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Zhou Y, Chen X, Chen J, Kendrick CD, Ramanathan RK, Graham RP, Kossick KF, Boardman LA, Barrett MT. Genomic landscape of diploid and aneuploid microsatellite stable early onset colorectal cancer. Sci Rep 2024; 14:9368. [PMID: 38654044 DOI: 10.1038/s41598-024-59398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
Although colorectal cancer (CRC) remains the second leading cause of cancer-related death in the United States, the overall incidence and mortality from the disease have declined in recent decades. In contrast, there has been a steady increase in the incidence of CRC in individuals under 50 years of age. Hereditary syndromes contribute disproportionately to early onset CRC (EOCRC). These include microsatellite instability high (MSI+) tumors arising in patients with Lynch Syndrome. However, most EOCRCs are not associated with familial syndromes or MSI+ genotypes. Comprehensive genomic profiling has provided the basis of improved more personalized treatments for older CRC patients. However, less is known about the basis of sporadic EOCRC. To define the genomic landscape of EOCRC we used DNA content flow sorting to isolate diploid and aneuploid tumor fractions from 21 non-hereditary cases. We then generated whole exome mutational profiles for each case and whole genome copy number, telomere length, and EGFR immunohistochemistry (IHC) analyses on subsets of samples. These results discriminate the molecular features of diploid and aneuploid EOCRC and provide a basis for larger population-based studies and the development of effective strategies to monitor and treat this emerging disease.
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Affiliation(s)
- Yumei Zhou
- Department of Research, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Xianfeng Chen
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jun Chen
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | - Conner D Kendrick
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ramesh K Ramanathan
- Mayo Clinic Cancer Center, Phoenix, AZ, 85054, USA
- Ironwood Cancer and Research Center, Scottsdale, AZ, 85260, USA
| | | | - Kimberlee F Kossick
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Lisa A Boardman
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Michael T Barrett
- Department of Research, Mayo Clinic in Arizona, Scottsdale, AZ, USA.
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic in Arizona, Scottsdale, AZ, USA.
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2
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Goldberg RM, Sargent DJ, Morton RF, Fuchs CS, Ramanathan RK, Williamson SK, Findlay BP, Pitot HC, Alberts SR. A Randomized Controlled Trial of Fluorouracil Plus Leucovorin, Irinotecan, and Oxaliplatin Combinations in Patients With Previously Untreated Metastatic Colorectal Cancer. J Clin Oncol 2023; 41:3461-3468. [PMID: 37379691 DOI: 10.1200/jco.22.02759] [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: 06/30/2023] Open
Abstract
PURPOSE Three agents with differing mechanisms of action are available for treatment of advanced colorectal cancer: fluorouracil, irinotecan, and oxaliplatin. In this study, we compared the activity and toxicity of three different two-drug combinations in patients with metastatic colorectal cancer who had not been treated previously for advanced disease. PATIENTS AND METHODS Patients were concurrently randomly assigned to receive irinotecan and bolus fluorouracil plus leucovorin (IFL, control combination), oxaliplatin and infused fluorouracil plus leucovorin (FOLFOX), or irinotecan and oxaliplatin (IROX). The primary end point was time to progression, with secondary end points of response rate, survival time, and toxicity. RESULTS A total of 795 patients were randomly assigned between May 1999 and April 2001. A median time to progression of 8.7 months, response rate of 45%, and median survival time of 19.5 months were observed for FOLFOX. These results were significantly superior to those observed for IFL for all end points (6.9 months, 31%, and 15.0 months, respectively) or for IROX (6.5 months, 35%, and 17.4 months, respectively) for time to progression and response. The FOLFOX regimen had significantly lower rates of severe nausea, vomiting, diarrhea, febrile neutropenia, and dehydration. Sensory neuropathy and neutropenia were more common with the regimens containing oxaliplatin. CONCLUSION The FOLFOX regimen of oxaliplatin and infused fluorouracil plus leucovorin was active and comparatively safe. It should be considered as a standard therapy for patients with advanced colorectal cancer.
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Affiliation(s)
- Richard M Goldberg
- From the North Central Cancer Treatment Group, Divisions of Hematology/Oncology and Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; North Central Cancer Treatment Group, Division of Biostatistics, Mayo Clinic, Rochester, MN; North Central Cancer Treatment Group, Iowa Oncology Research Association Community Clinical Oncology Program, Des Moines, IA; Cancer and Acute Leukemia Group B, Department of Oncology, Dana-Farber Cancer Institute, Boston, MA; Eastern Cooperative Oncology Group, Division of Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Southwestern Oncology Group, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St Catharines, Ontario, Canada
| | - Daniel J Sargent
- From the North Central Cancer Treatment Group, Divisions of Hematology/Oncology and Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; North Central Cancer Treatment Group, Division of Biostatistics, Mayo Clinic, Rochester, MN; North Central Cancer Treatment Group, Iowa Oncology Research Association Community Clinical Oncology Program, Des Moines, IA; Cancer and Acute Leukemia Group B, Department of Oncology, Dana-Farber Cancer Institute, Boston, MA; Eastern Cooperative Oncology Group, Division of Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Southwestern Oncology Group, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St Catharines, Ontario, Canada
| | - Roscoe F Morton
- From the North Central Cancer Treatment Group, Divisions of Hematology/Oncology and Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; North Central Cancer Treatment Group, Division of Biostatistics, Mayo Clinic, Rochester, MN; North Central Cancer Treatment Group, Iowa Oncology Research Association Community Clinical Oncology Program, Des Moines, IA; Cancer and Acute Leukemia Group B, Department of Oncology, Dana-Farber Cancer Institute, Boston, MA; Eastern Cooperative Oncology Group, Division of Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Southwestern Oncology Group, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St Catharines, Ontario, Canada
| | - Charles S Fuchs
- From the North Central Cancer Treatment Group, Divisions of Hematology/Oncology and Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; North Central Cancer Treatment Group, Division of Biostatistics, Mayo Clinic, Rochester, MN; North Central Cancer Treatment Group, Iowa Oncology Research Association Community Clinical Oncology Program, Des Moines, IA; Cancer and Acute Leukemia Group B, Department of Oncology, Dana-Farber Cancer Institute, Boston, MA; Eastern Cooperative Oncology Group, Division of Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Southwestern Oncology Group, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St Catharines, Ontario, Canada
| | - Ramesh K Ramanathan
- From the North Central Cancer Treatment Group, Divisions of Hematology/Oncology and Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; North Central Cancer Treatment Group, Division of Biostatistics, Mayo Clinic, Rochester, MN; North Central Cancer Treatment Group, Iowa Oncology Research Association Community Clinical Oncology Program, Des Moines, IA; Cancer and Acute Leukemia Group B, Department of Oncology, Dana-Farber Cancer Institute, Boston, MA; Eastern Cooperative Oncology Group, Division of Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Southwestern Oncology Group, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St Catharines, Ontario, Canada
| | - Stephen K Williamson
- From the North Central Cancer Treatment Group, Divisions of Hematology/Oncology and Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; North Central Cancer Treatment Group, Division of Biostatistics, Mayo Clinic, Rochester, MN; North Central Cancer Treatment Group, Iowa Oncology Research Association Community Clinical Oncology Program, Des Moines, IA; Cancer and Acute Leukemia Group B, Department of Oncology, Dana-Farber Cancer Institute, Boston, MA; Eastern Cooperative Oncology Group, Division of Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Southwestern Oncology Group, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St Catharines, Ontario, Canada
| | - Brian P Findlay
- From the North Central Cancer Treatment Group, Divisions of Hematology/Oncology and Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; North Central Cancer Treatment Group, Division of Biostatistics, Mayo Clinic, Rochester, MN; North Central Cancer Treatment Group, Iowa Oncology Research Association Community Clinical Oncology Program, Des Moines, IA; Cancer and Acute Leukemia Group B, Department of Oncology, Dana-Farber Cancer Institute, Boston, MA; Eastern Cooperative Oncology Group, Division of Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Southwestern Oncology Group, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St Catharines, Ontario, Canada
| | - Henry C Pitot
- From the North Central Cancer Treatment Group, Divisions of Hematology/Oncology and Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; North Central Cancer Treatment Group, Division of Biostatistics, Mayo Clinic, Rochester, MN; North Central Cancer Treatment Group, Iowa Oncology Research Association Community Clinical Oncology Program, Des Moines, IA; Cancer and Acute Leukemia Group B, Department of Oncology, Dana-Farber Cancer Institute, Boston, MA; Eastern Cooperative Oncology Group, Division of Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Southwestern Oncology Group, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St Catharines, Ontario, Canada
| | - Steven R Alberts
- From the North Central Cancer Treatment Group, Divisions of Hematology/Oncology and Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; North Central Cancer Treatment Group, Division of Biostatistics, Mayo Clinic, Rochester, MN; North Central Cancer Treatment Group, Iowa Oncology Research Association Community Clinical Oncology Program, Des Moines, IA; Cancer and Acute Leukemia Group B, Department of Oncology, Dana-Farber Cancer Institute, Boston, MA; Eastern Cooperative Oncology Group, Division of Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Southwestern Oncology Group, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St Catharines, Ontario, Canada
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Gordon MS, Nemunaitis J, Barve M, Wainberg ZA, Hamilton EP, Ramanathan RK, Sledge GW, Yue H, Morgan-Lappe SE, Blaney M, Kasichayanula S, Motwani M, Wang L, Naumovski L, Strickler JH. Phase I Open-Label Study Evaluating the Safety, Pharmacokinetics, and Preliminary Efficacy of Dilpacimab in Patients with Advanced Solid Tumors. Mol Cancer Ther 2021; 20:1988-1995. [PMID: 34315767 PMCID: PMC9398147 DOI: 10.1158/1535-7163.mct-20-0985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/01/2020] [Revised: 03/30/2021] [Accepted: 07/13/2021] [Indexed: 01/07/2023]
Abstract
Dilpacimab (formerly ABT-165), a novel dual-variable domain immunoglobulin, targets both delta-like ligand 4 (DLL4) and VEGF pathways. Here, we present safety, pharmacokinetic (PK), pharmacodynamic (PD), and preliminary efficacy data from a phase I study (trial registration ID: NCT01946074) of dilpacimab in patients with advanced solid tumors. Eligible patients (≥18 years) received dilpacimab intravenously on days 1 and 15 in 28-day cycles at escalating dose levels (range, 1.25-7.5 mg/kg) until progressive disease or unacceptable toxicity. As of August 2018, 55 patients with solid tumors were enrolled in the dilpacimab monotherapy dose-escalation and dose-expansion cohorts. The most common treatment-related adverse events (TRAE) included hypertension (60.0%), headache (30.9%), and fatigue (21.8%). A TRAE of special interest was gastrointestinal perforation, occurring in 2 patients (3.6%; 1 with ovarian and 1 with prostate cancer) and resulting in 1 death. The PK of dilpacimab showed a half-life ranging from 4.9 to 9.5 days, and biomarker analysis demonstrated that the drug bound to both VEGF and DLL4 targets. The recommended phase II dose for dilpacimab monotherapy was established as 3.75 mg/kg, primarily on the basis of tolerability through multiple cycles. A partial response was achieved in 10.9% of patients (including 4 of 16 patients with ovarian cancer). The remaining patients had either stable disease (52.7%), progressive disease (23.6%), or were deemed unevaluable (12.7%). These results demonstrate that dilpacimab monotherapy has an acceptable safety profile, with clinical activity observed in patients with advanced solid tumors.
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Affiliation(s)
- Michael S. Gordon
- HonorHealth Research Institute, Scottsdale, Arizona.,Corresponding Author: Michael S. Gordon, HonorHealth Research Institute, 10510 N. 92nd Street, Ste 200, Scottsdale, AZ 85258. Phone: 480-323-1350; Fax: 480-323-1359; E-mail:
| | - John Nemunaitis
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio.,ProMedica Health System, Toledo, Ohio
| | | | - Zev A. Wainberg
- School of Medicine, Ronald Reagan UCLA Medical Center, UCLA Health, University of California Los Angeles, Los Angeles, California
| | - Erika P. Hamilton
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, Tennessee
| | | | - George W. Sledge
- Stanford Cancer Institute, Stanford Medicine, Stanford, California
| | - Huibin Yue
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | | | - Martha Blaney
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | | | - Monica Motwani
- Translational Oncology, AbbVie Inc., North Chicago, Illinois
| | - Lan Wang
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | - Louie Naumovski
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | - John H. Strickler
- Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Ando K, Ozonoff A, Lee SY, Voisine M, Parker JT, Nakanishi R, Nishimura S, Yang J, Grace Z, Tran B, Diefenbach TJ, Maehara Y, Yasui H, Irino T, Salgia R, Terashima M, Gibbs P, Ramanathan RK, Oki E, Mori M, Kulke M, Hartshorn K, Bharti A. Multicohort Retrospective Validation of a Predictive Biomarker for Topoisomerase I Inhibitors. Clin Colorectal Cancer 2020; 20:e129-e138. [PMID: 33731288 DOI: 10.1016/j.clcc.2020.11.005] [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: 09/17/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The camptothecin (CPT) analogs topotecan and irinotecan specifically target topoisomerase I (topoI) and are used to treat colorectal, gastric, and pancreatic cancer. Response rate for this class of drug varies from 10% to 30%, and there is no predictive biomarker for patient stratification by response. On the basis of our understanding of CPT drug resistance mechanisms, we developed an immunohistochemistry-based predictive test, P-topoI-Dx, to stratify the patient population into those who did and did not experience a response. PATIENTS AND METHODS The retrospective validation studies included a training set (n = 79) and a validation cohort (n = 27) of gastric cancer (GC) patients, and 8 cohorts of colorectal cancer (CRC) patient tissue (n = 176). Progression-free survival for 6 months was considered a positive response to CPT-based therapy. Formalin-fixed, paraffin-embedded slides were immunohistochemically stained with anti-phospho-specific topoI-Serine10 (topoI-pS10), quantitated, and analyzed statistically. RESULTS We determined a threshold of 35% positive staining to offer optimal test characteristics in GC. The GC (n = 79) training set demonstrated 76.6% (95% confidence interval, 64-86) sensitivity; 68.8% (41-88) specificity; positive predictive value (PPV) 92.5% (81-98); and negative predictive value (NPV) 42.3% (24-62). The GC validation set (n = 27) demonstrated 82.4% (56-95) sensitivity and 70.0% (35-92) specificity. Estimated PPV and NPV were 82.4% (56-95) and 70.0% (35-92) respectively. In the CRC validation set (n = 176), the 40% threshold demonstrated 87.5% (78-94) sensitivity; 70.0% (59-79) specificity; PPV 70.7% (61-79); and NPV 87.0 % (77-93). CONCLUSION The analysis of retrospective data from patients (n = 282) provides clinical validity to our P-topoI-Dx immunohistochemical test to identify patients with disease that is most likely to respond to topoI inhibitors.
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Affiliation(s)
- Koji Ando
- Division of Hematology Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA; Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Al Ozonoff
- Division of Infectious Diseases, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Shin-Yin Lee
- Division of Hematology Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Michael Voisine
- Division of Hematology Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Julian-Taylor Parker
- Division of Hematology Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Ryota Nakanishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sho Nishimura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jing Yang
- Department of Pathology, Boston University School of Medicine, Boston, MA
| | - Zhao Grace
- Department of Pathology, Boston University School of Medicine, Boston, MA
| | - Ben Tran
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | | | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Yasui
- Division of Gastric Surgery and Division of Gastrointestinal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tomoyuki Irino
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutic Research, City of Hope, Duarte, CA
| | - Masanori Terashima
- Division of Gastric Surgery and Division of Gastrointestinal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Peter Gibbs
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | | | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Matthew Kulke
- Division of Hematology Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Kevan Hartshorn
- Division of Hematology Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Ajit Bharti
- Division of Hematology Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA.
