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Genta S, Lajkosz K, Yee NR, Spiliopoulou P, Heirali A, Hansen AR, Siu LL, Saibil S, Stayner LA, Yanekina M, Sauder MB, Keshavarzi S, Salawu A, Vornicova O, Butler MO, Bedard PL, Razak ARA, Rottapel R, Chruscinski A, Coburn B, Spreafico A. Autoimmune PaneLs as PrEdictors of Toxicity in Patients TReated with Immune Checkpoint InhibiTors (ALERT). J Exp Clin Cancer Res 2023; 42:276. [PMID: 37865776 PMCID: PMC10589949 DOI: 10.1186/s13046-023-02851-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/05/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Immune-checkpoint inhibitors (ICI) can lead to immune-related adverse events (irAEs) in a significant proportion of patients. The mechanisms underlying irAEs development are mostly unknown and might involve multiple immune effectors, such as T cells, B cells and autoantibodies (AutoAb). METHODS We used custom autoantigen (AutoAg) microarrays to profile AutoAb related to irAEs in patients receiving ICI. Plasma was collected before and after ICI from cancer patients participating in two clinical trials (NCT03686202, NCT02644369). A one-time collection was obtained from healthy controls for comparison. Custom arrays with 162 autoAg were used to detect IgG and IgM reactivities. Differences of median fluorescent intensity (MFI) were analyzed with Wilcoxon sign rank test and Kruskal-Wallis test. MFI 500 was used as threshold to define autoAb reactivity. RESULTS A total of 114 patients and 14 healthy controls were included in this study. irAEs of grade (G) ≥ 2 occurred in 37/114 patients (32%). We observed a greater number of IgG and IgM reactivities in pre-ICI collections from patients versus healthy controls (62 vs 32 p < 0.001). Patients experiencing irAEs G ≥ 2 demonstrated pre-ICI IgG reactivity to a greater number of AutoAg than patients who did not develop irAEs (39 vs 33 p = 0.040). We observed post-treatment increase of IgM reactivities in subjects experiencing irAEs G ≥ 2 (29 vs 35, p = 0.021) and a decrease of IgG levels after steroids (38 vs 28, p = 0.009). CONCLUSIONS Overall, these results support the potential role of autoAb in irAEs etiology and evolution. A prospective study is ongoing to validate our findings (NCT04107311).
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Affiliation(s)
- Sofia Genta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Noelle R Yee
- Toronto General Research Institute, University Health Network Toronto, Toronto, ON, Canada
| | - Pavlina Spiliopoulou
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alya Heirali
- Toronto General Research Institute, University Health Network Toronto, Toronto, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sam Saibil
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lee-Anne Stayner
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maryia Yanekina
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maxwell B Sauder
- Division of Dematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sareh Keshavarzi
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Abdulazeez Salawu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Olga Vornicova
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marcus O Butler
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Albiruni R Abdul Razak
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert Rottapel
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | | | - Bryan Coburn
- Toronto General Research Institute, University Health Network Toronto, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
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Vieito M, Moreno V, Spreafico A, Brana I, Wang JS, Preis M, Hernández T, Genta S, Hansen AR, Doger B, Galvao V, Lenox L, Brown RJ, Kalota A, Mehta J, Pastore F, Patel B, Mistry P, Gu J, Lauring J, Patel MR. Phase 1 Study of JNJ-64619178, a Protein Arginine Methyltransferase 5 Inhibitor, in Advanced Solid Tumors. Clin Cancer Res 2023; 29:3592-3602. [PMID: 37491846 DOI: 10.1158/1078-0432.ccr-23-0092] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/20/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE In this first-in-human, Phase 1, open-label, multicenter study, we evaluated JNJ-64619178, a selective and potent PRMT5 inhibitor, in patients with advanced malignant solid tumors or non-Hodgkin lymphomas (NHL). The primary objective was to evaluate the safety and to identify a recommended Phase 2 dose (RP2D) of JNJ-64619178. PATIENTS AND METHODS Adult patients with treatment-refractory advanced solid tumors or NHL and measurable disease received escalating doses of JNJ-64619178 following two schedules (Schedule A: 14 days on/7 days off; Schedule B: every day on a 21-day cycle). Safety, pharmacokinetics (PK), pharmacodynamics (PD), and clinical activity were evaluated. RESULTS Ninety patients received JNJ-64619178. Thrombocytopenia was identified as the only dose-limiting toxicity. JNJ-64619178 showed dose-proportional PK and robust target engagement, as measured by plasma symmetric dimethylarginine, across all dose levels. The objective response rate was 5.6% (5 of 90). Patients with adenoid cystic carcinoma (ACC) had an ORR of 11.5% (3 of 26) and a median progression-free survival of 19.1 months. CONCLUSIONS JNJ-64619178 demonstrated manageable dose-dependent toxicity and preliminary evidence of antitumor activity in ACC and other tumor types. Plasma exposure was dose dependent, and target inhibition was maintained with intermittent and continuous dosing. On the basis of safety, clinical activity, PK, and PD findings, two provisional RP2Ds were selected: 1.5 mg intermittently and 1.0 mg once daily. Aside from ACC, clinical benefit was limited, and biomarkers to enrich for responsiveness to PRMT5 inhibition will be needed for further development.
