigated in the USA. PATIENTS AND METHODS We evaluated PIPAC with 90 mg/m2 oxaliplatin alone (cycle 1) and preceded by systemic chemotherapy with fluorouracil (5-FU) and leucovorin (LV) (cycle 2-3) as a multicenter prospective phase I clinical trial (NCT04329494). The primary endpoint was treatment-related adverse events (AEs). Secondary endpoints included survival and laparoscopic, histologic, and radiographic response. RESULTS 12 patients were included: 8 with CRC and 4 with AC. Median prior chemotherapy cycles was 2 (interquartile range (IQR) 2-3). All patients were refractory to systemic oxaliplatin-based chemotherapy. Median peritoneal carcinomatosis index (PCI) was 28 (IQR 19-32). Six (50%) of twelve patients completed three PIPAC cycles. No surgical complications or dose-limiting toxicities were observed. Two patients developed grade 3 treatment-related toxicities (one abdominal pain and one anemia). Median overall survival (OS) was 12.0 months, and median progression-free survival (PFS) was 2.9 months. OS was correlated with stable disease by Response Evaluation Criteria in Solid Tumors (RECIST) criteria but not with laparoscopic response by PCI or histologic response by peritoneal regression grading system (PRGS). CONCLUSIONS This phase I trial in the USA demonstrated safety, feasibility, and early efficacy signal of PIPAC with oxaliplatin and chemotherapy in patients with PM from AC or CRC who are refractory to standard lines of systemic chemotherapy.
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Affiliation(s)
- Mustafa Raoof
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
| | | | - Kevin M Sullivan
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Christopher Ruel
- Department of Computation and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Paul H Frankel
- Department of Computation and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Sarah E Cole
- Department of Clinical Protocol Development, City of Hope National Medical Center, Duarte, CA, USA
| | - Raechelle Tinsley
- Clinical Trials Office, City of Hope National Medical Center, Duarte, CA, USA
| | - Melissa Eng
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Joseph Chao
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Dean Lim
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Yanghee Woo
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Isaac Benjamin Paz
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Michael Lew
- Department of Anesthesiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Michaela Cristea
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Sue Chang
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Amit Merchea
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Thanh H Dellinger
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
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Egelston CA, Guo W, Yost SE, Ge X, Lee JS, Frankel PH, Cui Y, Ruel C, Schmolze D, Murga M, Tang A, Martinez N, Karimi M, Somlo G, Lee PP, Waisman JR, Yuan Y. Immunogenicity and efficacy of pembrolizumab and doxorubicin in a phase I trial for patients with metastatic triple-negative breast cancer. Cancer Immunol Immunother 2023; 72:3013-3027. [PMID: 37294342 PMCID: PMC10412661 DOI: 10.1007/s00262-023-03470-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 05/18/2023] [Indexed: 06/10/2023]
Abstract
Currently there is a limited understanding for the optimal combination of immune checkpoint inhibitor and chemotherapy for patients with metastatic triple-negative breast cancer (mTNBC). Here we evaluate the safety, efficacy, and immunogenicity of a phase I trial for patients with mTNBC treated with pembrolizumab plus doxorubicin. Patients without prior anthracycline use and 0-2 lines of prior systemic chemotherapies received pembrolizumab and doxorubicin every 3 weeks for 6 cycles followed by pembrolizumab maintenance until disease progression or intolerance. The primary objectives were safety and objective response rate per RECIST 1.1. Best responses included one complete response (CR), five partial responses (PR), two stable disease (SD), and one progression of disease (PD). Overall response rate was 67% (95% CI 13.7%, 78.8%) and clinical benefit rate at 6 months was 56% (95% CI 21.2%, 86.3%). Median PFS was 5.2 months (95% CI 4.7, NA); median OS was 15.6 months (95% CI 13.3, NA). Grade 3-4 AEs per CTCAE 4.0 were neutropenia n = 4/10 (40%), leukopenia n = 2/10 (20%), lymphopenia n = 2/10 (20%), fatigue n = 2/10 (20%), and oral mucositis n = 1/10 (10%). Immune correlates showed increased frequencies of circulating CD3 + T cells (p = 0.03) from pre-treatment to cycle 2 day 1 (C2D1). An expansion of a proliferative exhausted-like PD-1 + CD8 + T cell population was identified in 8/9 patients, and exhausted CD8 + T cells were significantly expanded from pre-treatment to C2D1 in the patient with CR (p = 0.01). In summary, anthracycline-naïve patients with mTNBC treated with the combination of pembrolizumab and doxorubicin showed an encouraging response rate and robust T cell response dynamics.Trial registration: NCT02648477.
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Affiliation(s)
- Colt A Egelston
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Weihua Guo
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Susan E Yost
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Xuan Ge
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jin Sun Lee
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Paul H Frankel
- Department of Statistics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Yujie Cui
- Department of Statistics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Christopher Ruel
- Department of Statistics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Mireya Murga
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Aileen Tang
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Norma Martinez
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Misagh Karimi
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - George Somlo
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Peter P Lee
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - James R Waisman
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Yuan Yuan
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
- Division of Medical Oncology, Cedars-Sinai Cancer, Cedars-Sinai Medical Center, 127 S San Vincente Blvd. 7th Floor Los, Angeles, CA, 90048, USA.
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5
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Frankel PH, Groshen S, Beumer JH, Cleveland L, Kim ES, Karp JE. Ethics and Clinical Research: Improving Transparency and Informed Consent in Phase I Oncology Trials. J Clin Oncol 2023; 41:2155-2158. [PMID: 36724409 PMCID: PMC10448934 DOI: 10.1200/jco.22.01736] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/15/2022] [Accepted: 11/18/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Paul H. Frankel
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, CA
| | - Susan Groshen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Jan H. Beumer
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | - Judith E. Karp
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Yuan Y, Yost SE, Cui Y, Ruel C, Murga M, Tang A, Martinez N, Schmolze D, Waisman J, Patel N, Vora L, Tumyan L, Bozoghlanian M, Stewart D, Frankel PH. Phase I Trial of Ipatasertib Plus Carboplatin, Carboplatin/Paclitaxel, or Capecitabine and Atezolizumab in Metastatic Triple-Negative Breast Cancer. Oncologist 2023:7110249. [PMID: 37023705 DOI: 10.1093/oncolo/oyad026] [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: 09/07/2022] [Accepted: 01/11/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND This trial evaluated the safety and efficacy of ipatasertib in combination with carboplatin, carboplatin/paclitaxel, or capecitabine/atezolizumab in patients with metastatic triple-negative breast cancer (mTNBC). METHODS Eligibility criteria were mTNBC, RECIST 1.1 measurable disease, no prior use of platinum for metastatic disease (Arms A and B), and no prior exposure to immune checkpoint inhibitor (Arm C). Primary endpoints were safety and RP2D. Secondary endpoints were progression-free survival (PFS), response rate, and overall survival. RESULTS RP2D for Arm A (n = 10) was ipatasertib 300 mg daily, carboplatin AUC2, and paclitaxel 80 mg m-2 days 1, 8, and 15 every 28 days. RP2D for Arm B (n = 12) was ipatasertib 400 mg daily and carboplatin AUC2 days 1, 8, and 15 every 28 days. RP2D for Arm C (n = 6) was likely ipatasertib 300 mg 21 days on 7 days off, capecitabine 750 mg m-2, twice a day, 7 days on 7 days off, and atezolizumab 840 mg days 1 and 15 every 28 days. The most common (≥10%) grade 3-4 AEs at RP2D for Arm A (N = 7 at RP2D) were neutropenia (29%), diarrhea (14%), oral mucositis (14%), and neuropathy (14%); Arm B had diarrhea (17%) and lymphopenia (25%); and Arm C had anemia, fatigue, cognitive disturbance, and maculopapular rash (17% each). Overall responses at RP2D were 29% Arm A, 25% Arm B, and 33% Arm C. PFS was 4.8, 3.9, and 8.2 months for patients on Arms A, B, and C, respectively. CONCLUSIONS Continuous dosing of ipatasertib with chemotherapy was safe and well-tolerated. Further study is warranted in understanding the role of AKT inhibition in treatment of TNBCs. TRIAL REGISTRATION NCT03853707.
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Affiliation(s)
- Yuan Yuan
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Division of Medical Oncology, Cedars-Sinai Cancer, Los Angeles, CA, USA
| | - Susan E Yost
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Yujie Cui
- Department of Statistics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Christopher Ruel
- Department of Statistics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Mireya Murga
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Aileen Tang
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Norma Martinez
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - James Waisman
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Niki Patel
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Lalit Vora
- Department of Radiology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Lusine Tumyan
- Department of Radiology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Mari Bozoghlanian
- Department of Radiology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Daphne Stewart
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Paul H Frankel
- Department of Statistics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Egelston CA, Guo W, Yost SE, Ge X, Lee JS, Frankel PH, Cui Y, Ruel C, Schmolze D, Murga M, Tang A, Martinez N, Karimi M, Somlo G, Lee P, Waisman J, Yuan Y. Abstract OT2-08-03: Immunogenicity of pembrolizumab and doxorubicin in a phase I trial for patients with metastatic triple negative breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot2-08-03] [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: 03/06/2023]
Abstract
Abstract
Background: Combination of immune checkpoint inhibitor pembrolizumab and chemotherapy are standard of care therapy for patients with programmed death-ligand 1 positive (PD-L1+) metastatic triple negative breast cancer (mTNBC). However, a greater understanding of how immune checkpoint inhibitors and chemotherapies synergize to yield anti-tumor T cell responses is needed. The current phase I study evaluated the immunogenicity of doxorubicin plus pembrolizumab in patients with mTNBC. Patients and Methods: Patients with mTNBC, no prior anthracycline use, and 0-2 lines of prior systemic chemotherapies received pembrolizumab 200 mg IV and doxorubicin 50-60 mg/m2 IV every 3 weeks for 6 cycles followed by pembrolizumab maintenance until disease progression or intolerance. Patients were not selected based on PD-L1 expression. The primary objectives were safety and objective response rate per RECIST 1.1. Peripheral blood samples were collected at baseline, Cycle 2 Day 1 (C2D1), and post Cycle 3 for analysis by high parameter flow cytometry. Results: Ten patients were enrolled between March 2016 and November 2019. Best responses included one patient with complete response (CR), five with partial responses (PR), two with stable disease (SD), and one with progression of disease (PD). Flow cytometry showed increased CD3+ T cells (p=0.03) from pre-treatment to C2D1 with substantial inter-patient variation in CD3+ T cells. The expansion of proliferative exhausted-like PD-1+ CD8+ T cell population was identified in 8/9 patients, and exhausted CD8+ T cells were significantly expanded from pre-treatment to C2D1 in the patient with CR (p=0.01). Notably, frequencies of PD-1 high proliferative CD8+ T cells contracted significantly from C2D1 to post Cycle 3 (p=0.005), with a return to near baseline frequencies in the majority of the patients. In the context of all identified T cell subsets, PD-1hi proliferative CD8+ T cells demonstrated the greatest increase in fold change from pre-treatment to C2D1. In contrast, PD-1lo proliferative CD8+ T cells demonstrated the greatest decrease in fold change from pre-treatment to C3D1. Conclusion: Anthracycline-naïve patients with mTNBC treated with the combination of pembrolizumab and doxorubicin yielded robust peripheral blood T cell responses. Further studies dissecting the dynamics and durability of anti-tumor T cell responses and concurrent tumor immune microenvironment changes are needed to optimize combined immune checkpoint inhibitor and chemotherapy treatment for patients with mTNBC.
Citation Format: Colt A. Egelston, Weihua Guo, Susan E. Yost, Xuan Ge, Jin Sun Lee, Paul H. Frankel, Yujie Cui, Christopher Ruel, Daniel Schmolze, Mireya Murga, Aileen Tang, Norma Martinez, Misagh Karimi, George Somlo, Peter Lee, James Waisman, Yuan Yuan. Immunogenicity of pembrolizumab and doxorubicin in a phase I trial for patients with metastatic triple negative breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT2-08-03.
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Affiliation(s)
| | - Weihua Guo
- 2City of Hope National Medical Center, Duarte, California
| | - Susan E. Yost
- 3City of Hope National Medical Center, Duarte, California
| | - Xuan Ge
- 4City of Hope National Medical Center, Duarte, California
| | | | | | - Yujie Cui
- 7City of Hope National Medical Center
| | | | | | - Mireya Murga
- 10City of Hope National Medical Center, Duarte, California
| | - Aileen Tang
- 11City of Hope National Medical Center, Duarte, California
| | - Norma Martinez
- 12City of Hope National Medical Center, Duarte, California
| | | | | | - Peter Lee
- 15City of Hope National Medical Center
| | | | - Yuan Yuan
- 17City of Hope National Medical Center, Duarte, California
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Yuan Y, Egelston CA, Guo W, Yost SE, Frankel PH, Ruel C, Murga M, Tang A, Martinez N, Schmolze D, Stewart D, Waisman J, Yap K, Mortimer J, Tank N. Abstract OT2-01-06: Phase II trial of palbociclib plus endocrine therapy followed by combination of pembrolizumab, palbociclib and endocrine therapy in patients with hormone receptor positive metastatic breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot2-01-06] [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: 03/06/2023]
Abstract
Abstract
Background: The combination of CDK4/6 inhibitors (CDK4/6i) and endocrine therapy (ET) is standard-of-care for patients with hormone receptor positive (HR+) HER2- metastatic breast cancer (MBC). Immune modulatory effects of CDK4/6i are well documented preclinically but poorly understood in the clinical setting. Our previous study combining letrozole, palbociclib and pembrolizumab in patients with HR+ MBC (NCT02778685) showed a promising complete response rate of 31%. Dynamic changes in peripheral blood mononuclear cell (PBMC) subpopulations indicated that palbociclib may increase CD8+ TEMRA (terminally differentiated effector memory cells) and CD4+ TEM (effector memory cells) and enable immune activation. The current cohort 3 was designed to study the immune modulatory effect of palbociclib as an immune-priming agent with a biomarker enriched design. Methods: Women with ECOG 0-1, HR+ HER2- MBC, RECIST 1.1 measurable disease, no prior therapy for MBC were enrolled. Patients with endocrine therapy, including aromatase inhibitor +/- ovarian suppression or fulvestrant, were eligible. A palbociclib + ET lead-in design was used, starting on day -28 followed by combination therapy with pembrolizumab added on C1D1. Peripheral blood and tumor biopsy at baseline and on-treatment were collected to allow in-depth analysis of biomarkers predicting response to the combination. The primary endpoint was to evaluate if the palbociclib potentiated immune responses as a “priming” agent through PBMC analysis and on treatment tumor biopsy. Secondary endpoints included other immune cell subsets and changes that follow the combination with pembrolizumab. With 25 patients, assuming a standard deviation of 0.51 in the relative change in classic monocytes in PBMCs, there is 90% power to detect a relative change of log(C1D1/baseline) of 34.5% with a type I error (two-sided) of 0.05. Results: Between August 2020 and April 2022, 16 patients were enrolled in cohort 3. Currently 11 patients have adverse event (AEs) and 16 patients have response data. Median age was 57 years (39-72). 8/11 (73%) were non-Hispanic white, 1/11 (9%) Hispanic, 1/11 (9%) Asian, and 1/11 (9%) African American. 87% patients had grade 3 AEs, and 30% had grade 4 AEs. Grade 3 AEs were 9/11 (82%) neutropenia, 5/11 (45%) leukopenia, 1/11 (9%) elevated LFTs, and 1/11 (9%) each lymphopenia, hot flashes, febrile neutropenia, and pneumonitis. Grade 4 AEs were 1/11 (9%) lymphopenia. 8/16 (50%) patients achieved a partial response (PR), 5/16 (31%) had stable disease (SD), and 1/16 (6%) had progression of disease (PD) by RECIST 1.1. Additionally, 2/16 (13%) patients were too early to determine best overall response. Response rate (CR+PR) was 50%. PBMCs and tumor microenvironment profiling are ongoing. Conclusion: The combination of palbociclib, pembrolizumab and ET is well tolerated, and a response rate of 50% was identified in HR+ MBC patients who received this combination as front-line therapy. Dynamic changes in peripheral blood mononuclear cells and tumor microenvironment profiling are ongoing.