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Ramanathan RK, Von Hoff DD, Eskens F, Blumenschein G, Richards D, Genvresse I, Reschke S, Granvil C, Skubala A, Peña C, Mross K. Phase Ib Trial of the PI3K Inhibitor Copanlisib Combined with the Allosteric MEK Inhibitor Refametinib in Patients with Advanced Cancer. Target Oncol 2020; 15:163-174. [PMID: 32314268 PMCID: PMC7591420 DOI: 10.1007/s11523-020-00714-0] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Dual inhibition of PI3K and MAPK signaling is conceptually a promising anticancer therapy. Objective This phase 1b trial investigated the safety, maximum tolerated dose (MTD), recommended phase II dose, pharmacokinetics, tumor response, fluorodeoxyglucose positron emission tomography (FDG-PET) pharmacodynamics, and biomarker explorations for the combination of pan-PI3K inhibitor copanlisib and allosteric MEK inhibitor refametinib in patients with advanced solid tumors. Patients and methods This was an adaptive trial with eight dose cohorts combining dose escalation and varying schedules in repeated 28-day cycles. Patients received copanlisib (0.2–0.8 mg/kg intravenously) intermittently (days 1, 8, 15) or weekly (days 1, 8, 15, 22) each cycle, and refametinib (30–50 mg twice daily orally) continuously or 4 days on/3 days off. Patients with KRAS, NRAS, BRAF, or PI3KCA mutations were eligible for the expansion cohort. Results In the dose-escalation (n = 49) and expansion (n = 15) cohorts, the most common treatment-emergent adverse events included diarrhea (59.4%), nausea, acneiform rash, and fatigue (51.6% each). Dose-limiting toxicities included oral mucositis (n = 4), increased alanine aminotransferase/aspartate aminotransferase (n = 3), acneiform rash, hypertension (n = 2 each), and diarrhea (n = 1). MTD was copanlisib 0.4 mg/kg weekly and refametinib 30 mg twice daily. No pharmacokinetic interactions were identified. Decreased tumor FDG uptake and MEK-ERK signaling inhibition were demonstrated during treatment. Best response was stable disease (n = 21); median treatment duration was 6 weeks. Conclusions Despite sound rationale and demonstrable pharmacodynamic tumor activity in relevant tumor populations, a dose and schedule could not be identified for this drug combination that were both tolerable and offered clear efficacy in the population assessed. Clinicaltrials.gov identifier NCT01392521. Electronic supplementary material The online version of this article (10.1007/s11523-020-00714-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Ferry Eskens
- Erasmus MC Cancer Institute, PO Box 2040, 3015 GD, Rotterdam, The Netherlands
| | - George Blumenschein
- The University of Texas MD Anderson Cancer Center, Unit 432, PO Box 301402, Houston, TX, 77030, USA
| | - Donald Richards
- US Oncology Research, Texas Oncology, 910 E. Houston St., Suite 100, Tyler, TX, 75702, USA
| | - Isabelle Genvresse
- Pharmaceutical Division, Bayer AG, Müllerstraße 178, 13353, Berlin, Germany
| | - Susanne Reschke
- Pharmaceutical Division, Bayer AG, Müllerstraße 178, 13353, Berlin, Germany
| | - Camille Granvil
- Bayer HealthCare Pharmaceuticals, Inc., 100 Bayer Blvd, Whippany, NJ, 07981, USA
| | - Adam Skubala
- Chrestos Concept GmbH & Co. KG, Girardetstr. 1-5, 45131, Essen, Germany
| | - Carol Peña
- Bayer HealthCare Pharmaceuticals, Inc., 100 Bayer Blvd, Whippany, NJ, 07981, USA
| | - Klaus Mross
- KTB Klinik für Tumorbiologie, Breisacher Str. 117, 79106, Freiburg im Breisgau, Baden-Württemberg, Germany
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Mahalingam D, Patel MR, Sachdev JC, Hart LL, Halama N, Ramanathan RK, Sarantopoulos J, Völkel D, Youssef A, de Jong FA, Tsimberidou AM. Phase I study of imalumab (BAX69), a fully human recombinant antioxidized macrophage migration inhibitory factor antibody in advanced solid tumours. Br J Clin Pharmacol 2020; 86:1836-1848. [PMID: 32207164 PMCID: PMC7444762 DOI: 10.1111/bcp.14289] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 10/29/2019] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 12/15/2022] Open
Abstract
Aim Preclinical evidence suggests that oxidized macrophage migration inhibitory factor (oxMIF) may be involved in carcinogenesis. This phase 1 study (NCT01765790) assessed the safety, tolerability, pharmacokinetics and antitumour activity of imalumab, an oxMIF inhibitor, in patients with advanced cancer using ‘3 + 3’ dose escalation. Methods In Schedule 1, patients with solid tumours received doses from 1 to 50 mg/kg IV every 2 weeks. In Schedule 2, patients with metastatic colorectal adenocarcinoma, non‐small‐cell lung, or ovarian cancer received weekly doses of 10 or 25 mg/kg IV (1 cycle = 28 days). Treatment continued until disease progression, unacceptable toxicity, dose‐limiting toxicity, or withdrawal of consent. Results Fifty of 68 enrolled patients received imalumab. The most common treatment‐related adverse events (TRAEs) included fatigue (10%) and vomiting (6%); four grade 3 serious TRAEs (two patients) occurred. The dose‐limiting toxicity was allergic alveolitis (one patient, 50 mg/kg every 2 weeks). The maximum tolerated and biologically active doses were 37.5 mg/kg every 2 weeks and 10 mg/kg weekly, respectively. Of 39 assessed patients, 13 had stable disease (≥4 months in 8 patients). Conclusions Imalumab had a maximum tolerated dose of 37.5 mg/kg every 2 weeks in patients with advanced solid tumours, with a biologically active dose of 10 mg/kg weekly. Further investigation will help define the role of oxMIF as a cancer treatment target.
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Affiliation(s)
- Devalingam Mahalingam
- University of Texas Health Science Center, San Antonio, TX, USA.,Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Manish R Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL, USA
| | - Jasgit C Sachdev
- HonorHealth Research Institute/Translational Genomics Research Institute (TGen), Scottsdale, AZ, USA
| | | | - Niels Halama
- National Center for Tumor Diseases, University Medical Center Heidelberg, Heidelberg, Germany
| | | | - John Sarantopoulos
- Institute for Drug Development, Mays Cancer Center at University of Texas Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Dirk Völkel
- Baxalta Innovations GmbH a member of the Takeda group of companies, Vienna, Austria
| | - Ashraf Youssef
- Baxalta US Inc. a member of the Takeda group of companies, Cambridge, MA, USA
| | | | - Apostolia Maria Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase 1 Program), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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7
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Strickler JH, LoRusso P, Salgia R, Kang YK, Yen CJ, Lin CC, Ansell P, Motwani M, Wong S, Yue H, Wang L, Reilly E, Afar D, Naumovski L, Ramanathan RK. Phase I Dose-Escalation and -Expansion Study of Telisotuzumab (ABT-700), an Anti-c-Met Antibody, in Patients with Advanced Solid Tumors. Mol Cancer Ther 2020; 19:1210-1217. [PMID: 32127466 DOI: 10.1158/1535-7163.mct-19-0529] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/25/2019] [Accepted: 02/28/2020] [Indexed: 11/16/2022]
Abstract
This first-in-human phase I study evaluated the pharmacokinetics, safety, and preliminary efficacy of telisotuzumab, formerly called ABT-700, an antagonistic antibody directed against c-Met. For dose escalation (3+3 design), 3 to 6 patients with advanced solid tumors were enrolled into four dose cohorts (5-25 mg/kg). In the dose-expansion phase, a subset of patients was prospectively selected for MET amplification (FISH screening). Patients received telisotuzumab intravenously on day 1 every 21 days. For dose expansion, 15 mg/kg was chosen as the dose on the basis of safety, pharmacokinetics, and other data from the escalation cohorts. Forty-five patients were enrolled and received at least one dose of telisotuzumab (dose escalation, n = 15; dose expansion, n = 30). Telisotuzumab showed a linear pharmacokinetics profile; peak plasma concentration was proportional to dose level. There were no acute infusion reactions and no dose-limiting toxicities were observed. The most common treatment-related adverse events included hypoalbuminemia (n = 9, 20.0%) and fatigue (n = 5, 11.1%). By Response Evaluation Criteria In Solid Tumors (RECIST), 4 of 10 (40.0%) patients with MET-amplified tumors had confirmed partial response in target lesions (one ovarian, two gastric, and one esophageal), two (20.0%) had stable disease, three (30.0%) had progressive disease; one patient was unable to be evaluated. Among patients with nonamplified tumors (n = 35), no objective responses were observed; however, 11 patients had stable disease per RECIST criteria. In conclusion, telisotuzumab has an acceptable safety profile with clinical activity observed in patients with MET-amplified advanced solid tumors.
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Affiliation(s)
| | - Patricia LoRusso
- Yale University School of Medicine, Yale Cancer Center, New Haven, Connecticut
| | | | - Yoon-Koo Kang
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | - Chia Jui Yen
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Chia-Chi Lin
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Shekman Wong
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | - Huibin Yue
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | - Lan Wang
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | | | - Daniel Afar
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | - Louie Naumovski
- Oncology Early Development, AbbVie Inc., Redwood City, California
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8
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Shroff RT, Javle MM, Xiao L, Kaseb AO, Varadhachary GR, Wolff RA, Raghav KPS, Iwasaki M, Masci P, Ramanathan RK, Ahn DH, Bekaii-Saab TS, Borad MJ. Gemcitabine, Cisplatin, and nab-Paclitaxel for the Treatment of Advanced Biliary Tract Cancers: A Phase 2 Clinical Trial. JAMA Oncol 2020; 5:824-830. [PMID: 30998813 DOI: 10.1001/jamaoncol.2019.0270] [Citation(s) in RCA: 281] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Importance Administration of gemcitabine-cisplatin, the current standard therapy for advanced biliary tract cancers, results in median progression-free survival and overall survival of 8.0 and 11.7 months, respectively. New treatments offering improved survival outcomes are therefore needed. Objective To evaluate the association between progression-free survival and the addition of nanoparticle albumin-bound (nab)-paclitaxel to gemcitabine-cisplatin for the treatment of patients with advanced biliary tract cancer. Design, Setting, and Participants This open-label, single-arm, phase 2 clinical trial conducted at the University of Texas MD Anderson Cancer Center and the Mayo Clinic in Phoenix, Arizona, enrolled 62 patients with advanced biliary tract cancers between April 14, 2015, and April 24, 2017. Interventions Patients initially received gemcitabine, 1000 mg/m2, cisplatin, 25 mg/m2, and nab-paclitaxel, 125 mg/m2, on days 1 and 8 of 21-day cycles. Owing to hematologic adverse events among the first 32 patients enrolled, these starting doses were reduced to 800, 25, and 100 mg/m2, respectively, for the remaining 28 patients. Main Outcomes and Measures The primary trial end point was investigator-assessed progression-free survival in the intention-to-treat population. Results Of 60 patients who started treatment, the mean (SD) age was 58.4 (11.0) years, 38 (63%) had intrahepatic cholangiocarcinoma, 9 (15%) had extrahepatic cholangiocarcinoma, 13 (22%) had gallbladder cancer, 47 (78%) had metastatic disease, and 13 (22%) had locally advanced disease. Median follow-up was 12.2 (95% CI, 9.4-19.4) months, and median progression-free survival was 11.8 (95% CI, 6.0 to 15.6) months. The partial response rate was 45%, and the disease control rate was 84%. Median overall survival was 19.2 months (95% CI, 13.2 months to not estimable). Patients in the safety population (n = 57) received a median of 6 (interquartile range, 3-11) cycles of treatment; 26 patients (46%) remained on their starting dose throughout the trial. Grade 3 or higher adverse events occurred in 58% of patients, and 9 patients (16%) withdrew owing to adverse events. Neutropenia was the most common grade 3 or higher adverse event, occurring in 19 patients (33%) overall. Post hoc analyses showed that treatment efficacy was not significantly associated with starting dose, tumor type, or disease status and that tolerability was improved with reduced- vs high-dose treatment. Conclusions and Relevance Treatment with nab-paclitaxel plus gemcitabine-cisplatin prolonged median progression-free survival and overall survival vs those reported for historical controls treated with gemcitabine-cisplatin alone. These findings will be tested in a phase 3 randomized clinical trial. Trial Registration ClinicalTrials.gov identifier: NCT02392637.
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Affiliation(s)
- Rachna T Shroff
- Division of Hematology/Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson
| | - Milind M Javle
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Lianchun Xiao
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Gauri R Varadhachary
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Kanwal P S Raghav
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Michiko Iwasaki
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Peter Masci
- Department of Medical Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Daniel H Ahn
- Department of Medical Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Mitesh J Borad
- Department of Medical Oncology, Mayo Clinic, Phoenix, Arizona
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9
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De Jesus-Acosta A, Sugar EA, O'Dwyer PJ, Ramanathan RK, Von Hoff DD, Rasheed Z, Zheng L, Begum A, Anders R, Maitra A, McAllister F, Rajeshkumar NV, Yabuuchi S, de Wilde RF, Batukbhai B, Sahin I, Laheru DA. Phase 2 study of vismodegib, a hedgehog inhibitor, combined with gemcitabine and nab-paclitaxel in patients with untreated metastatic pancreatic adenocarcinoma. Br J Cancer 2020; 122:498-505. [PMID: 31857726 PMCID: PMC7029016 DOI: 10.1038/s41416-019-0683-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 11/12/2019] [Accepted: 11/28/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The Hedgehog (Hh) signalling pathway is overexpressed in pancreatic ductal adenocarcinoma (PDA). Preclinical studies have shown that Hh inhibitors reduce pancreatic cancer stem cells (pCSC), stroma and Hh signalling. METHODS Patients with previously untreated metastatic PDA were treated with gemcitabine and nab-paclitaxel. Vismodegib was added starting on the second cycle. The primary endpoint was progression-free survival (PFS) as compared with historical controls. Tumour biopsies to assess pCSC, stroma and Hh signalling were obtained before treatment and after cycle 1 (gemcitabine and nab-paclitaxel) or after cycle 2 (gemcitabine and nab-paclitaxel plus vismodegib). RESULTS Seventy-one patients were enrolled. Median PFS and overall survival (OS) were 5.42 months (95% confidence interval [CI]: 4.37-6.97) and 9.79 months (95% CI: 7.85-10.97), respectively. Of the 67 patients evaluable for response, 27 (40%) had a response: 26 (38.8%) partial responses and 1 complete response. In the tumour samples, there were no significant changes in ALDH + pCSC following treatment. CONCLUSIONS Adding vismodegib to chemotherapy did not improve efficacy as compared with historical rates observed with chemotherapy alone in patients with newly diagnosed metastatic pancreatic cancer. This study does not support the further evaluation of Hh inhibitors in this patient population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01088815.
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Affiliation(s)
- Ana De Jesus-Acosta
- Department of Medical Oncology, Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Elizabeth A Sugar
- Department of Biostatistics, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter J O'Dwyer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Ramesh K Ramanathan
- Honor Health Research Institute & Translational Genomics Research Institute, Scottsdale, AZ, USA
| | - Daniel D Von Hoff
- Honor Health Research Institute & Translational Genomics Research Institute, Scottsdale, AZ, USA
| | - Zeshaan Rasheed
- Department of Medical Oncology, Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD, USA
| | - Lei Zheng
- Department of Medical Oncology, Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD, USA
| | - Asma Begum
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Anders
- Departments of Pathology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anirban Maitra
- Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Florencia McAllister
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - N V Rajeshkumar
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Roeland F de Wilde
- Departments of Pathology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhavina Batukbhai
- Department of Medical Oncology, Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ismet Sahin
- Department of Engineering, Texas Southern University, Houston, TX, USA
| | - Daniel A Laheru
- Department of Medical Oncology, Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD, USA
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10
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Jameson GS, Borazanci E, Babiker HM, Poplin E, Niewiarowska AA, Gordon MS, Barrett MT, Rosenthal A, Stoll-D’Astice A, Crowley J, Shemanski L, Korn RL, Ansaldo K, Lebron L, Ramanathan RK, Von Hoff DD. Response Rate Following Albumin-Bound Paclitaxel Plus Gemcitabine Plus Cisplatin Treatment Among Patients With Advanced Pancreatic Cancer: A Phase 1b/2 Pilot Clinical Trial. JAMA Oncol 2020; 6:125-132. [PMID: 31580386 PMCID: PMC6777241 DOI: 10.1001/jamaoncol.2019.3394] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/20/2019] [Indexed: 01/05/2023]
Abstract
Importance Genomes of metastatic pancreatic cancers frequently contain intrachromosomal aberrations, indicating a DNA repair deficiency associated with sensitivity to DNA damaging agents, such as platinum. Objective To determine response rate following treatment with nab-paclitaxel plus gemcitabine plus platinum-based cisplatin for patients with metastatic pancreatic ductal adenocarcinoma (PDA). Design, Setting, and Participants This was a single-arm, open-label, phase 1b/2 clinical trial of nab-paclitaxel plus gemcitabine plus cisplatin treatment in which 25 patients with previously untreated metastatic PDA were enrolled. The trial was conducted from December 2013 to July 2016 at 3 US sites, with the last patient receiving study treatment at the end of October 2016, and the study closing January 2018. Interventions Patients were treated with nab-paclitaxel plus gemcitabine plus various doses of cisplatin, 25 mg/m2, 37.5 mg/m2, and 50 mg/m2, on days 1 and 8 of a 21-day cycle. Main Outcomes and Measures Primary end point was complete response rate as assessed by Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST), and levels of carbohydrate antigen 19-9 (or in nonexpressers, carbohydrate antigen 125 or carcinoembryonic antigen). Efficacy analysis included evaluable patients (those who received at least 1 dose of study treatment and had at least 1 postbaseline tumor assessment). Results Of 25 patients enrolled in the study, the median (range) age was 65.0 (47.0-79.0) years, 14 (56%) were men, and most (24) were white (96%). The maximum tolerable dose of cisplatin was 25 mg/m2. The most common treatment-related adverse events grade 3 or higher were thrombocytopenia (17 patients [68%]), anemia (8 patients [32%]), and neutropenia (6 patients [24%]). Fatal events occurred for 3 patients (12%); 2 were related to study participation. A median (range) of 8 (1-15) cycles was completed. The RECIST responses in 24 evaluable patients included 2 complete responses (8%), which was below the primary end point of 25%, 15 partial responses (62%), 4 stable disease (17%), and 3 progressive disease (12%), with median overall survival of 16.4 (95% CI, 10.2-25.3) months; 16 patients (64%) were alive at 1 year, 10 (40%) at 2 years, 4 (16%) at 3 years, and 1 (4%) at 4 plus years. Overall survival ranged from 36 to 59 months. Median progression-free survival was 10.1 (95% CI, 6.0-12.5) months. Thus, the overall response rate was 71%, and the disease control rate was 88%. Conclusions and Relevance This triple drug regimen showed substantial clinical activity in this small study. Although the primary end point was not reached, the high overall response rate, disease control rate, and median survival time among patients with advanced PDA treated with this combination are encouraging. The regimen is being studied in patients with PDA in the neoadjuvant setting and in patients with advanced biliary cancers. Trial Registration ClinicalTrials.gov identifier: NCT01893801.
