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Bhangoo MS, Boasberg P, Mehta P, Elvin JA, Ali SM, Wu W, Klempner SJ. Tumor Mutational Burden Guides Therapy in a Treatment Refractory POLE-Mutant Uterine Carcinosarcoma. Oncologist 2018; 23:518-523. [PMID: 29386312 DOI: 10.1634/theoncologist.2017-0342] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/30/2017] [Indexed: 01/31/2023] Open
Abstract
Gynecologic carcinosarcomas, previously known as malignant mixed Müllerian tumors, are uncommon malignancies that demonstrate an aggressive biology and lack a standard therapeutic approach. Molecular analyses have revealed recurrent alterations in chromatin remodeling genes, but clinical support for therapeutic significance is lacking. We prospectively identified a patient with refractory uterine carcinosarcoma whose tumor was subject to molecular profiling at diagnosis and again at radiographic progression. Initial molecular testing did not assess tumor mutational burden, DNA polymerase ɛ (POLE), or microsatellite status. After the failure of several lines of chemotherapy, comprehensive genomic profiling of a repeat biopsy identified two missense mutations of the exonuclease domain of POLE (P286R and T323A). Tumor mutational burden was elevated (169 mutations per DNA megabase), consistent with an ultramutator phenotype. As seen in previously reported POLE-endometrioid cases, our patient harbored alterations in PIK3CA, ARID1A, and PTEN and was microsatellite stable, with appreciable tumor-infiltrating lymphocytes. She achieved an ongoing durable response with pembrolizumab. This is the first report of programmed cell death protein 1 response in uterine carcinosarcoma. KEY POINTS Uterine carcinosarcoma is an uncommon and aggressive histologic variant of endometrial carcinoma with a poor prognosis.Inactivating DNA polymerase ɛ (POLE) mutations have been associated with high tumor mutational burden (TMB) and response to immune checkpoint inhibition.To the authors' knowledge, this is the first report of response to immune checkpoint inhibitor therapy in a patient with uterine carcinosarcoma.This case further supports expanding genomic profiling to include assessment of tumor mutational burden across tumor types, given the potential for immune checkpoint inhibitor therapy in TMB-high tumors.
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Affiliation(s)
- Munveer S Bhangoo
- Division of Hematology Oncology, Scripps Clinic, La Jolla, California, USA
| | - Peter Boasberg
- The Angeles Clinic and Research Institute, Los Angeles, California, USA
| | - Pareen Mehta
- Department of Radiology, The Angeles Clinic and Research Institute, Los Angeles, California, USA
| | - Julia A Elvin
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
| | - Siraj M Ali
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
| | - Winnie Wu
- Department of Pathology, John Wayne Cancer Institute, Providence Saint John's Medical Center, Los Angeles, California, USA
| | - Samuel J Klempner
- The Angeles Clinic and Research Institute, Los Angeles, California, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Chen A, Ali N, Boasberg P, Ho AS. Clinical Remission of Cutaneous Squamous Cell Carcinoma of the Auricle with Cetuximab and Nivolumab. J Clin Med 2018; 7:jcm7010010. [PMID: 29320468 PMCID: PMC5791018 DOI: 10.3390/jcm7010010] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 12/19/2017] [Revised: 12/30/2017] [Accepted: 01/03/2018] [Indexed: 01/12/2023] Open
Abstract
Cutaneous squamous cell carcinomas (SCC) affecting the regions of the head and neck can be challenging to resect surgically and refractory to chemotherapy or radiation therapy. Consequently; the treatment of squamous cell carcinomas of the skin is a focus of current research. One such advancement is immunotherapy. Herein we describe clinical remission of invasive, poorly differentiated squamous cell carcinoma of the pre-auricular region with external auditory canal involvement using cetuximab, an epidermal growth factor receptor (EGFR) antibody; and nivolumab, a programmed death receptor-1 (PD-1) antibody. Such durable and comprehensive disease resolution demonstrates the therapeutic potential of cetuximab and nivolumab in surgically challenging, treatment-resistant cutaneous squamous cell carcinoma.
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Affiliation(s)
- Alessandra Chen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
- David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA.
| | - Nabilah Ali
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
| | - Peter Boasberg
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
- The Angeles Clinic and Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
| | - Allen S Ho
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Nanda VGY, Peng W, Hwu P, Davies MA, Ciliberto G, Fattore L, Malpicci D, Aurisicchio L, Ascierto PA, Croce CM, Mancini R, Spranger S, Gajewski TF, Wang Y, Ferrone S, Vanpouille-Box C, Wennerberg E, Pilones KA, Formenti SC, Demaria S, Tang H, Wang Y, Fu YX, Dummer R, Puzanov I, Tarhini A, Chauvin JM, Pagliano O, Fourcade J, Sun Z, Wang H, Sanders C, Kirkwood JM, Chen THT, Maurer M, Korman AJ, Zarour HM, Stroncek DF, Huber V, Rivoltini L, Thurin M, Rau T, Lugli A, Pagès F, Camarero J, Sancho A, Jommi C, de Coaña YP, Wolodarski M, Yoshimoto Y, Gentilcore G, Poschke I, Masucci GV, Hansson J, Kiessling R, Scognamiglio G, Sabbatino F, Marino FZ, Anniciello AM, Cantile M, Cerrone M, Scala S, D’alterio C, Ianaro A, Cirin G, Liguori G, Bott G, Chapman PB, Robert C, Larkin J, Haanen JB, Ribas A, Hogg D, Hamid O, Testori A, Lorigan P, Sosman JA, Flaherty KT, Yue H, Coleman S, Caro I, Hauschild A, McArthur GA, Sznol M, Callahan MK, Kluger H, Postow MA, Gordan R, Segal NH, Rizvi NA, Lesokhin A, Atkins MB, Burke MM, Ralabate A, Rivera A, Kronenberg SA, Agunwamba B, Ruisi M, Horak C, Jiang J, Wolchok J, Ascierto PA, Liszkay G, Maio M, Mandalà M, Demidov L, Stoyakovskiy D, Thomas L, de la Cruz-Merino L, Atkinson V, Dutriaux C, Garbe C, Wongchenko M, Chang I, Koralek DO, Rooney I, Yan Y, Dréno B, Sullivan R, Patel M, Hodi S, Amaria R, Boasberg P, Wallin J, He X, Cha E, Richie N, Ballinger M, Smith DC, Bauer TM, Wasser JS, Luke JJ, Balmanoukian AS, Kaufman DR, Zhao Y, Maleski J, Leopold L, Gangadhar TC, Long GV, Michielin O, VanderWalde A, Andtbacka RHI, Cebon J, Fernandez E, Malvehy J, Olszanski AJ, Gause C, Chen L, Chou J, Stephen Hodi F, Brady B, Mortier L, Hassel JC, Rutkowski P, McNeil C, Kalinka-Warzocha E, Lebbé C, Ny L, Chacon M, Queirolo P, Loquai C, Cheema P, Berrocal A, Eizmendi KM, Bar-Sela G, Horak C, Hardy H, Weber JS, Grob JJ, Marquez-Rodas I, Schmidt H, Briscoe K, Baurain JF, Wolchok JD, Pinto R, De Summa S, Garrisi VM, Strippoli S, Azzariti A, Guida G, Guida M, Tommasi S, Jacquelot N, Enot D, Flament C, Pitt JM, Vimond N, Blattner C, Yamazaki T, Roberti MP, Vetizou M, Daillere R, Poirier-Colame V, la Semeraro M, Caignard A, Slingluff CL, Sallusto F, Rusakiewicz S, Weide B, Marabelle A, Kohrt H, Dalle S, Cavalcanti A, Kroemer G, Di Giacomo AM, Maio M, Wong P, Yuan J, Umansky V, Eggermont A, Zitvogel L, Anna P, Marco T, Stefania S, Francesco M, Mariaelena C, Gabriele M, Antonio AP, Franco S, Roberti MP, Enot DP, Semeraro M, Jégou S, Flores C, Chen THT, Kwon BS, Anderson AC, Borg C, Aubin F, Ayyoub M, De Presbiteris AL, Cordaro FG, Camerlingo R, Fratangelo F, Mozzillo N, Pirozzi G, Patriarca EJ, Caputo E, Motti ML, Falcon R, Miceli R, Capone M, Madonna G, Mallardo D, Carrier MV, Panza E, De Cicco P, Armogida C, Ercolano G, Botti G, Cirino G, Sandru A, Blank M, Balatoni T, Olasz J, Farkas E, Szollar A, Savolt A, Godeny M, Csuka O, Horvath S, Eles K, Shoenfeld Y, Kasler M, Costantini S, Capone F, Moradi F, Berglund P, Leandersson K, Linnskog R, Andersson T, Prasad CP, Nigro CL, Lattanzio L, Wang H, Proby C, Syed N, Occelli M, Cauchi C, Merlano