Citation Format: Yuan Yuan, Colt A. Egelston, Weihua Guo, Susan E. Yost, Paul H. Frankel, Christopher Ruel, Mireya Murga, Aileen Tang, Norma Martinez, Daniel Schmolze, Daphne Stewart, James Waisman, Kelly Yap, Joanne Mortimer, Niki Tank. Phase II trial of palbociclib plus endocrine therapy followed by combination of pembrolizumab, palbociclib and endocrine therapy in patients with hormone receptor positive metastatic breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT2-01-06.
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Affiliation(s)
- Yuan Yuan
- 1City of Hope National Medical Center, Duarte, California
| | | | - Weihua Guo
- 3City of Hope National Medical Center, Duarte, California
| | - Susan E. Yost
- 4City of Hope National Medical Center, Duarte, California
| | | | | | - Mireya Murga
- 7City of Hope National Medical Center, Duarte, California
| | - Aileen Tang
- 8City of Hope National Medical Center, Duarte, California
| | - Norma Martinez
- 9City of Hope National Medical Center, Duarte, California
| | | | - Daphne Stewart
- 11City of Hope National Medical Center, Duarte, California
| | | | - Kelly Yap
- 13City of Hope National Medical Center, Duarte, California
| | | | - Niki Tank
- 15City of Hope National Medical Center, Duarte, California
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Lavasani SM, Somlo G, Yost SE, Frankel PH, Ruel C, Cui Y, Murga M, Tang A, Martinez N, Kruper L, Tumyan L, Schmolze D, Yeon C, Yuan Y, Waisman JR, Mortimer J. Phase 2 prospective open label study of neoadjuvant nab-paclitaxel, trastuzumab, and pertuzumab in patients with HER2-positive primary breast cancer. Cancer 2023; 129:740-749. [PMID: 36517940 PMCID: PMC10107275 DOI: 10.1002/cncr.34589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the safety and efficacy of nab-paclitaxel, trastuzumab, and pertuzumab as neoadjuvant therapy (NAT) in patients with human epidermal growth factor receptor 2 HER2+ breast cancer (HER2+ BC) to determine pathologic complete response (pCR), invasive disease-free survival (iDFS), and overall survival. METHODS Forty-five patients with HER2+ BC Stages II-III were to be enrolled from 2013 to 2017. Patients were treated with weekly nab-paclitaxel (100 mg/m2 intravenously), weekly trastuzumab (4 mg/kg loading dose, then 2 mg/kg), and six cycles of pertuzumab (840 mg loading dose, then 420 mg intravenously day 1 every 21 days). RESULTS Median follow-up was 60 months (95% CI, 32.3-55.6) and pCR was 29/45 (64%). The 5-year iDFS for patients who achieved pCR (N = 29) was 96.3% (95% CI, 76.5-99.5) and non-pCR patients (N = 16) was 74.3% (95% CI, 39.1-91.0). The 5-year overall survival (N = 45) was 94.1% (95% CI, 77.6-98.5). Based on hormonal status, the 5-year iDFS for HR+ pCR patients (N = 14) was 92.3% (95% CI, 56.6-98.9) and for HR- (N = 15) was 100% (p = .3). CONCLUSIONS This anthracycline/carboplatin-free regimen with nab-paclitaxel achieved a pCR rate of 64% in patients with HER2+ BC. The 5-year iDFS in patients with and without pCR was 96.3% and 74.3%, respectively. The pCR rate is comparable with docetaxel, carboplatin, trastuzumab, and pertuzumab therapy in the NAT setting, but with fewer treatment-associated toxicities. This finding suggests the possibility of safe avoidance of anthracyclines and carboplatin as components of NAT in patients with HER2+ BC.
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Affiliation(s)
- Sayeh M Lavasani
- Department of Medical Oncology & Therapeutic Research, City of Hope National Medical Center, Duarte, California, USA
| | - George Somlo
- Department of Medical Oncology & Therapeutic Research, City of Hope National Medical Center, Duarte, California, USA
| | - Susan E Yost
- Department of Medical Oncology & Therapeutic Research, City of Hope National Medical Center, Duarte, California, USA
| | - Paul H Frankel
- Department of Biostatistics, City of Hope National Medical Center, Duarte, California, USA
| | - Christopher Ruel
- Department of Biostatistics, City of Hope National Medical Center, Duarte, California, USA
| | - Yujie Cui
- Department of Biostatistics, City of Hope National Medical Center, Duarte, California, USA
| | - Mireya Murga
- Department of Medical Oncology & Therapeutic Research, City of Hope National Medical Center, Duarte, California, USA
| | - Aileen Tang
- Department of Medical Oncology & Therapeutic Research, City of Hope National Medical Center, Duarte, California, USA
| | - Norma Martinez
- Department of Medical Oncology & Therapeutic Research, City of Hope National Medical Center, Duarte, California, USA
| | - Laura Kruper
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Lusine Tumyan
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, California, USA
| | - Daniel Schmolze
- Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Christina Yeon
- Department of Medical Oncology & Therapeutic Research, City of Hope National Medical Center, Duarte, California, USA
| | - Yuan Yuan
- Department of Medical Oncology & Therapeutic Research, City of Hope National Medical Center, Duarte, California, USA
| | - James R Waisman
- Department of Medical Oncology & Therapeutic Research, City of Hope National Medical Center, Duarte, California, USA
| | - Joanne Mortimer
- Department of Medical Oncology & Therapeutic Research, City of Hope National Medical Center, Duarte, California, USA
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Behrendt CE, Villalona-Calero MA, Newman EM, Frankel PH. Order of patient entry and outcomes in phase II clinical trials: A meta-analysis of individual patient data. Contemp Clin Trials 2023; 125:107083. [PMID: 36638911 DOI: 10.1016/j.cct.2023.107083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/11/2022] [Accepted: 01/08/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Prior meta-analysis of stem-cell transplantation trials for renal-cell carcinoma observed that clinical outcomes vary by subjects' order of entry, specifically their quartile of accrual. We test this hypothesis using meta-analysis of individual patient data from diverse Phase II trials conducted by an oncology consortium. METHODS Eligible were all Phase II trials in hematologic or solid tumors opened and closed by California Cancer Consortium during 2005-2020. Excluded were trials closed in first quartile or currently embargoed pending publication and subjects ineligible per protocol or untreated on study. The primary risk factor was entry by quartile of planned sample size. As a cross-protocol endpoint, primary outcome was time to discontinuation of intervention. One-stage meta-analysis used a shared frailty model with trial as random effect. As covariates, stepwise selection retained tumor type, obesity, their interaction, calendar year, entry at least 3 years post-diagnosis, and performance status but rejected age, sex, randomized design, and class of drug. RESULTS Twenty trials (including 8 terminated early, 2 not published) included n = 923 subjects. Most (90.6%) subjects discontinued intervention, usually for disease progression or toxicity. Independently of covariates, risk of discontinuation increased (p < 0.0001) with each quartile of entry (Hazards Ratio 1.13, 95% CI 1.06-1.22), culminating at Quartile 4 (HR 1.46, 1.36-1.57). The 95% prediction interval for the Hazards Ratio in future trials was (1.04-1.24). Progression-free survival similarly worsened by quartile of entry. CONCLUSION In Phase II trials, clinical outcome worsens with quartile of entry. This finding merits independent replication, and the cause of this phenomenon merits investigation.
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Affiliation(s)
- Carolyn E Behrendt
- Division of Biostatistics, Department of Computational and Quantitative Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
| | - Miguel A Villalona-Calero
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
| | - Edward M Newman
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
| | - Paul H Frankel
- Division of Biostatistics, Department of Computational and Quantitative Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Wong JYC, Yamauchi DM, Adhikarla V, Simpson J, Frankel PH, Fong Y, Melstrom KA, Chen YJ, Salehian BD, Woo Y, Dandapani SV, Colcher DM, Poku EK, Yazaki PJ, Wu AM, Shively JE. First-In-Human Pilot PET Immunoimaging Study of 64Cu-Anti-Carcinoembryonic Antigen Monoclonal Antibody (hT84.66-M5A) in Patients with Carcinoembryonic Antigen-Producing Cancers. Cancer Biother Radiopharm 2023; 38:26-37. [PMID: 36154291 DOI: 10.1089/cbr.2022.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: PET imaging using radiolabeled immunoconstructs shows promise in cancer detection and in assessing tumor response to therapies. The authors report the first-in-human pilot study evaluating M5A, a humanized anti-carcinoembryonic antigen (CEA) monoclonal antibody (mAb), radiolabeled with 64Cu in patients with CEA-expressing malignancies. The purpose of this pilot study was to identify the preferred patient population for further evaluation of this agent in an expanded trial. Methods: Patients with CEA-expressing primary or metastatic cancer received 64Cu-DOTA-hT84.66-M5A with imaging performed at 1 and 2 days postinfusion. 64Cu-DOTA-hT84.66-M5A PET scan findings were correlated with CT, MRI, and/or FDG PET scans and with histopathologic findings from planned surgery or biopsy performed postscan. Results: Twenty patients received 64Cu-DOTA-hT84.66-M5A. Twelve patients demonstrated positive images, which were confirmed in 10 patients as tumor by standard-of-care (SOC) imaging, biopsy, or surgical findings. Four of the 8 patients with negative imaging were confirmed as true negative, with the remaining 4 patients having disease demonstrated by SOC imaging or surgery. All 5 patients with locally advanced rectal cancer underwent planned biopsy or surgery after 64Cu-DOTA-hT84.66-M5A imaging (4 patients imaged 6-8 weeks after completing neoadjuvant chemotherapy and radiation therapy) and demonstrated a high concordance between biopsy findings and 64Cu-DOTA-hT84.66-M5A PET scan results. Three patients demonstrated positive uptake at the primary site later confirmed by biopsy and at surgery as residual disease. Two patients with negative scans each demonstrated complete pathologic response. In 5 patients with medullary thyroid cancer, 64Cu-DOTA-hT84.66-M5A identified disease not seen on initial CT scans in 3 patients, later confirmed to be disease by subsequent surgery or MRI. Conclusions: 64Cu-DOTA-hT84.66-M5A demonstrates promise in tumor detection, particularly in patients with locally advanced rectal cancer and medullary thyroid cancer. A successor trial in locally advanced rectal cancer has been initiated to further evaluate this agent's ability to define tumor extent before and assess disease response after neoadjuvant chemotherapy and radiotherapy. clinical trial.gov (NCT02293954).
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Affiliation(s)
- Jeffrey Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA.,Department of Immunology and Theranostics, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - David M Yamauchi
- Department of Diagnostic Radiology, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - Vikram Adhikarla
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - Jennifer Simpson
- Department of Clinical Trials Office, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - Paul H Frankel
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - Kurt A Melstrom
- Department of Surgery, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - Yi-Jen Chen
- Department of Radiation Oncology, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - Behrooz D Salehian
- Department of Diabetes and Endocrinology, and City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - Yanghee Woo
- Department of Surgery, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - Savita V Dandapani
- Department of Radiation Oncology, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - David M Colcher
- Department of Immunology and Theranostics, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - Erasmus K Poku
- Department of Radiopharmacy, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - Paul J Yazaki
- Department of Immunology and Theranostics, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - Anna M Wu
- Department of Immunology and Theranostics, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
| | - John E Shively
- Department of Immunology and Theranostics, City of Hope National Medical Center and the Beckman Research Institute, Duarte, California, USA
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Raoof M, Sullivan KM, Frankel PH, Fakih M, Synold TW, Lim D, Woo Y, Paz IB, Fong Y, Thomas RM, Chang S, Eng M, Tinsley R, Whelan RL, Deperalta D, Reymond MA, Jones J, Merchea A, Dellinger TH. Multicenter dose-escalation Phase I trial of mitomycin C pressurized intraperitoneal aerosolized chemotherapy in combination with systemic chemotherapy for appendiceal and colorectal peritoneal metastases: rationale and design. Pleura Peritoneum 2022; 7:169-177. [PMID: 36560966 PMCID: PMC9742457 DOI: 10.1515/pp-2022-0116] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/22/2022] [Indexed: 12/25/2022] Open
Abstract
Objectives Peritoneal metastasis (PM) from appendiceal cancer or colorectal cancer (CRC) has significant morbidity and limited survival. Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) is a minimally invasive approach to treat PM. We aim to conduct a dose-escalation trial of mitomycin C (MMC)-PIPAC combined with systemic chemotherapy (FOLFIRI) in patients with PM from appendiceal cancer or CRC. Methods This is a multicenter Phase I study of MMC-PIPAC (NCT04329494). Inclusion criteria include treatment with at least 4 months of first- or second-line systemic chemotherapy with ineligibility for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Exclusion criteria are: progression on chemotherapy; extraperitoneal metastases; systemic chemotherapy intolerance; bowel obstruction; or poor performance status (ECOG>2). Escalating MMC-PIPAC doses (7-25 mg/m2) will be administered in combination with standard dose systemic FOLFIRI. Safety evaluation will be performed on 15 patients (dose escalation) and six expansion patients: 21 evaluable patients total. Results The primary endpoints are recommended MMC dose and safety of MMC-PIPAC with FOLFIRI. Secondary endpoints are assessment of response (by peritoneal regression grade score; Response Evaluation Criteria in Solid Tumors [RECIST 1.1], and peritoneal carcinomatosis index), progression free survival, overall survival, technical failure rate, surgical complications, conversion to curative-intent CRS-HIPEC, patient-reported outcomes, and functional status. Longitudinal blood and tissue specimens will be collected for translational correlatives including pharmacokinetics, circulating biomarkers, immune profiling, and single-cell transcriptomics. Conclusions This Phase I trial will establish the recommended dose of MMC-PIPAC in combination with FOLFIRI. Additionally, we expect to detect an early efficacy signal for further development of this therapeutic combination.