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Affiliation(s)
- Gayle S. Jameson
- HonorHealth Research Institute, Scottsdale, Arizona
- Translational Genomics Research Institute, an Affiliate of City of Hope, Phoenix, Arizona
| | - Erkut Borazanci
- HonorHealth Research Institute, Scottsdale, Arizona
- Translational Genomics Research Institute, an Affiliate of City of Hope, Phoenix, Arizona
| | - Hani M. Babiker
- Translational Genomics Research Institute, an Affiliate of City of Hope, Phoenix, Arizona
- Comprehensive Cancer Center, The University of Arizona, Tucson
| | | | | | | | | | | | | | - John Crowley
- Cancer Research And Biostatistics, Seattle, Washington
| | | | | | | | | | | | - Daniel D. Von Hoff
- HonorHealth Research Institute, Scottsdale, Arizona
- Translational Genomics Research Institute, an Affiliate of City of Hope, Phoenix, Arizona
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11
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DeLeon TT, Zhou Y, Nagalo BM, Yokoda RT, Ahn DH, Ramanathan RK, Salomao MA, Aqel BA, Mahipal A, Bekaii-Saab TS, Borad MJ. Novel immunotherapy strategies for hepatobiliary cancers. Immunotherapy 2019; 10:1077-1091. [PMID: 30185133 DOI: 10.2217/imt-2018-0024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/06/2023] Open
Abstract
Despite recent advancements in therapeutic options for advanced hepatobiliary cancers, there remains an unmet need for innovative systemic treatments. Immunotherapy has shown an ability to provide prolonged clinical benefit, but this benefit remains limited to a small subset of patients. Numerous ongoing endeavors are investigating novel immunotherapy concepts. Immunotherapies that have demonstrated clinical efficacy in hepatobiliary cancers include PD-1 inhibitor therapy and CTLA-4 inhibitor therapy. Novel immunotherapy concepts include targeting emerging checkpoint proteins, bispecific T-cell engagers, combinatorial trials with checkpoint inhibitors, oncolytic virotherapy and chimeric antigen receptor T cells. The goal for these new treatment strategies is to achieve a meaningful expansion of patients deriving prolonged clinical benefit from immunotherapy.
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Affiliation(s)
- Thomas T DeLeon
- Department of Medicine, Division of Hematology & Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Yumei Zhou
- Department of Medicine, Division of Hematology & Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Bolni M Nagalo
- Department of Medicine, Division of Hematology & Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Raquel T Yokoda
- Department of Medicine, Division of Hematology & Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Daniel H Ahn
- Department of Medicine, Division of Hematology & Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Ramesh K Ramanathan
- Department of Medicine, Division of Hematology & Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Marcela A Salomao
- Department of Pathology, Division of Anatomic Pathology & Laboratory Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Bashar A Aqel
- Department of Medicine, Division of Gastroenterology & Hepatology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Amit Mahipal
- Department of Medicine, Division of Hematology & Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Tanios S Bekaii-Saab
- Department of Medicine, Division of Hematology & Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Mitesh J Borad
- Department of Medicine, Division of Hematology & Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA.,Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Mayo Clinic Cancer Center, Phoenix, AZ 85054, USA
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12
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Gorbunova V, Beck JT, Hofheinz RD, Garcia-Alfonso P, Nechaeva M, Gracian AC, Mangel L, Fernandez EE, Deming DA, Ramanathan RK, Torres AH, Sullivan D, Luo Y, Berlin JD. Correction: A phase 2 randomised study of veliparib plus FOLFIRI±bevacizumab versus placebo plus FOLFIRI±bevacizumab in metastatic colorectal cancer. Br J Cancer 2019; 121:429-430. [PMID: 31350526 PMCID: PMC6738103 DOI: 10.1038/s41416-019-0528-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Vera Gorbunova
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | | | - Ralf-Dieter Hofheinz
- Interdisciplinary Tumor Center, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
| | | | | | - Antonio Cubillo Gracian
- Centro Integral Oncológico Clara Campal Hospital Universitario Madrid Sanchinarro, Madrid, Spain, and Departamento de Ciencias Médicas Clínicas, Universidad CEU San Pablo, Madrid, Spain
| | - Laszlo Mangel
- Pecsi Tudomanyegyetem Klinikai Kozpont, Onkoterapias Intezet, Pécs, Hungary
| | | | | | | | | | | | - Yan Luo
- AbbVie Inc., North Chicago, IL, USA
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13
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Ramanathan RK, McDonough SL, Philip PA, Hingorani SR, Lacy J, Kortmansky JS, Thumar J, Chiorean EG, Shields AF, Behl D, Mehan PT, Gaur R, Seery T, Guthrie KA, Hochster HS. Phase IB/II Randomized Study of FOLFIRINOX Plus Pegylated Recombinant Human Hyaluronidase Versus FOLFIRINOX Alone in Patients With Metastatic Pancreatic Adenocarcinoma: SWOG S1313. J Clin Oncol 2019; 37:1062-1069. [PMID: 30817250 PMCID: PMC6494359 DOI: 10.1200/jco.18.01295] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [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] [Accepted: 01/22/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Pegylated recombinant human hyaluronidase (PEGPH20) degrades hyaluronan (HA) and, in combination with chemotherapy, prolongs survival in preclinical models. The activity of PEGPH20 with modified fluorouracil, leucovorin, irinotecan, and oxaliplatin (mFOLFIRINOX) was evaluated in patients with metastatic pancreatic cancer (mPC). MATERIALS AND METHODS Patients had untreated mPC, a performance status of 0 to 1, and adequate organ function. Tumor HA status was not required for eligibility. After a phase Ib dose-finding study of mFOLFIRINOX plus PEGPH20, the phase II open-label study randomly assigned patients (1:1) to the combination arm or to mFOLFIRINOX alone (n = 138). The primary end point was overall survival (OS). RESULTS PEGPH20 dosages of 3 µg/kg every 2 weeks were more tolerable than twice-weekly dosages used in the phase I study, so 3 µg/kg every 2 weeks was the phase II dosage. An amendment instituted enoxaparin prophylaxis in the PEGPH20 combination arm as a result of increased thromboembolic (TE) events. The planned interim futility analysis when 35 deaths (of 103 analyzable patients) occurred resulted in an OS hazard ratio (HR) of 2.07 that favored the control arm, and the study was closed to accrual. The treatment-related grade 3 to 4 toxicity was significantly increased in the PEGPH20 combination arm relative to control (odds ratio, 2.7; 95% CI, 1.1 to 7.1). The median OS in the mFOLFIRINOX arm was 14.4 months (95% CI, 10.1 to 15.7 months) versus 7.7 months (95% CI, 4.6 to 9.3 months) in the PEGPH20 combination arm. CONCLUSION Addition of PEGPH20 to mFOLFIRINOX seems to be detrimental in patients unselected for tumor HA status. This combination caused increased toxicity (mostly GI and TE events) and resulted in decreased treatment duration compared with mFOLFIRINOX alone. The median OS in the mFOLFIRINOX control arm (14.4 months) is, to our knowledge, the longest yet reported and can be considered for patients with good PS.
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Affiliation(s)
| | - Shannon L. McDonough
- Southwest Oncology Group Statistics and
Data Management Center, Seattle, WA
- Fred Hutchinson Cancer Research Center,
Seattle, WA
| | | | | | | | | | - Jaykumar Thumar
- Yale Cancer Center, New Haven, CT
- Saint Francis Hospital and Medical Center,
Enfield, MA
| | - E. Gabriela Chiorean
- Fred Hutchinson Cancer Research Center,
Seattle, WA
- University of Washington, Seattle,
WA
| | | | - Deepti Behl
- Sutter Cancer Research Consortium,
Sacramento, CA
| | - Paul T. Mehan
- Heartland NCI Community Oncology Research
Program (NCORP), Missouri Baptist Medical Center Cancer Center, St Louis,
MO
| | - Rakesh Gaur
- Kansas City NCI Community Oncology
Research Program (NCORP), Prairie Village, KS
| | | | - Katherine A. Guthrie
- Southwest Oncology Group Statistics and
Data Management Center, Seattle, WA
- Fred Hutchinson Cancer Research Center,
Seattle, WA
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14
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Ramanathan RK, Thomas GW, Khorana AA, Shah S, Zhou C, Wong S, Cole G, James D, Gabrail NY. A Phase 2 Study of PCI-27483, a Factor VIIa Inhibitor in Combination with Gemcitabine for Advanced Pancreatic Cancer. Oncology 2019; 96:217-222. [PMID: 30844808 PMCID: PMC6492608 DOI: 10.1159/000495988] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 09/20/2018] [Accepted: 11/22/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Tissue factor overexpression is associated with tumor progression, venous thromboembolism, and worsened survival in patients with cancer. Tissue factor and activated factor VII (FVIIa) complex may contribute to tumor invasiveness by promoting cell migration and angiogenesis. The study objective was to evaluate safety, pharmacokinetics, and efficacy of PCI-27483, a selective FVIIa inhibitor. METHODS This was an open-label, multicenter phase 2 trial of patients with advanced pancreatic cancer. Part A of the study was an intrapatient dose escalation lead-in portion in patients concurrently receiving gemcitabine, and in part B, patients were randomized 1: 1 to the recommended phase 2 dose combination PCI-27483-gemcitabine versus gemcitabine alone. RESULTS Target international normalized ratio (between 2.0-3.0) was achieved following PCI-27483 treatment. Overall safety of PCI-27483-gemcitabine (n = 26) was similar to gemcitabine alone (n = 16), with a higher incidence of mostly low-grade bleeding events (65% vs. 19%). Progression-free survival (PFS) and overall survival (OS) were not significantly different between patients treated with PCI-27483-gemcitabine (PFS: 3.7 months, OS: 5.7 months) and those treated with gemcitabine alone (PFS: 1.9 months, OS: 5.6 months). CONCLUSIONS Targeted inhibition of the coagulation cascade was achieved by administering PCI-27483. PCI-27483-gemcitabine was well tolerated, but superiority to single agent gemcitabine was not demonstrated.
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Affiliation(s)
- Ramesh K Ramanathan
- Honor Health Research Institute/Translational Genomics Research Institute, Scottsdale, Arizona, USA
| | - Gary W Thomas
- South Carolina Cancer Specialists, Hilton Head Island, South Carolina, USA
| | | | - Satish Shah
- Gettysburg Cancer Center, Gettysburg, Pennsylvania, USA
| | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California, USA
| | - Sofia Wong
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California, USA
| | - George Cole
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California, USA,
| | - Danelle James
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California, USA
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15
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Lee JW, Stone ML, Porrett PM, Thomas SK, Komar CA, Li JH, Delman D, Graham K, Gladney WL, Hua X, Black TA, Chien AL, Majmundar KS, Thompson JC, Yee SS, O'Hara MH, Aggarwal C, Xin D, Shaked A, Gao M, Liu D, Borad MJ, Ramanathan RK, Carpenter EL, Ji A, de Beer MC, de Beer FC, Webb NR, Beatty GL. Hepatocytes direct the formation of a pro-metastatic niche in the liver. Nature 2019; 567:249-252. [PMID: 30842658 PMCID: PMC6430113 DOI: 10.1038/s41586-019-1004-y] [Citation(s) in RCA: 224] [Impact Index Per Article: 44.8] [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: 01/26/2018] [Accepted: 02/12/2019] [Indexed: 12/25/2022]
Abstract
The liver is the most common site of metastatic disease1. Although this metastatic tropism may reflect the mechanical trapping of circulating tumour cells, liver metastasis is also dependent, at least in part, on the formation of a 'pro-metastatic' niche that supports the spread of tumour cells to the liver2,3. The mechanisms that direct the formation of this niche are poorly understood. Here we show that hepatocytes coordinate myeloid cell accumulation and fibrosis within the liver and, in doing so, increase the susceptibility of the liver to metastatic seeding and outgrowth. During early pancreatic tumorigenesis in mice, hepatocytes show activation of signal transducer and activator of transcription 3 (STAT3) signalling and increased production of serum amyloid A1 and A2 (referred to collectively as SAA). Overexpression of SAA by hepatocytes also occurs in patients with pancreatic and colorectal cancers that have metastasized to the liver, and many patients with locally advanced and metastatic disease show increases in circulating SAA. Activation of STAT3 in hepatocytes and the subsequent production of SAA depend on the release of interleukin 6 (IL-6) into the circulation by non-malignant cells. Genetic ablation or blockade of components of IL-6-STAT3-SAA signalling prevents the establishment of a pro-metastatic niche and inhibits liver metastasis. Our data identify an intercellular network underpinned by hepatocytes that forms the basis of a pro-metastatic niche in the liver, and identify new therapeutic targets.
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Affiliation(s)
- Jae W Lee
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Meredith L Stone
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paige M Porrett
- Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stacy K Thomas
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chad A Komar
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joey H Li
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Devora Delman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathleen Graham
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Whitney L Gladney
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xia Hua
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Taylor A Black
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Austin L Chien
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Krishna S Majmundar
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey C Thompson
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie S Yee
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark H O'Hara
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Charu Aggarwal
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dong Xin
- Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Abraham Shaked
- Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mingming Gao
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Dexi Liu
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Mitesh J Borad
- Mayo Clinic Cancer Center, Mayo Clinic, Phoenix, AZ, USA
| | - Ramesh K Ramanathan
- Mayo Clinic Cancer Center, Mayo Clinic, Phoenix, AZ, USA
- Merck Research Labs, Rahway, NJ, USA
| | - Erica L Carpenter
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ailing Ji
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA
| | - Maria C de Beer
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA
- Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Frederick C de Beer
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA
| | - Nancy R Webb
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Gregory L Beatty
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Mody K, Kasi PM, Surapaneni PK, Bekaii-Saab TS, Ramanathan RK, Ahn DH, Mahipal A, Starr JS, Ritter A, McMillan J, Wylie N, Roberts A, Nagy RJ, Borad MJ. Landscape of circulating tumor DNA and tissue-based profiling in advanced cholangiocarcinoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
291 Background: Cholangiocarcinoma (CCA) has limited treatment options. Genomic analyses have led to development of targeted therapies now in clinical trials, and may enable discovery of new treatment options. However, biopsy often yields limited tissue, thus hampering tissue-based profiling opportunities. Comparative data regarding circulating tumor DNA (ctDNA) analysis and tissue based profiling in CCA are limited. Methods: We performed ctDNA NGS analysis along with tissue based profiling in pts with advanced CCA (January 2015- February 2018). ctDNA analysis was performed using Guardant 360 (Guardant Health, CA) which detects single nucleotide variants, amplifications, fusions, and specific insertion/deletion mutations in up to 73 different genes and the majority of tissue based profiling using Foundation One. The mutant allele fraction (MAF) for detected alterations was calculated relative to wild type in ctDNA. Therapeutic relevance was defined as alterations within OncoKB levels 1-3B and R1. The study was conducted in accordance with Mayo Clinic IRB requirements. Results: Among 124 pts and 139 total samples, ctDNA NGS revealed at least one genomic alteration (excluding variants of uncertain significance and synonymous mutations) in 89% of pts. Median number of alterations per pt was 3 [range, 1-15], with a median MAF of 0.42% (range, 0.1% - 94.2%). The total number of unique alterations was 321. The most commonly altered genes: TP53 (31%), KRAS (11%), FGFR2 (7%), APC and PIK3CA (each 5%) and ARID1A (3%). Amplifications were noted in 14 genes: BRAF, CCND1, CCND2, CCNE1, CDK4, CDK6, EGFR, ERBB2, FGFR1, FGFR2, MET, MYC, PDGFRA, and PIK3CA. Tissue-based profiling was available in 57 (46%) pts, with a median of 63 days between liquid and tissue biopsy. IDH1, FGFR2, TP53 and KRAS were most common gene mutations found in pts who had both liquid and tissue biopsy done. (Comparative results to be shown). Conclusions: ctDNA plasma profiling of pts with advanced CCA is a feasible alternative method to gather comprehensive genomic data. Further larger cohort studies comparing landscape of alterations seen on ctDNA versus tissue-based assays are needed.
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17
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Gorbunova V, Beck JT, Hofheinz RD, Garcia-Alfonso P, Nechaeva M, Cubillo Gracian A, Mangel L, Elez Fernandez E, Deming DA, Ramanathan RK, Torres AH, Sullivan D, Luo Y, Berlin JD. A phase 2 randomised study of veliparib plus FOLFIRI±bevacizumab versus placebo plus FOLFIRI±bevacizumab in metastatic colorectal cancer. Br J Cancer 2018; 120:183-189. [PMID: 30531832 PMCID: PMC6342906 DOI: 10.1038/s41416-018-0343-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 05/17/2018] [Revised: 09/13/2018] [Accepted: 10/31/2018] [Indexed: 02/08/2023] Open
Abstract
Background Metastatic colorectal cancer (mCRC) has low survival rates. We assessed if addition of veliparib, concurrent to FOLFIRI, improves survival in patients with previously untreated mCRC. Methods This study compared veliparib (200 mg BID for 7 days of each 14-day cycle) to placebo, each with FOLFIRI. Bevacizumab was allowed in both arms. The primary endpoint was progression-free survival (PFS). Results Patients were randomised to receive veliparib (n = 65) or placebo (n = 65) in combination with FOLFIRI. Median PFS was 12 vs 11 months (veliparib vs placebo) [HR = 0.94 (95% CI: 0.60, 1.48)]. Median OS was 25 vs 27 months [HR = 1.26 (95% CI: 0.74, 2.16)]. Response rate was 57% vs 62%. Median DOR was 11 vs 9 months [HR = 0.73 (95% CI: 0.38, 1.40)]. AEs with significantly higher frequency (p < 0.05) in the veliparib group were anaemia (39% vs 19%, p = 0.019) and neutropenia (66% vs 37%, p = 0.001) for common AEs (≥20%); neutropenia (59% vs 22%, p < 0.001) for common Grade 3/4 AEs (≥5%); none in serious AEs. Haematopoietic cytopenias were more common with veliparib (79% vs 52%, p = 0.003). Fourteen percent of patients on veliparib and 15% on placebo discontinued treatment due to AEs. Conclusion Veliparib added to FOLFIRI ± bevacizumab demonstrated similar efficacy as FOLFIRI ± bevacizumab in frontline mCRC patients. No unexpected safety concerns occurred.