M, Harwood C, Thompson A, Crook T, Bifulco K, Ingangi V, Minopoli M, Ragone C, Pessi A, Mannavola F, D’Oronzo S, Felici C, Tucci M, Doronzo A, Silvestris F, Ferretta A, Guida S, Maida I, Cocco T, Passarelli A, Quaresmini D, Franzese O, Palermo B, Di Donna C, Sperduti I, Foddai M, Stabile H, Gismondi A, Santoni A, Nisticò P, Sponghini AP, Platini F, Marra E, Rondonotti D, Alabiso O, Fierro MT, Savoia P, Stratica F, Quaglino P, Di Monta G, Corrado C, Di Marzo M, Ugo M, Di Cecilia ML, Nicola M, Fusciello C, Marra A, Guarrasi R, Baldi C, Russo R, Di Giulio G, Faiola V, Zeppa P, Pepe S, Gambale E, Carella C, Di Paolo A, De Tursi M, Marra L, De Murtas F, Sorrentino V, Voinea S, Panaitescu E, Bolovan M, Stanciu A, Cinca S, Botti C, Aquino G, Anniciello A, Fortes C, Mastroeni S, Caggiati A, Passarelli F, Zappalà A, Capuano M, Bono R, Nudo M, Marino C, Michelozzi P, De Biasio V, Battarra VC, Formenti S, Ascierto ML, McMiller TL, Berger AE, Danilova L, Anders RA, Netto GJ, Xu H, Pritchard TS, Fan J, Cheadle C, Cope L, Drake CG, Pardoll DM, Taube JM, Topalian SL, Gnjatic S, Nataraj S, Imai N, Rahman A, Jungbluth AA, Pan L, Venhaus R, Park A, Lehmann FF, Lendvai N, Cohen AD, Cho HJ, Daniel S, Hirsh V. Melanoma and immunotherapy bridge 2015 : Naples, Italy. 1-5 December 2015. J Transl Med 2016; 14:65. [PMID: 27461275 PMCID: PMC4965835 DOI: 10.1186/s12967-016-0791-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
MELANOMA BRIDGE 2015 KEYNOTE SPEAKER PRESENTATIONS Molecular and immuno-advances K1 Immunologic and metabolic consequences of PI3K/AKT/mTOR activation in melanoma Vashisht G. Y. Nanda, Weiyi Peng, Patrick Hwu, Michael A. Davies K2 Non-mutational adaptive changes in melanoma cells exposed to BRAF and MEK inhibitors help the establishment of drug resistance Gennaro Ciliberto, Luigi Fattore, Debora Malpicci, Luigi Aurisicchio, Paolo Antonio Ascierto, Carlo M. Croce, Rita Mancini K3 Tumor-intrinsic beta-catenin signaling mediates tumor-immune avoidance Stefani Spranger, Thomas F. Gajewski K4 Intracellular tumor antigens as a source of targets of antibody-based immunotherapy of melanoma Yangyang Wang, Soldano Ferrone Combination therapies K5 Harnessing radiotherapy to improve responses to immunotherapy in cancer Claire Vanpouille-Box, Erik Wennerberg, Karsten A. Pilones, Silvia C. Formenti, Sandra Demaria K6 Creating a T cell-inflamed tumor microenvironment overcomes resistance to checkpoint blockade Haidong Tang, Yang Wang, Yang-Xin Fu K7 Biomarkers for treatment decisions? Reinhard Dummer K8 Combining oncolytic therapies in the era of checkpoint inhibitors Igor Puzanov K9 Immune checkpoint blockade for melanoma: should we combine or sequence ipilimumab and PD-1 antibody therapy? Michael A. Postow News in immunotherapy K10 An update on adjuvant and neoadjuvant therapy for melanom Ahmad Tarhini K11 Targeting multiple inhibitory receptors in melanoma Joe-Marc Chauvin, Ornella Pagliano, Julien Fourcade, Zhaojun Sun, Hong Wang, Cindy Sanders, John M. Kirkwood, Tseng-hui Timothy Chen, Mark Maurer, Alan J. Korman, Hassane M. Zarour K12 Improving adoptive immune therapy using genetically engineered T cells David F. Stroncek Tumor microenvironment and biomarkers K13 Myeloid cells and tumor exosomes: a crosstalk for assessing immunosuppression? Veronica Huber, Licia Rivoltini K14 Update on the SITC biomarker taskforce: progress and challenges Magdalena Thurin World-wide immunoscore task force: an update K15 The immunoscore in colorectal cancer highlights the importance of digital scoring systems in surgical pathology Tilman Rau, Alessandro Lugli K16 The immunoscore: toward an integrated immunomonitoring from the diagnosis to the follow up of cancer’s patients Franck Pagès Economic sustainability of melanoma treatments: regulatory, health technology assessment and market access issues K17 Nivolumab, the regulatory experience in immunotherapy Jorge Camarero, Arantxa Sancho K18 Evidence to optimize access for immunotherapies Claudio Jommi ORAL PRESENTATIONS Molecular and immuno-advances O1 Ipilimumab treatment results in CD4 T cell activation that is concomitant with a reduction in Tregs and MDSCs Yago Pico de Coaña, Maria Wolodarski, Yuya Yoshimoto, Giusy Gentilcore, Isabel Poschke, Giuseppe V. Masucci, Johan Hansson, Rolf Kiessling O2 Evaluation of prognostic and therapeutic potential of COX-2 and PD-L1 in primary and metastatic melanoma Giosuè Scognamiglio, Francesco Sabbatino, Federica Zito Marino, Anna Maria Anniciello, Monica Cantile, Margherita Cerrone, Stefania Scala, Crescenzo D’alterio, Angela Ianaro, Giuseppe Cirino, Paolo Antonio Ascierto, Giuseppina Liguori, Gerardo Botti O3 Vemurafenib in patients with BRAFV600 mutation–positive metastatic melanoma: final overall survival results of the BRIM-3 study Paul B. Chapman, Caroline Robert, James Larkin, John B. Haanen, Antoni Ribas, David Hogg, Omid Hamid, Paolo Antonio Ascierto, Alessandro Testori, Paul Lorigan, Reinhard Dummer, Jeffrey A. Sosman, Keith T. Flaherty, Huibin Yue, Shelley Coleman, Ivor Caro, Axel Hauschild, Grant A. McArthur O4 Updated survival, response and safety data in a phase 1 dose-finding study (CA209-004) of concurrent nivolumab (NIVO) and ipilimumab (IPI) in advanced melanoma Mario Sznol, Margaret K. Callahan, Harriet Kluger, Michael A. Postow, RuthAnn Gordan, Neil H. Segal, Naiyer A. Rizvi, Alexander Lesokhin, Michael B. Atkins, John M. Kirkwood, Matthew M. Burke, Amanda Ralabate, Angel Rivera, Stephanie A. Kronenberg, Blessing Agunwamba, Mary Ruisi, Christine Horak, Joel Jiang, Jedd Wolchok Combination therapies O5 Efficacy and correlative biomarker analysis of the coBRIM study comparing cobimetinib (COBI) + vemurafenib (VEM) vs placebo (PBO) + VEM in advanced BRAF-mutated melanoma patients (pts) Paolo A. Ascierto, Grant A. McArthur, James Larkin, Gabriella Liszkay, Michele Maio, Mario Mandalà, Lev Demidov, Daniil Stoyakovskiy, Luc Thomas, Luis de la Cruz-Merino, Victoria Atkinson, Caroline Dutriaux, Claus Garbe, Matthew Wongchenko, Ilsung Chang, Daniel O. Koralek, Isabelle Rooney, Yibing Yan, Antoni Ribas, Brigitte Dréno O6 Preliminary clinical safety, tolerability and activity results from a Phase Ib study of atezolizumab (anti-PDL1) combined with vemurafenib in BRAFV600-mutant metastatic melanoma Ryan Sullivan, Omid Hamid, Manish Patel, Stephen Hodi, Rodabe Amaria, Peter Boasberg, Jeffrey Wallin, Xian He, Edward Cha, Nicole Richie, Marcus Ballinger, Patrick Hwu O7 Preliminary safety and efficacy data from a phase 1/2 study of epacadostat (INCB024360) in combination with pembrolizumab in patients with advanced/metastatic melanoma Thomas F. Gajewski, Omid Hamid, David C. Smith, Todd M. Bauer, Jeffrey S. Wasser, Jason J. Luke, Ani S. Balmanoukian, David R. Kaufman, Yufan Zhao, Janet Maleski, Lance Leopold, Tara C. Gangadhar O8 Primary analysis of MASTERKEY-265 phase 1b study of talimogene laherparepvec (T-VEC) and pembrolizumab (pembro) for unresectable stage IIIB-IV melanoma Reinhard Dummer, Georgina V. Long, Antoni Ribas, Igor Puzanov, Olivier Michielin, Ari VanderWalde, Robert H.I. Andtbacka, Jonathan Cebon, Eugenio Fernandez, Josep Malvehy, Anthony J. Olszanski, Thomas F. Gajewski, John M. Kirkwood, Christine Gause, Lisa Chen, David R. Kaufman, Jeffrey Chou, F. Stephen Hodi News in immunotherapy O9 Two-year survival and safety update in patients (pts) with treatment-naïve advanced melanoma (MEL) receiving nivolumab (NIVO) or dacarbazine (DTIC) in CheckMate 066 Victoria Atkinson, Paolo A. Ascierto, Georgina V. Long, Benjamin Brady, Caroline Dutriaux, Michele Maio, Laurent Mortier, Jessica C. Hassel, Piotr Rutkowski, Catriona McNeil, Ewa Kalinka-Warzocha, Celeste Lebbé, Lars Ny, Matias Chacon, Paola Queirolo, Carmen Loquai, Parneet Cheema, Alfonso Berrocal, Karmele Mujika Eizmendi, Luis De La Cruz-Merino, Gil Bar-Sela, Christine Horak, Joel Jiang, Helene Hardy, Caroline Robert O10 