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Affiliation(s)
- Maria Vieito
- Vall de Hebron Institute of Oncology, Barcelona, Spain
| | - Victor Moreno
- START MADRID-FJD, Hospital Fundacion Jimenez Diaz, Madrid Spain
| | - Anna Spreafico
- Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Irene Brana
- Vall de Hebron Institute of Oncology, Barcelona, Spain
| | - Judy S Wang
- Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, Florida
| | | | | | - Sofia Genta
- Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Aaron R Hansen
- Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Bernard Doger
- START MADRID-FJD, Hospital Fundacion Jimenez Diaz, Madrid Spain
| | | | - Laurie Lenox
- Janssen Research & Development, Spring House, Pennsylvania
| | - Regina J Brown
- Janssen Research & Development, Spring House, Pennsylvania
| | - Anna Kalota
- Janssen Research & Development, Spring House, Pennsylvania
| | - Jaydeep Mehta
- Janssen Research & Development, Spring House, Pennsylvania
| | | | - Bharvin Patel
- Janssen Research & Development, Spring House, Pennsylvania
| | - Pankaj Mistry
- Janssen Research & Development, High Wycombe, United Kingdom
| | - Junchen Gu
- Janssen Research & Development, Spring House, Pennsylvania
| | - Josh Lauring
- Janssen Research & Development, Spring House, Pennsylvania
| | - Manish R Patel
- Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, Florida
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Sanz-Garcia E, Genta S, Chen X, Ou Q, Araujo DV, Abdul Razak AR, Hansen AR, Spreafico A, Bao H, Wu X, Siu LL, Bedard PL. Tumor-Naïve Circulating Tumor DNA as an Early Response Biomarker for Patients Treated With Immunotherapy in Early Phase Clinical Trials. JCO Precis Oncol 2023; 7:e2200509. [PMID: 37027812 DOI: 10.1200/po.22.00509] [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: 04/09/2023] Open
Abstract
PURPOSE To evaluate early circulating tumor DNA (ctDNA) kinetics using a tumor-naïve assay and correlate it with clinical outcomes in early phase immunotherapy (IO) trials. METHODS Plasma samples were analyzed using a 425-gene next-generation sequencing panel at baseline and before cycle 2 (3-4 weeks) in patients with advanced solid tumors treated with investigational IO agents. Variant allele frequency (VAF) for mutations in each gene, mean VAF (mVAF) from all mutations, and change in mVAF between both time points were calculated. Hyperprogression (HyperPD) was measured using Matos and Caramella criteria. RESULTS A total of 162 plasma samples were collected from 81 patients with 27 different tumor types. Patients were treated in 37 different IO phase I/II trials, 72% of which involved a PD-1/PD-L1 inhibitor. ctDNA was detected in 122 plasma samples (75.3%). A decrease in mVAF from baseline to precycle 2 was observed in 24 patients (37.5%) and was associated with longer progression-free survival (hazard ratio [HR], 0.43; 95% CI, 0.24 to 0.77; P < .01) and overall survival (HR, 0.54; 95% CI, 0.3 to 0.96; P = .03) compared with an increase. These differences were more marked if there was a >50% decrease in mVAF for both progression-free survival (HR, 0.29; 95% CI, 0.13 to 0.62; P < .001) and overall survival (HR, 0.23; 95% CI, 0.09 to 0.6; P = .001). No differences in mVAF changes were observed between the HyperPD and progressive disease patients. CONCLUSION A decrease in ctDNA within 4 weeks of treatment was associated with treatment outcomes in patients in early phase IO trials. Tumor-naïve ctDNA assays may be useful for identifying early treatment benefits in phase I/II IO trials.
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Affiliation(s)
- Enrique Sanz-Garcia
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Sofia Genta
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | | | | | - Daniel V Araujo
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
- Division of Medical Oncology, Hospital de Base, Sao Paulo, Brazil
| | - Albiruni R Abdul Razak
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Hua Bao
- Geneseeq Technology Inc, Toronto, Canada
| | - Xue Wu
- Geneseeq Technology Inc, Toronto, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
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Fuentes-Antrás J, Genta S, Vijenthira A, Siu LL. Antibody-drug conjugates: in search of partners of choice. Trends Cancer 2023; 9:339-354. [PMID: 36746689 DOI: 10.1016/j.trecan.2023.01.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [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: 10/03/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 02/05/2023]
Abstract
Antibody-drug conjugates (ADCs) have become a credentialled class of anticancer drugs for both solid and hematological malignancies, with regulatory approvals mainly as single agents. Despite extensive preclinical and clinical efforts to develop rational ADC-based combinations, to date only a limited number have demonstrated survival improvements over standard of care. The most appealing partners for ADCs are those that offer additive or synergistic effects on tumor cells or their microenvironment without unacceptable overlapping toxicities. Coadministration with antiangiogenic compounds, HER2-targeting drugs, DNA-damage response agents and immune checkpoint inhibitors (ICIs) represent active forerunners. Through the identification of targets with tumor-specific expression, improved conjugation technologies, and novel linkers and payloads offering superior therapeutic indices, the next generation of ADCs brings optimism to combinatorial approaches.