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Affiliation(s)
- Vera Gorbunova
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | | | - Ralf-Dieter Hofheinz
- Interdisciplinary Tumor Center, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
| | | | | | - Antonio Cubillo Gracian
- Centro Integral Oncológico Clara Campal Hospital Universitario Madrid Sanchinarro, Madrid, Spain, and Departamento de Ciencias Médicas Clínicas, Universidad CEU San Pablo, Madrid, Spain
| | - Laszlo Mangel
- Pecsi Tudomanyegyetem Klinikai Kozpont, Onkoterapias Intezet, Pécs, Hungary
| | | | | | | | | | | | - Yan Luo
- AbbVie Inc., North Chicago, IL, USA
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18
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Strickler JH, Weekes CD, Nemunaitis J, Ramanathan RK, Heist RS, Morgensztern D, Angevin E, Bauer TM, Yue H, Motwani M, Parikh A, Reilly EB, Afar D, Naumovski L, Kelly K. First-in-Human Phase I, Dose-Escalation and -Expansion Study of Telisotuzumab Vedotin, an Antibody–Drug Conjugate Targeting c-Met, in Patients With Advanced Solid Tumors. J Clin Oncol 2018; 36:3298-3306. [DOI: 10.1200/jco.2018.78.7697] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose This first-in-human study evaluated telisotuzumab vedotin (Teliso-V), formerly called ABBV-399, an antibody–drug conjugate of the anti–c-Met monoclonal antibody ABT-700 and monomethyl auristatin E. Materials and Methods For dose escalation, three to six patients with advanced solid tumors were enrolled in eight cohorts (0.15 to 3.3 mg/kg). The dose-expansion phase enrolled patients with non–small-cell lung cancer (NSCLC) with c-Met–overexpressing tumors (c-Met positive; immunohistochemistry membrane H-score ≥ 150). Patients received Teliso-V monotherapy intravenously on day 1 once every 3 weeks. Safety, tolerability, pharmacokinetics, and maximum tolerated dose were determined. Results Forty-eight patients were enrolled (median age, 65 years; 35.4% NSCLC; median four prior therapies). One patient each in the 3.0-mg/kg (n = 9) and 3.3-mg/kg (n = 3) cohorts experienced dose-limiting toxicities. Although the maximum tolerated dose was not formally identified, the recommended phase II dose was defined as 2.7 mg/kg on the basis of overall safety and tolerability. The most frequent treatment-emergent adverse events (any grade) were fatigue (42%), nausea (27%), constipation (27%), decreased appetite (23%), vomiting (21%), dyspnea (21%), diarrhea (19%), peripheral edema (19%), and neuropathy (17%). The most frequent Teliso-V–related grade ≥ 3 adverse events were fatigue, anemia, neutropenia, and hypoalbuminemia (4% each). Teliso-V and total antibody pharmacokinetics were approximately dose proportional, with a mean harmonic half-life of 2 to 4 days each. Prospective screening identified 35 (60%) of 58 patients with c-Met–positive NSCLC. Of 16 patients with c-Met–positive NSCLC who were treated with Teliso-V 2.4 to 3.0 mg/kg, three (18.8%; 95% CI, 4.1% to 45.7%) achieved a partial response (median response duration, 4.8 months; median progression-free survival, 5.7 months; 95% CI, 1.2 months to 15.4 months). No other patients experienced a response. Conclusion Teliso-V monotherapy demonstrated favorable safety and tolerability profiles, with encouraging evidence of antitumor activity in patients with c-Met–positive NSCLC.
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Affiliation(s)
- John H. Strickler
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Colin D. Weekes
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - John Nemunaitis
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Ramesh K. Ramanathan
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Rebecca S. Heist
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Daniel Morgensztern
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Eric Angevin
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Todd M. Bauer
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Huibin Yue
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Monica Motwani
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Apurvasena Parikh
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Edward B. Reilly
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Daniel Afar
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Louie Naumovski
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
| | - Karen Kelly
- John H. Strickler, Duke University Medical Center, Durham, NC; Colin D. Weekes, University of Colorado, Aurora, CO; John Nemunaitis, Mary Crowley Cancer Research Center, Dallas, TX; Ramesh K. Ramanathan, Virginia Piper Cancer Center at Honor Health/Translational Genomics Research Institute, Scottsdale, AZ; Rebecca S. Heist, Massachusetts General Hospital Cancer Center, Boston, MA; Daniel Morgensztern, Washington University School of Medicine, St. Louis, MO; Eric Angevin, Gustave Roussy, Villejuif,
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Abstract
The tumor stroma in pancreatic adenocarcinoma is recognized as an integral component in tumorigenesis through its effects on cell signaling, immunosuppression and inhibitory effect on therapeutic agents. Promising preclinical activity has been observed with novel therapeutic agents that target the tumor microenvironment and represent one of many potential treatment strategies of interest in this disease. Herein, we will highlight and review therapeutic novel agents aimed at tumor stroma in pancreas cancer.
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Affiliation(s)
- Daniel H Ahn
- Department of Hematology/Medical Oncology, Mayo Clinic Cancer Center, Phoenix, AZ, USA
| | - Ramesh K Ramanathan
- Department of Hematology/Medical Oncology, Mayo Clinic Cancer Center, Phoenix, AZ, USA.
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20
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Sohal DPS, Kennedy EB, Khorana A, Copur MS, Crane CH, Garrido-Laguna I, Krishnamurthi S, Moravek C, O'Reilly EM, Philip PA, Ramanathan RK, Ruggiero JT, Shah MA, Urba S, Uronis HE, Lau MW, Laheru D. Metastatic Pancreatic Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol 2018; 36:2545-2556. [PMID: 29791286 PMCID: PMC7504972 DOI: 10.1200/jco.2018.78.9636] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose In 2016, ASCO published a guideline to assist in clinical decision making in metastatic pancreatic cancer for initial assessment after diagnosis, first- and second-line treatment options, palliative and supportive care, and follow-up. The purpose of this update is to incorporate new evidence related to second-line therapy for patients who have experienced disease progression or intolerable toxicity during first-line therapy. Methods ASCO convened an Expert Panel to conduct a systematic review of the literature on second-line therapy published between June 2015 and January 2018. Recommendations on other topics covered in the 2016 Metastatic Pancreatic Cancer Guideline were endorsed by the Expert Panel. Results Two new studies were found that met the inclusion criteria. Recommendations For second-line therapy, gemcitabine plus nanoparticle albumin-bound paclitaxel should be offered to patients with first-line treatment with FOLFIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin), an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 to 1, and a favorable comorbidity profile; fluorouracil plus nanoliposomal irinotecan can be offered to patients with first-line treatment with gemcitabine plus NAB-paclitaxel, an ECOG PS of 0 to 1, and a favorable comorbidity profile; fluorouracil plus irinotecan or fluorouracil plus oxaliplatin may be offered when there is a lack of availability of fluorouracil plus nanoliposomal irinotecan; gemcitabine or fluorouracil should be offered to patients with either an ECOG PS of 2 or a comorbidity profile that precludes other regimens. Testing select patients for mismatch repair deficiency or microsatellite instability is recommended, and pembrolizumab is recommended for patients with mismatch repair deficiency or high microsatellite instability tumors. Endorsed recommendations from the 2016 version of this guideline for computed tomography, baseline performance status and comorbidity profile, defining goals of care, first-line therapy, and palliative care are also contained within the full guideline text. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines .
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Affiliation(s)
- Davendra P S Sohal
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Erin B Kennedy
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Alok Khorana
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Mehmet S Copur
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Christopher H Crane
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Ignacio Garrido-Laguna
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Smitha Krishnamurthi
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Cassadie Moravek
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Eileen M O'Reilly
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Philip A Philip
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Ramesh K Ramanathan
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Joseph T Ruggiero
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Manish A Shah
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Susan Urba
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Hope E Uronis
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Michelle W Lau
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Daniel Laheru
- Davendra P.S. Sohal, Alok Khorana, and Smitha Krishnamurthi, Cleveland Clinic, Cleveland OH; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mehmet S. Copur, CHI Health St. Francis Cancer Treatment Center, Grand Island, NE; Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; Ignacio Garrido-Laguna, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT; Cassadie Moravek, Pancreatic Cancer Action Network, Manhattan Beach, CA; Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center; Joseph T. Ruggiero and Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; Philip A. Philip, Barbara Ann Karmanos Cancer Institute, Farmington Hills; Susan Urba, University of Michigan Health System Comprehensive Cancer Center, Ann Arbor, MI; Ramesh K. Ramanathan, Mayo Clinic; Michelle W. Lau, Phoenix VA Medical Center, Phoenix, AZ; Hope E. Uronis, Duke University, Durham, NC; and Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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21
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Lee JW, Thomas SK, Komar CA, Gladney WL, Hua X, Xin D, Shaked A, Borad MJ, Ramanathan RK, Ji A, Webb NR, Beer MCD, Beer FCD, Porrett PM, Beatty GL. Abstract 1102: IL-6/STAT3 activation in hepatocytes drives pro-metastatic niche formation in the liver. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-1102] [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
The liver is the most common site of metastasis in pancreatic ductal adenocarcinoma (PDAC). This metastatic tropism is dependent, at least in part, on the formation of a “pro-metastatic” niche that supports tumor cell seeding and colonization in the liver. However, mechanisms that direct the formation of this niche remain poorly understood. We show using the LSL-KrasG12D/+;LSL-Trp53R172H/+;Pdx-1-Cre (KPC) model of PDAC that pancreatic tumor development enhances the susceptibility of the liver to metastatic seeding by inducing recruitment of F4/80+ and Ly6G+ myeloid cells and fibrosis within the liver. 3' mRNA sequencing (QuantSeq) on RNA isolated from the liver of KPC mice versus control PC mice revealed that the liver produces a specific set of myeloid chemoattractants, particularly serum amyloid A1 and A2 (SAA1/2), early during PDAC development. In addition, gene set enrichment analysis (GSEA) on genes upregulated in the liver of KPC mice demonstrated a significant enrichment of the interleukin 6 (IL-6)/Signal Transducer and Activator of Transcription 3 (STAT3) signaling pathway. Consistent with this finding, phosphorylation of STAT3 was detected in 20-30% of F4/80+ myeloid cells and 80-90% of hepatocytes. A requirement for IL-6/STAT3 signaling in the formation of a pro-metastatic niche was determined by comparing the metastatic potential of wild type mice, Il-6 knockout (Il-6-/-) mice, and mice treated with anti-IL-6 receptor (IL-6R) antibody after orthotopic implantation of KPC-derived PDAC cells. Compared to wild type mice, the liver of Il-6-/- mice and mice treated with anti-IL-6R antibody was less susceptible to metastatic seeding and showed significantly less accumulation of myeloid cells, fibrosis, and production of SAA1/2 in the liver. We obtained similar results with mice that lack Stat3 specifically in hepatocytes (Stat3flox/flox Alb-Cre), demonstrating that IL-6/STAT3 signaling in hepatocytes is necessary for the formation of a pro-metastatic niche in the liver. Further, using Saa1/2 double knockout (Saa-/-) mice, we found that SAA1/2 production by hepatocytes was required for formation of the pro-metastatic niche in the liver and increased susceptibility to metastatic seeding. Patients with a history of liver metastasis also showed higher levels of SAA1/2 in the plasma compared to normal donors, and SAA overexpression was detected in hepatocytes in liver biopsy samples collected from PDAC patients. Collectively, our study reveals a novel role for hepatocytes in directing the formation of a pro-metastatic niche in the liver during PDAC development and identifies IL-6/STAT3/SAA1/2 signaling as a promising therapeutic target for prevention of metastasis in PDAC.
Citation Format: Jae W. Lee, Stacy K. Thomas, Chad A. Komar, Whitney L. Gladney, Xia Hua, Dong Xin, Abraham Shaked, Mitesh J. Borad, Ramesh K. Ramanathan, Ailing Ji, Nancy R. Webb, Maria C. de Beer, Frederick C. de Beer, Paige M. Porrett, Gregory L. Beatty. IL-6/STAT3 activation in hepatocytes drives pro-metastatic niche formation in the liver [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1102.
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Affiliation(s)
- Jae W. Lee
- 1University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Xia Hua
- 1University of Pennsylvania, Philadelphia, PA
| | - Dong Xin
- 1University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Ailing Ji
- 3University of Kentucky, Lexington, KY
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Ahn DH, Ramanathan RK, Bekaii-Saab T. Emerging Therapies and Future Directions in Targeting the Tumor Stroma and Immune System in the Treatment of Pancreatic Adenocarcinoma. Cancers (Basel) 2018; 10:E193. [PMID: 29891787 PMCID: PMC6025083 DOI: 10.3390/cancers10060193] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 04/24/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 12/12/2022] Open
Abstract
Pancreatic adenocarcinoma is typically refractory to conventional treatments and associated with poor prognosis. While therapeutic advances over the past several years have improved patient outcomes, the observed benefits have been modest at best, highlighting the need for continued development of alternate treatment strategies. The tumor microenvironment has been identified as being integral to oncogenesis through its direct effect on cellular pathway communication, immune inhibition, and promoting chemo-resistance. A more in depth understanding of the biology of the disease, in addition with our ability to develop more effective novel therapies have led to ongoing studies that are investigating several promising treatment options in this disease. Herein, we highlight and review the therapeutic landscape in pancreatic adenocarcinoma.
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Affiliation(s)
- Daniel H Ahn
- Department of Hematology/Medical Oncology, Mayo Clinic Cancer Center, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Ramesh K Ramanathan
- Department of Hematology/Medical Oncology, Mayo Clinic Cancer Center, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Tanios Bekaii-Saab
- Department of Hematology/Medical Oncology, Mayo Clinic Cancer Center, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
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Mody K, Borad MJ, Bekaii-Saab TS, Yang JD, Ramanathan RK, Ahn DH, Mahipal A, Roberts A, Nagy RJ, Kasi PM. Real-time circulating tumor DNA profiling of advanced cholangiocarcinoma (CCA). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4089] [Citation(s) in RCA: 1] [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)
| | | | | | | | | | - Daniel H. Ahn
- Ohio State University Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | - Amit Mahipal
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Dean AP, Wainberg ZA, Ramanathan RK, Boland PM, Mody K, Zhang B, Belanger B, de Jong FA, Braun S. A phase 1/2, open-label dose-escalation study of liposomal irinotecan (nal-IRI) plus 5- fluorouracil/leucovorin (5-FU/LV) and oxaliplatin (OX) in patients with previously untreated metastatic pancreatic cancer (mPAC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4111] [Citation(s) in RCA: 1] [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)
| | - Zev A. Wainberg
- Department of Medicine, University of California Los Angeles School of Medicine, Los Angeles, CA
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Gorbunova V, Beck T, Hofheinz R, Garcia-Alfonso P, Nechaeva M, Cubillo Gracian A, Mangel L, Elez E, Deming DA, Ramanathan RK, Torres A, Sullivan DM, Komarnitsky PB, Berlin J. Phase 2 study of veliparib plus FOLFIRI ± bevacizumab versus placebo plus FOLFIRI ± bevacizumab in metastatic colorectal cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3543] [Citation(s) in RCA: 1] [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)
- Vera Gorbunova
- N. N. Blokhin Cancer Research Center, Moscow, Russian Federation
| | | | - Ralf Hofheinz
- Klinikum Mannheim Tagestherapie – Zentrum, Mannheim, Germany
| | | | - Marina Nechaeva
- Arkhangelsk Regional Clinical Oncologic Dispensary, Arkhangelsk, Russia
| | | | - Laszlo Mangel
- Pecsi Tudomanyegyetem Klinikai Kozpont, Pecsi, Hungary
| | - Elena Elez
- Medical Oncology Department, Vall d’Hebron University Hospital; Vall d’Hebron Institute of Oncology (VHIO)., Barcelona, Spain
| | | | | | | | | | | | - Jordan Berlin
- Vanderbilt University Ingram Cancer Center, Nashville, TN
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26
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Moschos SJ, Sullivan RJ, Hwu WJ, Ramanathan RK, Adjei AA, Fong PC, Shapira-Frommer R, Tawbi HA, Rubino J, Rush TS, Zhang D, Miselis NR, Samatar AA, Chun P, Rubin EH, Schiller J, Long BJ, Dayananth P, Carr D, Kirschmeier P, Bishop WR, Deng Y, Cooper A, Shipps GW, Moreno BH, Robert L, Ribas A, Flaherty KT. Development of MK-8353, an orally administered ERK1/2 inhibitor, in patients with advanced solid tumors. JCI Insight 2018; 3:92352. [PMID: 29467321 DOI: 10.1172/jci.insight.92352] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/28/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Constitutive activation of ERK1/2 occurs in various cancers, and its reactivation is a well-described resistance mechanism to MAPK inhibitors. ERK inhibitors may overcome the limitations of MAPK inhibitor blockade. The dual mechanism inhibitor SCH772984 has shown promising preclinical activity across various BRAFV600/RAS-mutant cancer cell lines and human cancer xenografts. METHODS We have developed an orally bioavailable ERK inhibitor, MK-8353; conducted preclinical studies to demonstrate activity, pharmacodynamic endpoints, dosing, and schedule; completed a study in healthy volunteers (P07652); and subsequently performed a phase I clinical trial in patients with advanced solid tumors (MK-8353-001). In the P07652 study, MK-8353 was administered as a single dose in 10- to 400-mg dose cohorts, whereas in the MK-8353-001 study, MK-8353 was administered in 100- to 800-mg dose cohorts orally twice daily. Safety, tolerability, pharmacokinetics, pharmacodynamics, and antitumor activity were analyzed. RESULTS MK-8353 exhibited comparable potency with SCH772984 across various preclinical cancer models. Forty-eight patients were enrolled in the P07652 study, and twenty-six patients were enrolled in the MK-8353-001 study. Adverse events included diarrhea (44%), fatigue (40%), nausea (32%), and rash (28%). Dose-limiting toxicity was observed in the 400-mg and 800-mg dose cohorts. Sufficient exposure to MK-8353 was noted that correlated with biological activity in preclinical data. Three of fifteen patients evaluable for treatment response in the MK-8353-001 study had partial response, all with BRAFV600-mutant melanomas. CONCLUSION MK-8353 was well tolerated up to 400 mg twice daily and exhibited antitumor activity in patients with BRAFV600-mutant melanoma. However, antitumor activity was not particularly correlated with pharmacodynamic parameters. TRIAL REGISTRATION ClinicalTrials.gov NCT01358331. FUNDING Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., and NIH (P01 CA168585 and R35 CA197633).