Efficacy and safety of nivolumab (NIVO) in patients (pts) with advanced melanoma (MEL) who were treated beyond progression in CheckMate 066/067 Georgina V. Long, Jeffrey S. Weber, James Larkin, Victoria Atkinson, Jean-Jacques Grob, Reinhard Dummer, Caroline Robert, Ivan Marquez-Rodas, Catriona McNeil, Henrik Schmidt, Karen Briscoe, Jean-François Baurain, F. Stephen Hodi, Jedd D. Wolchok Tumor microenvironment and biomarkers O11 New biomarkers for response/resistance to BRAF inhibitor therapy in metastatic melanoma Rosamaria Pinto, Simona De Summa, Vito Michele Garrisi, Sabino Strippoli, Amalia Azzariti, Gabriella Guida, Michele Guida, Stefania Tommasi O12 Chemokine receptor patterns in lymphocytes mirror metastatic spreading in melanoma and response to ipilimumab Nicolas Jacquelot, David Enot, Caroline Flament, Jonathan M. Pitt, Nadège Vimond, Carolin Blattner, Takahiro Yamazaki, Maria-Paula Roberti, Marie Vetizou, Romain Daillere, Vichnou Poirier-Colame, Michaëla Semeraro, Anne Caignard, Craig L Slingluff Jr, Federica Sallusto, Sylvie Rusakiewicz, Benjamin Weide, Aurélien Marabelle, Holbrook Kohrt, Stéphane Dalle, Andréa Cavalcanti, Guido Kroemer, Anna Maria Di Giacomo, Michaele Maio, Phillip Wong, Jianda Yuan, Jedd Wolchok, Viktor Umansky, Alexander Eggermont, Laurence Zitvogel O13 Serum levels of PD1- and CD28-positive exosomes before Ipilimumab correlate with therapeutic response in metastatic melanoma patients Passarelli Anna, Tucci Marco, Stucci Stefania, Mannavola Francesco, Capone Mariaelena, Madonna Gabriele, Ascierto Paolo Antonio, Silvestris Franco O14 Immunological prognostic factors in stage III melanomas María Paula Roberti, Nicolas Jacquelot, David P Enot, Sylvie Rusakiewicz, Michaela Semeraro, Sarah Jégou, Camila Flores, Lieping Chen, Byoung S. Kwon, Ana Carrizossa Anderson, Caroline Robert, Christophe Borg, Benjamin Weide, François Aubin, Stéphane Dalle, Michele Maio, Jedd D. Wolchok, Holbrook Kohrt, Maha Ayyoub, Guido Kroemer, Aurélien Marabelle, Andréa Cavalcanti, Alexander Eggermont, Laurence Zitvogel POSTER PRESENTATIONS Molecular and immuno-advances P1 Human melanoma cells resistant to B-RAF and MEK inhibition exhibit
mesenchymal-like features Anna Lisa De Presbiteris, Fabiola Gilda Cordaro, Rosa Camerlingo, Federica Fratangelo, Nicola Mozzillo, Giuseppe Pirozzi, Eduardo J. Patriarca, Paolo A. Ascierto, Emilia Caputo P2 Anti-proliferative and pro-apoptotic effect of ABT888 on melanoma cell lines and its potential role in the treatment of melanoma resistant to B-RAF inhibitors Federica Fratangelo, Rosa Camerlingo, Emilia Caputo, Maria Letizia Motti, Rosaria Falcone, Roberta Miceli, Mariaelena Capone, Gabriele Madonna, Domenico Mallardo, Maria Vincenza Carriero, Giuseppe Pirozzi and Paolo Antonio Ascierto P3 Involvement of the L-cysteine/CSE/H2S pathway in human melanoma progression Elisabetta Panza, Paola De Cicco, Chiara Armogida, Giuseppe Ercolano, Rosa Camerlingo, Giuseppe Pirozzi, Giosuè Scognamiglio, Gerardo Botti, Giuseppe Cirino, Angela Ianaro P4 Cancer stem cell antigen revealing pattern of antibody variable region genes were defined by immunoglobulin repertoire analysis in patients with malignant melanoma Beatrix Kotlan, Gabriella Liszkay, Miri Blank, Timea Balatoni, Judit Olasz, Emil Farkas, Andras Szollar, Akos Savolt, Maria Godeny, Orsolya Csuka, Szabolcs Horvath, Klara Eles, Yehuda Shoenfeld and Miklos Kasler P5 Upregulation of Neuregulin-1 expression is a hallmark of adaptive response to BRAF/MEK inhibitors in melanoma Debora Malpicci, Luigi Fattore, Susan Costantini, Francesca Capone, Paolo Antonio Ascierto, Rita Mancini, Gennaro Ciliberto P6 HuR positively regulates migration of HTB63 melanoma cells Farnaz Moradi, Pontus Berglund, Karin Leandersson, Rickard Linnskog, Tommy Andersson, Chandra Prakash Prasad P7 Prolyl 4- (C-P4H) hydroxylases have opposing effects in malignant melanoma: implication in prognosis and therapy Cristiana Lo Nigro, Laura Lattanzio, Hexiao Wang, Charlotte Proby, Nelofer Syed, Marcella Occelli, Carolina Cauchi, Marco Merlano, Catherine Harwood, Alastair Thompson, Tim Crook P8 Urokinase receptor antagonists: novel agents for the treatment of melanoma Maria Letizia Motti, Katia Bifulco, Vincenzo Ingangi, Michele Minopoli, Concetta Ragone, Federica Fratangelo, Antonello Pessi, Gennaro Ciliberto, Paolo Antonio Ascierto, Maria Vincenza Carriero P9 Exosomes released by melanoma cell lines enhance chemotaxis of primary tumor cells Francesco Mannavola, Stella D’Oronzo, Claudia Felici, Marco Tucci, Antonio Doronzo, Franco Silvestris P10 New insights in mitochondrial metabolic reprogramming in melanoma Anna Ferretta, Gabriella Guida, Stefania Guida, Imma Maida, Tiziana Cocco, Sabino Strippoli, Stefania Tommasi, Amalia Azzariti, Michele Guida P11 Lenalidomide restrains the proliferation in melanoma cells through a negative regulation of their cell cycle Stella D’Oronzo, Anna Passarelli, Claudia Felici, Marco Tucci, Davide Quaresmini, Franco Silvestris Combination therapies P12 Chemoimmunotherapy elicits polyfunctional anti-tumor CD8 + T cells depending on the activation of an AKT pathway sustained by ICOS Ornella Franzese, Belinda Palermo, Cosmo Di Donna, Isabella Sperduti, MariaLaura Foddai, Helena Stabile, Angela Gismondi, Angela Santoni, Paola Nisticò P13 Favourable toxicity profile of combined BRAF and MEK inhibitors in metastatic melanoma patients Andrea P. Sponghini, Francesca Platini, Elena Marra, David Rondonotti, Oscar Alabiso, Maria T. Fierro, Paola Savoia, Florian Stratica, Pietro Quaglino P14 Electrothermal bipolar vessel sealing system dissection reduces seroma output or time to drain removal following axillary and ilio-inguinal node dissection in melanoma patients: a pilot study Di Monta Gianluca, Caracò Corrado, Di Marzo Massimiliano, Marone Ugo, Di Cecilia Maria Luisa, Mozzillo Nicola News in immunotherapy P15 Clinical and immunological response to ipilimumab in a metastatic melanoma patient with HIV infection Francesco Sabbatino, Celeste Fusciello1, Antonio Marra, Rosario Guarrasi, Carlo Baldi, Rosa Russo, Di Giulio Giovanni, Vincenzo Faiola, Pio Zeppa, Stefano Pepe P16 Immunotherapy and hypophysitis: a case report Elisabetta Gambale, Consiglia Carella, Alessandra Di Paolo, Michele De Tursi Tumor microenvironment and biomarkers P17 New immuno- histochemical markers for the differential diagnosis of atypical melanocytic lesions with uncertain malignant potential Laura Marra, Giosuè Scognamiglio, Monica Cantile, Margherita Cerrone, Fara De Murtas, Valeria Sorrentino, Anna Maria Anniciello, Gerardo Botti P18 Utility of simultaneous measurement of three serum tumor markers in melanoma patients Angela Sandru, Silviu Voinea, Eugenia Panaitescu, Madalina Bolovan, Adina Stanciu, Sabin Cinca P19 The significance of various cut-off levels of melanoma inhibitory activity in evaluation of cutaneous melanoma patients Angela Sandru, Silviu Voinea, Eugenia Panaitescu, Madalina Bolovan, Adina Stanciu, Sabin Cinca P20 The long noncoding RNA HOTAIR is associated to metastatic progression of melanoma and it can be identified in the blood of patients with advanced disease Chiara Botti, Giosuè Scognamiglio, Laura Marra, Gabriella Aquino, Rosaria Falcone, Annamaria Anniciello, Paolo Antonio Ascierto, Gerardo Botti, Monica Cantile Other P21 The effect of Sentinel Lymph Node Biopsy in melanoma mortality: timing of dissection Cristina Fortes, Simona Mastroeni, Alessio Caggiati, Francesca Passarelli, Alba Zappalà, Maria Capuano, Riccardo Bono, Maurizio Nudo, Claudia Marino, Paola Michelozzi P22 Epidemiological survey on related psychopathology in melanoma Valeria De Biasio, Vincenzo C. Battarra IMMUNOTHERAPY BRIDGE KEYNOTE SPEAKER PRESENTATIONS Immunotherapy beyond melanoma K19 Predictor of response to radiation and immunotherapy Silvia Formenti K20 Response and resistance to PD-1 pathway blockade: clues from the tumor microenvironment Maria Libera Ascierto, Tracee L. McMiller, Alan E. Berger, Ludmila Danilova, Robert A. Anders, George J. Netto, Haiying Xu, Theresa S. Pritchard, Jinshui Fan, Chris Cheadle, Leslie Cope, Charles G. Drake, Drew M. Pardoll, Janis M. Taube and Suzanne L. Topalian K21 Combination immunotherapy with autologous stem cell transplantation, protein immunization, and PBMC reinfusion in myeloma patients Sacha Gnjatic, Sarah Nataraj, Naoko Imai, Adeeb Rahman, Achim A. Jungbluth, Linda Pan, Ralph Venhaus, Andrew Park, Frédéric F. Lehmann, Nikoletta Lendvai, Adam D. Cohen, and Hearn J. Cho K22 Anti-cancer immunity despite T cell “exhaustion” Speiser Daniel Immunotherapy in oncology (I-O): data from clinical trial K23 The Checkpoint Inhibitors for the Treatment of Metastatic Non-small Cell Lung Cancer (NSCLC) Vera Hirsh