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Affiliation(s)
- Mustafa Raoof
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Kevin M. Sullivan
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Paul H. Frankel
- Department of Computation and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutics, City of Hope National Medical Center, Duarte, CA, USA
| | - Timothy W. Synold
- Analytical Pharmacology Core, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Dean Lim
- Department of Medical Oncology and Therapeutics, City of Hope National Medical Center, Duarte, CA, USA
| | - Yanghee Woo
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Isaac Benjamin Paz
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Yuman Fong
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Sue Chang
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Melissa Eng
- Office of Clinical Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Raechelle Tinsley
- Office of Clinical Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Richard L. Whelan
- Department of Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, New Hyde Park, NY, USA
| | - Danielle Deperalta
- Department of Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, New Hyde Park, NY, USA
| | - Marc A. Reymond
- Department of Surgery, University of Tuebingen, Tubingen, Germany
| | - Jeremy Jones
- Department of Oncology (Medical), Mayo Clinic, Jacksonville, FL, USA
| | - Amit Merchea
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Thanh H. Dellinger
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
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Frankel PH, Garrett‐Mayer E, Krailo MD. Explicit underdose control based on toxicity: Four points to consider. Stat Med 2022; 41:5491-5493. [PMID: 36394105 PMCID: PMC9828021 DOI: 10.1002/sim.9492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Paul H. Frankel
- Department of Computational and Quantitative MedicineCity of Hope DuarteCaliforniaUSA
| | - Elizabeth Garrett‐Mayer
- Center for Research and Analytics, American Society of Clinical OncologyAlexandriaVirginiaUSA
| | - Mark D. Krailo
- Department of Population and Public Health SciencesKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
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Chiuppesi F, Zaia JA, Faircloth K, Johnson D, Ly M, Karpinski V, La Rosa C, Drake J, Marcia J, Acosta AM, Dempsey S, Taplitz RA, Zhou Q, Park Y, Ortega Francisco S, Kaltcheva T, Frankel PH, Rosen S, Wussow F, Dadwal S, Diamond DJ. Vaccine-induced spike- and nucleocapsid-specific cellular responses maintain potent cross-reactivity to SARS-CoV-2 Delta and Omicron variants. iScience 2022; 25:104745. [PMID: 35846380 PMCID: PMC9272674 DOI: 10.1016/j.isci.2022.104745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/16/2022] [Accepted: 07/06/2022] [Indexed: 01/06/2023] Open
Abstract
Cell-mediated immunity may contribute to providing protection against SARS-CoV-2 and its variants of concern (VOC). We developed COH04S1, a synthetic multiantigen modified vaccinia Ankara (MVA)-based COVID-19 vaccine that stimulated potent spike (S) and nucleocapsid (N) antigen-specific humoral and cellular immunity in a phase 1 clinical trial in healthy adults. Here, we show that individuals vaccinated with COH04S1 or mRNA vaccine BNT162b2 maintain robust cross-reactive cellular immunity for six or more months post-vaccination. Although neutralizing antibodies induced in COH04S1- and BNT162b2-vaccinees showed reduced activity against Delta and Omicron variants compared to ancestral SARS-CoV-2, S-specific T cells elicited in both COH04S1- and BNT162b2-vaccinees and N-specific T cells elicited in COH04S1-vaccinees demonstrated potent and equivalent cross-reactivity against ancestral SARS-CoV-2 and the major VOC. These results suggest that vaccine-induced T cells to S and N antigens may constitute a critical second line of defense to provide long-term protection against SARS-CoV-2 VOC.
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Affiliation(s)
- Flavia Chiuppesi
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - John A. Zaia
- Center for Gene Therapy, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Katelyn Faircloth
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Daisy Johnson
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Minh Ly
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Veronica Karpinski
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Corinna La Rosa
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Jennifer Drake
- Clinical Trials Office, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Joan Marcia
- Clinical Trials Office, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Ann Marie Acosta
- Clinical Trials Office, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Shannon Dempsey
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Randy A. Taplitz
- Division of Infectious Diseases, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
- Department of Medicine, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Qiao Zhou
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Yoonsuh Park
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Sandra Ortega Francisco
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Teodora Kaltcheva
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Paul H. Frankel
- Department of Biostatistics, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Steven Rosen
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Felix Wussow
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Sanjeet Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
- Department of Medicine, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Don J. Diamond
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, 1500 E. Duarte Road, Duarte, CA 91010, USA
- Corresponding author
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Mortimer JE, Bading JR, Frankel PH, Carroll MI, Yuan Y, Park JM, Tumyan L, Gidwaney N, Poku EK, Shively JE, Colcher DM. Use of 64Cu-DOTA-Trastuzumab PET to Predict Response and Outcome of Patients Receiving Trastuzumab Emtansine for Metastatic Breast Cancer: A Pilot Study. J Nucl Med 2022; 63:1145-1148. [PMID: 34857660 PMCID: PMC9364339 DOI: 10.2967/jnumed.121.262940] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/08/2021] [Indexed: 02/03/2023] Open
Abstract
We hypothesized that functional imaging with 64Cu-DOTA-trastuzumab PET/CT would predict the response to the antibody-drug conjugate trastuzumab-emtansine (T-DM1). Methods: Ten women with metastatic human epidermal growth factor receptor 2-positive breast cancer underwent 18F-FDG PET/CT and 64Cu-DOTA-trastuzumab PET/CT on days 1 and 2 before treatment with T-DM1. Results: T-DM1-responsive patients had higher uptake than nonresponsive patients. Day 1 minimum SUVmax (5.6 vs. 2.8, P < 0.02), day 2 minimum SUVmax (8.1 vs. 3.2, P < 0.01), and day 2 average SUVmax (8.5 vs. 5.4, P < 0.05) for 64Cu-DOTA-trastuzumab all favored responding patients. Tumor-level response suggested threshold dependence on SUVmax Patients with a day 2 minimum SUVmax above versus below the threshold had a median time to treatment failure of 28 mo versus 2 mo (P < 0.02). Conclusion: Measurement of trastuzumab uptake in tumors via PET/CT is promising for identifying patients with metastatic breast cancer who will benefit from T-DM1.
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Affiliation(s)
- Joanne E. Mortimer
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - James R. Bading
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - Paul H. Frankel
- Department of Information Sciences, City of Hope, Duarte, California
| | - Mary I. Carroll
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - Yuan Yuan
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - Jinha M. Park
- Department of Radiology, City of Hope, Duarte, California; and
| | - Lusine Tumyan
- Department of Radiology, City of Hope, Duarte, California; and
| | - Nikita Gidwaney
- Department of Radiology, City of Hope, Duarte, California; and
| | - Erasmus K. Poku
- Department of Cancer Molecular Imaging and Therapy, Beckman Research Institute of the City of Hope, Duarte, California
| | - John E. Shively
- Department of Cancer Molecular Imaging and Therapy, Beckman Research Institute of the City of Hope, Duarte, California
| | - David M. Colcher
- Department of Cancer Molecular Imaging and Therapy, Beckman Research Institute of the City of Hope, Duarte, California
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Lee JS, Yost SE, Li SM, Cui Y, Frankel PH, Yuan YC, Schmolze D, Egelston CA, Guo W, Murga M, Chang H, Bosserman L, Yuan Y. Genomic Markers of CDK 4/6 Inhibitor Resistance in Hormone Receptor Positive Metastatic Breast Cancer. Cancers (Basel) 2022; 14:3159. [PMID: 35804935 PMCID: PMC9264913 DOI: 10.3390/cancers14133159] [Citation(s) in RCA: 1] [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: 05/31/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 02/06/2023] Open
Abstract
Cyclin-dependent kinase 4/6 inhibitors are the standard of care for hormone receptor-positive metastatic breast cancer. This retrospective study reports on genomic biomarkers of CDK 4/6i resistance utilizing genomic data acquired through routine clinical practice. Patients with HR+ MBC treated with palbociclib, ribociclib, or abemaciclib and antiestrogen therapy were identified. Patients were grouped into early (<6 months); intermediate (6−24 months for 0−1 lines; 6−9 months for ≥2 lines); or late progressors (>24 months for 0−1 lines; >9 months PFS for ≥2 lines). NGS and RNA sequencing data were analyzed in association with PFS, and survival analysis was stratified by prior lines of chemotherapy. A total of 795 patients with HR+ MBC treated with CDK 4/6i were identified. Of these, 144 (18%) patients had genomic data and 29 (3.6%) had RNA data. Among the 109 patients who received CDK4/6i as 1st- or 2nd-line therapy, 17 genes showed associations with PFS (p-value ≤ 0.15 and HR ≥ 1.5 or HR < 0.5). Whole transcriptome RNAseq was analyzed for 24/109 (22%) patients with 0−1 prior lines of therapy and 56 genes associated with PFS (HR ≥ 4 or HR ≤ 0.25 and FDR ≤ 0.15). In this retrospective analysis, genomic biomarkers including FGFR1 amplification, PTEN loss, and DNA repair pathway gene mutations showed significant associations with shorter PFS for patients receiving CDK4/6 inhibitor therapy.
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Affiliation(s)
- Jin Sun Lee
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (J.S.L.); (S.E.Y.); (M.M.); (H.C.); (L.B.)
| | - Susan E. Yost
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (J.S.L.); (S.E.Y.); (M.M.); (H.C.); (L.B.)
| | - Sierra Min Li
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (S.M.L.); (Y.C.); (P.H.F.)
| | - Yujie Cui
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (S.M.L.); (Y.C.); (P.H.F.)
| | - Paul H. Frankel
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (S.M.L.); (Y.C.); (P.H.F.)
| | - Yate-Ching Yuan
- Department of Computational Quantitative Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA;
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA;
| | - Colt A. Egelston
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (C.A.E.); (W.G.)
| | - Weihua Guo
- Department of Immuno-Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (C.A.E.); (W.G.)
| | - Mireya Murga
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (J.S.L.); (S.E.Y.); (M.M.); (H.C.); (L.B.)
| | - Helen Chang
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (J.S.L.); (S.E.Y.); (M.M.); (H.C.); (L.B.)
| | - Linda Bosserman
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (J.S.L.); (S.E.Y.); (M.M.); (H.C.); (L.B.)
| | - Yuan Yuan
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA; (J.S.L.); (S.E.Y.); (M.M.); (H.C.); (L.B.)
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Villarreal-Garza C, Ferrigno AS, Aranda-Gutierrez A, Frankel PH, Ruel NH, Fonseca A, Narod S, Chavarri-Guerra Y, Sifuentes E, Magallanes-Hoyos MC, Herzog J, Castillo D, Alvarez-Gomez RM, Mohar-Betancourt A, Weitzel JN. Influence of germline BRCA genotype on the survival of patients with triple-negative breast cancer. Cancer Res Commun 2021; 1:140-147. [PMID: 35875314 PMCID: PMC9307147 DOI: 10.1158/2767-9764.crc-21-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The presence of BRCA pathogenic variants (PVs) in triple-negative breast cancer (TNBC) is associated with a distinctive genomic profile that makes the tumor particularly susceptible to DNA-damaging treatments. However, patients with BRCA PVs can develop treatment resistance through the appearance of reversion mutations and restored BRCA expression. As copy-number variants (CNV) could be less susceptible to reversion mutations than point mutations, we hypothesize that carriers of BRCA CNVs may have improved survival after treatment compared to carriers of other BRCA PVs or BRCA wild-type. Women diagnosed with stage I-III TNBC at ≤50 years at a cancer center in Mexico City were screened for BRCA PVs using a recurrent PV assay (HISPANEL; 77% sensitivity). The recurrence-free (RFS) and overall survival (OS) were compared according to mutational status. Among 180 women, 17 (9%) were carriers of BRCA1 ex9-12del CNV and 26 (14%) of other BRCA PVs. RFS at ten years for the whole cohort was 79.2% (95% CI 72.3-84.6%), with no significant differences according to mutational status. 10-year OS for the entire cohort was 85.3% (95%CI: 78.7-90.0%), with BRCA CNV carriers demonstrating numerically superior OS rates other PV carriers and non-carriers (100% vs. 78.6% and 84.7%; log-rank p=0.037 and p=0.051, respectively). This study suggests that BRCA1 ex9-12del CNV carriers with TNBC may have a better OS, and supports the hypothesis that the genotype of BRCA PVs may influence survival by limiting treatment resistance mediated by reversion mutations among CNV carriers.
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Affiliation(s)
- Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico.,Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Ana S. Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | | | | | - Alan Fonseca
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Steven Narod
- Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Yanin Chavarri-Guerra
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | - Jeffrey N. Weitzel
- Latin American School of Oncology, Sierra Madre, California.,Corresponding Author: Jeffrey N. Weitzel, Latin American School of Oncology, 578 Acacia Street, Sierra Madre, CA 91024. Phone: 626-233-9713; E-mail:
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Pal SK, Frankel PH, Mortazavi A, Milowsky M, Vaishampayan U, Parikh M, Lyou Y, Weng P, Parikh R, Teply B, Dreicer R, Emamekhoo H, Michaelson D, Hoimes C, Zhang T, Srinivas S, Kim WY, Cui Y, Newman E, Lara PN. Effect of Cisplatin and Gemcitabine With or Without Berzosertib in Patients With Advanced Urothelial Carcinoma: A Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 7:1536-1543. [PMID: 34436521 PMCID: PMC8391778 DOI: 10.1001/jamaoncol.2021.3441] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 04/16/2021] [Accepted: 06/01/2021] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Preclinical studies suggest that inhibition of single-stranded DNA repair by ataxia telangiectasia and Rad3 (ATR) may enhance the cytotoxicity of cisplatin, gemcitabine, and other chemotherapeutic agents. Cisplatin with gemcitabine remains the standard up-front therapy for treatment in patients with metastatic urothelial cancer. OBJECTIVE To determine whether the use of the selective ATR inhibitor, berzosertib, could augment the activity of cisplatin with gemcitabine. DESIGN, SETTING, AND PARTICIPANTS In a phase 2 randomized clinical trial, 87 patients across 23 centers in the National Cancer Institute Experimental Therapeutics Clinical Trials Network were randomized to receive either cisplatin with gemcitabine alone (control arm) or cisplatin with gemcitabine plus berzosertib (experimental arm). Key eligibility criteria included confirmed metastatic urothelial cancer, no prior cytotoxic therapy for metastatic disease, 12 months or more since perioperative therapy, and eligibility for cisplatin receipt based on standard criteria. The study was conducted from January 27, 2017, to December 15, 2020. INTERVENTIONS In the control arm, cisplatin, 70 mg/m2, was given on day 1 and gemcitabine, 1000 mg/m2, was given on days 1 and 8 of a 21-day cycle. In the experimental arm, cisplatin, 60 mg/m2, was given on day 1; gemcitabine, 875 mg/m2, on days 1 and 8; and berzosertib, 90 mg/m2, on days 2 and 9 of a 21-day cycle. MAIN OUTCOMES AND MEASURES The primary end point of the study was progression-free survival. The analysis was on all patients who started therapy. RESULTS Of the total of 87 patients randomized, 41 patients received cisplatin with gemcitabine alone and 46 received cisplatin with gemcitabine plus berzosertib. Median age was 67 (range, 32-84) years, and 68 patients (78%) were men. Median progression-free survival was 8.0 months for both arms (Bajorin risk-adjusted hazard ratio, 1.22; 95% CI, 0.72-2.08). Median overall survival was shorter with cisplatin with gemcitabine plus berzosertib compared with cisplatin with gemcitabine alone (14.4 vs 19.8 months; Bajorin risk-adjusted hazard ratio, 1.42; 95% CI, 0.76-2.68). Higher rates of grade 3 vs grade 4 thrombocytopenia (59% vs 39%) and neutropenia (37% vs 27%) were observed with cisplatin with gemcitabine and berzosertib compared with cisplatin with gemcitabine alone; consequently, more dose reductions were needed in the experimental arm. Patients in the experimental arm received a median cisplatin dose of 250 mg/m2, which was significantly lower than the median dose of 370 mg/m2 in the control arm (P < .001). CONCLUSIONS AND RELEVANCE The addition of berzosertib to cisplatin with gemcitabine did not prolong progression-free survival relative to cisplatin with gemcitabine alone in patients with metastatic urothelial cancer, and a trend toward inferior survival was observed with this combination. Berzosertib plus cisplatin with gemcitabine was associated with significantly higher hematologic toxicities despite attenuated dosing of cisplatin with gemcitabine. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02567409.