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Affiliation(s)
- Stergios J Moschos
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ryan J Sullivan
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Wen-Jen Hwu
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ramesh K Ramanathan
- Translational Genomics Research Institute, Phoenix, Arizona, USA; Virginia G. Piper Cancer Center, Scottsdale, Arizona, USA
| | - Alex A Adjei
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Peter C Fong
- The University of Auckland and Auckland City Hospital, Auckland, New Zealand
| | | | - Hussein A Tawbi
- University of Pittsburgh School of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA
| | | | | | - Da Zhang
- Merck & Co. Inc., Kenilworth, New Jersey, USA
| | | | | | | | | | | | | | | | - Donna Carr
- Merck & Co. Inc., Kenilworth, New Jersey, USA
| | | | | | - Yongqi Deng
- Merck & Co. Inc., Kenilworth, New Jersey, USA
| | - Alan Cooper
- Merck & Co. Inc., Kenilworth, New Jersey, USA
| | | | - Blanca Homet Moreno
- Jonsson Comprehensive Cancer Center at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Lidia Robert
- Jonsson Comprehensive Cancer Center at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Antoni Ribas
- Jonsson Comprehensive Cancer Center at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Keith T Flaherty
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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DeLeon TT, Ahn DH, Bogenberger JM, Anastasiadis PZ, Arora M, Ramanathan RK, Aqel BA, Vasmatzis G, Truty MJ, Oklu R, Bekaii-Saab TS, Borad MJ. Novel targeted therapy strategies for biliary tract cancers and hepatocellular carcinoma. Future Oncol 2018; 14:553-566. [PMID: 29460642 DOI: 10.2217/fon-2017-0451] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Worldwide hepatobiliary cancers are the second leading cause of cancer related death. Despite their relevance, hepatobiliary cancers have a paucity of approved systemic therapy options. However, there are a number of emerging therapeutic biomarkers and therapeutic concepts that show promise. In hepatocellular carcinoma, nivolumab appears particularly promising and recently received US FDA approval. In intrahepatic cholangiocarcinoma, therapies targeting FGFR2 and IDH1 and immune checkpoint inhibitors are the furthest along and generating the most excitement. There are additional biomarkers that merit further exploration in hepatobiliary cancers including FGF19, ERRFI1, TERT, BAP1, BRAF, CDKN2A, tumor mutational burden and ERBB2 (HER2/neu). Development of new and innovative therapies would help address the unmet need for effective systemic therapies in advanced and metastatic hepatobiliary cancers.
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Affiliation(s)
- Thomas T DeLeon
- Division of Hematology Oncology, Department of Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Daniel H Ahn
- Division of Hematology Oncology, Department of Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - James M Bogenberger
- Division of Hematology Oncology, Department of Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | | | - Mansi Arora
- Division of Hematology Oncology, Department of Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Ramesh K Ramanathan
- Division of Hematology Oncology, Department of Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Bashar A Aqel
- Division of Gastroenterology & Hepatology, Department of Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - George Vasmatzis
- Department of Molecular Medicine, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN 55902, USA
| | - Mark J Truty
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN 55902, USA
| | - Rahmi Oklu
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Tanios S Bekaii-Saab
- Division of Hematology Oncology, Department of Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Mitesh J Borad
- Division of Hematology Oncology, Department of Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
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Borazanci EH, Jameson GS, Borad MJ, Ramanathan RK, Korn RL, Caldwell L, Ansaldo K, Hendrickson K, Marceau K, Von Hoff DD. A phase II pilot trial of nivolumab (N) + albumin bound paclitaxel (AP) + paricalcitol (P) + cisplatin (C) + gemcitabine (G) (NAPPCG) in patients with previously untreated metastatic pancreatic ductal adenocarcinoma (PDAC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.358] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
358 Background: Effective therapy for the treatment of PDAC remains one of the greatest unmet oncology clinical needs. The addition of C to G and AP has shown promising clinical data in a previously reported study [J Clin Oncol 35, 2017 (suppl 4S; abstract 341)]. In preclinical work, vitamin D (Vit D) analog therapy decreases myeloid derived suppressor cells and regulatory T cells, turning PDAC into a more immune-friendly microenvironment. This trial combines AP/C/G with Vit D analog P and the anti-PD-1 antibody N as a combination therapy for patients with previously untreated metastatic PDAC. This trial evaluates the efficacy and safety of NAPPCG in that patient population (NCT02754726). Methods: Eligibility criteria include Stage IV PDAC, no prior chemotherapy for systemic disease, KPS ≥ 70, and measurable disease. Doses are AP 125 mg/m2 undiluted, G 1000 mg/m2 in 250 ml of normal saline (NS), each infused over 30 minutes with C 25 mg/ m2 in 500 ml of NS infused over 60 minutes on days 1, 8, 22, and 29 of a 42-day cycle. N is given at a fixed dose of 240 mg as a 60 minute infusion on days 1, 15, and 29. P is given at a fixed dose of 25 µg IV twice weekly. Primary objective is to determine the efficacy of the combination for patients with previously untreated metastatic PDAC through determining CR, ORR, PFS, and OS. The secondary objective is to evaluate safety in patients with previously untreated metastatic PDAC. Results: Trial was initiated May 2016 and10 patients have been enrolled in the initial phase of the study and are evaluable (baseline and ≥1 follow up CT scan). Most common drug-related grade (Gr) 3-4 adverse events (AE’s), n = 10, are thrombocytopenia 100% (gr 3 = 50%, gr 4 = 50%) with no serious bleeding events, anemia 50% (gr 3 = 50%, gr 4 = 0%), and colitis 20% (gr 3 = 20%, gr 4 = 0%). By RECIST 1.1 criteria, the best response is 8 PR and 2 SD, yielding an 80% ORR. Median PFS is 8.2 months. Median OS has not been reached. Conclusions: Although a small study, the high response rate is encouraging. This regimen is being expanded to 25 patients with plans to include exploratory inflammatory biomarkers. Clinical trial information: NCT02754726.
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DeLeon T, Alberts SR, McWilliams RR, Hubbard JM, Ahn DH, Bekaii-Saab TS, Mody K, Roberts LR, Salomao M, Kipp B, Halfdanarson TR, Murtaza M, Ramanathan RK, Dueck AC, Borad MJ. A pilot study of ponatinib in cholangiocarcinoma patients with FGFR2 fusions. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.tps532] [Citation(s) in RCA: 2] [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
TPS532 Background: Recent studies have shown that FGFR2 fusions may represent recurrent (prevalence ~10-15% in larger cohorts) driver events amenable to therapeutic targeting in patients with advanced, intrahepatic cholangiocarcinoma. Methods: This single arm pilot study (NCT02265341) is being conducted at 3 centers (Mayo Clinic Arizona, Mayo Clinic Florida and Mayo Clinic Rochester; enrollment initiated December 2014). Next-generation sequencing based assays and a FISH-break apart assay are used to identify tumors with FGFR2 fusions. Patients must additionally have histologically/cytologically confirmed cholangiocarcinoma, ECOG performance score 0-2, measurable disease, preserved hematologic/renal and hepatic function and absence of cardiac events/stroke in the preceding 6 months. Ponatinib is administered at 45 mg once daily. Patients will be treated until disease progression, intolerable toxicity or patient decision to not pursue further therapy. The primary objective of the study is to estimate the clinical benefit rate (defined as composite of partial response rate, complete response rate and stable disease rate ≥ 4 months; as defined by RECIST criteria v1.1). Secondary endpoints include estimation of progression-free survival, overall survival, CA19-9 response rate (defined as > 50% reduction from baseline) and evaluation of the overall adverse event profile of ponatinib in this patient population. Translational objectives include serial circulating DNA (ct-DNA) monitoring, target knockdown assessments in tumor tissue (p-FGFR2, p-FRS2, p-Akt and p-ERK) and evaluation of mechanisms of resistance through comparison of baseline and progression biopsy samples using multi-platform sequencing (exome, RNA-Seq and methyl-Seq). Additionally, quality of life assessments will be evaluated using EORTC-QLQ-C30 and BIL21 tools. A total of 30 patients will be enrolled into the study (12 of 30 patients have been enrolled). The trial is designed using an underlying assumption of clinical benefit rate (CBR) of 5% with significance level of 0.15 and 80% power to detect a 20% CBR. Clinical trial information: NCT02265341.
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Shroff RT, Javle MM, Xiao L, Kaseb AO, Varadhachary GR, Wolff RA, Raghav KPS, Iwasaki M, Masci P, Ramanathan RK, Ahn DH, Bekaii-Saab TS, Borad MJ. A phase II trial of gemcitabine (G), cisplatin (C), and nab-paclitaxel (N) in advanced biliary tract cancers (aBTCs): Updated survival analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
350 Background: BTCs are often diagnosed at an advanced stage and have a poor prognosis. The standard therapy for aBTCs is the combination of GC. However, the median overall survival (mOS) is dismal at 11.7 months (mos) with a median progression free survival (mPFS) of 8 mos. Methods: A single arm, phase II study was conducted at MD Anderson and Mayo Clinic Arizona. Patients (pts) with aBTC were treated at initial dose level of G/C/N (in mg/m2) at 1000/25/125 (n = 30) which was reduced to lower doses due to grade 3/4 hematological (heme) toxicity (tox) - G/C/N: 800/25/100 (n = 30). Cycles were q21 days with restaging q3 cycles until progression. PFS was the primary endpoint (endpt). Using a Bayesian hypothesis test-based design, we assumed mPFS of 8 mos under the null hypothesis (H0), 10 mos under the alternative (H1). Secondary endpts included mOS, RECIST v1.1 response rate (RR), safety and CA19-9 response. Results: 60 pts were enrolled with 51 being response-evaluable having received more than 1 cycle of therapy (age: median 60 yrs [range 31-77], ECOG PS 0/1 (22/38), M/F (33/27), intrahepatic cholangiocarcinoma/extrahepatic/gallbladder (38/9/13). Median follow-up was 14 mos and median number of treatment (trmt) cycles = 5.24. Pts at initial dose level had significant grade 3/4 heme tox: neutropenia, febrile neutropenia, anemia, and thrombocytopenia leading to trmt discontinuation in 6/30 pts. After dose reduction to G/C/N (in mg/m2) at 800/25/100, trmt was better tolerated with only 3 pts experiencing grade 4 heme tox. Non-heme tox were grade 3 in 19 pts: nausea/vomiting, diarrhea, thromboembolic event/CVA, hypokalemia, constipation, cystitis, LFT elevations. The mPFS = 11.4 mos (95% CI: 6.1, 16.1) and mOS = 19.2 (95%CI: 13.6, NA), 1-year survival rate 67.6%. 51 pts evaluable for response: disease control rate (PR+CR+SD)-84.3% and RR-39%. 12 unresectable cases were operated post trmt with 1 pathologic CR. Conclusions: The combination of GCN was well tolerated at adjusted doses and demonstrates encouraging efficacy having met its mPFS endpt and an impressive mOS higher than historical control. These results merit evaluating GC +/-N in a randomized controlled study. Clinical trial information: NCT02392637.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Daniel H. Ahn
- Ohio State University Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
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Weiss GJ, Jameson G, Von Hoff DD, Valsasina B, Davite C, Di Giulio C, Fiorentini F, Alzani R, Carpinelli P, Di Sanzo A, Galvani A, Isacchi A, Ramanathan RK. Phase I dose escalation study of NMS-1286937, an orally available Polo-Like Kinase 1 inhibitor, in patients with advanced or metastatic solid tumors. Invest New Drugs 2018; 36:85-95. [PMID: 28726132 DOI: 10.1007/s10637-017-0491-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 06/02/2017] [Accepted: 07/07/2017] [Indexed: 12/21/2022]
Abstract
Background Pharmacological inhibition of polo-like kinase 1 (PLK1) represents a new approach for the treatment of solid tumors. This study was aimed at determining the first cycle dose-limiting toxicities (DLTs) and related maximum tolerated dose (MTD) of NMS-1286937, a selective ATP-competitive PLK1-specific inhibitor. Secondary objectives included evaluation of its safety and pharmacokinetic (PK) profile in plasma, its antitumor activity, and its ability to modulate intracellular targets in biopsied tissue. Methods This was a Phase I, open-label, dose-escalation trial in patients with advanced/metastatic solid tumors. A treatment cycle comprised 5 days of oral administration followed by 16 days of rest, for a total of 21 days (3-week cycle). Results Nineteen of 21 enrolled patients with confirmed metastatic disease received study medication. No DLTs occurred at the first 3 dose levels (6, 12, and 24 mg/m2/day). At the subsequent dose level (48 mg/m2/day), 2 of 3 patients developed DLTs. An intermediate level of 36 mg/m2/day was therefore investigated. Four patients were treated and two DLTs were observed. After further cohort expansion, the MTD and recommended phase II dose (RP2D) were determined to be 24 mg/m2/day. Disease stabilization, observed in several patients, was the best treatment response observed. Hematological toxicity (mostly thrombocytopenia and neutropenia) was the major DLT. Systemic exposure to NMS-1286937 increased with dose and was comparable between two cycles of treatment following oral administration of the drug. Conclusions This study successfully identified the MTD and DLTs for NMS-1286937 and characterized its safety profile.
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Affiliation(s)
- Glen J Weiss
- Western Regional Medical Center, Cancer Treatment Centers of America, 14200 W Celebrate Life Way, Goodyear, AZ, 85338, USA.
- Virginia G. Piper Cancer Centers at Scottsdale Healthcare, Scottsdale, AZ, USA.
| | - Gayle Jameson
- Virginia G. Piper Cancer Centers at Scottsdale Healthcare, Scottsdale, AZ, USA
| | - Daniel D Von Hoff
- Virginia G. Piper Cancer Centers at Scottsdale Healthcare, Scottsdale, AZ, USA
| | | | - Cristina Davite
- CLInical Organization for Strategies and Solutions (CLIOSS) S.r.l, Mayo Scottsdale, Nerviano, Italy
| | - Claudia Di Giulio
- CLInical Organization for Strategies and Solutions (CLIOSS) S.r.l, Mayo Scottsdale, Nerviano, Italy
| | | | | | | | - Alessandro Di Sanzo
- CLInical Organization for Strategies and Solutions (CLIOSS) S.r.l, Mayo Scottsdale, Nerviano, Italy
| | | | | | - Ramesh K Ramanathan
- Virginia G. Piper Cancer Centers at Scottsdale Healthcare, Scottsdale, AZ, USA
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Ramanathan RK, McDonough S, Philip PA, Hingorani SR, Lacy J, Kortmansky JS, Thumar JR, Chiorean EG, Shields AF, Behl D, Mehan PT, Gaur R, Seery TE, Guthrie K, Hochster HS. A phase IB/II randomized study of mFOLFIRINOX (mFFOX) + pegylated recombinant human hyaluronidase (PEGPH20) versus mFFOX alone in patients with good performance status metastatic pancreatic adenocarcinoma (mPC): SWOG S1313 (NCT #01959139). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.208] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
208 Background: PEGPH20 degrades hyaluronan (HA), a major component of the stroma, increases delivery of gemcitabine and prolongs survival in preclinical models. We evaluated the activity of PEGPH20 in combination with mFFOX in mPC , unselected for tumor HA. Methods: Pertinent eligibility: untreated mPC, PS of 0-1 and adequate organ function. Standard FFOX was modified to add prophylactic growth factor support and omit bolus 5FU. Due to increased thromboembolic (TE) events with PEGPH20, an amendment instituted LMWH prophylaxis in the PEGPH20 arm only. Following a dose finding cohort of mFFOX + PEGPH20, the Phase II study randomized patients (1:1) to the combination arm or mFFOX alone (n = 138). The primary endpoint was overall survival (OS), with a null median OS of 10 mo and an alternative of 15 mo (1-sided type 1 error 0.1, 80% power). Results: PEGPH20 at 3 mcg/kg, q2 weeks was more tolerable than twice weekly dosing. The randomized phase II study began May 2015. The planned interim futility analysis when 35 deaths occurred gave a HR of 0.44 favoring the standard arm, thus the study was closed to accrual (March 2017). As of August 22, 2017 (n = 111), the estimated median OS in the mFFOX arm was 15.1 mo (95% CI 10.1-15.7) vs 7.6 mo (95% CI 4.6-9.2) in the PEGPH20 arm. Conclusions: OS in the mFFOX control arm (15.1 mo) is longest yet reported. Addition of PEGPH20 to mFFOX is not recommended for further study and appears to be detrimental (HR = 0.48). The impact of PEGPH20 on OS was unexpected and in contrast to favorable results reported for the combination of gemcitabine/nab-paclitaxel + PEGPH20 especially in the HA high cohort (Hingorani S et al. A 4008, ASCO 2017). PEGPH20 with mFFOX caused increased toxicity (mostly GI and TE events) and decreased treatment duration compared to mFFOX alone. Tumor HA content will be analyzed. Funding: NIH/NCI grants CA180888, CA180819; and in part by Halozyme Inc. Clinical trial information: 01959139. [Table: see text]
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Affiliation(s)
| | | | | | | | - Jill Lacy
- Yale School of Medicine, Yale University, New Haven, CT
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Sonbol MB, Buras M, Ahn DH, Borad MJ, Gores GJ, Mathur A, Heimbach J, DeLeon T, Taner C, Halfdanarson TR, Hobday TJ, Ramanathan RK, Mody K, Stucky CCH, Truty MJ, Moss AA, Bekaii-Saab TS. Long-term outcomes of liver transplantation (LT) for the treatment of neuroendocrine liver metastases (NELM): The Mayo Clinic experience. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
355 Background: In this study, we sought to determine the prognostic factors impacting survival of patients with NELM who underwent LT at Mayo Clinic. Methods: We performed a three-site retrospective analysis of patients with unresectable NELM treated with LT from 1990 -2017. Cases were identified from clinical databases at Mayo Clinic. Data on demographics, timing of diagnosis and transplant, extent of liver involvement, and tumor grade, were extracted. Extent of liver involvement was calculated using previously validated standardized volumetry with high defined as > 25% increase in the weight of the extracted liver at the time of the transplant as compared to the standard liver volume. Survival was calculated using the Kaplan–Meier method. Results: We identified 37 patients. Median age at LT was 47 (range 17.0-64.0), male: female (73% vs. 27%, respectively). Primary tumor site was in the pancreas in 51.3% and in the small bowels in 43.2%; 78.4% had NELM at presentation. While primary tumor resection was done at the time of LT in 5 (13.9%) cases, most patients (80.6%) had ˃6-months interval between primary tumor resection and LT surgery. Prior to LT, 25 (74.3%) patients received somatostatin analogues and 18 (61.3%) had liver-directed therapy. Median time from diagnosis to transplant was 33.6 months (0-246). High extent of liver involvement was identified in 12 patients (33.3%). Disease-Free Survival (DFS) at 3, 5, and 10 years was 56.8%, 43.1%, and 22.4% respectively. Overall-survival (OS) at 3, 5, and 10 years was 86.9%, 79.6%, and 52.6% respectively. High extent of liver involvement at the time of transplantation was associated with inferior DFS and OS and patients˃45 years-old at the time of transplantation had worse DFS. Patients whose disease met the OPTN (Organ Procurement and Transplantation Network) criteria for NELM transplantation had significantly better DFS and OS with median 10-year OS of 80.7 % vs. 17%. Conclusions: LT is a reasonable therapeutic option for selected patients with unresectable NELM with 10-year OS of 52.6%. High extent of liver involvement was associated with worse long-term outcomes while meeting OPTN criteria resulted in best outcomes.