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Boasberg P. Medical Oncology Analysis. Integr Cancer Ther 2016. [DOI: 10.1177/153473540200100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Peter Boasberg
- John Wayne Cancer Institute, 2001 Santa Monica Blvd, 5th floor, Santa Monica Calif 90404,
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Bhatia S, Pavlick AC, Boasberg P, Thompson JA, Mulligan G, Pickard MD, Faessel H, Dezube BJ, Hamid O. A phase I study of the investigational NEDD8-activating enzyme inhibitor pevonedistat (TAK-924/MLN4924) in patients with metastatic melanoma. Invest New Drugs 2016; 34:439-49. [PMID: 27056178 PMCID: PMC4919369 DOI: 10.1007/s10637-016-0348-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [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: 02/17/2016] [Accepted: 03/18/2016] [Indexed: 12/31/2022]
Abstract
Purpose The therapeutic index of proteasome inhibitors may be improved through selective inhibition of a sub-component of the ubiquitin-proteasome system, such as the NEDD8-conjugation pathway. This multicenter, phase I, dose-escalation study assessed safety and the maximum tolerated dose (MTD), pharmacokinetics, pharmacodynamics, and antitumor activity of pevonedistat, an investigational NEDD8-activating enzyme (NAE) inhibitor, in patients with metastatic melanoma. Methods Patients received intravenous pevonedistat on Days 1, 4, 8, 11 (schedule A) or 1, 8, 15 (schedule B) of 21-day cycles. Results 26 patients received pevonedistat 50–278 mg/m2 on schedule A; 11 patients received pevonedistat 157 mg/m2 on schedule B. The schedule A MTD was 209 mg/m2: dose-limiting toxicities (DLTs) included grade 3 hypophosphatemia and grade 3 increased blood creatinine (associated with grade 3 hyperbilirubinemia). Two schedule A patients experienced acute organ failure toxicities, one of whom experienced grade 5 acute renal failure. Dose escalation did not occur in schedule B: DLTs included grade 3 myocarditis, grade 2 acute renal failure, and grade 2 hyperbilirubinemia in a single patient. Pevonedistat pharmacokinetics were approximately dose-proportional across the dose range studied, with a biphasic disposition profile characterized by a short elimination half-life (~10 h). Pharmacodynamic studies showed increases in NAE-regulated transcripts post-treatment; all post-dose biopsy samples were positive for pevonedistat-NEDD8 adduct. One schedule A patient achieved a partial response; 15 patients had stable disease (4 lasting ≥6.5 months). Conclusions Pevonedistat was generally well tolerated at the MTD. Anticipated pharmacodynamic effects of NAE inhibition were observed with single-agent pevonedistat in peripheral blood and tumor tissue.
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Affiliation(s)
- Shailender Bhatia
- Department of Medicine/Medical Oncology, University of Washington Medical Center/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, 825 Eastlake Ave W, G4-830, Seattle, WA, 98109-1023, USA.
| | - Anna C Pavlick
- Departments of Medicine (Perlmutter Cancer Center) and Dermatology, NYU Langone Medical Center, New York, NY, USA
| | - Peter Boasberg
- The Angeles Clinic and Research Institute, Translational Research & Cutaneous Oncology, Los Angeles, CA, USA
| | - John A Thompson
- Department of Medicine/Medical Oncology, University of Washington Medical Center/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, 825 Eastlake Ave W, G4-830, Seattle, WA, 98109-1023, USA
| | - George Mulligan
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Michael D Pickard
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Hélène Faessel
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Bruce J Dezube
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Omid Hamid
- The Angeles Clinic and Research Institute, Translational Research & Cutaneous Oncology, Los Angeles, CA, USA
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Barkhoudarian G, Deutsch G, Yost S, Duong H, Chaloner C, Eisenberg A, Boasberg P, Faries M, Hamid O, Kelly D. BM-05 * IPILUMUMAB THERAPY FOR MELANOMA BRAIN METASTASES IS ASSOCIATED WITH INCREASED RADIATION NECROSIS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou240.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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7
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Robert C, Ribas A, Wolchok JD, Hodi FS, Hamid O, Kefford R, Weber JS, Joshua AM, Hwu WJ, Gangadhar TC, Patnaik A, Dronca R, Zarour H, Joseph RW, Boasberg P, Chmielowski B, Mateus C, Postow MA, Gergich K, Elassaiss-Schaap J, Li XN, Iannone R, Ebbinghaus SW, Kang SP, Daud A. Anti-programmed-death-receptor-1 treatment with pembrolizumab in ipilimumab-refractory advanced melanoma: a randomised dose-comparison cohort of a phase 1 trial. Lancet 2014; 384:1109-17. [PMID: 25034862 DOI: 10.1016/s0140-6736(14)60958-2] [Citation(s) in RCA: 1360] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The anti-programmed-death-receptor-1 (PD-1) antibody pembrolizumab has shown potent antitumour activity at different doses and schedules in patients with melanoma. We compared the efficacy and safety of pembrolizumab at doses of 2 mg/kg and 10 mg/kg every 3 weeks in patients with ipilimumab-refractory advanced melanoma. METHODS In an open-label, international, multicentre expansion cohort of a phase 1 trial, patients (aged ≥18 years) with advanced melanoma whose disease had progressed after at least two ipilimumab doses were randomly assigned with a computer-generated allocation schedule (1:1 final ratio) to intravenous pembrolizumab at 2 mg/kg every 3 weeks or 10 mg/kg every 3 weeks until disease progression, intolerable toxicity, or consent withdrawal. Primary endpoint was overall response rate (ORR) assessed with the Response Evaluation Criteria In Solid Tumors (RECIST, version 1.1) by independent central review. Analysis was done on the full-analysis set (all treated patients with measurable disease at baseline). This study is registered with ClinicalTrials.gov, number NCT01295827. FINDINGS 173 patients received pembrolizumab 2 mg/kg (n=89) or 10 mg/kg (n=84). Median follow-up duration was 8 months. ORR was 26% at both doses--21 of 81 patients in the 2 mg/kg group and 20 of 76 in the 10 mg/kg group (difference 0%, 95% CI -14 to 13; p=0·96). Treatment was well tolerated, with similar safety profiles in the 2 mg/kg and 10 mg/kg groups and no drug-related deaths. The most common drug-related adverse events of any grade in the 2 mg/kg and 10 mg/kg groups were fatigue (29 [33%] vs 31 [37%]), pruritus (23 [26%] vs 16 [19%]), and rash (16 [18%] vs 15 [18%]). Grade 3 fatigue, reported in five (3%) patients in the 2 mg/kg pembrolizumab group, was the only drug-related grade 3 to 4 adverse event reported in more than one patient. INTERPRETATION The results suggest that pembrolizumab at a dose of 2 mg/kg or 10 mg/kg every 3 weeks might be an effective treatment in patients for whom there are few effective treatment options. FUNDING Merck Sharp and Dohme.