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Affiliation(s)
- Sumanta K. Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Paul H. Frankel
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Amir Mortazavi
- Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus
| | - Matthew Milowsky
- Department of Medicine, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Ulka Vaishampayan
- Department of Internal Medicine, University of Michigan Cancer Center, Ann Arbor
| | - Mamta Parikh
- Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, California
| | - Yung Lyou
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Peng Weng
- Department of Internal Medicine, University of Kentucky Markey Cancer Center, Lexington
| | - Rahul Parikh
- Department of Internal Medicine, University of Kansas Medical Center, Westwood
| | - Benjamin Teply
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Robert Dreicer
- Department of Medicine, University of Virginia Cancer Center, Charlottesville
| | - Hamid Emamekhoo
- Department of Medicine, University of Wisconsin Cancer Center, Madison
| | - Dror Michaelson
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Christopher Hoimes
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Tian Zhang
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Sandy Srinivas
- Department of Medicine, Stanford Cancer Center, Palo Alto, California
| | - William Y. Kim
- Department of Medicine, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Yujie Cui
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Edward Newman
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Primo N. Lara
- Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, California
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Yuan Y, Lee JS, Yost SE, Li SM, Frankel PH, Ruel C, Schmolze D, Robinson K, Tang A, Martinez N, Stewart D, Waisman J, Kruper L, Jones V, Menicucci A, Uygun S, Yoder E, van der Baan B, Yim JH, Yeon C, Somlo G, Mortimer J. Phase II Trial of Neoadjuvant Carboplatin and Nab-Paclitaxel in Patients with Triple-Negative Breast Cancer. Oncologist 2021; 26:e382-e393. [PMID: 33098195 PMCID: PMC7930424 DOI: 10.1002/onco.13574] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In this phase II clinical trial, we evaluated the efficacy of the nonanthracycline combination of carboplatin and nab-paclitaxel in early stage triple-negative breast cancer (TNBC). PATIENTS AND METHODS Patients with newly diagnosed stage II-III TNBC (n = 69) were treated with neoadjuvant carboplatin (area under the curve 6) every 28 days for four cycles plus nab-paclitaxel (100 mg/m2 ) weekly for 16 weeks. Pathological complete response (pCR) and residual cancer burden (RCB) were analyzed with germline mutation status, tumor-infiltrating lymphocytes (TILs), TNBC molecular subtype, and GeparSixto immune signature (GSIS). RESULTS Sixty-seven patients were evaluable for safety and response. Fifty-three (79%) patients experienced grade 3/4 adverse events, including grade 3 anemia (43%), neutropenia (39%), leukopenia (15%), thrombocytopenia (12%), fatigue (7%), peripheral neuropathy (7%), neutropenia (16%), and leukopenia (1%). Twenty-four patients (35%) had at least one dose delay, and 50 patients (72%) required dose reduction. Sixty-three (94%) patients completed scheduled treatment. The responses were as follows: 32 of 67 patients (48%) had pCR (RCB 0), 10 of 67 (15%) had RCB I, 19 of 67 (28%) had RCB II, 5 of 67 (7%) had RCB III, and 1 of 67 (2%) progressed and had no surgery. Univariate analysis showed that immune-hot GSIS and DNA repair defect (DRD) were associated with higher pCR with odds ratios of 4.62 (p = .005) and 4.76 (p = .03), respectively, and with RCB 0/I versus RCB II/III with odds ratio 4.80 (p = .01). Immune-hot GSIS was highly correlated with DRD status (p = .03), TIL level (p < .001), and TNBC molecular subtype (p < .001). After adjusting for age, race, stage, and grade, GSIS remained associated with higher pCR and RCB class 0/I versus II/III with odds ratios 7.19 (95% confidence interval [CI], 2.01-25.68; p = .002) and 8.95 (95% CI, 2.09-38.23; p = .003), respectively. CONCLUSION The combination of carboplatin and nab-paclitaxel for early stage high-risk TNBC showed manageable toxicity and encouraging antitumor activity. Immune-hot GSIS is associated with higher pCR rate and RCB class 0/1. This study provides an additional rationale for using nonanthracycline platinum-based therapy for future neoadjuvant trials in early stage TNBCs. Clinical trial identification number: NCT01525966 IMPLICATIONS FOR PRACTICE: Platinum is an important neoadjuvant chemotherapy agent for treatment of early stage triple-negative breast cancer (TNBC). In this study, carboplatin and nab-paclitaxel were well tolerated and highly effective in TNBC, resulting in pathological complete response of 48%. In univariate and multivariate analyses adjusting for age, race, tumor stage and grade, "immune-hot" GeparSixto immune signature (GSIS) and DNA repair defect (DRD) were associated with higher pathological complete response (pCR) and residual cancer burden class 0/1. The association of immune-hot GSIS with higher pCR holds promise for de-escalating neoadjuvant chemotherapy for patients with early stage TNBC. Although GSIS is not routinely used in clinic, further development of this immune signature into a clinically applicable assay is indicated.
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Affiliation(s)
- Yuan Yuan
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Jin Sun Lee
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Susan E. Yost
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Sierra Min Li
- Department of Biostatistics, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Paul H. Frankel
- Department of Biostatistics, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Christopher Ruel
- Department of Biostatistics, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Kim Robinson
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Aileen Tang
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Norma Martinez
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Daphne Stewart
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - James Waisman
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Laura Kruper
- Department of Surgery, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Veronica Jones
- Department of Surgery, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | | | - Sahra Uygun
- Agendia Precision OncologyIrvineCaliforniaUSA
| | - Erin Yoder
- Agendia Precision OncologyIrvineCaliforniaUSA
| | | | - John H. Yim
- Department of Surgery, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Christina Yeon
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - George Somlo
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Joanne Mortimer
- Department of Medical Oncology and Therapeutic Research, City of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
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Yuan Y, Yost SE, Lee JS, Frankel PH, Ruel C, Murga M, Tang A, Martinez N, Waisman J, Patel N, Sedrak M, Stewart D, Lavasani S, Mortimer J. Abstract OT-24-01: Phase I study combining ipatasertib with chemotherapy and atezolizumab in patients with metastatic triple negative breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ot-24-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The PI3K-ATK pathway is one of the most common cancer drivers in breast cancer, and the AKT inhibitor ipatasertib (ipat) has shown great efficacy in patients (pts) with metastatic triple negative breast cancer (mTNBC). The current phase I trial is designed to test the safety and efficacy of the following ipat combinations: ipat + carboplatin (C) + paclitaxel (T); ipat + C; ipat + capecitabine (cape) + atezolizumab (atezo). Trial Design: This is a Phase I open-label study for pts with mTNBC. Eligible pts receive one of three regimens: A) weekly carbo AUC 2 plus taxol 80 mg/m2 days 1, 8, 15 and daily ipat 300 mg every 28 days; B) weekly carbo AUC 2, days 1, 8, 15 and daily ipat 400 mg every 28 days; C) cape 750 mg bid 1 week on 1 week off, ipat 300 mg daily and atezo 840 mg iv days 1, 15 every 28 days. Eligibility Criteria: Eligible patients must have histologically confirmed mTNBC (ER/PR ≤ 10%, HER2- per ASCO/CAP); RECIST 1.1 measurable disease; 0-2 lines of chemotherapy prior for mTNBC; AEs recovered to ≤ Gr 2 per CTCAE 5.0; adequate bone marrow, hepatic and renal function. Prior exposure to AKT targeted therapy is excluded.Specific Aims: Primary objectives are to evaluate the safety and tolerability of the combinations and determine the recommended Phase II dose (RP2D) of the combinations. Secondary objectives are to evaluate response rate, clinical benefit rate, progression free survival, and overall survival. Statistical Design: For the safety-lead in, a “3 at risk design” will be utilized to assess toxicity for the combination therapy. The DLT period is 1-cycle (28 days). Each participant will remain on the dosing level according to the escalation dose level they were enrolled in, and intra-dose level escalations will not be allowed, even if the MTD is defined at a higher dose level. Rules for escalation are as follows: if escalating from Level 1, two dose levels will be open, Level 2A, and Level 2B. Only if both 2A and 2B result in a decision to escalate will dose level 3 for this triplet be open. When both 2A and 2B are both open, slots will be given to the arm with the most open slots (starting with 2A if there are ties). When a maximum tolerable dose level has been defined by the dose escalation portion of the study, and the recommended phase 2 dose (RP2D not to exceed the MTD) has been selected, additional patients will be accrued to confirm the tolerability of the regimen. For Arm C, at least 12 patients will be treated at the RP2D to confirm tolerability. Additional patients can be accrued if the total number of patients accrued does not exceed 21 patients (e.g. if the RP2D is dose level 1, with 2A and 2B not well-tolerated based on 3 patients on each 2A and 2B, the total at RP2D could be 15). If one agent is discontinued due to toxicity, then the participant may continue to receive the remaining single agent or doublet agent therapy on protocol. With 12 patients, any specific severe toxicity with 20% incidence will be observed with 93% probability.
Citation Format: Yuan Yuan, Susan E. Yost, Jin Sun Lee, Paul H. Frankel, Christopher Ruel, Mireya Murga, Aileen Tang, Norma Martinez, James Waisman, Niki Patel, Mina Sedrak, Daphne Stewart, Sayeh Lavasani, Joanne Mortimer. Phase I study combining ipatasertib with chemotherapy and atezolizumab in patients with metastatic triple negative breast cancer [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 OT-24-01.
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Yuan Y, Lee JS, Yost SE, Frankel PH, Ruel C, Egelston CA, Guo W, Gillece JD, Folkerts M, Reining L, Highlander SK, Robinson K, Padam S, Martinez N, Tang A, Schmolze D, Waisman J, Sedrak M, Lee PP, Mortimer J. A Phase II Clinical Trial of Pembrolizumab and Enobosarm in Patients with Androgen Receptor-Positive Metastatic Triple-Negative Breast Cancer. Oncologist 2020; 26:99-e217. [PMID: 33141975 DOI: 10.1002/onco.13583] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/24/2020] [Indexed: 01/02/2023] Open
Abstract
LESSONS LEARNED The combination of enobosarm and pembrolizumab was well tolerated and showed a modest clinical benefit rate of 25% at 16 weeks. Future trials investigating androgen receptor-targeted therapy in combination with immune checkpoint inhibitors are warranted. BACKGROUND Luminal androgen receptor is a distinct molecular subtype of triple-negative breast cancer (TNBC) defined by overexpression of androgen receptor (AR). AR-targeted therapy has shown modest activity in AR-positive (AR+) TNBC. Enobosarm (GTx-024) is a nonsteroidal selective androgen receptor modulator (SARM) that demonstrates preclinical and clinical activity in AR+ breast cancer. The current study was designed to explore the safety and efficacy of the combination of enobosarm and pembrolizumab in patients with AR+ metastatic TNBC (mTNBC). METHODS This study was an open-label phase II study for AR+ (≥10%, 1+ by immunohistochemistry [IHC]) mTNBC. Eligible patients received pembrolizumab 200 mg intravenous (IV) every 3 weeks and enobosarm 18 mg oral daily. The primary objective was to evaluate the safety of enobosarm plus pembrolizumab and determine the response rate. Peripheral blood, tumor biopsies, and stool samples were collected for correlative analysis. RESULTS The trial was stopped early because of the withdrawal of GTx-024 drug supply. Eighteen patients were enrolled, and 16 were evaluable for responses. Median age was 64 (range 36-81) years. The combination was well tolerated, with only a few grade 3 adverse events: one dry skin, one diarrhea, and one musculoskeletal ache. The responses were 1 of 16 (6%) complete response (CR), 1 of 16 (6%) partial response (PR), 2 of 16 (13%) stable disease (SD), and 12 of 16 (75%) progressive disease (PD). Response rate (RR) was 2 of 16 (13%). Clinical benefit rate (CBR) at 16 weeks was 4 of 16 (25%). Median follow-up was 24.9 months (95% confidence interval [CI], 17.5-30.9). Progression-free survival (PFS) was 2.6 months (95% CI, 1.9-3.1) and overall survival (OS) was 25.5 months (95% CI, 10.4-not reached [NR]). CONCLUSION The combination of enobosarm and pembrolizumab was well tolerated, with a modest clinical benefit rate of 25% at 16 weeks in heavily pretreated AR+ TNBC without preselected programmed death ligand-1 (PD-L1). Future clinical trials combining AR-targeted therapy with immune checkpoint inhibitor (ICI) for AR+ TNBC warrant investigation.
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Affiliation(s)
- Yuan Yuan
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Jin Sun Lee
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Susan E Yost
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Paul H Frankel
- Department of Biostatistics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Christopher Ruel
- Department of Biostatistics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Colt A Egelston
- Department of Immune-Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Weihua Guo
- Department of Immune-Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - John D Gillece
- Pathogen and Microbiome Division, Translational Genomics Research Institute North, Flagstaff, Arizona, USA
| | - Megan Folkerts
- Pathogen and Microbiome Division, Translational Genomics Research Institute North, Flagstaff, Arizona, USA
| | - Lauren Reining
- Pathogen and Microbiome Division, Translational Genomics Research Institute North, Flagstaff, Arizona, USA
| | - Sarah K Highlander
- Pathogen and Microbiome Division, Translational Genomics Research Institute North, Flagstaff, Arizona, USA
| | - Kim Robinson
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Simran Padam
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Norma Martinez
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Aileen Tang
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - James Waisman
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Mina Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Peter P Lee
- Department of Immune-Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
| | - Joanne Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California, USA
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Frankel PH, Chung V, Xing Y, Longmate J, Groshen S, Newman EM. Untenable dosing: A common pitfall of modern DLT-targeting Phase I designs in oncology. Curr Probl Cancer 2020; 44:100583. [PMID: 32446637 DOI: 10.1016/j.currproblcancer.2020.100583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/04/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is increasing use of Phase I statistical designs to find a dose that causes rapidly emerging and particularly concerning severe or life-threatening toxicities (dose-limiting toxicities, DLTs) in a specified percent of patients most commonly 25%. While a convenient statistical framework, the foundation for selecting any specified target DLT rate, and its relevance to the recommended Phase II dose is generally lacking. METHOD We surveyed 78 medical oncologists, most (69%) with experience as a principal investigator on a Phase I study, to ascertain their opinions related to this approach to Phase I studies and the targets often chosen. RESULTS Eighty-seven percent of respondents preferred severe toxicities in only 5%-10% of patients, consistent with 58% of respondents noting that 10% or fewer patients experience severe toxicities in the first cycle with standard outpatient treatments. The survey also documented in an example that the majority (62%) of physicians modify their patient selection during the conduct of the study based on observed toxicity and 78% note that higher toxicity is acceptable in patients where a cure is more likely. CONCLUSION DLT-target rate designs search for a single target that is rarely well-supported in a patient population that is not stable. The most common target used is inconsistent with the toxicity of most clinically used drugs and investigator preference and can lead to the pursuit of unacceptable doses. Use of Phase I trial designs with a target DLT rate should be limited to settings with a well-justified target and should specify how the target relates to the recommended Phase II dose.
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Affiliation(s)
- Paul H Frankel
- Division of Biostatistics, City of Hope, Duarte, California.
| | - Vincent Chung
- Department of Medical Oncology, City of Hope, Duarte, California
| | - Yan Xing
- Department of Medical Oncology, City of Hope, Duarte, California
| | - Jeff Longmate
- Division of Biostatistics, City of Hope, Duarte, California
| | - Susan Groshen
- Biostatistics Core, University of Southern California/Norris Cancer Center, Los Angeles, California
| | - Edward M Newman
- Division of Molecular Pharmacology, Department of Medical Oncology, City of Hope, Duarte, California
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Abstract
IMPORTANCE Phase 1 cancer studies, which guide dose selection for subsequent studies, are almost 3 times more prevalent than phase 3 studies and have a median study duration considerably longer than 2 years, which constitutes a major component of drug development time. OBJECTIVE To discern a method to reduce the duration of phase 1 studies in adult and pediatric cancer studies without violating risk limits by better accommodating the accrual and evaluation process (or queue). DESIGN The process modeled, the phase 1 queue (IQ), includes patient interarrival time, screening, and dose-limiting toxicity evaluation. For this proof of principle, the rules of the 3 + 3 and rolling 6 phase 1 designs were modified to improve patient flow through the queue without exceeding the maximum risk permitted in the parent designs. The resulting designs, the IQ 3 + 3 and the IQ rolling 6, were each compared with their parent design by simulations in 12 different scenarios. MAIN OUTCOMES AND MEASURES (1) The time from study opening to determination of the maximum tolerated dose (MTD), (2) the number of patients treated to determine the MTD, and (3) the association of the design with the dose selected as the MTD. RESULTS Based on 800 simulations, for all 12 scenarios considered, the IQ 3 + 3 and the IQ rolling 6 designs were associated with reduced expected study durations compared with the parent design. The expected IQ 3 + 3 reduction ranged from 1.6 to 10.4 months (with 3.7 months for the standard scenario), and the expected reduction associated with IQ rolling 6 ranged from 0.4 to 10.5 months (with 3.4 months for the standard scenario). The increase in the mean number of patients treated in the IQ 3 + 3 compared with the 3 + 3 ranged from 0.6 to 3.2 patients. No increase in the number of patients was associated with the IQ rolling 6 compared with the rolling 6 design. The probability of selecting a dose level as the MTD changed by less than 3% for all dose levels and scenarios in both parent designs. CONCLUSIONS AND RELEVANCE This study found that IQ designs were associated with reduced mean duration of phase 1 studies compared with their parent designs without changing the risk limits or MTD selection operating characteristics. These approaches have been successfully implemented in both hematology and solid tumor phase 1 studies.