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Javle M, Lowery M, Shroff RT, Weiss KH, Springfeld C, Borad MJ, Ramanathan RK, Goyal L, Sadeghi S, Macarulla T, El-Khoueiry A, Kelley RK, Borbath I, Choo SP, Oh DY, Philip PA, Chen LT, Reungwetwattana T, Van Cutsem E, Yeh KH, Ciombor K, Finn RS, Patel A, Sen S, Porter D, Isaacs R, Zhu AX, Abou-Alfa GK, Bekaii-Saab T. Phase II Study of BGJ398 in Patients With FGFR-Altered Advanced Cholangiocarcinoma. J Clin Oncol 2018; 36:276-282. [PMID: 29182496 PMCID: PMC6075847 DOI: 10.1200/jco.2017.75.5009] [Citation(s) in RCA: 455] [Impact Index Per Article: 75.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose No standard treatment exists for patients with cholangiocarcinoma for whom first-line gemcitabine-based therapy fails. Fibroblast growth factor receptor 2 ( FGFR2) fusions/translocations are present in 13% to 17% of intrahepatic cholangiocarcinomas. BGJ398, an orally bioavailable, selective pan-FGFR kinase inhibitor, has shown preliminary clinical activity against tumors with FGFR alterations. Methods A multicenter, open-label, phase II study ( ClinicalTrials.gov identifier: NCT02150967) evaluated BGJ398 antitumor activity in patients age ≥ 18 years with advanced or metastatic cholangiocarcinoma containing FGFR2 fusions or other FGFR alterations whose disease had progressed while receiving prior therapy. Patients received BGJ398 125 mg once daily for 21 days, then 7 days off (28-day cycles). The primary end point was investigator-assessed overall response rate. Results Sixty-one patients (35 women; median age, 57 years) with FGFR2 fusion (n = 48), mutation (n = 8), or amplification (n = 3) participated. At the prespecified data cutoff (June 30, 2016), 50 patients had discontinued treatment. All responsive tumors contained FGFR2 fusions. The overall response rate was 14.8% (18.8% FGFR2 fusions only), disease control rate was 75.4% (83.3% FGFR2 fusions only), and estimated median progression-free survival was 5.8 months (95% CI, 4.3 to 7.6 months). Adverse events included hyperphosphatemia (72.1% all grade), fatigue (36.1%), stomatitis (29.5%), and alopecia (26.2%). Grade 3 or 4 treatment-related adverse events occurred in 25 patients (41%) and included hyperphosphatemia (16.4%), stomatitis (6.6%), and palmar-plantar erythrodysesthesia (4.9%). Conclusion BGJ398 is a first-in-class FGFR kinase inhibitor with manageable toxicities that shows meaningful clinical activity against chemotherapy-refractory cholangiocarcinoma containing FGFR2 fusions. This promising antitumor activity supports continued development of BGJ398 in this highly selected patient population.
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Affiliation(s)
- Milind Javle
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ.,Corresponding author: Milind Javle, MD, Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; e-mail:
| | - Maeve Lowery
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Rachna T. Shroff
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Karl Heinz Weiss
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Christoph Springfeld
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Mitesh J. Borad
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Ramesh K. Ramanathan
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Lipika Goyal
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Saeed Sadeghi
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Teresa Macarulla
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Anthony El-Khoueiry
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Robin Kate Kelley
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Ivan Borbath
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Su Pin Choo
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Do-Youn Oh
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Philip A. Philip
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Li-Tzong Chen
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Thanyanan Reungwetwattana
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Eric Van Cutsem
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Kun-Huei Yeh
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Kristen Ciombor
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Richard S. Finn
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Anuradha Patel
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Suman Sen
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Dale Porter
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Randi Isaacs
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Andrew X. Zhu
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Ghassan K. Abou-Alfa
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Tanios Bekaii-Saab
- Milind Javle and Rachna T. Shroff, The University of Texas MD Anderson Cancer Center, Houston, TX; Maeve Lowery and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Karl Heinz Weiss and Christoph Springfeld, Universitäts Klinikum Heidelberg, Heidelberg, Germany; Mitesh J. Borad, Ramesh K. Ramanathan, and Tanios Bekaii-Saab, Mayo Clinic, Phoenix, AZ; Lipika Goyal and Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Boston, MA; Saeed Sadeghi and Richard S. Finn, David Geffen School of Medicine at UCLA; Anthony El-Khoueiry, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles; Robin Kate Kelley, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Teresa Macarulla, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain; Ivan Borbath, Cliniques Universitaires Saint-Luc, Brussels; Eric Van Cutsem, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium; Su Pin Choo, National Cancer Centre of Singapore, Singapore; Do-Youn Oh, Seoul National University, Seoul, South Korea; Philip A. Philip, Karmanos Cancer Institute, Detroit, MI; Li-Tzong Chen, National Institute of Cancer Research and National Cheng Kung University Hospital, Tainan; Kun-Huei Yeh, National Taiwan University Hospital Cancer Center, and Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kristen Ciombor, The Ohio State University Wexner Medical Center, Columbus, OH; and Anuradha Patel, Suman Sen, Dale Porter, and Randi Isaacs, Novartis Pharmaceuticals Corporation, East Hanover, NJ
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35
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Ramanathan RK, Weiss GJ, Posner RG, Rajeshkumar NV, Jameson G, Aziz M, Hoering A, Bolejack V, Maitra A, Fulk M, Stites EC, Hlavacek WS, Gatalica Z, Xiu J, Hidalgo M, Von Hoff DD, Barrett MT. A phase 2 trial of personalized cytotoxic therapy based on tumor immunohistochemistry in previously treated metastatic pancreatic cancer patients. J Gastrointest Oncol 2018; 8:925-935. [PMID: 29299351 DOI: 10.21037/jgo.2017.09.05] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The choice of a regimen in metastatic pancreatic cancer patients following progression on 1st line therapy is empiric and outcomes are unsatisfactory. This phase II study was performed to evaluate the efficacy of therapy selected by immunohistochemistry (IHC) in these patients following progression after one or more therapies. Methods Eligible patients underwent a percutaneous biopsy of a metastatic lesion and treatment selection was determined by IHC. The study required 35 evaluable patients (power of 86%) for detecting a true 1-year survival rate of >20%. Results A tumor biopsy was performed in 48 of 49 accrued patients. Study therapy was not given (n=13) either due to insufficient tumor on biopsy (n=8) or due to worsening cancer related symptoms after biopsy (n=5). The demographics of evaluable patients (n=35) are male/female (59%/41%), with age range 34-78 years (median 63 years). Patients had 1-6 prior regimens (median of 2). The most common IHC targets were topoisomerase 1 or 2, thymidylate synthase, excision repair cross-complementation group 1 protein (ERCC1), and osteonectin secreted protein acidic and rich in cysteine (SPARC). Commercially available treatment regimens prescribed included FOLFIRI, FOLFOX, irinotecan, and doxorubicin. The response (RECIST) was 9%, the median survival was 5.6 months (94% CI, 3.8-8.2), and the 1-year survival was 20% (95% CI, 7-33%). Conclusions In all patients, IHC assays resulted in identification of at least two targets for therapy and a non-cross resistant regimen could be prescribed for therapy with evidence of some benefit. An IHC based treatment strategy is feasible and needs validation in larger studies.
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Affiliation(s)
- Ramesh K Ramanathan
- Honor Health Research Institute, Scottsdale, AZ, USA.,Mayo Clinic Cancer Center, Phoenix, AZ, USA.,Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Glen J Weiss
- Honor Health Research Institute, Scottsdale, AZ, USA.,Translational Genomics Research Institute, Phoenix, AZ, USA
| | | | - N V Rajeshkumar
- Department of Oncology and Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Human Therapeutics Division, Intrexon Corporation, Germantown, MD, USA
| | - Gayle Jameson
- Honor Health Research Institute, Scottsdale, AZ, USA
| | - Meraj Aziz
- Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Antje Hoering
- Human Therapeutics Division, Intrexon Corporation, Germantown, MD, USA
| | | | - Anirban Maitra
- Department of Oncology and Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Sheikh Ahmed Pancreatic Cancer Research Center, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Monica Fulk
- Honor Health Research Institute, Scottsdale, AZ, USA
| | | | | | | | | | - Manuel Hidalgo
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Centro Nacional de Investigaciones Oncológicas and Hospital de Madrid, Madrid, Spain
| | - Daniel D Von Hoff
- Honor Health Research Institute, Scottsdale, AZ, USA.,Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Michael T Barrett
- Mayo Clinic Cancer Center, Phoenix, AZ, USA.,Translational Genomics Research Institute, Phoenix, AZ, USA
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Patnaik A, Appleman LJ, Tolcher AW, Papadopoulos KP, Beeram M, Rasco DW, Weiss GJ, Sachdev JC, Chadha M, Fulk M, Ejadi S, Mountz JM, Lotze MT, Toledo FGS, Chu E, Jeffers M, Peña C, Xia C, Reif S, Genvresse I, Ramanathan RK. First-in-human phase I study of copanlisib (BAY 80-6946), an intravenous pan-class I phosphatidylinositol 3-kinase inhibitor, in patients with advanced solid tumors and non-Hodgkin's lymphomas. Ann Oncol 2017; 27:1928-40. [PMID: 27672108 PMCID: PMC5035790 DOI: 10.1093/annonc/mdw282] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [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: 03/30/2016] [Accepted: 07/06/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To evaluate the safety, tolerability, pharmacokinetics, and maximum tolerated dose (MTD) of copanlisib, a phosphatidylinositol 3-kinase inhibitor, in patients with advanced solid tumors or non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS Phase I dose-escalation study including patients with advanced solid tumors or NHL, and a cohort of patients with type 2 diabetes mellitus. Patients received three weekly intravenous infusions of copanlisib per 28-day cycle over the dose range 0.1-1.2 mg/kg. Plasma copanlisib levels were analyzed for pharmacokinetics. Biomarker analysis included PIK3CA, KRAS, BRAF, and PTEN mutational status and PTEN immunohistochemistry. Whole-body [(18)F]-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) was carried out at baseline and following the first dose to assess early pharmacodynamic effects. Plasma glucose and insulin levels were evaluated serially. RESULTS Fifty-seven patients received treatment. The MTD was 0.8 mg/kg copanlisib. The most frequent treatment-related adverse events were nausea and transient hyperglycemia. Copanlisib exposure was dose-proportional with no accumulation; peak exposure positively correlated with transient hyperglycemia post-infusion. Sixteen of 20 patients treated at the MTD had reduced (18)FDG-PET uptake; 7 (33%) had a reduction >25%. One patient achieved a complete response (CR; endometrial carcinoma exhibiting both PIK3CA and PTEN mutations and complete PTEN loss) and two had a partial response (PR; both metastatic breast cancer). Among the nine NHL patients, all six with follicular lymphoma (FL) responded (one CR and five PRs) and one patient with diffuse large B-cell lymphoma had a PR by investigator assessment; two patients with FL who achieved CR (per post hoc independent radiologic review) were on treatment >3 years. CONCLUSION Copanlisib, dosed intermittently on days 1, 8, and 15 of a 28-day cycle, was well tolerated and the MTD was determined to be 0.8 mg/kg. Copanlisib exhibited dose-proportional pharmacokinetics and promising anti-tumor activity, particularly in patients with NHL. CLINICALTRIALSGOV NCT00962611; https://clinicaltrials.gov/ct2/show/NCT00962611.
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Affiliation(s)
- A Patnaik
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | | | - A W Tolcher
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - K P Papadopoulos
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - M Beeram
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - D W Rasco
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - G J Weiss
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale Cancer Treatment Centers of America, Goodyear
| | - J C Sachdev
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | - M Chadha
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | - M Fulk
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | - S Ejadi
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | | | - M T Lotze
- University of Pittsburgh, Pittsburgh
| | | | - E Chu
- University of Pittsburgh, Pittsburgh
| | - M Jeffers
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, USA
| | - C Peña
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, USA
| | - C Xia
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, USA
| | - S Reif
- Bayer Pharma AG, Berlin, Germany
| | | | - R K Ramanathan
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
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37
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Sonbol MB, Firwana B, Wang Z, Almader-Douglas D, Borad MJ, Makhoul I, Ramanathan RK, Ahn DH, Bekaii-Saab T. Second-line treatment in patients with pancreatic ductal adenocarcinoma: A meta-analysis. Cancer 2017; 123:4680-4686. [PMID: 28817187 DOI: 10.1002/cncr.30927] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 06/12/2017] [Accepted: 07/05/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND There are limited therapeutic options for treatment-refractory pancreatic ductal adenocarcinoma (PDAC), with a paucity of data to support the best option after progression on gemcitabine-based regimens. The authors performed a meta-analysis to determine the effectiveness of adding oxaliplatin (OX) or various irinotecan formulations to a fluoropyrimidine (FP) after first-line treatment progression in patients with PDAC. METHODS Different databases, including PubMed, EMBASE, and Cochrane, were searched to identify randomized controlled trials comparing FP monotherapy versus FP combination therapy that included either oxaliplatin (FPOX) or various irinotecan formulations (FPIRI) in patients with PDAC who progressed after first-line treatment. Secondary analyses were planned to assess the effectiveness of FPOX and FPIRI compared with FP. Outcomes of interest included overall survival (OS) and progression-free survival (PFS). RESULTS Five studies with 895 patients were identified. Patients randomized to receive FPIRI/FPOX had a significantly improved PFS and a trend toward improved OS compared with those who received FP monotherapy. When comparing FPIRI with FP, there was an improvement in both PFS (hazard ratio, 0.64; 95% confidence interval, 0.47-0.87; P = .005) and OS (hazard ratio, 0.70; 95% confidence interval, 0.55-0.89; P = .004) in patients who received the combination. Conversely, FPOX produced only a modest improvement in PFS with no improvement in OS. CONCLUSIONS Combination chemotherapy with OX or various IRI formulations appears to improve PFS compared with single-agent FP. FPIRI, but not FPOX, appears to confer an OS advantage. The combination of FP with irinotecan formulations appears to be the appropriate next line of treatment upon progression after gemcitabine-based chemotherapy regimens. Cancer 2017;123:4680-4686. © 2017 American Cancer Society.
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Affiliation(s)
| | - Belal Firwana
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Zhen Wang
- Evidence-Based Practice Center, Mayo Clinic, Rochester, New York
| | | | - Mitesh J Borad
- Mayo Clinic Cancer Center, Mayo Clinic, Phoenix, Arizona
| | - Issam Makhoul
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Daniel H Ahn
- Mayo Clinic Cancer Center, Mayo Clinic, Phoenix, Arizona
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Egan JB, Marks DL, Hogenson TL, Vrabel AM, Sigafoos AN, Tolosa EJ, Carr RM, Safgren SL, Enriquez Hesles E, Almada LL, Romecin-Duran PA, Iguchi E, Ala’Aldeen A, Kocher JPA, Oliver GR, Prodduturi N, Mead DW, Hossain A, Huneke NE, Tagtow CM, Ailawadhi S, Ansell SM, Banck MS, Bryce AH, Carballido EM, Chanan-Khan AA, Curtis KK, Resnik E, Gawryletz CD, Go RS, Halfdanarson TR, Ho TH, Joseph RW, Kapoor P, Mansfield AS, Meurice N, Nageswara Rao AA, Nowakowski GS, Pardanani A, Parikh SA, Cheville JC, Feldman AL, Ramanathan RK, Robinson SI, Tibes R, Finnes HD, McCormick JB, McWilliams RR, Jatoi A, Patnaik MM, Silva AC, Wieben ED, McAllister TM, Rumilla KM, Kerr SE, Lazaridis KN, Farrugia G, Stewart AK, Clark KJ, Kennedy EJ, Klee EW, Borad MJ, Fernandez-Zapico ME. Molecular Modeling and Functional Analysis of Exome Sequencing–Derived Variants of Unknown Significance Identify a Novel, Constitutively Active FGFR2 Mutant in Cholangiocarcinoma. JCO Precis Oncol 2017; 2017. [PMID: 30761385 PMCID: PMC6369924 DOI: 10.1200/po.17.00018] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Genomic testing has increased the quantity of information available to oncologists. Unfortunately, many identified sequence alterations are variants of unknown significance (VUSs), which thus limit the clinician’s ability to use these findings to inform treatment. We applied a combination of in silico prediction and molecular modeling tools and laboratory techniques to rapidly define actionable VUSs. Materials and Methods Exome sequencing was conducted on 308 tumors from various origins. Most single nucleotide alterations within gene coding regions were VUSs. These VUSs were filtered to identify a subset of therapeutically targetable genes that were predicted with in silico tools to be altered in function by their variant sequence. A subset of receptor tyrosine kinase VUSs was characterized by laboratory comparison of each VUS versus its wild-type counterpart in terms of expression and signaling activity. Results The study identified 4,327 point mutations of which 3,833 were VUSs. Filtering for mutations in genes that were therapeutically targetable and predicted to affect protein function reduced these to 522 VUSs of interest, including a large number of kinases. Ten receptor tyrosine kinase VUSs were selected to explore in the laboratory. Of these, seven were found to be functionally altered. Three VUSs (FGFR2 F276C, FGFR4 R78H, and KDR G539R) showed increased basal or ligand-stimulated ERK phosphorylation compared with their wild-type counterparts, which suggests that they support transformation. Treatment of a patient who carried FGFR2 F276C with an FGFR inhibitor resulted in significant and sustained tumor response with clinical benefit. Conclusion The findings demonstrate the feasibility of rapid identification of the biologic relevance of somatic mutations, which thus advances clinicians’ ability to make informed treatment decisions.