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Affiliation(s)
| | - Antoni Ribas
- University of California Los Angeles, Los Angeles, CA, USA
| | - Jedd D Wolchok
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Omid Hamid
- Angeles Clinic and Research Institute, Los Angeles, CA, USA
| | - Richard Kefford
- Crown Princess Mary Cancer Centre, Westmead Hospital and Melanoma Institute Australia, Westmead, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | | | | | - Wen-Jen Hwu
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tara C Gangadhar
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA, USA
| | - Amita Patnaik
- South Texas Accelerated Research Therapeutics, San Antonio, TX, USA
| | | | | | | | - Peter Boasberg
- Angeles Clinic and Research Institute, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | | - Adil Daud
- University of California San Francisco, San Francisco, CA, USA
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8
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Ribas A, Gonzalez R, Pavlick A, Hamid O, Gajewski TF, Daud A, Flaherty L, Logan T, Chmielowski B, Lewis K, Kee D, Boasberg P, Yin M, Chan I, Musib L, Choong N, Puzanov I, McArthur GA. Combination of vemurafenib and cobimetinib in patients with advanced BRAFV600-mutated melanoma: a phase 1b study. Lancet Oncol 2014; 15:954-65. [DOI: 10.1016/s1470-2045(14)70301-8] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Hamid O, Robert C, Daud A, Hodi FS, Hwu WJ, Kefford R, Wolchok JD, Hersey P, Joseph RW, Weber JS, Dronca R, Gangadhar TC, Patnaik A, Zarour H, Joshua AM, Gergich K, Elassaiss-Schaap J, Algazi A, Mateus C, Boasberg P, Tumeh PC, Chmielowski B, Ebbinghaus SW, Li XN, Kang SP, Ribas A. Safety and tumor responses with lambrolizumab (anti-PD-1) in melanoma. N Engl J Med 2013; 369:134-44. [PMID: 23724846 PMCID: PMC4126516 DOI: 10.1056/nejmoa1305133] [Citation(s) in RCA: 2635] [Impact Index Per Article: 239.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The programmed death 1 (PD-1) receptor is a negative regulator of T-cell effector mechanisms that limits immune responses against cancer. We tested the anti-PD-1 antibody lambrolizumab (previously known as MK-3475) in patients with advanced melanoma. METHODS We administered lambrolizumab intravenously at a dose of 10 mg per kilogram of body weight every 2 or 3 weeks or 2 mg per kilogram every 3 weeks in patients with advanced melanoma, both those who had received prior treatment with the immune checkpoint inhibitor ipilimumab and those who had not. Tumor responses were assessed every 12 weeks. RESULTS A total of 135 patients with advanced melanoma were treated. Common adverse events attributed to treatment were fatigue, rash, pruritus, and diarrhea; most of the adverse events were low grade. The confirmed response rate across all dose cohorts, evaluated by central radiologic review according to the Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1, was 38% (95% confidence interval [CI], 25 to 44), with the highest confirmed response rate observed in the cohort that received 10 mg per kilogram every 2 weeks (52%; 95% CI, 38 to 66). The response rate did not differ significantly between patients who had received prior ipilimumab treatment and those who had not (confirmed response rate, 38% [95% CI, 23 to 55] and 37% [95% CI, 26 to 49], respectively). Responses were durable in the majority of patients (median follow-up, 11 months among patients who had a response); 81% of the patients who had a response (42 of 52) were still receiving treatment at the time of analysis in March 2013. The overall median progression-free survival among the 135 patients was longer than 7 months. CONCLUSIONS In patients with advanced melanoma, including those who had had disease progression while they had been receiving ipilimumab, treatment with lambrolizumab resulted in a high rate of sustained tumor regression, with mainly grade 1 or 2 toxic effects. (Funded by Merck Sharp and Dohme; ClinicalTrials.gov number, NCT01295827.).
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Affiliation(s)
- Omid Hamid
- Angeles Clinic and Research Institute, Los Angeles, CA, USA
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10
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Nanney AD, Adel JG, Smith TR, Chandler JP, Kimmell KT, Walter K, Zacharia BE, Deibert C, Malone HR, Sonabend AM, Neugut AI, Spencer B, Bruce JN, Wang Y, Li S, Zhang Z, Chen X, You G, Yang P, Yan W, Bao Z, Yao K, Liu Y, Wang L, Jiang T, Farhoud MK, Ruge MI, Brandes AA, Ermani M, Fioravanti A, Andreoli A, Pozzati E, Bacci A, Bartolini S, Poggi R, Crisi G, Franceschi E, Recinos PF, Grabowski MM, Nowacki AS, Thompson N, Vogelbaum MA, Sun P, Krueger D, Liu Z, Kohrman M, Dagens AB, Rachinger W, Kunz M, Eigenbrod S, Lutz J, Tonn JC, Kreth FW, Duong HT, Chaloner C, Bordo G, Eisenberg A, Rosenthal K, Sim MS, Boasberg P, Faries MB, Hamid O, Kelly DF, Kreth FW, Thon N, Simon M, Westphal M, Schackert G, Nikkhah G, Hentschel B, Pietsch T, Reifenberger G, Weller M, Tonn JC, Ironside S, Perry J, Tsao M, Mainprize T, Keith J, Laperrierre N, Paszat L, Sahgal A, Hoover JM, Nwojo M, Puffer R, Parney IF, Tanaka S, Nakada M, Hayashi Y, Hamada JI, Lee IY, Ekram T, Jain R, Scarpace L, Omodon M, Rock J, Rosenblum M, Kalkanis S, Amankulor NM, Kim JH, Tabar V, Peck KK, Holodny AI, Gutin PH, Kim CY, Kim YH, Kim T, Kim IK, Kim JW, Kim YH, Han JH, Park CK, Kim DG, Jung HW, Nonaka M, Bamba Y, Kanemura Y, Nakajima S. NEUROSURGICAL TREATMENTS. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Malignant melanoma is rising faster in incidence than any other malignancy. Long-term remission or "cure" is rare and is almost exclusively limited to therapies that stimulate an immune antitumor response. Ipilimumab is a novel targeted human immunostimulatory monoclonal antibody that blocks cytotoxic T-lymphocyte antigen4 (CTLA-4), an immune-inhibitory site expressed on activated T cells. Ipilimumab is well tolerated as an outpatient infusion therapy. Multiple studies have confirmed significant antimelanoma activity. A randomized trial has documented a survival benefit when ipilimumab was compared to a gp-100 vaccine only arm. The unique mechanism of action of ipilimumab makes assessment of response by conventional criteria difficult. Benefit from ipilimumab can occur after what would be considered progression with World Health Oganization (WHO) or Response Evaluation Criteria in Solid Tumors (RECIST) criteria. New immune response criteria have been proposed. Therapeutic responses peak between 12 and 24 weeks, with slow responses continuing up to and beyond 12 months. The major drug- related adverse side effects (10%-15% grade 3 or above) are immune-related and consist most commonly of rash, colitis, hypophysitis, thyroiditis, and hepatitis. Colonic perforation can occur and patients with diarrhea have to be monitored carefully with strict adherence to treatment algorithms. Algorithms for the treatment of other adverse side effects have been developed. The treatment of immune-related side effects with immunosuppressive agents, such as corticosteroids, does not appear to impair antitumor response. With proper monitoring and management of side effects, ipilimumab is an extremely safe drug to administer. The benefits of ipilimumab will most certainly extend to other malignancies in the near future.
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Affiliation(s)
- Peter Boasberg
- The Angeles Clinic & Research Institute, 2001 Santa Monica Blvd, Suite 560W, Santa Monica, CA 90404, USA.
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12
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Koyanagi K, O'Day SJ, Boasberg P, Atkins MB, Wang HJ, Gonzalez R, Lewis K, Thompson JA, Anderson CM, Lutzky J, Amatruda TT, Hersh E, Richards J, Weber JS, Hoon DSB. Serial monitoring of circulating tumor cells predicts outcome of induction biochemotherapy plus maintenance biotherapy for metastatic melanoma. Clin Cancer Res 2010; 16:2402-8. [PMID: 20371696 DOI: 10.1158/1078-0432.ccr-10-0037] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Molecular biomarkers in blood are promising for assessment of tumor progression and treatment response. We hypothesized that serial monitoring of circulating tumor cells (CTC) with the use of multimarker quantitative real-time reverse transcriptase-PCR assays could be a surrogate predictor of outcome for melanoma patients enrolled in a multicenter phase II clinical trial of biochemotherapy (BCT) combined with maintenance biotherapy (mBT). EXPERIMENTAL DESIGN Blood specimens were collected from 87 patients before and during induction BCT and mBT for stage IV melanoma. Expression of five melanoma-associated CTC biomarkers (MART-1, GalNAc-T, PAX-3, MAGE-A3, and Mitf) was assessed by quantitative real-time reverse transcriptase-PCR, and correlated with treatment response and disease outcome. RESULTS The number of positive CTC biomarkers decreased overall during induction BCT (P < 0.0001). CTC biomarker detection after two cycles of BCT was correlated with treatment response (P = 0.005) and overall survival (P = 0.001): an increase in the number of CTC biomarkers was associated with poor response (P = 0.006) and overall survival (P < 0.0001). Multivariate analyses with the use of a Cox proportional hazards model identified the change in CTC biomarkers after two cycles of BCT as an independent prognostic factor for disease progression (risk ratio, 12.6; 95% confidence interval, 4.78-33.4; P < 0.0001) and overall survival (risk ratio, 6.11; 95% confidence interval, 2.37-15.7; P = 0.0005). CONCLUSION Serial monitoring of CTC during induction BCT may be useful for predicting therapeutic efficacy and disease outcome in patients receiving BCT and mBT for stage IV melanoma.