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Affiliation(s)
- Paul H. Frankel
- Division of Biostatistics, Department of Research Information Sciences, City of Hope, Duarte, California
| | - Vincent Chung
- Department of Medical Oncology, City of Hope, Duarte, California
| | - Joseph Tuscano
- Hematology/Oncology, University of California, Davis, Davis
| | - Tanya Siddiqi
- Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Sagus Sampath
- Radiation Oncology, City of Hope, Duarte, California
| | - Jeffrey Longmate
- Division of Biostatistics, Department of Research Information Sciences, City of Hope, Duarte, California
| | - Susan Groshen
- Biostatistics Core, Norris Cancer Center, University of Southern California, Los Angeles
| | - Edward M. Newman
- Department of Medical Oncology, City of Hope, Duarte, California
- Developmental Cancer Therapeutics Program, Division of Molecular Pharmacology, City of Hope, Duarte, California
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24
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He TF, Yost SE, Frankel PH, Dagis A, Cao Y, Wang R, Rosario A, Tu TY, Solomon S, Schmolze D, Mortimer J, Lee P, Yuan Y. Multi-panel immunofluorescence analysis of tumor infiltrating lymphocytes in triple negative breast cancer: Evolution of tumor immune profiles and patient prognosis. PLoS One 2020; 15:e0229955. [PMID: 32150594 PMCID: PMC7062237 DOI: 10.1371/journal.pone.0229955] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/17/2020] [Indexed: 12/19/2022] Open
Abstract
The evolutionary changes in immune profiles of triple negative breast cancer (TNBC) are not well understood, although it is known that immune checkpoint inhibitors have diminished activity in heavily pre-treated TNBC patients. This study was designed to characterize immune profile changes of longitudinal tumor specimens by studying immune subsets of tumor infiltrating lymphocytes (TILs) in paired primary and metastatic TNBC in a cohort of "poor outcome" (relapsed within 5 years) patients. Immune profiles of TNBCs in a cohort of "good outcome" (no relapse within 5 years) patients were also analyzed. Immune subsets were characterized for CD4, CD8, FOXP3, CD20, CD33, and PD1 using immuno-fluorescence staining in stroma, tumor, and combined stroma and tumor tissue. TIL subsets in "good outcome" versus "poor outcome" patients were also analyzed. Compared with primary, metastatic TNBCs had significantly lower TILs by hematoxylin and eosin (H&E) staining. Stromal TILs (sTILs), but not tumoral TILs (tTILs) had significantly reduced cytotoxic CD8+ T cells (CTLs), PD1+ CTLs, and total PD1+ TILs in metastatic compared with matched primary TNBCs. Higher PD1+ CTLs, PD1+CD4+ helper T cells (PD1+TCONV) and all PD1+ T cells in sTILs, tTILs and total stromal and tumor TILS (s+tTIL) were all associated with better prognosis. In summary, TIL subsets decrease significantly in metastatic TNBCs compared with matched primary. Higher PD1+ TILs are associated with better prognosis in early stage TNBCs. This finding supports the application of immune checkpoint inhibitors early in the treatment of TNBCs.
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Affiliation(s)
- Ting-Fang He
- Department of Immuno-Oncology, City of Hope National Medical Center, Duarte, California, United States of America
| | - Susan E. Yost
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, California, United States of America
| | - Paul H. Frankel
- Department of Biostatistics, City of Hope National Medical Center, Duarte, California, United States of America
| | - Andrew Dagis
- Department of Biostatistics, City of Hope National Medical Center, Duarte, California, United States of America
| | - Yu Cao
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, California, United States of America
| | - Roger Wang
- Department of Immuno-Oncology, City of Hope National Medical Center, Duarte, California, United States of America
| | - Anthony Rosario
- Department of Immuno-Oncology, City of Hope National Medical Center, Duarte, California, United States of America
| | - Travis Yiwey Tu
- Department of Immuno-Oncology, City of Hope National Medical Center, Duarte, California, United States of America
| | - Shawn Solomon
- Department of Immuno-Oncology, City of Hope National Medical Center, Duarte, California, United States of America
| | - Daniel Schmolze
- Department of Pathology, City of Hope National Medical Center, Duarte, California, United States of America
| | - Joanne Mortimer
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, California, United States of America
| | - Peter Lee
- Department of Immuno-Oncology, City of Hope National Medical Center, Duarte, California, United States of America
| | - Yuan Yuan
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, California, United States of America
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Yuan Y, Yost SE, Lee JS, Egelston C, Frankel PH, Ruel C, Padam S, Tang A, Martinez N, Portnow J, Yeon C, Presant C, Rajurkar S, Sedrak M, Patel N, Lee P, Mortimer J. Abstract P3-11-04: A phase II study of pembrolizumab, letrozole and palbociclib in patients with metastatic estrogen receptor positive breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-11-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The combination of CDK4/6 inhibitor and aromatase inhibitor is the current standard of care therapy for patients with estrogen receptor positive (ER+) metastatic breast cancer (MBC). Single agent immune check point inhibitor (ICI) pembrolizumab has a response rate of 12% in selected patients (PD-L1+), and preclinical studies demonstrated immune-modulatory effect of CDK4/6 inhibitors. The combination of CDK 4/6 inhibitors and ICI might turn “immune-cold” breast cancer tumors into “immune-hot” tumors. This study was designed to evaluate the safety and efficacy of adding pembrolizumab to letrozole and palbociclib in patients with ER+ MBC.
Methods: This is an open-label single arm study enrolling patients with biopsy proven ER+ MBC with measurable disease by RECIST1.1, ECOG performance status 0-1. Patient received letrozole (2.5mg po daily), palbociclib (125mg po daily 3 weeks on, 1 week off), and pembrolizumab (200mg iv q3wks). Two cohorts were included: cohort 1 for patients who were previously on letrozole and palbociclib for > 6 months and had pembrolizumab added on C1D1, and cohort 2 for patients who had all 3 drugs started on C1D1. Premenopausal patients received ovarian suppression prior to C1D1. The primary objective was to determine the safety and tolerability of the combination. The secondary objectives were RR, PFS, and OS. For both cohorts, a three-at-risk design (modified rolling design) was used for safety-lead to ensure the triplet was well-tolerated. This design permitted only 3 patients to be a risk for DLT at any one time during the “safety lead-in” and permitted continuing accrual if ≤1 DLT occurred in the first 6 patients. Secondary consideration was response (cohort 2 only), with an a priori requirement of at least 9 responses to warrant further evaluation. Baseline tumor specimen, peripheral blood plasma, and PBMCs were collected for immune correlative analysis.
Results: A total of 20 patients were accrued to this trial (4 in cohort 1, 16 in cohort 2), with 19 eligible for response assessment because one patient was determined to be TNBC upon repeat of biopsy. Median age was 49 years, with 40% Hispanic, and 60% non-Hispanic. There were 2 DLTs (1 biopsy site infection and delay in treatment that was possibly related to treatment in cohort 1, and 1 pneumonitis in cohort 2). 9/20 patients (45%) had dose delay and 9/20 patients (45%) had dose reduction, with the most common cause being neutropenia. Gr 4 AEs included neutropenia (n=4), WBC (n=3), LFT (n=1), and bowel perforation (n=1). Grade 3 AEs included neutropenia (n=11), WBC (n=9), LFT (n=3), PLT (n=2), and pneumonitis, pruritus, anemia, biopsy site infection (n=1 each). Other immune-related toxicities of Grade 2 included: hypothyroidism, colitis, LFTs, and dermatitis (n≤2 each). Responses were CR 1/19 (5.3%), PR 8/19 (42.1%), SD 6/19 (31.6%) and PD 4/19 (21.1%). Median follow up was 13.7 (95% CI 6.4-16.9) months and median PFS was not reached. No association of baseline tumor PD-L1 (22C3) and clinical response were observed (data available on 13 patients). PBMC flow from the first 9 patients (5 PR, 4 SD) showed lower percentage of naïve CD8+ T cells (CD8+CD45RA+ CD27+), and higher level of non-naïve KLRG1+CD8+ T cell (CD8+CD45RA− CD27− KLRG1+) were associated with clinical response (p<0.05).
Conclusion: The combination of letrozole, palbociclib, and pembrolizumab is well tolerated in patients with ER+ MBC.
Citation Format: Yuan Yuan, Susan E Yost, Jin Sun Lee, Colt Egelston, Paul H Frankel, Christopher Ruel, Simran Padam, Aileen Tang, Norma Martinez, Jana Portnow, Christina Yeon, Cary Presant, Swapnil Rajurkar, Mina Sedrak, Niki Patel, Peter Lee, Joanne Mortimer. A phase II study of pembrolizumab, letrozole and palbociclib in patients with metastatic estrogen receptor positive breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-11-04.
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Akhavan D, Yazaki P, Yamauchi D, Simpson J, Frankel PH, Bading J, Colcher D, Poku K, Chen YJ, Lim D, Cristea M, Wu A, Shively J, Wong JY. Phase I Study of Yttrium-90 Radiolabeled M5A Anti-Carcinoembryonic Antigen Humanized Antibody in Patients with Advanced Carcinoembryonic Antigen Producing Malignancies. Cancer Biother Radiopharm 2020; 35:10-15. [PMID: 31910346 PMCID: PMC7044770 DOI: 10.1089/cbr.2019.2992] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 11/13/2022] Open
Abstract
Background: M5A is a humanized monoclonal antibody (mAb) directed against carcinoembryonic antigen (CEA) The purpose of this first in human phase I dose-escalation trial was to characterize the toxicities and determine the maximum tolerated dose (MTD) of yttrium-90 (90Y)-DOTA-M5A as a single agent and in combination with gemcitabine (gem). Methods: Patients with advanced metastatic CEA-producing malignancies who had progressed on standard therapies were first administered indium-111 (111In)-DOTA-M5A. If tumor targeting was observed, the patient then received the therapy dose of 90Y-DOTA-M5A. Serial scans, blood sampling, and 24 h urine collections were then performed to estimate radiation doses to organs and total body. Assays for human antihuman antibody (HAHA) responses were performed out to 6 months. Results: Of the 18 patients who received 111In-DOTA-M5A, 16 received 90Y-DOTA-M5A therapy; 1 patient at 14 mCi/m2 with gem (150 mg/m2 days 1and 3), 3 patients at 12 mCi/m2 with gem, 6 patients at 12 mCi/m2 without gem, and 6 at 10 mCi/m2 without gem. Prolonged cytopenias resulted in discontinuation of dose escalation with gemcitabine. A single agent MTD of 10 mCi/m2 was established based on dose-limiting hematopoietic toxicities. HAHA immune response was identified in 2 of 16 patients (12.5%). Stable disease at 3 months was seen in 10 patients and 2 patients demonstrated an 88% and 64% decrease in CEA back to normal levels. In 2 patients 111In-DOTA-M5A imaging revealed previously unknown brain metastases. Conclusion: This study demonstrates the potential utility of the 90Y-DOTA-M5A anti-CEA mAb as a therapeutic antibody. There is decreased immunogenicity compared with murine and chimeric mAbs, allowing for the potential of multiple administrations. Combined modality therapy approaches incorporating this agent should continue to be evaluated.
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Affiliation(s)
- David Akhavan
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Paul Yazaki
- Department of Molecular Imaging and Therapy, Beckman Research Institute, Duarte, California
| | - Dave Yamauchi
- Department of Diagnostic Radiology, City of Hope National Cancer Center, Duarte, California
| | - Jennifer Simpson
- Department of Medical Oncology, City of Hope National Cancer Center, Duarte, California
| | - Paul H. Frankel
- Department of Information Sciences, City of Hope National Cancer Center, Duarte, California
| | - James Bading
- Department of Molecular Imaging and Therapy, Beckman Research Institute, Duarte, California
| | - David Colcher
- Department of Molecular Imaging and Therapy, Beckman Research Institute, Duarte, California
| | - Kofi Poku
- Department of Molecular Imaging and Therapy, Beckman Research Institute, Duarte, California
| | - Yi-jen Chen
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Dean Lim
- Department of Medical Oncology, City of Hope National Cancer Center, Duarte, California
| | - Mihaela Cristea
- Department of Medical Oncology, City of Hope National Cancer Center, Duarte, California
| | - Anna Wu
- Department of Molecular Imaging and Therapy, Beckman Research Institute, Duarte, California
| | - John Shively
- Department of Molecular Imaging and Therapy, Beckman Research Institute, Duarte, California
| | - Jeffrey Y.C. Wong
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
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Afkhami M, Schmolze D, Yost SE, Frankel PH, Dagis A, Amanam IU, Telatar M, Nguyen K, Yu KW, Luu T, Pillai R, Aoun PA, Mortimer J, Yuan Y. Mutation and immune profiling of metaplastic breast cancer: Correlation with survival. PLoS One 2019; 14:e0224726. [PMID: 31693690 PMCID: PMC6834262 DOI: 10.1371/journal.pone.0224726] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/21/2019] [Indexed: 12/18/2022] Open
Abstract
The goal of this study is to characterize the genomic and immune profiles of metaplastic breast cancer (MpBC) and identify the association with survival through an analysis of archived tumor tissue. A next-generation sequencing-based mutational assay (Onco-48) was performed for 21 MpBC patients. Clinicopathologic characteristics were captured, including relapse free survival (RFS) and overall survival (OS). Immunohistochemistry (IHC) for CD3, CD4, CD8, and programmed death-ligand 1 (PD-L1) was also performed. Recurrence free survival (RFS) at 5 years was 57% (95% CI 0.34-0.75) and overall survival (OS) at 5 years was 66% (95% CI 0.41-0.82). The most commonly altered genes were TP53 (68.4%, 13/19), PIK3CA (42.1%, 8/19), and PTEN (15.8%, 3/19. For patients with PIK3CA mutations, RFS and OS were significantly worse than for those without (HR 5.6, 95% CI 1.33-23.1 and HR 8.0, 95% CI 1.53-41.7, respectively). Cox regression estimated that PD-L1 expression was associated with worse RFS and OS (HR 1.08, 95% CI 1.01-1.16 and HR 1.05, 95% CI 1.00-1.11, respectively, for an absolute increase in PD-L1 expression of 1%). In conclusion, PIK3CA mutation and PD-L1 expression confer poor prognosis in this cohort of patients with MpBC.