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Affiliation(s)
- Jesús Fuentes-Antrás
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sofia Genta
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Abi Vijenthira
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Spiliopoulou P, Vornicova O, Genta S, Spreafico A. Shaping the Future of Immunotherapy Targets and Biomarkers in Melanoma and Non-Melanoma Cutaneous Cancers. Int J Mol Sci 2023; 24:ijms24021294. [PMID: 36674809 PMCID: PMC9862040 DOI: 10.3390/ijms24021294] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Recent advances in treating cutaneous melanoma have resulted in impressive patient survival gains. Refinement of disease staging and accurate patient risk classification have significantly improved our prognostic knowledge and ability to accurately stratify treatment. Undoubtedly, the most important step towards optimizing patient outcomes has been the advent of cancer immunotherapy, in the form of immune checkpoint inhibition (ICI). Immunotherapy has established its cardinal role in the management of both early and late-stage melanoma. Through leveraging outcomes in melanoma, immunotherapy has also extended its benefit to other types of skin cancers. In this review, we endeavor to summarize the current role of immunotherapy in melanoma and non-melanoma skin cancers, highlight the most pertinent immunotherapy-related molecular biomarkers, and lastly, shed light on future research directions.
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Affiliation(s)
- Pavlina Spiliopoulou
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Olga Vornicova
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
- Mount Sinai Hospital, University Health Network, Toronto, ON M5G 1X5, Canada
| | - Sofia Genta
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Anna Spreafico
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
- Correspondence: ; Tel.: +1-416-946-4501 (ext. 5083)
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Salawu A, Genta S, Spiliopoulou P, Yee N, M. Ye, Ly L, Taylor R, Vornicova O, Abdul Razak A, Bedard P, Wang L, Siu L, Coburn B, Spreafico A. 34TiP Prospective analysis of intestinal microbiome and autoimmune panels as predictors of toxicity in immunoncology patients (INSPECT-IO Study). Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Genta S, Coburn B, Cescon DW, Spreafico A. Patient-derived cancer models: Valuable platforms for anticancer drug testing. Front Oncol 2022; 12:976065. [PMID: 36033445 PMCID: PMC9413077 DOI: 10.3389/fonc.2022.976065] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Molecularly targeted treatments and immunotherapy are cornerstones in oncology, with demonstrated efficacy across different tumor types. Nevertheless, the overwhelming majority metastatic disease is incurable due to the onset of drug resistance. Preclinical models including genetically engineered mouse models, patient-derived xenografts and two- and three-dimensional cell cultures have emerged as a useful resource to study mechanisms of cancer progression and predict efficacy of anticancer drugs. However, variables including tumor heterogeneity and the complexities of the microenvironment can impair the faithfulness of these platforms. Here, we will discuss advantages and limitations of these preclinical models, their applicability for drug testing and in co-clinical trials and potential strategies to increase their reliability in predicting responsiveness to anticancer medications.
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Affiliation(s)
- Sofia Genta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bryan Coburn
- Division of Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - David W. Cescon
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Sanz Garcia E, Genta S, Chen X, Ou Q, Araujo DV, Abdul Razak AR, Hansen AR, Spreafico A, Bao H, Wu X, Siu LL, Bedard PL. Early circulating tumor DNA (ctDNA) kinetics using a tumor-naïve assay as a predictive biomarker in early-phase immunotherapy (IO) clinical trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2546] [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
2546 Background: ctDNA kinetics with tumor-informed assays can predict treatment outcome in patients (pts) treated with anti-PD1 IO ( Bratman et al, Nature Cancer 2020). We evaluated whether early ctDNA kinetics with a tumor-naïve assay were associated with clinical outcomes in advanced solid tumor patients treated on early phase IO trials. Methods: Advanced solid tumor pts treated with investigational IO agents at the Princess Margaret Phase I program were enrolled. Baseline (B) and pre-cycle 2 (C2) (3-4 weeks after first dose) plasma samples were prospectively collected via an institutional liquid biopsy program (LIBERATE, NCT03702309). ctDNA was assessed using the tumor-naïve 425-gene Geneseeq Prime panel in a clinical laboratory. Mutations in each gene detected in ctDNA were measured as Variant Allele Fraction (VAF). Mean VAF from all mutations was calculated. Radiological response was measured per RECIST criteria and correlated using ROC curves. Hyperprogression (HPD) was defined using VHIO criteria ( Matos et al, CCR 2020). Survival outcomes were estimated using the Kaplan Meier method. Results: From 12/2017 to 3/2020, 162 plasma samples from 81 pts with 25 different tumor types were collected. Pts were treated within 25 different IO phase I/II trials, 72% of which involved a PD-1/PD-L1 inhibitor. Median age was 58y (range 21 – 79), 54% female, 76% ECOG1. Sarcoma and colorectal (11%, each) followed by breast (8%) and melanoma (7%) were the most frequent tumors. Median follow up was 10.3 months (m) (1.8-46.9). CR 4% (n = 3), PR 6% (n = 5), HPD 11% (n = 9). Clinical benefit (CB) rate (CR+PR+SD > 6 months) was 20% (n = 16). ctDNA was detected in 122/162 samples (75.3%) (60 at B, 62 at C2). The most frequent mutations were TP53 (32%), PI3KCA (12%), PKHD1 (11%), and KRAS (9%). Mean VAF at B below median was not associated with OS (HR = 0.68 95%CI 0.4-1.16; p = 0.16) or PFS (HR = 0.93 95%CI 0.56-1.54; p = 0.77). Mean VAF change (difference between mean VAF at B and at C2) was associated with response (AUC = 0.99) and CB (AUC = 0.86). A decrease in mean VAF from B to C2 was seen in 24 pts (37.5%) and was associated with longer PFS (median PFS 2.7 vs 1.8 m; HR: 0.43, 95%CI 0.24-0.77; p < 0.01) and OS (median OS 10.8 vs 9.1 m; HR: 0.54; 95%CI 0.3-0.96; p = 0.03) compared to an increase in mean VAF. These differences were more marked if there was > 50% decrease in mean VAF from B to C2 (n = 11, 17%) compared to decrease < 50% or increase: median PFS 3.6 vs 1.8 m (HR: 0.29, 95%CI 0.13-0.62; p < 0.01) and median OS not reached vs 9.6 m (HR: 0.23, 95%CI 0.09-0.6; p < 0.01). No differences in mean VAF change were seen between HPD and PD pts. Conclusions: In a pan-cancer solid tumor early phase trial IO cohort, a decrease in ctDNA within 4 weeks of treatment was associated with increased CB, OS and PFS. HPD pts did not show greater increases in ctDNA. Tumor-naïve ctDNA assays may be useful to identify early treatment benefit in phase I/II trials with IO.