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Affiliation(s)
- Kazuo Koyanagi
- Department of Molecular Oncology, John Wayne Cancer Institute, Santa Monica, California 90404, USA
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O'Day SJ, Atkins MB, Boasberg P, Wang HJ, Thompson JA, Anderson CM, Gonzalez R, Lutzky J, Amatruda T, Hersh EM, Weber JS. Phase II multicenter trial of maintenance biotherapy after induction concurrent Biochemotherapy for patients with metastatic melanoma. J Clin Oncol 2009; 27:6207-12. [PMID: 19917850 DOI: 10.1200/jco.2008.20.3075] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Biochemotherapy improves responses in metastatic melanoma, but not overall survival, in randomized trials. We developed a maintenance biotherapy regimen after induction biochemotherapy in an attempt to improve durability of responses and overall survival. PATIENTS AND METHODS One hundred thirty-three chemotherapy-naïve patients with metastatic melanoma without CNS metastases were treated at 10 melanoma centers. The biochemotherapy induction regimen included cisplatin, vinblastine, dacarbazine, decrescendo interleukin-2 (IL-2), and interferon alfa-2b with granulocyte-macrophage colony-stimulating factor (GM-CSF) cytokine support. Patients not experiencing disease progression were eligible for maintenance biotherapy with low-dose IL-2 and GM-CSF followed by intermittent pulses of decrescendo IL-2 over 12 months. Patients were observed for response, progression-free survival, toxicity, and overall survival. RESULTS The response rate to induction biochemotherapy was 44% (95% CI, 35% to 52%; complete response, 8%; partial response, 36%; stable disease, 29%). The median number of biochemotherapy cycles was four, and the median number of maintenance biotherapy cycles was five. The median progression-free survival was 9 months, and the median survival was 13.5 months. The 12-month and 24-month survival rates were 57% and 23%, respectively. Twenty percent of patients remain alive (12 without disease), with median follow-up of 30 months (95% CI, 25+ to 45+ months). Thirty-nine percent of patients developed CNS metastases. The median times to CNS progression and death were 8 months and 5 months, respectively. CONCLUSION Maintenance biotherapy after induction biochemotherapy seems to prolong progression-free survival and improve overall survival compared with recent multicenter trials of biochemotherapy or chemotherapy. The regimen should be studied in a randomized clinical trial in patients with advanced metastatic melanoma. CNS progression remains a formidable challenge.
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Affiliation(s)
- Steven J O'Day
- Melanoma Program, The Angeles Clinic and Research Institute, 2001 Santa Monica Blvd, Suite 560 W, Santa Monica, CA 90404, USA.
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Minor DR, Moore D, Kim C, Kashani-Sabet M, Venna SS, Wang W, Boasberg P, O'Day S. Prognostic factors in metastatic melanoma patients treated with biochemotherapy and maintenance immunotherapy. Oncologist 2009; 14:995-1002. [PMID: 19776094 DOI: 10.1634/theoncologist.2009-0083] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 11/17/2022] Open
Abstract
BACKGROUND With no U.S. Food and Drug Administration-approved standard therapy other than high-dose interleukin-2 and dacarbazine for metastatic melanoma, biochemotherapy has shown promise, with long-term survival in selected patients. We felt that the study of prognostic factors would determine which patients might benefit from this intensive therapy. METHODS One hundred thirty-five consecutive patients with metastatic melanoma treated with decrescendo biochemotherapy followed by maintenance immunotherapy over 5 years were retrospectively studied to determine the most important prognostic factors for both overall survival and progression-free survival. RESULTS The median overall survival (OS) time was 16.6 months, with 1-year and 5-year survival rates of 70% and 28%, respectively. The median progression-free survival (PFS) time was 7.6 months, with 15% of patients progression free at 5 years. PFS curves showed no relapses after 30 months, so remissions were durable. For OS, a performance status score of zero, normal lactate dehydrogenase (LDH) level, stage M1a, and nonvisceral sites of metastasis were favorable factors. The group with normal LDH levels and skin or nodes as one of their metastatic sites had a relatively good prognosis, with median survival time of 44 months and an estimated 5-year survival rate of 38%. Conversely, patients with an elevated LDH level without any skin or nodal metastases had a poor prognosis, with no long-term survivors. CONCLUSIONS Metastatic melanoma patients treated with biochemotherapy and maintenance immunotherapy who have either a normal LDH level or skin or nodes as one of their metastatic sites may have durable remissions of their disease, and this therapy should be studied further in these groups.
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Affiliation(s)
- David R Minor
- California Pacific Medical Center, 2100 Webster Street, Suite 326, San Francisco, California 94115, USA.
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Boasberg P, Cruickshank S, Hamid O, O'Day S, Weber R, Spitler L. Nab-paclitaxel and bevacizumab as first-line therapy in patients with unresectable stage III and IV melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9061^ Background: Nab-paclitaxel (Abraxane) increases intra-tumoral concentrations of paclitaxel and has efficacy superior to that of paclitaxel for the treatment of metastatic breast cancer (J Clin Oncol 2005:23:7794–7803). Nab-paclitaxel demonstrated single agent activity in metastatic melanoma. (ASCO 2005:7558) Bevacizumab is a monoclonal antibody that targets VEGF resulting in inhibition of tumor angiogenesis and enhances tumor response to paclitaxel. (NEJM 2007:357:2666–2676) Methods: Eligible were chemotherapy-naïve patients with unresectable stage III or IV melanoma, ECOG performance status of 0–1, and adequate organ function. The treatment regimen was given in a 28-day cycle in which nab-paclitaxel 150 mg/m2 was administered on days 1, 8, and 15 and bevacizumab 10mg/kg on days 1 and 15 until disease progression or dose limiting toxicity. Response assessments were made by RECIST criteria every 2 cycles. Results: Forty-one patients have been treated since 08/15/07. Over 50% of the patients had stage IV, MIc disease. The median duration of follow-up for progression-free survival from start of protocol treatment is 5.3 months. Progression-free survival at 4 months is 83%,(95%CI:69%-97%). Median progression free survival is 6.25 months (95%CI: 5.63–9.41). The median duration of follow-up for survival is 4.7 months. Three patients have died and 38 patients remain alive. The 6 month survival rate is 91% (95%CI:79%-100%).The 12 month survival rate is 83% (95% CI:65%-100%). The median duration of overall survival has not been reached yet. Dose modifying toxicities consisted primarily of neutropenia, neuropathy, and hypertension. Conclusions: Early experience suggests that nab-paclitaxel and bevacizumab is an effective and well-tolerated regimen as first-line therapy in patients with metastatic melanoma. The study is ongoing with an accrual target of 50 patients. [Table: see text] ASCO Conflict of Interest Policy and Exceptions In compliance with the guidelines established by the ASCO Conflict of Interest Policy (J Clin Oncol. 2006 Jan 20;24[3]:519–521) and the Accreditation Council for Continuing Medical Education (ACCME), ASCO strives to promote balance, independence, objectivity, and scientific rigor through disclosure of financial and other interests, and identification and management of potential conflicts. According to the ASCO Conflict of Interest Policy, the following financial and other relationships must be disclosed: employment or leadership position, consultant or advisory role, stock ownership, honoraria, research funding, expert testimony, and other remuneration (J Clin Oncol. 2006 Jan 20;24[3]:520). The ASCO Conflict of Interest Policy disclosure requirements apply to all authors who submit abstracts to the Annual Meeting. For clinical trials that began accrual on or after April 29, 2004, ASCO's Policy places some restrictions on the financial relationships of principal investigators (J Clin Oncol. 2006 Jan 20;24[3]:521). If a principal investigator holds any restricted relationships, his or her abstract will be ineligible for placement in the 2009 Annual Meeting unless the ASCO Ethics Committee grants an exception. Among the circumstances that might justify an exception are that the principal investigator (1) is a widely acknowledged expert in a particular therapeutic area; (2) is the inventor of a unique technology or treatment being evaluated in the clinical trial; or (3) is involved in international clinical oncology research and has acted consistently with recognized international standards of ethics in the conduct of clinical research. NIH-sponsored trials are exempt from the Policy restrictions. Abstracts for which authors requested and have been granted an exception in accordance with ASCO's Policy are designated with a caret symbol (^) in the Annual Meeting Proceedings. For more information about the ASCO Conflict of Interest Policy and the exceptions process, please visit www.asco.org/conflictofinterest .