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Affiliation(s)
- Jan B. Egan
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - David L. Marks
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Tara L. Hogenson
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Anne M. Vrabel
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Ashley N. Sigafoos
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Ezequiel J. Tolosa
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Ryan M. Carr
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Stephanie L. Safgren
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Elisa Enriquez Hesles
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Luciana L. Almada
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Paola A. Romecin-Duran
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Eriko Iguchi
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Aryan Ala’Aldeen
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Jean-Pierre A. Kocher
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Gavin R. Oliver
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Naresh Prodduturi
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - David W. Mead
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Asif Hossain
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Norine E. Huneke
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Colleen M. Tagtow
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Sikander Ailawadhi
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Stephen M. Ansell
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Michaela S. Banck
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Alan H. Bryce
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Estrella M. Carballido
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Asher A. Chanan-Khan
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Kelly K. Curtis
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Ernesto Resnik
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Chelsea D. Gawryletz
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Ronald S. Go
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Thorvardur R. Halfdanarson
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Thai H. Ho
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Richard W. Joseph
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Prashant Kapoor
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Aaron S. Mansfield
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Nathalie Meurice
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Amulya A. Nageswara Rao
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Grzegorz S. Nowakowski
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Animesh Pardanani
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Sameer A. Parikh
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - John C. Cheville
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Andrew L. Feldman
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Ramesh K. Ramanathan
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Steven I. Robinson
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Raoul Tibes
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Heidi D. Finnes
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Jennifer B. McCormick
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Robert R. McWilliams
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Aminah Jatoi
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Mrinal M. Patnaik
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Alvin C. Silva
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Eric D. Wieben
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | | | | | | | | | - Gianrico Farrugia
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - A. Keith Stewart
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Karl J. Clark
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Eileen J. Kennedy
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Eric W. Klee
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Mitesh J. Borad
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
| | - Martin E. Fernandez-Zapico
- David L. Marks, Tara L. Hogenson, Anne M. Vrabel, Ashley N. Sigafoos, Ezequiel J. Tolosa, Ryan M. Carr, Stephanie L. Safgren, Elisa Enriquez Hesles, Luciana L. Almada, Paola A. Romecin-Duran, Eriko Iguchi, Aryan Ala’Aldeen, Jean-Pierre A. Kocher, Gavin R. Oliver, Naresh Prodduturi, David W. Mead, Asif Hossain, Norine E. Huneke, Colleen M. Tagtow, Sikander Ailawadhi, Stephen M. Ansell, Michaela S. Banck, Asher A. Chanan-Khan, Ronald S. Go, Thorvardur R. Halfdanarson, Richard W. Joseph, Prashant Kapoor,
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Lam ET, Eckhardt SG, Messersmith W, Jimeno A, O'Bryant CL, Ramanathan RK, Weiss GJ, Chadha M, Oey A, Ding HT, Culp PA, Keller SF, Zhao VY, Tsao LC, Singhal A, Holen KD, Von Hoff D. Phase I Study of Enavatuzumab, a First-in-Class Humanized Monoclonal Antibody Targeting the TWEAK Receptor, in Patients with Advanced Solid Tumors. Mol Cancer Ther 2017; 17:215-221. [PMID: 29054986 DOI: 10.1158/1535-7163.mct-17-0330] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/23/2017] [Accepted: 10/04/2017] [Indexed: 02/06/2023]
Abstract
This phase I study evaluates the safety, MTD, pharmacokinetics (PK), pharmacodynamics, and preliminary anticancer activity of enavatuzumab, a humanized IgG1 antibody to the TWEAK receptor, in patients with advanced solid malignancies. Patients received escalating doses of enavatuzumab given intravenously over 60 minutes every 2 weeks. Blood was obtained for PK and biomarker assessment. Three patients were enrolled per dose level in a standard 3+3 design with response assessment by RECIST version 1.0, every 8 weeks. Thirty patients were enrolled at 6 dose levels ranging from 0.1 to 1.5 mg/kg. Dose-limiting toxicities included grade 4 (G4) lipase, G3 bilirubin, and G4 amylase elevations. There was no apparent correlation of liver or pancreatic enzyme elevation with drug exposure or the presence of liver metastases. Enavatuzumab exhibited a two-compartment linear PK model. Estimated systemic clearance was 23 to 33 mL/h with an elimination half-life of 7 to 18 days. The predicted target efficacious peak and trough concentrations occurred at 1.0 mg/kg following the second dose. There were no objective responses; 4 patients had stable disease. The MTD of enavatuzumab is 1.0 mg/kg i.v. every 2 weeks. Higher doses were not tolerated due to hepatopancreatic lab abnormalities. Further evaluation of the mechanisms of the liver and pancreatic enzyme toxicities is needed before embarking on further single-agent or combination strategies. Mol Cancer Ther; 17(1); 215-21. ©2017 AACR.
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Affiliation(s)
- Elaine T Lam
- University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado.
| | - S Gail Eckhardt
- University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Wells Messersmith
- University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Antonio Jimeno
- University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Cindy L O'Bryant
- University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Ramesh K Ramanathan
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare, Scottsdale, Arizona
| | - Glen J Weiss
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare, Scottsdale, Arizona
| | - Manpreet Chadha
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare, Scottsdale, Arizona
| | - Abbie Oey
- AbbVie Biotherapeutics Inc., Redwood City, California
| | - Han Ting Ding
- AbbVie Biotherapeutics Inc., Redwood City, California
| | | | | | - Vivian Y Zhao
- AbbVie Biotherapeutics Inc., Redwood City, California
| | - L Claire Tsao
- AbbVie Biotherapeutics Inc., Redwood City, California
| | - Anil Singhal
- AbbVie Biotherapeutics Inc., Redwood City, California
| | | | - Daniel Von Hoff
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare, Scottsdale, Arizona
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40
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Infante JR, Korn RL, Rosen LS, LoRusso P, Dychter SS, Zhu J, Maneval DC, Jiang P, Shepard HM, Frost G, Von Hoff DD, Borad MJ, Ramanathan RK. Phase 1 trials of PEGylated recombinant human hyaluronidase PH20 in patients with advanced solid tumours. Br J Cancer 2017; 118:153-161. [PMID: 28949957 PMCID: PMC5785735 DOI: 10.1038/bjc.2017.327] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/10/2017] [Accepted: 08/25/2017] [Indexed: 12/18/2022] Open
Abstract
Background: Hyaluronan accumulation in tumour stroma is associated with reduced survival in preclinical cancer models. PEGPH20 degrades hyaluronan to facilitate tumour access for cancer therapies. Our objective was to assess safety and antitumour activity of PEGPH20 in patients with advanced solid tumours. Methods: In HALO-109-101 (N=14), PEGPH20 was administered intravenously once or twice weekly (0.5 or 50 μg kg−1) or once every 3 weeks (0.5–1.5 μg kg−1). In HALO-109-102 (N=27), PEGPH20 was administered once or twice weekly (0.5–5.0 μg kg−1), with dexamethasone predose and postdose. Results: Dose-limiting toxicities included grade ⩾3 myalgia, arthralgia, and muscle spasms; the maximum tolerated dose was 3.0 μg kg−1 twice weekly. Plasma hyaluronan increased in a dose-dependent manner, achieving steady state by Day 8 in multidose studies. A decrease in tumour hyaluronan level was observed in 5 of the 6 patients with pretreatment and posttreatment tumour biopsies. Exploratory imaging showed changes in tumour perfusion and decreased tumour metabolic activity, consistent with observations in animal models. Conclusions: The tumour stroma has emerging importance in the development of cancer therapeutics. PEGPH20 3.0 μg kg−1 administered twice weekly is feasible in patients with advanced cancers; exploratory analyses indicate antitumour activity supporting further evaluation of PEGPH20 in solid tumours.
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Affiliation(s)
- Jeffrey R Infante
- Early Development Oncology, Janssen Research & Development, LLC, Welsh & McKean Roads, Spring House, PA 19477, USA
| | - Ronald L Korn
- Scottsdale Medical Imaging, 9700 N. 91st Suite C-200, Scottsdale, AZ 85258, USA
| | - Lee S Rosen
- Division of Hematology-Oncology, University of California - Los Angeles, 2020 Santa Monica Boulevard, Suite 600, Santa Monica, CA 90404, USA
| | | | - Samuel S Dychter
- Fate Therapeutics, Inc., 3535 General Atomics Court, San Diego, CA 92121, USA
| | - Joy Zhu
- SBIO Pte, Ltd., 1 Science Park Road, #05-09, The Capricorn Science Park 2, Singapore, 117 528, Singapore
| | - Daniel C Maneval
- Halozyme Therapeutics, Inc., 11388 Sorrento Valley Road, San Diego, CA 92121, USA
| | - Ping Jiang
- Halozyme Therapeutics, Inc., 11388 Sorrento Valley Road, San Diego, CA 92121, USA
| | - H Michael Shepard
- Halozyme Therapeutics, Inc., 11388 Sorrento Valley Road, San Diego, CA 92121, USA
| | - Gregory Frost
- F1 Bioventures LLC, 505 S. Flagler Drive, West Palm Beach, FL 33401, USA
| | - Daniel D Von Hoff
- Translational Genomics Research Institute (TGen), 445 N. Fifth Street, Phoenix, AZ 85004, USA
| | - Mitesh J Borad
- Mayo Clinic, 13400 E. Shea Boulevard, Scottsdale, AZ 85259, USA
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41
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Ramanathan RK, Triulzi DJ, Logan TF. Transfusion-Related Acute Lung
Injury following Random Donor
Platelet Transfusion:
A Report of Two Cases. Vox Sang 2017. [DOI: 10.1159/000461898] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Korn RL, Von Hoff DD, Borad MJ, Renschler MF, McGovern D, Curtis Bay R, Ramanathan RK. 18F-FDG PET/CT response in a phase 1/2 trial of nab-paclitaxel plus gemcitabine for advanced pancreatic cancer. Cancer Imaging 2017; 17:23. [PMID: 28774338 PMCID: PMC5543580 DOI: 10.1186/s40644-017-0125-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 03/07/2017] [Accepted: 07/06/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Positron emission tomography (PET) is poised to become a useful imaging modality in staging and evaluating therapeutic responses in patients with metastatic pancreatic cancer (mPC). This analysis from a phase 1/2 study examined the utility of early PET imaging in patients with mPC treated with nab-paclitaxel plus gemcitabine. METHODS Tumors were measured by [18F]2-fluoro-2-deoxyglucose PET/computed tomography (CT) in patients who received nab-paclitaxel 100 (n = 13), 125 (n = 38), or 150 (n = 1) mg/m2 plus gemcitabine 1000 mg/m2 on days 1, 8, and 15 of a 28-day cycle. Lesion metabolic activity was evaluated at baseline and 6 and 12 weeks postbaseline. RESULTS Fifty-two patients had baseline and ≥1 follow-up PET scan. The median maximum standardized uptake values per pancreatic lesion in the nab-paclitaxel 100 mg/m2 and 125 mg/m2 cohorts were 5.1 and 6.5, respectively. Among patients who had a metabolic response by PET, those who received nab-paclitaxel 125 mg/m2 had a 4-month survival advantage over those who received 100 mg/m2. All patients in the nab-paclitaxel 125 mg/m2 cohort experienced an early complete metabolic response (CMR; 34%) or partial metabolic response (PMR; 66%). In the nab-paclitaxel 125 mg/m2 cohort, investigator-assessed objective response rates were 77% and 44% among patients with a CMR and PMR, respectively, with no correlation between PET and CT response (Spearman r s = 0.22; P = 0.193). Patients in the nab-paclitaxel 125 mg/m2 cohort with a CMR experienced a significantly longer overall survival vs those with a PMR (median, 23.0 vs 11.2 months; P = 0.011), and a significant correlation was found between best percentage change in tumor burden by PET and survival: for each 1% decrease in PET score, the risk of death decreased by 2%. CONCLUSIONS The majority of primary pancreatic tumors and their metastases were PET avid, and PET effectively measured changes in tumor metabolic activity at 6 and 12 weeks. These results support the antitumor activity of nab-paclitaxel 125 mg/m2 plus gemcitabine 1000 mg/m2 for treating mPC and the utility of PET for measuring treatment response. Treatment response by PET analysis may be considered when evaluating investigational agents in mPC. TRIAL REGISTRATION NCT00398086.
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Affiliation(s)
- Ronald L Korn
- Imaging Endpoints Core Lab, 9700 N 91st St, B-200, Scottsdale, AZ, 85258, USA.
| | - Daniel D Von Hoff
- Translational Genomics Research Institute and HonorHealth, 445 North Fifth St, Suite 600, Phoenix, AZ, 85004, USA
| | - Mitesh J Borad
- Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | | | | | - R Curtis Bay
- Department of Interdisciplinary Health Sciences, A. T. Still University, 5850 E Still Circle, Mesa, AZ 85206, USA
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Goldstein D, Von Hoff DD, Chiorean EG, Reni M, Tabernero J, Ramanathan RK, Aly A, Botteman M, Wilkersen J, Margunato-Debay S, Lu B, Louis CU, Renschler MF, McGovern DMT, Lee CK. Nomogram for predicting overall survival (OS) in patients (pts) treated with nab-paclitaxel ( nab-P) plus gemcitabine (Gem) or Gem alone for metastatic pancreatic cancer (MPC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4109 Background: Prognostic nomograms have been developed in various cancers, including ovarian, breast, and gastrointestinal; however, there is limited information on nomograms in MPC. The large, phase 3 MPACT study of nab-P + Gem vs Gem alone for the treatment of MPC provides a robust database for the development of a nomogram to predict OS using baseline patient variables. Methods: A multivariable Cox model was created from MPACT data using factors that were significantly predictive of OS in univariable analysis or considered clinically important (stepwise selection to remain in model). From the Cox model, a nomogram was derived that assigned points equal to the weighted sum of relative significance of each variable. The nomogram was internally validated using bootstrapping, a concordance index (c-index), and calibration plots. Results: Data from all 861 pts were used. Seven of the 34 considered variables were retained in the multivariable analysis (Table; all factors significant at the P < 0.01 level, except for analgesic use [ P = 0.07]). The resulting nomogram was able to distinguish low (n = 216), medium (n = 430), and high (n = 215) risk groups (c-index: 0.69; CI: 0.67-0.71) with median OS values of 12.9, 8.2, and 3.7 months, respectively. Calibration curves showed that the nomogram’s predicted probabilities were mostly consistent with observed probabilities for 6-, 9-, and 12-month OS. Conclusions: Treatment arm, Karnofsky performance status (KPS), neutrophil-to-lymphocyte ratio (NLR), albumin level, sum of longest tumor diameters (SLD), and presence of liver metastasis were the key predictors of OS. This nomogram, which will be presented in visual format in the final presentation, may help physicians and pts make informed treatment decisions. Clinical trial information: NCT00844649. [Table: see text]
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Affiliation(s)
- David Goldstein
- Prince of Wales Hospital, University of New South Wales, Cancer Survivors Centre, Sydney, Australia
| | - Daniel D. Von Hoff
- Translational Genomics Research Institute (TGen) and HonorHealth, Phoenix, AZ
| | | | - Michele Reni
- Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Josep Tabernero
- Vall d’Hebron University Hospital Institute of Oncology (VHIO), Barcelona, Spain
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Sonbol MB, Firwana B, Wang Z, Ahn DH, Borad MJ, Makhoul I, Ramanathan RK, Bekaii-Saab TS. Second-line treatment in patients with pancreatic ductal adenocarcinoma: A meta-analysis. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15779 Background: There is paucity of data regarding the best available second-line treatment following progression on gemcitabine-based regimens in metastatic pancreatic ductal adenocarcinoma (PDAC). While a Nanoliposomal formulation of irinotecan (MM398) is considered a standard of care, there is conflicting data relating to the use of oxaliplatin in this setting. We performed a meta-analysis to determine the effectiveness of adding oxaliplatin (OX) or various irinotecan (IRI) formulations to a fluoropyrimidine (FP) as a second-line in PDAC patients. Methods: We searched different databases, including PubMed, Embase and Cochrane, to identify randomized controlled trials comparing FP monotherapy to FP combination therapy that includes either oxaliplatin (FPOX) or various irinotecan formulations (FPIRI) in PDAC patients who progressed after first-line treatment. Secondary analyses were planned to assess the effectiveness of FPOX and FPIRI compared to FP. Outcomes of interest included overall survival (OS) and progression-free survival (PFS). The overall effect was pooled using the DerSimonian and Laird random effects models. Results: Five studies (2 with FPIRI and 3 with FPOX) with 895 patients were identified. Patients randomized to FPIRI/FPOX had a significantly improved PFS (HR = 0.74, CI 0.62 to 0.89) and a trend towards an improved OS compared to FP monotherapy (HR = 0.88, CI 0.65 to 1.19). When comparing FPIRI to FP, there was an improvement in both PFS (HR = 0.64, CI 0.47 to 0.87) and OS (HR = 0.70, CI 0.55 to 0.89) in patients treated with the combination. Conversely, FPOX showed only a modest improvement in PFS (HR = 0.81, CI 0.67, 0.97) with no improvement in OS (HR = 1.03, CI 0.64 to 1.67). Conclusions: Combination chemotherapy with oxaliplatin or various irinotecan formulations seem to improve PFS vs. single agent FP. FPIRI, but not FPOX seem to confer an OS advantage. Oxaliplatin with FP following gemcitabine failure may need further confirmatory studies to establish its role in refractory pancreas cancer.