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Affiliation(s)
- Enrique Sanz Garcia
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sofia Genta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Xiaoxi Chen
- Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Qiuxiang Ou
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Daniel Vilarim Araujo
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Aaron Richard Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Hua Bao
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Xue Wu
- Geneseeq Technology Inc., Toronto, ON, Canada
| | - Lillian L. Siu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Genta S, Keshavarzi S, Yee N, Heirali A, Hansen AR, Siu LL, Saibil S, Stayner LA, Yanekina M, Sauder M, Salawu A, Spiliopoulou P, Vornicova O, Vilbert MTS, Butler MO, Bedard PL, Abdul Razak AR, Coburn B, Chruscinski A, Spreafico A. Customized autoantibodies (autoAbs) profiling to predict and monitor immune-related adverse events (irAEs) in patients receiving immune checkpoint inhibitors (ICI). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2528 Background: Using a customized microarray, we previously reported that patients (pts) who develop irAEs grade (G)≥2 and those who do not, have different median fluorescent intensity (MFI) levels of specific autoAbs at baseline (pre-ICI). Leveraging a larger dataset, we evaluated whether overall baseline autoAbs elevation and early increases in autoAbs after ICI can predict irAEs as well as if steroid treatment can reduce autoAbs. Methods: Plasma was obtained from pts receiving ICI in two clinical trials (MET4-IO, NCT03686202 and INSPIRE, NCT02644369) and from healthy controls (hc). Collection time points in MET4-IO and INSPIRE studies included: baseline, 3-4 weeks (w), 6-8 w, 24 w and at the end of treatment and baseline and 6 w respectively. Arrays with 162 autoAg customized for frequent irAEs were incubated with plasma and probed with Abs to detect IgG and IgM reactivity. AutoAbs with MFI >500 per individual were compared between hc and pts with and without irAEs G≥2 by the Student-t test. Results: Samples from 114 pts and 14 hc were analyzed (pts characteristics are summarized in the Table). G≥2 irAEs included: hypothyroidism (13), pneumonitis (10), colitis (7), hepatitis (4), skin toxicity (7), infusion reaction (2), pancreatitis (2), meningitis (1), hypophysitis (1), corneal ulcer (1), high creatinine (1), myocarditis (1), myositis (1), diabetes (1), mucositis (1), myasthenia (1) and adrenal failure (1). Hc had less autoAbs with MFI >500 as compared to pts at baseline (median 32 vs 62 p<0.001). IgG with MFI >500 were higher at baseline in pts who developed G≥2 irAEs vs those without G≥2 irAEs (median 39 vs 33, p=0.03). In 23 pts with plasma collected at the time of irAEs, we observed a significant increase of autoAbs with MFI>500 from baseline (median 84 vs 77 p= 0.009). Paired samples at the time of irAEs and after steroids were available for 9/23 pts, showing lower autoAbs after steroid treatment (54 vs 79 p=0.006). No differences in autoAbs with MFI>500 pre and post ICI were seen in pts without G≥2 irAEs (baseline vs first post ICI collection median 58 vs 60, p=0.13). Conclusions: We observed a higher number of IgG with MFI >500 at baseline and a greater increase after ICI administration in individuals with irAEs compared to those without irAEs. Steroid treatment resulted in a decrease in autoAbs. A prospective study is ongoing to validate the potential role of autoAbs for risk stratification and monitoring of irAEs. [Table: see text]
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Affiliation(s)
- Sofia Genta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sareh Keshavarzi
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Noelle Yee
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Alya Heirali
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aaron Richard Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lillian L. Siu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Samuel Saibil
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | | | - Maxwell Sauder
- University Health Network, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Abdulazeez Salawu
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Pavlina Spiliopoulou
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Olga Vornicova
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Marcus O. Butler
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Albiruni Ryan Abdul Razak
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Bryan Coburn
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | | | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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10
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Salawu A, Gupta AA, Al-Ezzi EM, Genta S, Malone ER, Vora TS, Watson GA, Vornicova O, Wang L, Arones L, Phillips MJ, Lee J, Abdul Razak AR. Phase 1b study of weekly split-dose selinexor in soft tissue sarcoma (STS). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11563] [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