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Affiliation(s)
- Michelle Afkhami
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Susan E. Yost
- Department of Medical Oncology & Therapeutic Research, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Paul H. Frankel
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Andrew Dagis
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Idoroenyi U. Amanam
- Department of Medical Oncology & Therapeutic Research, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Milhan Telatar
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Kim Nguyen
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Kim Wai Yu
- Department of Clinical Pharmacy, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Thehang Luu
- Department of Medical Oncology & Therapeutic Research, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Raju Pillai
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Patricia A. Aoun
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Joanne Mortimer
- Department of Medical Oncology & Therapeutic Research, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Yuan Yuan
- Department of Medical Oncology & Therapeutic Research, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
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28
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Egelston CA, Avalos C, Tu TY, Rosario A, Wang R, Solomon S, Srinivasan G, Nelson MS, Huang Y, Lim MH, Simons DL, He TF, Yim JH, Kruper L, Mortimer J, Yost S, Guo W, Ruel C, Frankel PH, Yuan Y, Lee PP. Resident memory CD8+ T cells within cancer islands mediate survival in breast cancer patients. JCI Insight 2019; 4:130000. [PMID: 31465302 DOI: 10.1172/jci.insight.130000] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/23/2019] [Indexed: 12/17/2022] Open
Abstract
CD8+ tumor-infiltrating lymphocytes (TILs) correlate with relapse-free survival (RFS) in most cancer types, including breast cancer. However, subset composition, functional status, and spatial location of CD8+ TILs in relation to RFS in human breast tumors remain unclear. Spatial tissue analysis via quantitative immunofluorescence showed that infiltration of CD8+ T cells into cancer islands was more significantly associated with RFS than CD8+ T cell infiltration into either tumor stroma or total tumor. Localization into cancer islands within tumors is mediated by expression of the integrin CD103, which is a marker for tissue-resident memory T cells (TRMs). Analysis of fresh tumor samples revealed that CD8+ TRMs are functionally similar to other CD8+ TILs, suggesting that the basis of their protective effect is their spatial distribution rather than functional differences. Indeed, CD103+ TRMs, as compared with CD103-CD8+ TILs, are enriched within cancer islands, and CD8+ TRM proximity to cancer cells drives the association of CD8+ TIL densities with RFS. Together, these findings reveal the importance of cancer island-localized CD8+ TRMs in surveillance of the breast tumor microenvironment and as a critical determinant of RFS in patients with breast cancer.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Christopher Ruel
- Department of Biostatistics, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Paul H Frankel
- Department of Biostatistics, Beckman Research Institute, City of Hope, Duarte, California, USA
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Lin FM, Yost SE, Wen W, Frankel PH, Schmolze D, Chu PG, Yuan YC, Liu Z, Yim J, Chen Z, Yuan Y. Differential gene expression and AKT targeting in triple negative breast cancer. Oncotarget 2019; 10:4356-4368. [PMID: 31320990 PMCID: PMC6633890 DOI: 10.18632/oncotarget.27026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 04/10/2019] [Accepted: 05/30/2019] [Indexed: 02/03/2023] Open
Abstract
Background: Metastatic triple negative breast cancer (mTNBC) is a heterogeneous disease with poor prognosis. Molecular evolution of TNBC through chemotherapy selection pressure is well recognized but poorly understood. PI3K/AKT/mTOR is one of the most commonly identified oncogenic-driver pathways in breast cancer. The current study is designed to understand the genomic and transcriptomic changes, focusing on the PI3K/AKT/mTOR pathway alterations in paired primary and metastatic TNBCs. Results: Genomic analysis of 7 paired specimens identified 67 known mutations including those from the following signaling pathways: cell cycle, p53, PI3K/AKT/mTOR, RAS/MAPK, and RTK/GF. Principle coordinate analysis (PCoA) identified 4 distinctive molecular groups based on the gene expression patterns of PI3K/AKT/mTOR pathway. Key differentially-expressed genes included AKT3, GSK3B, GNA11, PI3KR1, and GNAQ. Importantly, AKT-targeted therapy showed efficacy in a patient-derived xenograft (PDX) model of TNBC in vivo. Conclusion: Genomic discordance of paired primary and metastatic TNBCs was identified, with significant increase in tumor proliferation pathways seen in metastases. Among the differentially expressed genes, AKT3 can potentially serve as a target for novel combination therapy for treatment of metastatic TNBC. Methods: Paired specimens from 10 patients with TNBCs were identified through an IRB-approved protocol (2002-2015). FoundationOneTM sequencing was performed for genomic profiling, and Affymetrix Human Genechip 2.0st was used for mRNA expression profiling. The similarity among samples was calculated based on Pearson correlation coefficients, which were used to construct hierarchical clustering and heat maps.
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Affiliation(s)
- Feng-Mao Lin
- Department of Diabetes Complications and Metabolism, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Susan E. Yost
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Wei Wen
- Department of Surgery, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Paul H. Frankel
- Department of Biostatistics, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Daniel Schmolze
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Pei-Guo Chu
- Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Yate-Ching Yuan
- Bioinformatics Core Facility, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Zheng Liu
- Bioinformatics Core Facility, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - John Yim
- Department of Surgery, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Zhen Chen
- Department of Diabetes Complications and Metabolism, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - Yuan Yuan
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
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Reckamp KL, Frankel PH, Ruel N, Mack PC, Gitlitz BJ, Li T, Koczywas M, Gadgeel SM, Cristea MC, Belani CP, Newman EM, Gandara DR, Lara PN. Phase II Trial of Cabozantinib Plus Erlotinib in Patients With Advanced Epidermal Growth Factor Receptor ( EGFR)-Mutant Non-small Cell Lung Cancer With Progressive Disease on Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Therapy: A California Cancer Consortium Phase II Trial (NCI 9303). Front Oncol 2019; 9:132. [PMID: 30915273 PMCID: PMC6421302 DOI: 10.3389/fonc.2019.00132] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 01/09/2019] [Accepted: 02/14/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: Mesenchymal epidermal transition and vascular endothelial growth factor pathways are important in mediating non-small cell lung cancer (NSCLC) tumorigenesis and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) resistance. We hypothesized that treatment with cabozantinib plus erlotinib in EGFR mutation-positive NSCLC following progression on EGFR TKI therapy may allow tumors to overcome this resistance or restore sensitivity to therapy regardless of T790M status. Methods: Patients with advanced NSCLC, known EGFR mutation and progressive disease on an EGFR TKI immediately prior to enrollment without intervening therapy were enrolled. Patients received erlotinib 150 mg and cabozantinib 40 mg daily. The primary endpoint was evaluation of efficacy by objective response rate. Secondary endpoints included assessment of progression free survival (PFS), overall survival, change in tumor growth rate, safety and toxicity, and the evaluation of specific EGFR mutations and MET amplification in pre-treatment tissue and plasma. Results: Thirty-seven patients were enrolled at 4 centers. Four patients had partial response (10.8%) and 21 had stable disease (59.5%). A greater than 30% increase in tumor doubling time was observed in 79% of assessable patients (27/34). Median PFS was 3.6 months for all patients. Diarrhea (32%) was the most common grade 3 adverse event; 3 patients had asymptomatic grade 4 elevation of amylase and lipase. Conclusions: Combination erlotinib and cabozantinib demonstrates activity in a highly pretreated population of patients with EGFR mutation and progression on EGFR TKI. Further elucidation of beneficial patient subsets is warranted. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01866410.
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Affiliation(s)
- Karen L. Reckamp
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Paul H. Frankel
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Nora Ruel
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Philip C. Mack
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States
| | | | - Tianhong Li
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States
| | | | - Shirish M. Gadgeel
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States
| | | | | | - Edward M. Newman
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - David R. Gandara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States
| | - Primo N. Lara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States
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Blenman KRM, He TF, Frankel PH, Ruel NH, Schwartz EJ, Krag DN, Tan LK, Yim JH, Mortimer JE, Yuan Y, Lee PP. Sentinel lymph node B cells can predict disease-free survival in breast cancer patients. NPJ Breast Cancer 2018; 4:28. [PMID: 30155518 PMCID: PMC6107630 DOI: 10.1038/s41523-018-0081-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 03/07/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/31/2022] Open
Abstract
Tumor invasion into draining lymph nodes, especially sentinel lymph nodes (SLNs), is a key determinant of prognosis and treatment in breast cancer as part of the TNM staging system. Using multicolor histology and quantitative image analysis, we quantified immune cells within SLNs from a discovery cohort of 76 breast cancer patients. We found statistically more in situ CD3+ T cells in tumor negative vs. tumor positive nodes (mean of 8878 vs. 6704, respectively, p = 0.006), but no statistical difference in CD20+ B cells or CD1a+ dendritic cells. In univariate analysis, a reduced hazard was seen with a unit increase in log CD3 with HR 0.49 (95% CI 0.30–0.80) and log CD20 with HR 0.37 (95% CI 0.22–0.62). In multivariate analysis, log CD20 remained significant with HR 0.42 (95% CI 0.25–0.69). When restricted to SLN tumor negative patients, increased log CD20 was still associated with improved DFS (HR = 0.26, 95% CI 0.08–0.90). The CD20 results were validated in a separate cohort of 21 patients (n = 11 good outcome, n = 10 poor outcome) with SLN negative triple-negative breast cancer (TNBC) (“good” mean of 7011 vs. “poor” mean of 4656, p = 0.002). Our study demonstrates that analysis of immune cells within SLNs, regardless of tumor invasion status, may provide additional prognostic information, and highlights B cells within SLNs as important in preventing future recurrence. B cells within the tumor-draining lymph nodes may have an important biological role in preventing relapse of breast cancer. A team led by Peter Lee from City of Hope in Duarte, California, USA, quantified the levels of three populations of immune cells—T cells, B cells and dendritic cells—within sentinel lymph nodes biopsied from a cohort of 76 patients. They found that larger numbers of T cells and B cells were both linked to longer progression-free survival in the women. However, after statistically accounting for correlations between the two immune cell types, the researchers concluded that B cells had the dominant beneficial effect on survival times. They validated the finding that high B-cell counts are a prognostic indicator of better outcomes in a separate cohort of 21 women with triple-negative breast cancer.
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Affiliation(s)
- Kim R M Blenman
- 1Department of Immuno-Oncology, City of Hope and Beckman Research Institute, Duarte, CA USA.,8Present Address: Department of Dermatology, Yale University, New Haven, CT USA
| | - Ting-Fang He
- 1Department of Immuno-Oncology, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Paul H Frankel
- 2Department of Biostatistics, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Nora H Ruel
- 2Department of Biostatistics, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Erich J Schwartz
- 3Department of Pathology, Stanford University, Stanford, CA USA.,9Present Address: Department of Pathology, Beaumont Health, Farmington Hills, MI USA
| | - David N Krag
- 4Department of Surgery, University of Vermont College of Medicine, Burlington, VT USA
| | - Lee K Tan
- 5Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - John H Yim
- 6Department of Surgery, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Joanne E Mortimer
- 7Department of Women's Health, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Yuan Yuan
- 7Department of Women's Health, City of Hope and Beckman Research Institute, Duarte, CA USA
| | - Peter P Lee
- 1Department of Immuno-Oncology, City of Hope and Beckman Research Institute, Duarte, CA USA
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Mortimer JE, Bading JR, Park JM, Frankel PH, Carroll MI, Tran TT, Poku EK, Rockne RC, Raubitschek AA, Shively JE, Colcher DM. Tumor Uptake of 64Cu-DOTA-Trastuzumab in Patients with Metastatic Breast Cancer. J Nucl Med 2017. [PMID: 28637802 DOI: 10.2967/jnumed.117.193888] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The goal of this study was to characterize the relationship between tumor uptake of 64Cu-DOTA-trastuzumab as measured by PET/CT and standard, immunohistochemistry (IHC)-based, histopathologic classification of human epidermal growth factor receptor 2 (HER2) status in women with metastatic breast cancer (MBC). Methods: Women with biopsy-confirmed MBC and not given trastuzumab for 2 mo or more underwent complete staging, including 18F-FDG PET/CT. Patients were classified as HER2-positive (HER2+) or -negative (HER2-) based on fluorescence in situ hybridization (FISH)-supplemented immunohistochemistry of biopsied tumor tissue. Eighteen patients underwent 64Cu-DOTA-trastuzumab injection, preceded in 16 cases by trastuzumab infusion (45 mg). PET/CT was performed 21-25 (day 1) and 47-49 (day 2) h after 64Cu-DOTA-trastuzumab injection. Radiolabel uptake in prominent lesions was measured as SUVmax Average intrapatient SUVmax (<SUVmax>pt) was compared between HER2+ and HER2- patients. Results: Eleven women were HER2+ (8 immunohistochemistry 3+; 3 immunohistochemistry 2+/FISH amplified), whereas 7 were HER2- (3 immunohistochemistry 2+/FISH nonamplified; 4 immunohistochemistry 1+). Median <SUVmax>pt for day 1 and day 2 was 6.6 and 6.8 g/mL for HER 2+ and 3.7 and 4.3 g/mL for HER2- patients (P < 0.005 either day). The distributions of <SUVmax>pt overlapped between the 2 groups, and interpatient variability was greater for HER2+ than HER2- disease (P < 0.005 and 0.001, respectively, on days 1 and 2). Conclusion: By 1 d after injection, uptake of 64Cu-DOTA-trastuzumab in MBC is strongly associated with patient HER2 status and is indicative of binding to HER2. The variability within and among HER2+ patients, as well as the overlap between the HER2+ and HER2- groups, suggests a role for 64Cu-DOTA-trastuzumab PET/CT in optimizing treatments that include trastuzumab.
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Affiliation(s)
- Joanne E Mortimer
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - James R Bading
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - Jinha M Park
- Department of Radiology, City of Hope, Duarte, California
| | - Paul H Frankel
- Department of Information Sciences, City of Hope, Duarte, California
| | - Mary I Carroll
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - Tri T Tran
- Department of Radiology, City of Hope, Duarte, California
| | - Erasmus K Poku
- Department of Cancer Immunotherapy and Tumor Immunology, Beckman Research Institute of the City of Hope, Duarte, California; and
| | - Russell C Rockne
- Department of Information Sciences, City of Hope, Duarte, California
| | - Andrew A Raubitschek
- Department of Cancer Immunotherapy and Tumor Immunology, Beckman Research Institute of the City of Hope, Duarte, California; and
| | - John E Shively
- Department of Immunology, Beckman Research Institute of the City of Hope, Duarte, California
| | - David M Colcher
- Department of Cancer Immunotherapy and Tumor Immunology, Beckman Research Institute of the City of Hope, Duarte, California; and
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Somlo G, Frankel PH, Arun BK, Ma CX, Garcia AA, Cigler T, Cream LV, Harvey HA, Sparano JA, Nanda R, Chew HK, Moynihan TJ, Vahdat LT, Goetz MP, Beumer JH, Hurria A, Mortimer J, Piekarz R, Sand S, Herzog J, Van Tongeren LR, Ferry-Galow KV, Chen AP, Ruel C, Newman EM, Gandara DR, Weitzel JN. Efficacy of the PARP Inhibitor Veliparib with Carboplatin or as a Single Agent in Patients with Germline BRCA1- or BRCA2-Associated Metastatic Breast Cancer: California Cancer Consortium Trial NCT01149083. Clin Cancer Res 2017; 23:4066-4076. [PMID: 28356425 DOI: 10.1158/1078-0432.ccr-16-2714] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/05/2016] [Accepted: 03/24/2017] [Indexed: 11/16/2022]
Abstract
Purpose: We aimed to establish the MTD of the poly (ADP-ribose) (PAR) polymerase inhibitor, veliparib, in combination with carboplatin in germline BRCA1- and BRCA2- (BRCA)-associated metastatic breast cancer (MBC), to assess the efficacy of single-agent veliparib, and of the combination treatment after progression, and to correlate PAR levels with clinical outcome.Experimental Design: Phase I patients received carboplatin (AUC of 5-6, every 21 days), with escalating doses (50-20 mg) of oral twice-daily (BID) veliparib. In a companion phase II trial, patients received single-agent veliparib (400 mg BID), and upon progression, received the combination at MTD. Peripheral blood mononuclear cell PAR and serum veliparib levels were assessed and correlated with outcome.Results: Twenty-seven phase I trial patients were evaluable. Dose-limiting toxicities were nausea, dehydration, and thrombocytopenia [MTD: veliparib 150 mg po BID and carboplatin (AUC of 5)]. Response rate (RR) was 56%; 3 patients remain in complete response (CR) beyond 3 years. Progression-free survival (PFS) and overall survival (OS) were 8.7 and 18.8 months. The PFS and OS were 5.2 and 14.5 months in the 44 patients in the phase II trial, with a 14% RR in BRCA1 (n = 22) and 36% in BRCA2 (n = 22). One of 30 patients responded to the combination therapy after progression on veliparib. Higher baseline PAR was associated with clinical benefit.Conclusions: Safety and efficacy are encouraging with veliparib alone and in combination with carboplatin in BRCA-associated MBC. Lasting CRs were observed when the combination was administered first in the phase I trial. Further investigation of PAR level association with clinical outcomes is warranted. Clin Cancer Res; 23(15); 4066-76. ©2017 AACR.