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Affiliation(s)
| | - Belal Firwana
- University of Arkansas for Medical Sciences Hematology/Oncology Department, Little Rock, AR
| | | | | | | | - Issam Makhoul
- University of Arkansas for Medical Sciences, Little Rock, AR
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Shroff RT, Borad MJ, Xiao L, Kaseb AO, Varadhachary GR, Wolff RA, Raghav KPS, Iwasaki M, Masci P, Ramanathan RK, Ahn DH, Bekaii-Saab TS, Javle MM. A phase II trial of gemcitabine (G), cisplatin (C), and nab-paclitaxel (N) in advanced biliary tract cancers (aBTCs). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4018 Background: BTCs are often diagnosed at an advanced stage and have a poor prognosis. The standard therapy for aBTCs is the combination of GC. However, the median overall survival (mOS) is dismal at 11.7 months (mos) with a median progression free survival (mPFS) of 8 mos. Methods: A single arm, phase II study was conducted at MD Anderson and Mayo Clinic Arizona. Patients (pts) with aBTC were treated at initial dose level of G/C/N (in mg/m2) at 1000/25/125 (n = 27) which was reduced to lower doses due to grade 3/4 hematological (heme) toxicity (tox) - G/C/N: 800/25/100 (n = 33). Cycles were q21 days with restaging q3 cycles until progression. PFS was the primary endpoint (endpt). Using a Bayesian hypothesis test-based design, we assumed mPFS of 8 mos under the null hypothesis (H0), 10 mos under the alternative (H1). Secondary endpts included mOS, RECIST v1.1 response rate (RR), safety and CA19-9 response. Results: 60 pts were enrolled with data on 51 available as of the time of this abstract (age: median 60 yrs [range 31-77], ECOG PS 0/1 (17/34), M/F (30/21), intrahepatic cholangiocarcinoma/extrahepatic/gallbladder (32/8/11). Median follow-up was 11.5 mos and median number of treatment (trmt) cycles = 5. Pts at initial dose level had significant grade 3/4 heme tox: neutropenia, febrile neutropenia, anemia, and thrombocytopenia leading to trmt discontinuation in 6/27 pts. After dose reduction to G/C/N (in mg/m2) at 800/25/100, trmt was better tolerated with only 4 pts experiencing grade 4 heme tox. Non-heme tox were grade 3 in 10 pts: nausea/vomiting, diarrhea, thromboembolic event/CVA, hypokalemia, constipation, cystitis, LFT elevations. In the initial 51 pts, mPFS = 11.4 mos (95% CI: 6.1, not reached) and mOS not reached (estimated > 20 mos, 1-year survival rate 66.7%; 95%CI: 65.9-92.2%). 34 pts evaluable for response: disease control rate (PR+CR+SD)-82.3% and RR-32.3%. 3 unresectable cases were operated post trmt with 1 pathologic CR. Conclusions: The combination of GCN was well tolerated at adjusted doses and demonstrates encouraging preliminary efficacy having met its mPFS endpt and a 1-year survival rate higher than historical control. These results merit evaluating GC +/-N in a randomized controlled study. Clinical trial information: NCT02392637.
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Affiliation(s)
| | | | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gauri R. Varadhachary
- The University of Texas MD Anderson Cancer Center, Department of Gastrointestinal Medical Oncology, Houston, TX
| | - Robert A. Wolff
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Michiko Iwasaki
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Milind M. Javle
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Juric D, Krop I, Ramanathan RK, Wilson TR, Ware JA, Sanabria Bohorquez SM, Savage HM, Sampath D, Salphati L, Lin RS, Jin H, Parmar H, Hsu JY, Von Hoff DD, Baselga J. Phase I Dose-Escalation Study of Taselisib, an Oral PI3K Inhibitor, in Patients with Advanced Solid Tumors. Cancer Discov 2017; 7:704-715. [PMID: 28331003 DOI: 10.1158/2159-8290.cd-16-1080] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/06/2016] [Accepted: 03/20/2017] [Indexed: 12/31/2022]
Abstract
Taselisib is a potent and selective tumor growth inhibitor through PI3K pathway suppression. Thirty-four patients with locally advanced or metastatic solid tumors were treated (phase I study, modified 3+3 dose escalation; 5 cohorts; 3-16 mg taselisib once-daily capsule). Taselisib pharmacokinetics were dose-proportional; mean half-life was 40 hours. Frequent dose-dependent, treatment-related adverse events included diarrhea, hyperglycemia, decreased appetite, nausea, rash, stomatitis, and vomiting. At 12 and 16 mg dose levels, dose-limiting toxicities (DLT) were observed, with an accumulation of higher-grade adverse events after the cycle 1 DLT assessment window. Pharmacodynamic findings showed pathway inhibition at ≥3 mg in patient tumor samples, consistent with preclinical PIK3CA-mutant tumor xenograft models. Confirmed response rate was 36% for PIK3CA-mutant tumor patients with measurable disease [5/14: 4 breast cancer (3 patients at 12 mg); 1 non-small cell lung cancer], where responses started at 3 mg, and 0% in patients with tumors without known PIK3CA hotspot mutations (0/15).Significance: Preliminary data consistent with preclinical data indicate increased antitumor activity of taselisib in patients with PIK3CA-mutant tumors (in comparison with patients with tumors without known activating PIK3CA hotspot mutations) starting at the lowest dose tested of 3 mg, thereby supporting higher potency for taselisib against PIK3CA-mutant tumors. Cancer Discov; 7(7); 704-15. ©2017 AACR.See related commentary by Rodon and Tabernero, p. 666This article is highlighted in the In This Issue feature, p. 653.
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Affiliation(s)
- Dejan Juric
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Ian Krop
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | | | | | | | | | - Ray S Lin
- Genentech, Inc., South San Francisco, California
| | - Huan Jin
- Genentech, Inc., South San Francisco, California
| | - Hema Parmar
- Genentech, Inc., South San Francisco, California
| | - Jerry Y Hsu
- Genentech, Inc., South San Francisco, California
| | | | - José Baselga
- Memorial Sloan Kettering Cancer Center, New York, New York.
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de Bono J, Ramanathan RK, Mina L, Chugh R, Glaspy J, Rafii S, Kaye S, Sachdev J, Heymach J, Smith DC, Henshaw JW, Herriott A, Patterson M, Curtin NJ, Byers LA, Wainberg ZA. Phase I, Dose-Escalation, Two-Part Trial of the PARP Inhibitor Talazoparib in Patients with Advanced Germline BRCA1/2 Mutations and Selected Sporadic Cancers. Cancer Discov 2017; 7:620-629. [PMID: 28242752 DOI: 10.1158/2159-8290.cd-16-1250] [Citation(s) in RCA: 300] [Impact Index Per Article: 42.9] [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: 11/08/2016] [Revised: 12/15/2016] [Accepted: 02/21/2017] [Indexed: 12/12/2022]
Abstract
Talazoparib inhibits PARP catalytic activity, trapping PARP1 on damaged DNA and causing cell death in BRCA1/2-mutated cells. We evaluated talazoparib therapy in this two-part, phase I, first-in-human trial. Antitumor activity, MTD, pharmacokinetics, and pharmacodynamics of once-daily talazoparib were determined in an open-label, multicenter, dose-escalation study (NCT01286987). The MTD was 1.0 mg/day, with an elimination half-life of 50 hours. Treatment-related adverse events included fatigue (26/71 patients; 37%) and anemia (25/71 patients; 35%). Grade 3 to 4 adverse events included anemia (17/71 patients; 24%) and thrombocytopenia (13/71 patients; 18%). Sustained PARP inhibition was observed at doses ≥0.60 mg/day. At 1.0 mg/day, confirmed responses were observed in 7 of 14 (50%) and 5 of 12 (42%) patients with BRCA mutation-associated breast and ovarian cancers, respectively, and in patients with pancreatic and small cell lung cancer. Talazoparib demonstrated single-agent antitumor activity and was well tolerated in patients at the recommended dose of 1.0 mg/day.Significance: In this clinical trial, we show that talazoparib has single-agent antitumor activity and a tolerable safety profile. At its recommended phase II dose of 1.0 mg/day, confirmed responses were observed in patients with BRCA mutation-associated breast and ovarian cancers and in patients with pancreatic and small cell lung cancer. Cancer Discov; 7(6); 620-9. ©2017 AACR.This article is highlighted in the In This Issue feature, p. 539.
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Affiliation(s)
- Johann de Bono
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom.
| | - Ramesh K Ramanathan
- Clinical Trials Program, Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Scottsdale, Arizona
| | - Lida Mina
- Simon Cancer Center, Indiana University, Indianapolis, Indiana
| | - Rashmi Chugh
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
| | - John Glaspy
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Saeed Rafii
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
| | - Stan Kaye
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
| | - Jasgit Sachdev
- Clinical Trials Program, Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Scottsdale, Arizona
| | - John Heymach
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Smith
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
| | - Joshua W Henshaw
- Pharmacokinetics/Pharmacodynamics, BioMarin Pharmaceutical, Inc., Novato, California
| | - Ashleigh Herriott
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Miranda Patterson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicola J Curtin
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lauren Averett Byers
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zev A Wainberg
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California
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Burris HA, Bakewell S, Bendell JC, Infante J, Jones SF, Spigel DR, Weiss GJ, Ramanathan RK, Ogden A, Von Hoff D. Safety and activity of IT-139, a ruthenium-based compound, in patients with advanced solid tumours: a first-in-human, open-label, dose-escalation phase I study with expansion cohort. ESMO Open 2017; 1:e000154. [PMID: 28848672 PMCID: PMC5548977 DOI: 10.1136/esmoopen-2016-000154] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [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: 12/22/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE This phase I clinical study (NCT01415297) evaluated the safety, tolerability, maximum-tolerated dose (MTD), pharmacokinetics and pharmacodynamics of IT-139 (formerly NKP-1339) monotherapy in patients with advanced solid tumours. IT-139, sodium trans-(tetrachlorobis(1H-indazole)ruthenate(III)), is a novel small molecule that suppresses the stress induction of GRP78 in tumour cells. GRP78 is a key regulator of misfolded protein processing, and its upregulation in tumours is associated with intrinsic and drug-induced resistance. METHODS Forty-six patients with advanced solid tumours refractory to treatment received intravenous infusions of IT-139 on days 1, 8 and 15 for every 28 days, and doses were evaluated across nine cohorts at 20, 40, 80, 160, 320, 420, 500, 625 and 780 mg/m2. RESULTS Overall, IT-139 was well tolerated. The treatment-emergent adverse events (AEs) occurring in ≥20% of patients were nausea, fatigue, vomiting, anaemia and dehydration. The majority of patients had AEs that were ≤grade 2, regardless of relationship with the study drug. Of the total 38 efficacy-evaluable patients, one patient with a carcinoid tumour achieved a durable partial response. Nine additional patients achieved stable disease . The MTD was determined to be 625 mg/m2. IT-139 exhibited first-order linear pharmacokinetics. CONCLUSIONS IT-139 demonstrated a manageable safety profile at the MTD and modest anti-tumour activity in this study of patients with solid tumours refractory to treatment. The lack of dose-limiting haematological toxicity and the absence of neurotoxicity position IT-139 well for use in combination with a broad spectrum of anticancer drugs. TRIAL REGISTRATION NUMBER NCT01415297.
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Affiliation(s)
| | | | | | | | | | - David R Spigel
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
| | - Glen J Weiss
- Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, Arizona, USA
| | | | - Angela Ogden
- Novateur Ventures,Vancouver, British Columbia, Canada
| | - Daniel Von Hoff
- Translational Genomics Research Institute, Phoenix, Arizona, USA
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Ramanathan RK, Korn RL, Raghunand N, Sachdev JC, Newbold RG, Jameson G, Fetterly GJ, Prey J, Klinz SG, Kim J, Cain J, Hendriks BS, Drummond DC, Bayever E, Fitzgerald JB. Correlation between Ferumoxytol Uptake in Tumor Lesions by MRI and Response to Nanoliposomal Irinotecan in Patients with Advanced Solid Tumors: A Pilot Study. Clin Cancer Res 2017; 23:3638-3648. [PMID: 28159813 DOI: 10.1158/1078-0432.ccr-16-1990] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 11/16/2022]
Abstract
Purpose: To determine whether deposition characteristics of ferumoxytol (FMX) iron nanoparticles in tumors, identified by quantitative MRI, may predict tumor lesion response to nanoliposomal irinotecan (nal-IRI).Experimental Design: Eligible patients with previously treated solid tumors had FMX-MRI scans before and following (1, 24, and 72 hours) FMX injection. After MRI acquisition, R2* signal was used to calculate FMX levels in plasma, reference tissue, and tumor lesions by comparison with a phantom-based standard curve. Patients then received nal-IRI (70 mg/m2 free base strength) biweekly until progression. Two percutaneous core biopsies were collected from selected tumor lesions 72 hours after FMX or nal-IRI.Results: Iron particle levels were quantified by FMX-MRI in plasma, reference tissues, and tumor lesions in 13 of 15 eligible patients. On the basis of a mechanistic pharmacokinetic model, tissue permeability to FMX correlated with early FMX-MRI signals at 1 and 24 hours, while FMX tissue binding contributed at 72 hours. Higher FMX levels (ranked relative to median value of multiple evaluable lesions from 9 patients) were significantly associated with reduction in lesion size by RECIST v1.1 at early time points (P < 0.001 at 1 hour and P < 0.003 at 24 hours FMX-MRI, one-way ANOVA). No association was observed with post-FMX levels at 72 hours. Irinotecan drug levels in lesions correlated with patient's time on treatment (Spearman ρ = 0.7824; P = 0.0016).Conclusions: Correlation between FMX levels in tumor lesions and nal-IRI activity suggests that lesion permeability to FMX and subsequent tumor uptake may be a useful noninvasive and predictive biomarker for nal-IRI response in patients with solid tumors. Clin Cancer Res; 23(14); 3638-48. ©2017 AACR.
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Affiliation(s)
- Ramesh K Ramanathan
- Virginia G Piper Cancer Center, Honor Healthcare, Scottsdale, Arizona. .,Translational Genomics Research Institute, Phoenix, Arizona
| | - Ronald L Korn
- Virginia G Piper Cancer Center, Honor Healthcare, Scottsdale, Arizona.,Imaging Endpoints, Scottsdale, Arizona
| | | | - Jasgit C Sachdev
- Virginia G Piper Cancer Center, Honor Healthcare, Scottsdale, Arizona
| | - Ronald G Newbold
- Virginia G Piper Cancer Center, Honor Healthcare, Scottsdale, Arizona.,Imaging Endpoints, Scottsdale, Arizona
| | - Gayle Jameson
- Virginia G Piper Cancer Center, Honor Healthcare, Scottsdale, Arizona
| | | | - Joshua Prey
- Roswell Park Cancer Institute, Buffalo, New York
| | | | - Jaeyeon Kim
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts
| | - Jason Cain
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts
| | | | | | - Eliel Bayever
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts
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Jameson GS, Borazanci EH, Babiker HM, Poplin E, Niewiarowska AA, Gordon MS, Barrett MT, Ansaldo K, Lebron L, Stoll AC, Rosenthal A, Shemanski LR, Korn RL, Ramanathan RK, Von Hoff DD. A phase Ib/II pilot trial with nab-paclitaxel plus gemcitabine plus cisplatin in patients (pts) with stage IV pancreatic cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.341] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
341 Background: Genomes of metastatic pancreatic cancers frequently contain intrachromosomal aberrations indicating DNA repair abnormalities associated with sensitivity to DNA damaging agents such as the platinums. Cisplatin was added to a nab-paclitaxel + gemcitabine regimen, which has been determined to improve survival over gemcitabine alone (NEJM 2013; 369:1691-1703). The objectives are to determine the efficacy and safety of nab-paclitaxel and gemcitabine plus cisplatin in patients with Stage IV pancreatic cancer. Methods: Eligibility criteria included Stage IV adenocarcinoma of the pancreas, no prior chemotherapy for systemic disease, KPS ≥ 70; life expectancy ≥ 12 weeks and measurable disease. Doses are nab-paclitaxel 125 mg/m2 undiluted, gemcitabine 1000 mg/m2 in 500 ml of normal saline (NS), each infused over 30 minutes on days 1 and 8 of a 21 day cycle, along with 3 different dose levels of cisplatin (25, 37.5 or 50 mg/m2) in 500 ml of NS infused over 60 minutes, after the nab-paclitaxel infusion. Pre and post cisplatin hydration was given. The maximum tolerated dose and phase II dose of cisplatin is 25 mg/m2. Results: 25 pts were treated; 24 were evaluable (baseline and ≥ 1 follow up CT scan). The most common drug related grade (gr) 3 - 4 adverse events (AEs), n = 25, were thrombocytopenia 76% (gr 3 = 36%, gr 4 = 40%) with no serious bleeding events, anemia 32% (gr 3 = 32%, gr 4 = 0%), neutropenia 24% (gr 3 = 20%, gr 4 = 4%), infection 20% (gr 3 = 16%, gr 4 = 4%), and diarrhea 16% (gr 3 = 16%, gr 4 = 0%). Peripheral neuropathy ≥ gr 3 was seen in only 1 pt (gr 3 = 4%). Grade 5 AEs were infection (1), cardiac arrest (1), and stroke (1). Median time on therapy was 5.5 months, range (1 – 9.5). By RECIST 1.1 criteria, 2 pts had complete response (8.3%), 15 partial response (62.5%), 4 stable disease (16.7%), and 3 progressive disease (12.5%). Median overall survival to date as of 11/10/16 is 16.5 months. Conclusions: Although a small study, the high response rate and landmark evolving median survival are very encouraging. This regimen is being expanded in patients with stage IV pancreatic cancer, neoadjuvant and adjuvant settings. Clinical trial information: NCT01893801.
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Affiliation(s)
| | | | | | | | | | - Michael S. Gordon
- Pinnacle Oncology Hematology/Honor Health Research Institute, Scottsdale, AZ
| | | | | | | | | | | | | | | | | | - Daniel D. Von Hoff
- Translational Genomics Research Institute (TGen) and HonorHealth, Phoenix and Scottsdale, AZ
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