11563 Background: Selinexor has demonstrated clinical activity in a variety of tumors including STS. Selinexor dosing at 60mg twice a week or 80mg once a week in later phase trials was associated with gastrointestinal and hematologic toxicities requiring frequent dose interruption and reduction. Preclinical in vivo studies show that selinexor use in a split-dose regimen or sustained-release formula is associated with less toxicity. This phase 1b study aimed to evaluate the safety and tolerability of split-dose selinexor in patients (pts) with advanced STS. Methods: Eligible pts with advanced STS of any histologic subtype, and ECOG performance status (PS) ≤ 1 were treated with split-dose selinexor (40mg, 20mg, 20mg in the morning, afternoon, and evening, respectively) on days 1, 8, 15 and 22 of a 28-day cycle, until unacceptable toxicity or disease progression. Antiemetic prophylaxis (oral dexamethasone and ondansetron) was given to all pts. The primary endpoint was the rate of grade ≥ 3 treatment-related adverse events (TRAE) by CTCAE v5.0. The secondary endpoint was assessment of quality of life (QoL) using the EORTC QLQ-c30 tool v3. Descriptive analyses of Global Health Status (GHS) QoL scores at screening (baseline) and cycle 2 day 1 (C2D1) were performed. Radiologic tumor assessments (by RECIST v1.1) were performed every 8 weeks while on treatment. Results: Nineteen pts [12 female and 7 male; ECOG 0/1, 8/11; median age 61 years (range 41 – 83)] were enrolled. The most frequent of 12 STS subtypes was leiomyosarcoma (n = 7, 37%). Among 18 patients evaluable for toxicity, there were no grade ≥ 3 TRAE. The most common grade ≤ 2 TRAE were dysgeusia (n = 11, 61%), nausea (n = 11, 61%), fatigue (n = 10, 56%) and vomiting (n = 10, 56%). Grade ≤ 2 hematologic TRAE were thrombocytopenia (n = 6, 33%), neutropenia (n = 4, 22%) and anemia (n = 1, 6%). Dose reduction was required in 3 pts (17%) due to intolerable grade 2 TRAE (fatigue, nausea, thrombocytopenia). No serious adverse event due to selinexor was noted. QoL scores were evaluable for 15 pts. The mean (± SEM) change in GHS QoL score from baseline to C2D1 was -10.6 (± 4.8). Among 16 pts evaluable for radiologic response, the best response was stable disease (SD) in 10 pts (63%), and progressive disease (PD) in 6 pts (37%). Durable clinical benefit (SD for > 16 weeks) was seen in 5 pts (31%; 95%CI 11.0 – 58.7%) The median PFS was 3.6 months (95%CI 1.7 – 7.3). Conclusions: Split-dose selinexor was well tolerated in this heterogeneous group of pts with advanced STS and warrants further interrogation. Updated toxicity, safety, efficacy and QoL data will be presented at the meeting. Clinical trial information: NCT04811196.
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Affiliation(s)
- Abdulazeez Salawu
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Abha A. Gupta
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Esmail Mutahar Al-Ezzi
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sofia Genta
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Eoghan Ruadh Malone
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Tushar Shailesh Vora
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Geoffrey Alan Watson
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Olga Vornicova
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lisa Wang
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Limore Arones
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Madeline J. Phillips
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jasmine Lee
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Albiruni Ryan Abdul Razak
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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11
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Genta S, Araujo DV, Keshavarzi S, Pimentel Muniz T, Saeed Kamil Z, Howarth K, Terrell S, Joad A, Ventura R, Covelli A, Saibil S, Spiliopoulou P, Vornicova O, Easson AM, Butler MO, Siu LL, Bratman SV, Spreafico A. Leveraging personalized circulating tumor DNA (ctDNA) for detection and monitoring of molecular residual disease in high-risk melanoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9579] [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
9579 Background: High-risk melanoma has variable prognosis. Adjuvant immuno- (IO) and targeted therapy (TT) are approved for stage III-IV resected disease. However, a significant proportion of patients (pts) are cured by local treatment alone or relapse despite adjuvant therapy. Liquid biopsy with ctDNA assays have been used to predict response to treatment and identify pts at higher risk of progression/death. Personalized ctDNA assays are a highly sensitive approach that may enhance upfront risk stratification and early detection of relapse. Methods: Serial ctDNA Monitoring as a predictive Biomarker in advanced neoplAsms (SAMBA) is a Princess Margaret prospective ctDNA kinetics study (NCT03702309) in high-risk melanoma pts. Plasma is collected pre-op (pre-local treatment, if feasible), post-op (after surgery), and every 3-6 months (m) until radiological progressive disease (rPD). Personalized amplicon based NGS assays by Inivata (RaDaR) were used to detect somatic variants in ctDNA identified through whole-exome sequencing of matched tumor tissue. Progression free survival (PFS) and overall survival (OS) from the time of surgery were estimated with the Kaplan Meier and compared with the log-rank test. Results: As of December 2021, 82 of 100 planned pts have been enrolled. A total of 191 samples from 47 pts have been analyzed. Median age was 66 years (27-87), 33 were male (70%). Seven (15%), 30 (64%) and 10 (21%) were stage II/III/IV respectively. All pts had surgery and 8 (17%) adjuvant radiation. No systemic therapy was given to 11 pts (23%); 30 (64%) had IO and 6 (13%) TT. rPD occurred in 13 pts (28%). Median follow up was 24 months. A median of 48 variants were included in the personalized ctDNA panel design (35-52). ctDNA was detected (ctDNA+) at any time point in 12/47 pts (26%), of which 5/12 (42%) were BRAF and NRAS wt on tissue. Median PFS was 4.9 months (m) for ctDNA+ pts and not reached (NR) for ctDNA- pts at post-op (HR = 2.71 CI 0.60-12.31, p = 0.179). Median OS was 23.1 m vs NR in ctDNA+ vs ctDNA- pts (HR = 8.9, CI 1.45-54.77, p = 0.004). Two ctDNA+ pts had neoadjuvant IO and became ctDNA- before surgery. One, free of disease after 12 m, had ctDNA- in 4 follow up samples. The other pt was ctDNA+ in the post-op sample and relapsed within 3 m. Four of 45 (9%) pts had ctDNA+ at post-op. Two of them, including a pt who had neoadjuvant IO, did not receive adjuvant therapy and had rPD within 3 m. The other 2 pts received adjuvant IO; ctDNA cleared and pts remain free of disease at 12 and 34 m. Three pts with rising ctDNA over time experienced rPD after a median of 4 m (2-7). Conclusions: Personalized ctDNA analysis with RaDaR may improve risk of death stratification and selection of pts who could benefit from adjuvant treatment. Detection of ctDNA may precede rPD. Follow-up will continue in pts with rising ctDNA who have not yet had rPD. Pts accrual and sample collection are ongoing, and additional data will be presented. Clinical trial information: NCT03702309.
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Affiliation(s)
- Sofia Genta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Daniel Vilarim Araujo
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sareh Keshavarzi
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Thiago Pimentel Muniz
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Zaid Saeed Kamil
- Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | | | - Andy Joad
- Inivata Limited, Cambridge, United Kingdom
| | | | - Andrea Covelli
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Samuel Saibil
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Olga Vornicova
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alexandra Maria Easson
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Marcus O. Butler
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lillian L. Siu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Scott Victor Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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12
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Watson GA, Sanz-Garcia E, Zhang WJ, Liu ZA, Yang SC, Wang B, Liu S, Kubli S, Berman H, Pfister T, Genta S, Spreafico A, Hansen AR, Bedard PL, Lheureux S, Abdul Razak A, Cescon D, Butler MO, Xu W, Mak TW, Siu LL, Chen E. Increase in serum choline levels predicts for improved progression-free survival (PFS) in patients with advanced cancers receiving pembrolizumab. J Immunother Cancer 2022; 10:jitc-2021-004378. [PMID: 35705312 PMCID: PMC9204435 DOI: 10.1136/jitc-2021-004378] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Recent studies have demonstrated that T cells can induce vasodilation in a choline-acetyltransferase dependent manner, leading to an increase in T cell migration to infected tissues in response to viral infection, but its role in cancer is unclear. Choline acetyltransferase catalyzes the production of acetylcholine from choline and acetyl-CoA, however, acetylcholine is challenging to quantify due to its extremely short half-life while choline is stable. This study aims to correlate serum choline levels in patients with advanced solid tumors receiving pembrolizumab with treatment outcomes. Methods Blood samples were collected at baseline and at week 7 (pre-cycle 3) in patients treated with pembrolizumab in the INvestigator-initiated Phase 2 Study of Pembrolizumab Immunological Response Evaluation phase II trial (NCT02644369). Samples were analyzed for choline and circulating tumor DNA (ctDNA). Multivariable Cox models were used to assess the association between choline and overall survival (OS) and progression-free survival (PFS) when including ΔctDNAC3 (the change in ctDNA from baseline to cycle 3), cohort, PD-L1 expression and tumor mutation burden (TMB). An independent validation cohort from the LIBERATE study (NCT03702309) included patients on early phase trials treated with a PD-1 inhibitor. Results A total of 106 pts were included in the analysis. With a median follow-up of 12.6 months, median PFS and OS were 1.9 and 13.7 months, respectively. An increase in serum choline level at week 7 compared with baseline (ΔcholineC3) in 81 pts was significantly associated with a better PFS (aHR 0.48, 95% CI 0.28 to 0.83, p=0.009), and a trend toward a better OS (aHR 0.64, 95% CI 0.37 to 1.12, p=0.119). A combination of ΔctDNAC3 and ΔcholineC3 was prognostic for both OS and PFS. Multivariable analyses show ΔcholineC3 was a prognostic factor for PFS independent of ΔctDNAC3, cohort, PD-L1 and TMB. In the independent validation cohort (n=51), an increase in serum choline at cycle 2 was associated with a trend to improved PFS. Conclusions This is the first exploratory report of serum choline levels in pan-cancer patients receiving pembrolizumab. The association between improved PFS and ΔcholineC3 suggests a possible role for the cholinergic system in the regulation of antitumor immunity. Further pre-clinical and clinical studies are required to validate this finding. Trial registration number NCT03702309.