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Affiliation(s)
- George Somlo
- City of Hope Comprehensive Cancer Center, Duarte, California.
| | - Paul H Frankel
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Banu K Arun
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cynthia X Ma
- Washington University School of Medicine, St. Louis, Missouri
| | - Agustin A Garcia
- University of Southern California/Norris Cancer Center, Los Angeles, California
| | | | - Leah V Cream
- Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Joseph A Sparano
- Montefiore Medical Center, Moses & Weuker Divisions, Department of Oncology, Bronx, New York
| | - Rita Nanda
- The University of Chicago, Chicago, Illinois
| | - Helen K Chew
- University of California, Davis Cancer Center, Sacramento, California
| | | | | | | | - Jan H Beumer
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Arti Hurria
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Joanne Mortimer
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Richard Piekarz
- Investigational Drug Branch, Cancer Therapy Evaluation Program, DCTD, NCI, Bethesda, Maryland
| | - Sharon Sand
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Josef Herzog
- City of Hope Comprehensive Cancer Center, Duarte, California
| | | | - Katherine V Ferry-Galow
- Applied/Developmental Research Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratories, Frederick, Maryland
| | - Alice P Chen
- Investigational Drug Branch, Cancer Therapy Evaluation Program, DCTD, NCI, Bethesda, Maryland
| | | | - Edward M Newman
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - David R Gandara
- University of California, Davis Cancer Center, Sacramento, California
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Abstract
OPINION STATEMENT The immune system plays an active role in the pathogenesis of ovarian cancer (OC), as well as in the mechanisms of disease progression and overall survival (OS). Immunotherapy in gynecological cancers could help to revert immunosuppression and lymphocyte depletion due to prior treatments. Current immunotherapies for ovarian cancer, like all cancer immunotherapy, are based on either stimulating the immune system or reverting immune suppression. Several approaches have been used, including therapeutic vaccines, monoclonal antibodies; checkpoint inhibitors and adoptive T cell transfer. Most of these therapies are still in early-phase testing (phase I and II) for ovarian cancer, but the initial data in ovarian cancer and successful use in other types of cancers suggests some of these approaches may ultimately prove useful for ovarian cancer as well. Ovarian cancer vaccines have shown only a modest benefit in ovarian cancer when used as monotherapy, but these agents may be able to enhance antitumor activity when combined with chemotherapy, checkpoint inhibitors, or other immunotherapies. Monoclonal antibodies have been explored in ovarian cancer but despite encouraging phase II data, randomized studies failed to demonstrate significant clinical benefit. Check point inhibitors have promising activity in several solid tumors and have demonstrated a favorable toxicity profile. Data from early clinical trials utilizing PD1 and PD-L1 inhibitors showed encouraging results. Ongoing clinical trials are evaluating the role of check point inhibitors in combination with chemotherapy. Adoptive T cell transfer involves the infusion of ex vivo activated and expanded tumor specific T cells, using various sources and types of T cells. While this approach has been explored in several hematologic malignancies, it constitutes early research in ovarian cancer. Immunotherapy remains investigational in ovarian cancer and the benefit of this approach in improving progression-free survival (PFS) or OS is unknown. Previous clinical trials have not selected patients based on biomarkers and this may explain the negative results. We expect to discover that tumor response will relate to the patient's immune features and specific tumor characteristics. We are only beginning to realize the potential of immunotherapy for ovarian cancer patients, and one goal of future clinical trials will be to identify subsets of patient based on histologic, molecular, and immune characteristics.
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Affiliation(s)
- Nicola Hardwick
- Department of Experimental Therapeutics, Beckman Research Institute of City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Paul H Frankel
- Division of Biostatistics, Beckman Research Institute of City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Mihaela Cristea
- Department of Medical Oncology, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA.
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Wang Y, Han E, Xing Q, Yan J, Arrington A, Wang C, Tully D, Kowolik CM, Lu DM, Frankel PH, Zhai J, Wen W, Horne D, Yip MLR, Yim JH. Baicalein upregulates DDIT4 expression which mediates mTOR inhibition and growth inhibition in cancer cells. Cancer Lett 2014; 358:170-179. [PMID: 25543165 DOI: 10.1016/j.canlet.2014.12.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/12/2014] [Accepted: 12/14/2014] [Indexed: 11/28/2022]
Abstract
Baicalein is a natural flavone that exhibits anticancer properties. Using microarrays we found that DDIT4 was the highest transcript induced by baicalein in cancer cells. We confirmed in multiple cancer cell lines large, dose-related expression of DDIT4 by quantitative RT-PCR and immunoblot, which correlates with growth inhibition. Time course experiments demonstrate that DDIT4 is rapidly inducible, with high expression maintained for several days in vitro. Induction of DDIT4 expression is p53 independent based on evaluation of p53 knockout cells. Since DDIT4 is known to inhibit mTORC1 activity we confirmed that baicalein suppresses phosphorylation of mTORC1 targets. Using RNA interference we demonstrate that mTORC1 activity and growth inhibition by baicalein is attenuated by knockdown of DDIT4. We furthermore demonstrate suppression of established tumors by baicalein in a mouse model of breast cancer with increased DDIT4 expression in the tumors. Finally, we demonstrate that baicalein upregulates DDIT4 and causes mTORC1 and growth inhibition in platinum resistant cancer cells in marked contrast to platinum chemotherapy treatment. These studies demonstrate that baicalein inhibits mTORC1 through DDIT4 expression, and may be useful in cancer chemotherapy and chemoprevention.
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Affiliation(s)
- Yujun Wang
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Ernest Han
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Quanhua Xing
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Jin Yan
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Amanda Arrington
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Charles Wang
- Molecular & Cellular Biology, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Dylan Tully
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Claudia M Kowolik
- Molecular & Cellular Biology, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA; Medical Oncology, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - David M Lu
- Molecular Medicine, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Paul H Frankel
- Biostatistics, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Jing Zhai
- Pathology, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - Wei Wen
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - David Horne
- Molecular Medicine, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - M L Richard Yip
- Molecular Medicine, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA
| | - John H Yim
- Departments of Surgery, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd, Duarte, CA 91010, USA.
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36
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Koczywas M, Frankel PH, Synold TW, Lenz HJ, Mortimer JE, El-Khoueiry AB, Gandara DR, Cristea MC, Chung VM, Lim D, Reckamp KL, Lau DH, Doyle LA, Ruel C, Carroll MI, Newman EM. Phase I study of the halichondrin B analogue eribulin mesylate in combination with cisplatin in advanced solid tumors. Br J Cancer 2014; 111:2268-74. [PMID: 25349975 PMCID: PMC4264453 DOI: 10.1038/bjc.2014.554] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/05/2014] [Accepted: 10/01/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Eribulin mesylate is a synthetic macrocyclic ketone analogue of Halichondrin B that has demonstrated high antitumor activity in preclinical and clinical settings. This phase I study aimed to determine the maximum tolerated dose (MTD), dose-limiting toxicities (DLTs), and pharmacokinetics in combination with cisplatin (CP) in patients with advanced solid tumours. METHODS Thirty-six patients with advanced solid tumours received eribulin mesylate 0.7-1.4 mg m(-2) and CP 60-75 mg m(-2). Eribulin mesylate was administered on days 1, 8, and 15 in combination with CP day 1 every 28-day cycle. The protocol was amended after dose level 4 (eribulin mesylate 1.4 mg m(-2), CP 60 mg m(-2)) when it was not feasible to administer eribulin mesylate on day 15 because of neutropenia; the treatment schedule was changed to eribulin mesylate on days 1 and 8 and CP on day 1 every 21 days. RESULTS On the 28-day schedule, three patients had DLT during the first cycle: grade (G) 4 febrile neutropenia (1.0 mg m(-2), 60 mg m(-2)); G 3 anorexia/fatigue/hypokalemia (1.2 mg m(-2), 60 mg m(-2)); and G 3 stomatitis/nausea/vomiting/fatigue (1.4 mg m(-2), 60 mg m(-2)). On the 21-day schedule, three patients had DLT during the first cycle: G 3 hypokalemia/hyponatremia (1.4 mg m(-2), 60 mg m(-2)); G 4 mucositis (1.4 mg m(-2), 60 mg m(-2)); and G 3 hypokalemia (1.2 mg m(-2), 75 mg m(-2)). The MTD and recommended phase II dose was determined as eribulin mesylate 1.2 mg m(-2) (days 1, 8) and CP 75 mg m(-2) (day 1), on a 21-day cycle. Two patients had unconfirmed partial responses (PR) (pancreatic and breast cancers) and two had PR (oesophageal and bladder cancers). CONCLUSIONS On the 21-day cycle, eribulin mesylate 1.2 mg m(-2), administered on days 1 and 8, in combination with CP 75 mg m(-2), administered on day 1 is well tolerated and showed preliminary anticancer activity.
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Affiliation(s)
- M Koczywas
- Department of Medical Oncology, City of Hope, Duarte, CA, USA
| | - P H Frankel
- Department of Information Sciences, City of Hope, Duarte, CA, USA
| | - T W Synold
- Department of Molecular Pharmacology, City of Hope National Medical Center, Duarte, CA, USA
| | - H-J Lenz
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - J E Mortimer
- Department of Medical Oncology, City of Hope, Duarte, CA, USA
| | - A B El-Khoueiry
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - D R Gandara
- Medical Center, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - M C Cristea
- Department of Medical Oncology, City of Hope, Duarte, CA, USA
| | - V M Chung
- Department of Medical Oncology, City of Hope, Duarte, CA, USA
| | - D Lim
- Department of Medical Oncology, City of Hope, Duarte, CA, USA
| | - K L Reckamp
- Department of Medical Oncology, City of Hope, Duarte, CA, USA
| | - D H Lau
- Medical Center, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - L A Doyle
- Investigational Drug Research, National Cancer Institute, Rockville, MD, USA
| | - C Ruel
- Department of Information Sciences, City of Hope, Duarte, CA, USA
| | - M I Carroll
- Department of Research-RN, City of Hope, Duarte, CA, USA
| | - E M Newman
- Department of Molecular Pharmacology, City of Hope National Medical Center, Duarte, CA, USA
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Pal SK, Hossain DMS, Zhang Q, Gao C, Jones JO, Frankel PH, Figlin RA, Kortylewski M. Abstract CT334: Pazopanib as third-line therapy for metastatic renal cell carcinoma: Clinical efficacy and temporal analysis of cytokine profile. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-ct334] [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: Pazopanib was assessed in a phase III study conducted in patients (pts) with mRCC who were either cytokine-refractory or treatment-naïve, and clinical outcomes with pazopanib have been associated with a specific immunologic profile (IP). The activity of pazopanib in the third-line setting and temporal changes in molecular profile during therapy are poorly understood, however.
Methods: Eligibility was limited to pts with 2 prior lines of therapy (including at least 1 VEGF-directed therapy), ECOG PS 0-2, and clear cell histology. Pts received pazopanib 800 mg/daily on a 28d cycle. A Simon MinMax 2-stage design was employed, with 80% power of declaring an encouraging overall response rate (ORR) of 23% (type I error=10%). IPs were assessed monthly on a Luminex platform using the Human Cytokine 30-plex Cytokine Immunoassay (Invitrogen).
Results: 28 pts were enrolled with a median age of 63 (range, 45-86). In the pre-specified intent-to-treat analysis, 12/28 pts (43%) had a confirmed response (1 CR, 11 PR), with 1 additional unconfirmed PR. Median progression-free survival for the cohort was 17.4 mos (95% CI 14.7-NR). No grade 4 treatment-related toxicities were observed. The most common grade 3 toxicities included hypertension (46%) and proteinuria (14%). Amongst patients still on therapy at 6 months and 12 months, responders had lower levels of HGF, VEGF, IL-6, IL-8 and soluble IL-2R (P<0.05 for each). Non-responders also showed increased numbers of myeloid-derived suppressor cells (MDSCs) at both time intervals. Phenotypic and functional studies confirmed that MDSCs from these mRCC patients were granulocytic.
Conclusions: The ORR observed with pazopanib in the current study is the highest to date in a third-line trial in mRCC. Differences in cytokine profile and granulocytic MDSC quantity between responders and non-responders suggest that the mechanism of pazopanib resistance is at least partly related to generation of systemic tumor immune tolerance.
Citation Format: Sumanta K. Pal, Dewan Md Sakib Hossain, Qifang Zhang, Chan Gao, Jeremy O. Jones, Paul H. Frankel, Robert A. Figlin, Marcin Kortylewski. Pazopanib as third-line therapy for metastatic renal cell carcinoma: Clinical efficacy and temporal analysis of cytokine profile. [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 CT334. doi:10.1158/1538-7445.AM2014-CT334
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Affiliation(s)
| | | | - Qifang Zhang
- 1City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Chan Gao
- 1City of Hope Comprehensive Cancer Center, Duarte, CA
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Waliany S, Dieli-Conwright CM, Frankel PH, Hurria A, Chao J, Tiep B, Mortimer JE. Validation and feasibility of a caloric expenditure measuring device in women with early-stage breast cancer. Support Care Cancer 2014; 22:2329-36. [PMID: 25082619 DOI: 10.1007/s00520-014-2212-5] [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] [Received: 07/27/2013] [Accepted: 03/09/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study is to validate the Bodybugg (BB), a caloric expenditure measuring device, in breast cancer patients undergoing adjuvant and neoadjuvant chemotherapy for early-stage breast cancer. METHODS Twenty-five women with stages I-III breast cancer who were to receive adjuvant dose-dense doxorubicin/cyclophosphamide were recruited. Participants were asked to wear the BB and record activity logs for seven pretreatment days (prior to commencing chemotherapy) and seven posttreatment days (upon completing cycle 4 of chemotherapy). The BB's caloric expenditure measurements were used to calculate metabolic equivalent (MET) values of patients' recorded activities. BB-calculated METs were compared with matching METs from the 2011 Compendium of Physical Activities Tracking Guide to assess accuracy of the device. RESULTS The overall patient sample wore the device for an average of 5.32 (SD 1.75) pre- and 4.88 (SD 2.01) posttreatment days. The mean pairwise difference between BB and Compendium METs was 0.043 (SD 0.77) for 308 pretreatment activities recorded by 12 patients and 0.065 (SD 0.61) for 108 posttreatment activities recorded by 6 patients, indicating close to zero bias between the BB's and Compendium's measurements. Hierarchical linear modeling showed that Compendium METs strongly predict for BB METs (P < 0.00001). CONCLUSIONS The BB is feasible to use in study designs involving defined time periods of measurement and provides accurate and objective measurements of caloric expenditure in breast cancer patients.