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Affiliation(s)
- P. Boasberg
- The Angeles Clinic and Research Institute, Santa Monica, CA; Scott Cruickshank and Associates, Santa Barbara, CA; The Angeles Clinic and Research Institute, Santa Monica, CA; N. Ca. Melanoma Center at St. Mary's Medical Center, San Francisco, CA
| | - S. Cruickshank
- The Angeles Clinic and Research Institute, Santa Monica, CA; Scott Cruickshank and Associates, Santa Barbara, CA; The Angeles Clinic and Research Institute, Santa Monica, CA; N. Ca. Melanoma Center at St. Mary's Medical Center, San Francisco, CA
| | - O. Hamid
- The Angeles Clinic and Research Institute, Santa Monica, CA; Scott Cruickshank and Associates, Santa Barbara, CA; The Angeles Clinic and Research Institute, Santa Monica, CA; N. Ca. Melanoma Center at St. Mary's Medical Center, San Francisco, CA
| | - S. O'Day
- The Angeles Clinic and Research Institute, Santa Monica, CA; Scott Cruickshank and Associates, Santa Barbara, CA; The Angeles Clinic and Research Institute, Santa Monica, CA; N. Ca. Melanoma Center at St. Mary's Medical Center, San Francisco, CA
| | - R. Weber
- The Angeles Clinic and Research Institute, Santa Monica, CA; Scott Cruickshank and Associates, Santa Barbara, CA; The Angeles Clinic and Research Institute, Santa Monica, CA; N. Ca. Melanoma Center at St. Mary's Medical Center, San Francisco, CA
| | - L. Spitler
- The Angeles Clinic and Research Institute, Santa Monica, CA; Scott Cruickshank and Associates, Santa Barbara, CA; The Angeles Clinic and Research Institute, Santa Monica, CA; N. Ca. Melanoma Center at St. Mary's Medical Center, San Francisco, CA
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Hwu P, Sznol M, Pavlick A, Kluger H, Kim KB, Boasberg P, Sanders D, Simantov R, Crowley E, Hamid O. A phase I/II study of CR011-vcMMAE, an antibody-drug conjugate (ADC) targeting glycoprotein NMB (GPNMB) in patients (pts) with advanced melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9032 Background: GPNMB is expressed on melanoma cells and represents a potential target for ADCs. CR011-vcMMAE is a fully-human monoclonal antibody to GPNMB conjugated to the tubulin inhibitor monomethylauristatin E (MMAE). Dose limiting toxicity in Phase I (n=32) was rash; tumor shrinkage including one partial response (PR) was observed. We now report Phase II data at the maximum tolerated dose of 1.88 mg/kg iv q3w. Methods: Eligible pts had unresectable stage III or stage IV melanoma and had received no more than 1 prior cytotoxic regimen but any number of other therapies. Pts received CR011-vcMMAE until disease progression (PD) or intolerable toxicity. The primary endpoint was overall response (ORR) by RECIST using a minimax two-stage design (p0=0.5; p1=0.2, α=β=0.1) with 18 patients in the first stage and a total of 32 pts. Secondary endpoints included progression free survival (PFS) and duration of response. Results: 36 pts (median age 67 years [range 37–79]; 94% stage IV; 68% M1c) were treated for a median of 2.4 months (m)(range 0.5–7.5m). 18 pts discontinued (14 PD, 2 consent, 1 adverse event [AE], 1 stable disease [SD]) and 18 pts were ongoing. The study met the criteria for advancement to the second stage; 4 PRs (1 unconfirmed) and 19 SD (range 1.7–7.5 mo) have been observed; final ORR is pending. The unconfirmed PR was in a pt with 96% tumor reduction and PD 6 weeks later. Median PFS was 4m. The most common AEs were rash (81%), fatigue (72%), alopecia (63%) and pruritus (56%). The most common grade 3/4 AEs were neutropenia (22%) and rash (19%). Grade 2 or higher rash was associated with longer PFS. Conclusions: CR011-vcMMAE is active and well-tolerated in heavily pretreated pts with advanced melanoma. Rash may be a useful biomarker for activity. More frequent dosing is being explored. [Table: see text]
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Affiliation(s)
- P. Hwu
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Yale Cancer Center, New Haven, CT; New York University Medical Center, New York, NY; The Angeles Clinic and Research Institute, Santa Monica, CA; CuraGen Corporation, Branford, CT
| | - M. Sznol
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Yale Cancer Center, New Haven, CT; New York University Medical Center, New York, NY; The Angeles Clinic and Research Institute, Santa Monica, CA; CuraGen Corporation, Branford, CT
| | - A. Pavlick
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Yale Cancer Center, New Haven, CT; New York University Medical Center, New York, NY; The Angeles Clinic and Research Institute, Santa Monica, CA; CuraGen Corporation, Branford, CT
| | - H. Kluger
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Yale Cancer Center, New Haven, CT; New York University Medical Center, New York, NY; The Angeles Clinic and Research Institute, Santa Monica, CA; CuraGen Corporation, Branford, CT
| | - K. B. Kim
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Yale Cancer Center, New Haven, CT; New York University Medical Center, New York, NY; The Angeles Clinic and Research Institute, Santa Monica, CA; CuraGen Corporation, Branford, CT
| | - P. Boasberg
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Yale Cancer Center, New Haven, CT; New York University Medical Center, New York, NY; The Angeles Clinic and Research Institute, Santa Monica, CA; CuraGen Corporation, Branford, CT
| | - D. Sanders
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Yale Cancer Center, New Haven, CT; New York University Medical Center, New York, NY; The Angeles Clinic and Research Institute, Santa Monica, CA; CuraGen Corporation, Branford, CT
| | - R. Simantov
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Yale Cancer Center, New Haven, CT; New York University Medical Center, New York, NY; The Angeles Clinic and Research Institute, Santa Monica, CA; CuraGen Corporation, Branford, CT
| | - E. Crowley
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Yale Cancer Center, New Haven, CT; New York University Medical Center, New York, NY; The Angeles Clinic and Research Institute, Santa Monica, CA; CuraGen Corporation, Branford, CT
| | - O. Hamid
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Yale Cancer Center, New Haven, CT; New York University Medical Center, New York, NY; The Angeles Clinic and Research Institute, Santa Monica, CA; CuraGen Corporation, Branford, CT
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Hwu P, Sznol M, Kluger H, Rink L, Kim KB, Papadopoulos NE, Sanders D, Boasberg P, Ooi CE, Hamid O. A phase I/II study of CR011-vcMMAE, an antibody toxin conjugate drug, in patients with unresectable stage III/IV melanoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Boasberg P, Minor DR, Hamid O, Weber JS, Wollman R, Anderson CM, O’Day SJ. Prophylatic cranial irradiation (PCI) in patients (Pts) with stage IV metastatic melanoma (MM) receiving concurrent biochemotherapy (cBCT) and maintenance biotherapy (MBT). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
The management of metastatic melanoma in 2005 remains a major clinical challenge. Multidisciplinary treatment planning and careful attention to sites of metastases, tumor biology, and comorbid conditions are critical to making the best clinical decisions for individual patients. No standard of care exists because no systemic therapies have yet shown efficacy in phase III trials. Single-agent or combination chemotherapy has not impacted over-all survival, and response rates are of short duration. High-dose IL-2 produces durable responses in a small subset (7%) of highly selected patients and has considerable toxicity and quality-of-life trade-offs. Biochemotherapy results in overall higher responses, but its impact on overall survival has been disappointing and its toxicity and expense are considerable. Re-searchers are further investigating biochemotherapy modifications with maintenance biotherapy and CNS consolidation in effort to increase durability of responses and prevent or delay the devastating sequela of CNS metastases. Despite a disappointing past, the advancement of science and a better understanding of critical cellular targets and pathways make the future of melanoma research encouraging. Clinical trials are actively studying novel immune potentiators, cytotoxics, and targeted therapies. Combinations of these new agents will likely be necessary to advance the treatment of the dis-ease. All patients should be encouraged to participate in clinical trials.
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Affiliation(s)
- Steven O'Day
- Department of Medicine, Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, KAM 500, Los Angeles, CA 90089-9034, USA.
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O’Day S, Atkins M, Weber J, Thompson J, Anderson C, Gonzalez R, Lutzky J, Amatruda T, Hersh E, Boasberg P. A phase II multi-center trial of maintenance biotherapy (MBT) after induction concurrent biochemotherapy (BCT) for patients (Pts) with metastatic melanoma (MM). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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)
- S. O’Day
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - M. Atkins
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - J. Weber
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - J. Thompson
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - C. Anderson
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - R. Gonzalez
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - J. Lutzky
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - T. Amatruda
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - E. Hersh
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
| | - P. Boasberg
- Cancer Institute Medcl Group, Santa Monica, CA; Beth Israel Deaconess Medcl Ctr, Boston, MA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Seattle Cancer Care Alliance, Seattle, WA; Ellis Fischel Cancer Ctr, Columbia, MD; Univ of Colorado Cancer Ctr, Aurora, CO; Mount Sinai Comprehensive Cancer Ctr, Miami Beach, FL; Hubert H. Humphrey Cancer Ctr, Robinsdale, MN; Arizona Cancer Ctr, Tucson, AZ
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Liu D, O'Day SJ, Yang D, Boasberg P, Milford R, Kristedja T, Groshen S, Weber J. Impact of gene polymorphisms on clinical outcome for stage IV melanoma patients treated with biochemotherapy: an exploratory study. Clin Cancer Res 2005; 11:1237-46. [PMID: 15709194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
PURPOSE Biochemotherapy can achieve high response rates in advanced melanoma, but the factors that influence regression and survival remain unknown. The present exploratory study tested the hypothesis that cytokine gene polymorphisms predict clinical outcome in stage IV melanoma patients treated with biochemotherapy. EXPERIMENTAL DESIGN Ninety patients with stage IV melanoma were treated with biochemotherapy, including cisplatin, vinblastine, and dacarbazine combined with interleukin (IL)-2 and IFN-alpha either with or without tamoxifen. Cytokine gene polymorphisms for IFN-gamma (+874A-->T) and IL-10 (-1082G-->A) were assessed. X-ray repair cross-complementing gene 1 (XRCC1; Arg399Gln), xeroderma pigmentosum complementary group D (XPD; Lys751Gln), and excision repair cross-complementing gene 1 (ERCC1; codon 118) DNA repair polymorphisms were also determined. RESULTS IFN-gamma (+874A-->T) gene polymorphism was statistically significantly associated with response (P = 0.001), progression-free survival (P = 0.0012), and overall survival (P < 0.001), whereas the IL-10 polymorphism was marginally associated with response (P = 0.03) and overall survival (P = 0.065). Multivariate analysis revealed that IFN-gamma (+874A-->T) independently predicted overall survival (P = 0.003). The ERCC1 polymorphism was weakly associated with overall survival (P = 0.045). Combining polymorphisms for IFN-gamma, IL-10, and ERCC1 stratified patients into four distinct groups with significantly different clinical outcome (P < 0.001), so that patients with more "favorable" polymorphisms had a better outcome. CONCLUSIONS Cytokine gene polymorphisms predicted clinical outcome for advanced melanoma patients who received biochemotherapy. The combined effects of multiple genetic polymorphisms may provide more accurate prognostic information. Additional independent studies are needed to confirm these pilot findings.