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Affiliation(s)
- Geoffrey Alan Watson
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Enrique Sanz-Garcia
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Wen-Jiang Zhang
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Zhihui Amy Liu
- Biostatistics, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.,University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Sy Cindy Yang
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Ben Wang
- Laboratory Medicine and Pathobiology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Shaofeng Liu
- Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Kubli
- Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Hal Berman
- Laboratory Medicine and Pathobiology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Thomas Pfister
- Laboratory Medicine and Pathobiology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sofia Genta
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Stephanie Lheureux
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Albiruni Abdul Razak
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Dave Cescon
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marcus O Butler
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Wei Xu
- Biostatistics, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Tak W Mak
- Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Eric Chen
- Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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13
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Genta S, Ghilardi G, Cascione L, Juskevicius D, Tzankov A, Schär S, Milan L, Pirosa MC, Esposito F, Ruberto T, Giovanella L, Hayoz S, Mamot C, Dirnhofer S, Zucca E, Ceriani L. Integration of Baseline Metabolic Parameters and Mutational Profiles Predicts Long-Term Response to First-Line Therapy in DLBCL Patients: A Post Hoc Analysis of the SAKK38/07 Study. Cancers (Basel) 2022; 14:cancers14041018. [PMID: 35205765 PMCID: PMC8870624 DOI: 10.3390/cancers14041018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 12/16/2022] Open
Abstract
Accurate estimation of the progression risk after first-line therapy represents an unmet clinical need in diffuse large B-cell lymphoma (DLBCL). Baseline (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) parameters, together with genetic analysis of lymphoma cells, could refine the prediction of treatment failure. We evaluated the combined impact of mutation profiling and baseline PET/CT functional parameters on the outcome of DLBCL patients treated with the R-CHOP14 regimen in the SAKK38/07 clinical trial (NCT00544219). The concomitant presence of mutated SOCS1 with wild-type CREBBP and EP300 defined a group of patients with a favorable prognosis and 2-year progression-free survival (PFS) of 100%. Using an unsupervised recursive partitioning approach, we generated a classification-tree algorithm that predicts treatment outcomes. Patients with elevated metabolic tumor volume (MTV) and high metabolic heterogeneity (MH) (15%) had the highest risk of relapse. Patients with low MTV and favorable mutational profile (9%) had the lowest risk, while the remaining patients constituted the intermediate-risk group (76%). The resulting model stratified patients among three groups with 2-year PFS of 100%, 82%, and 42%, respectively (p < 0.001).
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Affiliation(s)
- Sofia Genta
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (S.G.); (M.C.P.); (F.E.); (E.Z.)
| | - Guido Ghilardi
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
| | - Luciano Cascione
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6500 Bellinzona, Switzerland;
- Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Darius Juskevicius
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (D.J.); (A.T.); (S.D.)
| | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (D.J.); (A.T.); (S.D.)
| | - Sämi Schär
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, 3008 Bern, Switzerland; (S.S.); (S.H.)
| | - Lisa Milan
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (L.M.); (T.R.); (L.G.)
| | - Maria Cristina Pirosa
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (S.G.); (M.C.P.); (F.E.); (E.Z.)
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
| | - Fabiana Esposito
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (S.G.); (M.C.P.); (F.E.); (E.Z.)
| | - Teresa Ruberto
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (L.M.); (T.R.); (L.G.)
| | - Luca Giovanella
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (L.M.); (T.R.); (L.G.)
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
| | - Stefanie Hayoz
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, 3008 Bern, Switzerland; (S.S.); (S.H.)
| | - Christoph Mamot
- Division of Oncology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland;
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (D.J.); (A.T.); (S.D.)
| | - Emanuele Zucca
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (S.G.); (M.C.P.); (F.E.); (E.Z.)
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6500 Bellinzona, Switzerland;
- Department of Medical Oncology, Bern University Hospital, University of Bern, 3008 Bern, Switzerland
| | - Luca Ceriani
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6500 Bellinzona, Switzerland;
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (L.M.); (T.R.); (L.G.)