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Affiliation(s)
- Sarah Waliany
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, USA
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Senthil M, Chaudhary P, Smith DD, Ventura PE, Frankel PH, Pullarkat V, Trisal V. A shortened activated partial thromboplastin time predicts the risk of catheter-associated venous thrombosis in cancer patients. Thromb Res 2014; 134:165-8. [DOI: 10.1016/j.thromres.2014.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/08/2014] [Accepted: 04/15/2014] [Indexed: 11/16/2022]
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Frankel PH, Parker RS, Madsen FC, Whanger PD. Baseline selenium and prostate cancer risk: comments and open questions. J Natl Cancer Inst 2014; 106:dju005. [PMID: 24563520 DOI: 10.1093/jnci/dju005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Paul H Frankel
- Affiliations of authors: Division of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA (PHF); Division of Nutritional Sciences, Cornell University, Ithaca, NY (RSP); Madsen Nutrition Services, Highland, IL (FCM); Department of Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR (PDW)
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Kwok CS, Frankel PH, Lopatin G, Williams LE. Using a single parameter to describe time-activity curves. Cancer Biother Radiopharm 2014; 29:83-6. [PMID: 24383763 DOI: 10.1089/cbr.2013.1568] [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: 11/13/2022] Open
Abstract
Time-activity uptake curves [u(t) in % injected dose per gram of tissue] may be described by different--often complicated--functional forms. Because of the need to readily compare sequences of engineered radiopharmaceuticals, it is efficient to use mean residence time (MRT) as a one-parameter descriptor. In applying this computation to a sequence of five cognate anti-carcinoembryonic antigen (CEA) antibodies, it was found that the intact form had the longest MRT in the blood with the other four cognates having values less by approximately a factor of 10 or more. This difference probably follows from the lack of an intact Fc segment on the latter engineered molecules. MRT values for a sequence of six scFv-Fc engineered fragments demonstrated that the double mutant had the shortest blood residence time--30-fold less compared with the wild type. Whereas it is not possible to directly apply the MRT to nonbolus (tumor or organ) curves, a residence time (τ) may be assigned using the uptake function. Using τ, it was found that the intact (natural) form of the anti-CEA cognate set had the longest time at the tumor site in the human xenograft model in nude mice. The MRT and τ concept are proposed to also allow comparison of possible relative blood and tissue exposures, respectively, for cognate sets of unlabeled engineered antibodies used to treat malignancies although no data are yet available in the literature for this application.
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Affiliation(s)
- Cheuk S Kwok
- 1 Division of Cancer Immunotherapy and Tumor Immunology, City of Hope National Medical Center , Duarte, California
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Mortimer JE, Bading JR, Colcher DM, Conti PS, Frankel PH, Carroll MI, Tong S, Poku E, Miles JK, Shively JE, Raubitschek AA. Functional imaging of human epidermal growth factor receptor 2-positive metastatic breast cancer using (64)Cu-DOTA-trastuzumab PET. J Nucl Med 2013; 55:23-9. [PMID: 24337604 DOI: 10.2967/jnumed.113.122630] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [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: 01/10/2023] Open
Abstract
UNLABELLED Women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer are candidates for treatment with the anti-HER2 antibody trastuzumab. Assessment of HER2 status in recurrent disease is usually made by core needle biopsy of a single lesion, which may not represent the larger tumor mass or other sites of disease. Our long-range goal is to develop PET of radiolabeled trastuzumab for systemically assessing tumor HER2 expression and identifying appropriate use of anti-HER2 therapies. The purpose of this study was to evaluate PET/CT of (64)Cu-DOTA-trastuzumab for detecting and measuring tumor uptake of trastuzumab in patients with HER2-positive metastatic breast cancer. METHODS Eight women with biopsy-confirmed HER2-positive metastatic breast cancer and no anti-HER2 therapy for 4 mo or longer underwent complete staging, including (18)F-FDG PET/CT. For 6 of the 8 patients, (64)Cu-DOTA-trastuzumab injection (364-512 MBq, 5 mg of trastuzumab) was preceded by trastuzumab infusion (45 mg). PET/CT (PET scan duration 1 h) was performed 21-25 (day 1) and 47-49 (day 2) h after (64)Cu-DOTA-trastuzumab injection. Scan fields of view were chosen on the basis of (18)F-FDG PET/CT. Tumor detection sensitivity and uptake analyses were limited to lesions identifiable on CT; lesions visualized relative to adjacent tissue on PET were considered PET-positive. Radiolabel uptake in prominent lesions was measured as maximum single-voxel standardized uptake value (SUVmax). RESULTS Liver uptake of (64)Cu was reduced approximately 75% with the 45-mg trastuzumab predose, without significant effect on tumor uptake. The study included 89 CT-positive lesions. Detection sensitivity was 77%, 89%, and 93% for day 1, day 2, and (18)F-FDG, respectively. On average, tumor uptake was similar for (64)Cu-DOTA-trastuzumab and (18)F-FDG (SUVmax and range, 8.1 and 3.0-22.5 for day 1 [n = 48]; 8.9 and 0.9-28.9 for day 2 [n = 38]; 9.7 and 3.3-25.4 for (18)F-FDG [n = 56]), but same-lesion SUVmax was not correlated between the 2 radiotracers. No toxicities were observed, and estimated radiation dose from (64)Cu-DOTA-trastuzumab was similar to (18)F-FDG. CONCLUSION (64)Cu-DOTA-trastuzumab visualizes HER2-positive metastatic breast cancer with high sensitivity and is effective in surveying disseminated disease. A 45-mg trastuzumab predose provides a (64)Cu-DOTA-trastuzumab biodistribution favorable for tumor imaging. (64)Cu-DOTA-trastuzumab PET/CT warrants further evaluation for assessing tumor HER2 expression and individualizing treatments that include trastuzumab.
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Affiliation(s)
- Joanne E Mortimer
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
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Sahebi F, Frankel PH, Farol L, Krishnan AY, Cai JL, Somlo G, Thomas SH, Reburiano E, Popplewell LL, Parker PM, Spielberger RT, Kogut NM, Karanes C, Htut M, Ruel C, Duarte L, Murata-Collins JL, Forman SJ. Sequential bortezomib, dexamethasone, and thalidomide maintenance therapy after single autologous peripheral stem cell transplantation in patients with multiple myeloma. Biol Blood Marrow Transplant 2011; 18:486-92. [PMID: 22198542 DOI: 10.1016/j.bbmt.2011.12.580] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 12/17/2011] [Indexed: 11/29/2022]
Abstract
We report feasibility and response results of a phase II study investigating prolonged weekly bortezomib and dexamethasone followed by thalidomide and dexamethasone as maintenance therapy after single autologous stem cell transplantation (ASCT) in patients with multiple myeloma. Within 4 to 8 weeks of ASCT, patients received weekly bortezomib and dexamethasone for six cycles, followed by thalidomide and dexamethasone for six more cycles. Thalidomide alone was continued until disease progression. Forty-five patients underwent ASCT. Forty patients started maintenance therapy; of these, 36 patients received four cycles, and 32 completed six cycles of maintenance bortezomib. Of these 40 patients, nine (22%) were in complete response (CR) before ASCT, 13 (32%) achieved CR after ASCT but before bortezomib maintenance therapy, and 21 (53%) achieved CR after bortezomib maintenance therapy. Nine patients not previously in CR (33%) upgraded their response to CR with bortezomib maintenance. At 1 year post-ASCT, 20 patients achieved CR, and two achieved very good partial response. Twenty-seven patients experienced peripheral neuropathy during bortezomib therapy, all grade 1 or 2. Our findings indicate that prolonged sequential weekly bortezomib, dexamethasone, and thalidomide maintenance therapy after single ASCT is feasible and well tolerated. Bortezomib maintenance treatment upgraded post-ASCT CR responses with no severe grade 3/4 peripheral neuropathy.
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Affiliation(s)
- Firoozeh Sahebi
- Department of Hematology and HCT, City of Hope, Duarte, California 91010, USA.
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Li T, Christensen SD, Frankel PH, Margolin KA, Agarwala SS, Luu T, Mack PC, Lara PN, Gandara DR. A phase II study of cell cycle inhibitor UCN-01 in patients with metastatic melanoma: a California Cancer Consortium trial. Invest New Drugs 2010; 30:741-8. [PMID: 20967484 PMCID: PMC3277821 DOI: 10.1007/s10637-010-9562-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [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: 09/04/2010] [Accepted: 10/03/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND Genetic abnormalities in cell cycle control are common in malignant melanoma. UCN-01 (7-hydroxystaurosporine) is an investigational agent that exhibits antitumor activity by perturbing the cancer cell cycle. A patient with advanced melanoma experienced a partial response in a phase I trial of single agent UCN-01. We sought to determine the activity of UCN-01 against refractory metastatic melanoma in a phase II study. Patients and methods Patients with advanced melanoma received UCN-01 at 90 mg/m(2) over 3 h on cycle 1, reduced to 45 mg/m(2) over 3 h for subsequent cycles, every 21 days. Primary endpoint was tumor response. Secondary endpoints included progression-free survival (PFS) and overall survival (OS). A two-stage (17 + 16), single arm phase II design was employed. A true response rate of ≥ 20% (i.e., at least one responder in the first stage, or at least four responders overall) was to be considered promising for further development of UCN-01 in this setting. Results Seventeen patients were accrued in the first stage. One patient was inevaluable for response. Four (24%) patients had stable disease, and 12 (71%) had disease progression. As there were no responders in the first stage, the study was closed to further accrual. Median PFS was 1.3 months (95% CI, 1.2-3.0) while median OS was 7.3 months (95% CI, 3.4-18.4). One-year and two year OS rates were 41% and 12%, respectively. A median of two cycles were delivered (range, 1-18). Grade 3 treatment-related toxicities include hyperglycemia (N = 2), fatigue (N = 1), and diarrhea (N = 1). One patient experienced grade 4 creatinine elevation and grade 4 anemia possibly due to UCN-01. No dose modification was required as these patients had disease progression. Conclusion Although well tolerated, UCN-01 as a single agent did not have sufficient clinical activity to warrant further study in refractory melanoma.
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Affiliation(s)
- Tianhong Li
- Division of Hematology & Oncology, University of California Davis Cancer Center, 4501 X Street, Suite 3016, Sacramento, CA 95817, USA.
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Frankel PH, Twardowski P. Guideline for 5-α-Reductase Inhibitors in the Prevention of Prostate Cancer Is Premature. J Clin Oncol 2009; 27:e164; author reply e165. [DOI: 10.1200/jco.2009.23.1167] [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)
- Paul H. Frankel
- Division of Biostatistics, City of Hope National Medical Center, Duarte, CA
| | - Przemyslaw Twardowski
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA
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Abstract
The finding of a genome-wide oscillation in transcription that gates cells into S phase and coordinates mitochondrial and metabolic functions has altered our understanding of how the cell cycle is timed and how stable cellular phenotypes are maintained. Here we present the evidence and arguments in support of the idea that everything oscillates, and the rationale for viewing the cell as an attractor from which deterministic noise can be tuned by appropriate coupling among the many feedback loops, or regulons, that make up the transcriptional-respiratory attractor cycle. The existence of this attractor also explains many of the dynamic macroscopic properties of the cell cycle and appears to be the timekeeping oscillator in both cell cycles and circadian rhythms. The path taken by this primordial oscillator in the course of differentiation or drug response may involve period-doubling behavior. Evidence for a relatively high-frequency timekeeping oscillator in yeast and mammalian cells comes from expression array analysis, and GC/MS in the case of yeast, and primarily from macroscopic measures of phase response to perturbation in the case of mammalian cells. Low-amplitude, genome-wide oscillations, a ubiquitous but often unrecognized attribute of phenotype, may be a source of seemingly intractable biological noise in microarray and proteomic studies. These oscillations in transcript and protein levels and the repeated cycles of synthesis and degradation they require, represent a high energy cost to the cell which must, from an evolutionary point of view, be recovered as essential information. We suggest that the information contained in this genome-wide oscillation is the dynamic code that organizes a stable phenotype from an otherwise passive genome.
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Affiliation(s)
- Robert R Klevecz
- Dynamic Systems Group, Department of Biology, Beckman Research Institute, City of Hope Medical Center, Duarte CA 91010, USA.
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Frankel PH, Reid ME, Marshall JR. A permutation test for a weighted Kaplan-Meier estimator with application to the nutritional prevention of cancer trial. Contemp Clin Trials 2006; 28:343-7. [PMID: 17150413 PMCID: PMC7449600 DOI: 10.1016/j.cct.2006.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2005] [Revised: 09/21/2006] [Accepted: 10/09/2006] [Indexed: 11/27/2022]
Abstract
The phenomenon of losing statistical significance with increasing follow-up can arise when a proportional hazard model is applied in a clinical trial where the impact of the intervention results in delaying a negative event such as cancer diagnosis, progression or death. Often parametric methods can be employed in such a setting, however, in studies where only a small percentage of subjects have an event, these methods are often inappropriate. We present an alternative method based on a weighted Kaplan-Meier estimator and a permutation test, and demonstrate its utility in the setting of the Nutritional Prevention of Cancer study where increasing follow-up resulted in loss of statistical significance for the ability of selenized yeast to prevent lung cancer.
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Affiliation(s)
- Paul H Frankel
- Department of Biostatistics, City of Hope National Medical Center, 1500 E. Duarte Rd., Duarte, CA 91010-3000, United States.
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Esworthy RS, Yang L, Frankel PH, Chu FF. Epithelium-specific glutathione peroxidase, Gpx2, is involved in the prevention of intestinal inflammation in selenium-deficient mice. J Nutr 2005; 135:740-5. [PMID: 15795427 DOI: 10.1093/jn/135.4.740] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mice deficient in 2 intracellular selenium (Se)-dependent glutathione peroxidases (Gpx1 and Gpx2), by genetically disrupting both alleles of the Gpx1 and Gpx2 genes (Gpx1(-/-)Gpx2(-/-)), develop ileocolitis around weaning. However, decreased Gpx activity in Se-depleted wild-type animals does not produce pathology in the gastrointestinal tract. Because a small percentage of Se-sufficient Gpx1(+/-)Gpx2(-/-) mice have mild ileocolitis, we hypothesized that Se-deficient Gpx1(+/-)Gpx2(-/-) mice will develop severe ileocolitis similarly to the Gpx1(-/-)Gpx2(-/-) mice, and even a trace amount of Gpx2 can protect intestinal mucosa against inflammation. To test our hypothesis, we fed mice at various stages of development with either Gpx1(+/)(-)Gpx2(-/-) or Gpx1(-/-)Gpx2(+/)(-) genotypes an Se-deficient diet for 4-5 wk and assessed the symptoms and pathology. Gpx1(+/)(-)Gpx2(-/-) mice that were deprived of Se in utero or at weaning (18-22 d of age), but not as young adults (31-51 d of age), manifested significantly worse pathology than their Se-sufficient counterparts. Both Gpx1 and Gpx2 activities and mRNA levels were significantly depressed in the ileum of Se-deprived mice. In mice deprived in utero, the pathology included acute inflammation with neutrophil and monocyte infiltration particularly in the colon and was externally manifested by perianal alopecia and ulceration. On the other hand, Gpx1(-/-)Gpx2(+/)(-) mice were unaffected by Se deprivation, regardless of the age of onset. The results show that a trace amount of Gpx2 is protective against ileocolitis, and Se-deficient young Gpx1(+/-)Gpx2(-/-) mice will develop pathology and symptoms similar to Se-adequate Gpx1(-/-)Gpx2(-/-) mice.
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Affiliation(s)
- R Steven Esworthy
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010-3000, USA
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Frankel PH. Obesity and cancer. N Engl J Med 2003; 349:502-4; author reply 502-4. [PMID: 12892102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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