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Affiliation(s)
- Dongxin Liu
- Department of Medicine, University of Southern California, Keck School of Medicine/Norris Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA 90033, USA
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Liu D, O'Day SJ, Yang D, Boasberg P, Milford R, Kristedja T, Groshen S, Weber JS. Immune gene polymorphisms predict overall survival for stage IV melanoma patients treated with biochemotherapy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. Liu
- USC/Norris Cacer Center, Los Angeles, CA; John Wayne Cancer Institute, Cancer Institute Medical Group, Santa Monica, CA; USC/Norris Cancer Center, Los Angeles, CA
| | - S. J. O'Day
- USC/Norris Cacer Center, Los Angeles, CA; John Wayne Cancer Institute, Cancer Institute Medical Group, Santa Monica, CA; USC/Norris Cancer Center, Los Angeles, CA
| | - D. Yang
- USC/Norris Cacer Center, Los Angeles, CA; John Wayne Cancer Institute, Cancer Institute Medical Group, Santa Monica, CA; USC/Norris Cancer Center, Los Angeles, CA
| | - P. Boasberg
- USC/Norris Cacer Center, Los Angeles, CA; John Wayne Cancer Institute, Cancer Institute Medical Group, Santa Monica, CA; USC/Norris Cancer Center, Los Angeles, CA
| | - R. Milford
- USC/Norris Cacer Center, Los Angeles, CA; John Wayne Cancer Institute, Cancer Institute Medical Group, Santa Monica, CA; USC/Norris Cancer Center, Los Angeles, CA
| | - T. Kristedja
- USC/Norris Cacer Center, Los Angeles, CA; John Wayne Cancer Institute, Cancer Institute Medical Group, Santa Monica, CA; USC/Norris Cancer Center, Los Angeles, CA
| | - S. Groshen
- USC/Norris Cacer Center, Los Angeles, CA; John Wayne Cancer Institute, Cancer Institute Medical Group, Santa Monica, CA; USC/Norris Cancer Center, Los Angeles, CA
| | - J. S. Weber
- USC/Norris Cacer Center, Los Angeles, CA; John Wayne Cancer Institute, Cancer Institute Medical Group, Santa Monica, CA; USC/Norris Cancer Center, Los Angeles, CA
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23
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Papadimitrakopoulou V, Boasberg P, Figlin R, Zinner R, Blumenschein G, King L, Truong M, Patel K, Brown GL, Hanna N. Phase 1–2a dose ranging study of TLK286 (a novel glutathione analog) in combination with docetaxel in platinum-resistant non-small cell lung cancer (NSCLC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7140] [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)
- V. Papadimitrakopoulou
- M. D. Anderson Cancer Center, Houston, TX; Cancer Institute Medical Group, Los Angeles, CA; University of California Los Angeles, Los Angeles, CA; Telik, Inc, Palo Alto, CA; Indiana University Cancer Center, Indianapolis, IN
| | - P. Boasberg
- M. D. Anderson Cancer Center, Houston, TX; Cancer Institute Medical Group, Los Angeles, CA; University of California Los Angeles, Los Angeles, CA; Telik, Inc, Palo Alto, CA; Indiana University Cancer Center, Indianapolis, IN
| | - R. Figlin
- M. D. Anderson Cancer Center, Houston, TX; Cancer Institute Medical Group, Los Angeles, CA; University of California Los Angeles, Los Angeles, CA; Telik, Inc, Palo Alto, CA; Indiana University Cancer Center, Indianapolis, IN
| | - R. Zinner
- M. D. Anderson Cancer Center, Houston, TX; Cancer Institute Medical Group, Los Angeles, CA; University of California Los Angeles, Los Angeles, CA; Telik, Inc, Palo Alto, CA; Indiana University Cancer Center, Indianapolis, IN
| | - G. Blumenschein
- M. D. Anderson Cancer Center, Houston, TX; Cancer Institute Medical Group, Los Angeles, CA; University of California Los Angeles, Los Angeles, CA; Telik, Inc, Palo Alto, CA; Indiana University Cancer Center, Indianapolis, IN
| | - L. King
- M. D. Anderson Cancer Center, Houston, TX; Cancer Institute Medical Group, Los Angeles, CA; University of California Los Angeles, Los Angeles, CA; Telik, Inc, Palo Alto, CA; Indiana University Cancer Center, Indianapolis, IN
| | - M. Truong
- M. D. Anderson Cancer Center, Houston, TX; Cancer Institute Medical Group, Los Angeles, CA; University of California Los Angeles, Los Angeles, CA; Telik, Inc, Palo Alto, CA; Indiana University Cancer Center, Indianapolis, IN
| | - K. Patel
- M. D. Anderson Cancer Center, Houston, TX; Cancer Institute Medical Group, Los Angeles, CA; University of California Los Angeles, Los Angeles, CA; Telik, Inc, Palo Alto, CA; Indiana University Cancer Center, Indianapolis, IN
| | - G. L. Brown
- M. D. Anderson Cancer Center, Houston, TX; Cancer Institute Medical Group, Los Angeles, CA; University of California Los Angeles, Los Angeles, CA; Telik, Inc, Palo Alto, CA; Indiana University Cancer Center, Indianapolis, IN
| | - N. Hanna
- M. D. Anderson Cancer Center, Houston, TX; Cancer Institute Medical Group, Los Angeles, CA; University of California Los Angeles, Los Angeles, CA; Telik, Inc, Palo Alto, CA; Indiana University Cancer Center, Indianapolis, IN
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Abstract
Current indications for breast cancer screening in the male population are lacking, although family history of breast cancer may be such an indication. The authors describe a man with a history of clinically diagnosed right breast cancer who subsequently tested positive for the breast cancer susceptibility gene BRCA2 and received a diagnosis of mammographically detected left breast cancer at screening. The authors discuss the clinical implications of this approach to detecting male breast cancer.
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MESH Headings
- Aged
- BRCA2 Protein/genetics
- Biopsy, Needle
- Breast/pathology
- Breast Neoplasms, Male/diagnostic imaging
- Breast Neoplasms, Male/genetics
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/therapy
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Follow-Up Studies
- Germ-Line Mutation
- Humans
- Male
- Mass Screening
- Mastectomy
- Neoplasm Staging
- Neoplasms, Hormone-Dependent/diagnostic imaging
- Neoplasms, Hormone-Dependent/genetics
- Neoplasms, Hormone-Dependent/pathology
- Neoplasms, Hormone-Dependent/therapy
- Neoplasms, Multiple Primary/diagnostic imaging
- Neoplasms, Multiple Primary/genetics
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Radiography
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Reoperation
- Sentinel Lymph Node Biopsy
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Affiliation(s)
- R James Brenner
- Eisenberg Keefer Breast Center, John Wayne Cancer Institute, Saint Johns Health Center, 1328 22nd St, Santa Monica, CA 90404, USA.
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Kut V, Boasberg P, Sagar S, Miller S, Birdsall TC, Rey S, Martin J, Rogers M, Wicke RW, Cheung CS, He B, Chen K, Hovi MA, Dreher H, McCray P, Block KI. Integrative tumor board: Advanced breast cancer. Integr Cancer Ther 2003; 1:179-214. [PMID: 14664744 DOI: 10.1177/1534735402001002010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Victoria Kut
- Block Center for Integrative Cancer Care, Evanston, IL 60201, USA.
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Vernino S, Tuite P, Adler CH, Meschia JF, Boeve BF, Boasberg P, Parisi JE, Lennon VA. Paraneoplastic chorea associated with CRMP-5 neuronal antibody and lung carcinoma. Ann Neurol 2002; 51:625-30. [PMID: 12112110 DOI: 10.1002/ana.10178] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.3] [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: 11/06/2022]
Abstract
Paraneoplastic chorea is described in 16 patients: 11 with limited small-cell carcinoma, 2 with lung cancer revealed by imaging, 1 with renal cell carcinoma, and 1 with lymphoma. All had CRMP-5-IgG; 6 also had ANNA-1 (anti-Hu), including 1 without evident cancer. Chorea was the initial and most prominent symptom in 11 patients, asymmetric or unilateral in 5 patients, and part of a multifocal syndrome in 14 patients. Basal ganglia abnormalities were revealed by magnetic resonance imaging and at autopsy (as perivascular inflammation and microglial activation). Four patients improved with chemotherapy, and 2 improved with intravenous methylprednisolone.
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Affiliation(s)
- Steven Vernino
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
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