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Edelman MJ, Tan MT, Fidler MJ, Sanborn RE, Otterson G, Sequist LV, Evans TL, Schneider BJ, Keresztes R, Rogers JS, de Mayolo JA, Feliciano J, Yang Y, Medeiros M, Zaknoen SL. Randomized, double-blind, placebo-controlled, multicenter phase II study of the efficacy and safety of apricoxib in combination with either docetaxel or pemetrexed in patients with biomarker-selected non-small-cell lung cancer. J Clin Oncol 2014; 33:189-94. [PMID: 25452446 DOI: 10.1200/jco.2014.55.5789] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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 Overexpression of COX-2 correlates with advanced stage and worse outcomes in non-small-cell lung cancer (NSCLC), possibly as a result of elevated levels of COX-2-dependent prostaglandin E2 (PGE2). Exploratory analyses of studies that used COX-2 inhibitors have demonstrated potentially superior outcome in patients in whom the urinary metabolite of PGE2 (PGE-M) is suppressed. We hypothesized that patients with disease defined by PGE-M suppression would benefit from the addition of apricoxib to second-line docetaxel or pemetrexed. PATIENTS AND METHODS Patients with NSCLC who had disease progression after one line of platinum-based therapy, performance status of 0 to 2, and normal organ function were potentially eligible. Only patients with a ≥ 50% decrease in urinary PGE-M after 5 days of treatment with apricoxib could enroll. Docetaxel 75 mg/m(2) or pemetrexed 500 mg/m(2) once every 21 days per the investigator was administered with apricoxib or placebo 400 mg once per day. The primary end point was progression-free survival (PFS). Exploratory analysis was performed regarding baseline urinary PGE-M and outcomes. RESULTS In all, 101 patients completed screening, and 72 of the 80 who demonstrated ≥ 50% suppression were randomly assigned to apricoxib or placebo. Toxicity was similar between the arms. No improvement in PFS was seen with apricoxib versus placebo. The median PFS for the control arm was 97 days (95% CI, 52 to 193 days) versus 85 days (95% CI, 67 to 142 days) for the experimental arm (P = .91). CONCLUSION Apricoxib did not improve PFS, despite biomarker-driven patient selection.
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Affiliation(s)
- Martin J Edelman
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA.
| | - Ming T Tan
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - Mary J Fidler
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - Rachel E Sanborn
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - Greg Otterson
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - Lecia V Sequist
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - Tracey L Evans
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - Bryan J Schneider
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - Roger Keresztes
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - John S Rogers
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - Jorge Antunez de Mayolo
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - Josephine Feliciano
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - Yang Yang
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - Michelle Medeiros
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
| | - Sara L Zaknoen
- Martin J. Edelman, Josephine Feliciano, Yang Yang, and Michelle Medeiros, University of Maryland Greenebaum Cancer Center, Baltimore, MD; Ming T. Tan, Georgetown University, Washington, DC; Mary J. Fidler, Rush University Medical Center, Chicago, IL; Rachel E. Sanborn, Providence Portland Medical Center, Portland, OR; Greg Otterson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Lecia V. Sequist, Massachusetts General Hospital Cancer Center, Boston, MA; Tracey L. Evans, University of Pennsylvania, Philadelphia, PA; Bryan J. Schneider, Weill Cornell Medical College, New York City; Roger Keresztes, State University of New York Stony Brook, Stony Brook, NY; John S. Rogers, West Virginia University School of Medicine, Morgantown, WV; Jorge Antunez de Mayolo, Mercy Research Institute, Miami, FL; and Sara L. Zaknoen, Tragara, San Diego, CA
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Ocean AJ, Schnoll-Sussman F, Keresztes R, Chen X, Holloway S, Matthews N, Christos P, Mazumdar M, Wright J, Wadler S. Phase II study of PS-341 (bortezomib) with or without irinotecan in patients (pts) with advanced gastric adenocarcinomas (AGA). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14040] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14040 Background: We are conducting a phase II trial of the proteasome inhibitor, PS-341, with or without irinotecan in pts with AGA. The combination of PS-341 and irinotecan has been studied in preclinical tumor models including a murine xenograft model of colon cancer, where the combination achieved significantly more tumor shrinkage than either agent alone. The primary objective of this study is to determine response rates, toxicities, progression-free survival, and overall survival in pts with AGA receiving PS-341 alone or in combination with irinotecan. Methods: All pts had gastric adenocarcinoma beyond the scope of surgical resection, measurable disease, and normal bone marrow, hepatic and renal function. All gave informed consent. In previously untreated patients, PS-341 was administered at 1.3 mg/m2 on days 1, 4, 8, and 11 as IV bolus every 21 days. Irinotecan was administered IV at 125 mg/m2 over 90 mins on days 1 and 8 every 21 days (Arm A). For previously treated patients, PS-341 was administered as a single agent at 1.3mg/m2 on days 1, 4, 8, 11 as an IV bolus every 21 days (Arm B). Radiologic evaluation and tumor measurements were performed every 8 weeks. Results: Thirty-seven pts have been enrolled; 29 are evaluable (4 never treated, 4 TETE). Twenty-two pts were treated in Arm A, and 11 in Arm B. All pts were eligible and the 29 treated pts were fully evaluable. Median age 58 (33–87); 26 males/7 females; median number of cycles received was 2.0. Most common toxicities: Grade 4 cardiac arrest (1), stomach perforation (1), leukopenia (2), diarrhea (1), edema (1); Grade 3 nausea (6), vomiting (7), diarrhea (4), febrile neutropenia (3), thrombocytopenia (6), anemia (6); Grade 5 death (3). Severe toxicities likely attributed to disease progression. Response rate was 33% for Arm A, 9% for Arm B. Progression-free survival was 1.8 mo. in Arm A, 1.4 mo. in Arm B. Median overall survival was 4.8 mo. in Arm A, 5.4 mo. in Arm B. Conclusions: The combination of PS-341 and irinotecan, a non-cisplatin containing therapy, is active in AGA and should be considered a key regimen. Monotherapy with PS-341 has a 9% response rate in this population of pre-treated patients with advanced disease. Accrual to this study is continuing. [Table: see text]
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Affiliation(s)
- A. J. Ocean
- Weill Medical College of Cornell University, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; National Cancer Institute, Bethesda, MD
| | - F. Schnoll-Sussman
- Weill Medical College of Cornell University, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; National Cancer Institute, Bethesda, MD
| | - R. Keresztes
- Weill Medical College of Cornell University, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; National Cancer Institute, Bethesda, MD
| | - X. Chen
- Weill Medical College of Cornell University, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; National Cancer Institute, Bethesda, MD
| | - S. Holloway
- Weill Medical College of Cornell University, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; National Cancer Institute, Bethesda, MD
| | - N. Matthews
- Weill Medical College of Cornell University, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; National Cancer Institute, Bethesda, MD
| | - P. Christos
- Weill Medical College of Cornell University, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; National Cancer Institute, Bethesda, MD
| | - M. Mazumdar
- Weill Medical College of Cornell University, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; National Cancer Institute, Bethesda, MD
| | - J. Wright
- Weill Medical College of Cornell University, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; National Cancer Institute, Bethesda, MD
| | - S. Wadler
- Weill Medical College of Cornell University, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; National Cancer Institute, Bethesda, MD
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