- Correspondence:
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14
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Muniz TP, Araujo DV, Savage KJ, Cheng T, Saha M, Song X, Gill S, Monzon JG, Grenier D, Genta S, Allen MJ, Arteaga DP, Saibil SD, Butler MO, Spreafico A, Hogg D. CANDIED: A Pan-Canadian Cohort of Immune Checkpoint Inhibitor-Induced Insulin-Dependent Diabetes Mellitus. Cancers (Basel) 2021; 14:cancers14010089. [PMID: 35008256 PMCID: PMC8750429 DOI: 10.3390/cancers14010089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/01/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 01/08/2023] Open
Abstract
Simple Summary Immune checkpoint inhibitor-induced insulin-dependent diabetes mellitus (ICI-induced IDDM) is an emerging form of autoimmune diabetes. We describe the characteristics of 34 patients who developed ICI-induced IDDM across five Canadian cancer centres. We observed that presentation with hyperglycemic crisis is common and that patients treated with combination immunotherapy regimens develop ICI-induced IDDM earlier than those treated with monotherapy. Our results suggest that ICI-induced IDDM is irreversible but is associated with high tumor response rates and prolonged survival. The data generated by this study may help clinicians manage ICI-induced IDDM. Abstract Immune checkpoint inhibitor (ICI)-induced insulin-dependent diabetes mellitus (IDDM) is a rare but potentially fatal immune-related adverse event (irAE). In this multicentre retrospective cohort study, we describe the characteristics of ICI-induced IDDM in patients treated across five Canadian cancer centres, as well as their tumor response rates and survival. In 34 patients identified, 25 (74%) were male and 19 (56%) had melanoma. All patients received anti-programed death 1 (anti-PD1) or anti-programmed death ligand-1 (anti-PD-L1)-based therapy. From ICI initiation, median time to onset of IDDM was 2.4 months (95% CI 1.1–3.6). Patients treated with anti-PD1/PD-L1 in combination with an anti-cytotoxic T lymphocyte antigen 4 antibody developed IDDM earlier compared with patients on monotherapy (1.4 vs. 3.9 months, p = 0.05). Diabetic ketoacidosis occurred in 21 (62%) patients. Amongst 30 patients evaluable for response, 10 (33%) had a complete response and another 10 (33%) had a partial response. Median overall survival was not reached (95% CI NE; median follow-up 31.7 months). All patients remained insulin-dependent at the end of follow-up. We observed that ICI-induced IDDM is an irreversible irAE and may be associated with a high response rate and prolonged survival.
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Affiliation(s)
- Thiago P. Muniz
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, University Health Network, Toronto, ON M5S 1Z5, Canada; (S.G.); (M.J.A.); (D.P.A.); (S.D.S.); (M.O.B.); (A.S.); (D.H.)
- Correspondence:
| | - Daniel V. Araujo
- Hospital de Base, Faculdade de Medicina de Sao Jose do Rio Preto, Sao Jose do Rio Preto 15090-000, Brazil;
| | - Kerry J. Savage
- Division of Medical Oncology, Department of Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Tina Cheng
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (T.C.); (J.G.M.)
| | - Moumita Saha
- Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada; (M.S.); (S.G.)
| | - Xinni Song
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
| | - Sabrina Gill
- Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada; (M.S.); (S.G.)
| | - Jose G. Monzon
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (T.C.); (J.G.M.)
| | - Debjani Grenier
- Department of Medical Oncology, University of Manitoba, Winnipeg, MB R3A 1R9, Canada;
| | - Sofia Genta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, University Health Network, Toronto, ON M5S 1Z5, Canada; (S.G.); (M.J.A.); (D.P.A.); (S.D.S.); (M.O.B.); (A.S.); (D.H.)
| | - Michael J. Allen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, University Health Network, Toronto, ON M5S 1Z5, Canada; (S.G.); (M.J.A.); (D.P.A.); (S.D.S.); (M.O.B.); (A.S.); (D.H.)
| | - Diana P. Arteaga
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, University Health Network, Toronto, ON M5S 1Z5, Canada; (S.G.); (M.J.A.); (D.P.A.); (S.D.S.); (M.O.B.); (A.S.); (D.H.)
| | - Samuel D. Saibil
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, University Health Network, Toronto, ON M5S 1Z5, Canada; (S.G.); (M.J.A.); (D.P.A.); (S.D.S.); (M.O.B.); (A.S.); (D.H.)
| | - Marcus O. Butler
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, University Health Network, Toronto, ON M5S 1Z5, Canada; (S.G.); (M.J.A.); (D.P.A.); (S.D.S.); (M.O.B.); (A.S.); (D.H.)
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, University Health Network, Toronto, ON M5S 1Z5, Canada; (S.G.); (M.J.A.); (D.P.A.); (S.D.S.); (M.O.B.); (A.S.); (D.H.)
| | - David Hogg
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, University Health Network, Toronto, ON M5S 1Z5, Canada; (S.G.); (M.J.A.); (D.P.A.); (S.D.S.); (M.O.B.); (A.S.); (D.H.)
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Genta S, Aghababazadeh FA, Tsao MS, Hansen AR, Butler MO, Razak AR, Bedard PL, Wang BX, Trevor PJ, Hakgor S, Woo J, Haibe-Kains B, Siu LL, Spreafico A. Abstract LBA021: Immune resistance interrogation study (IRIS): Initial report of next generation sequencing (NGS) results in patients with primary versus acquired resistance to anti-PD1/L1 antibodies. Mol Cancer Ther 2021. [DOI: 10.1158/1535-7163.targ-21-lba021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The molecular mechanisms underlying primary versus acquired resistance to anti-PD-1/L1 antibodies have not been comprehensively evaluated across different tumor types. Methods: The Immune Resistance Interrogation Study (IRIS; NCT04243720) is a prospective, investigator-initiated study at the Princess Margaret Cancer Centre, aimed to perform extensive multi-omic characterization of solid tumors with primary resistance (disease progression on first imaging; or stable disease <6 months) versus acquired resistance (partial or complete response; or stable disease ≥6 months) to antiPD-1/L1 agents. A one-time fresh tumor biopsy is collected from patients (pts) who have progressed on anti-PD1/L1 antibody-based treatment as their most recent line of therapy; liquid biopsy or archived FFPE tissue is allowed as alternates when fresh biopsy is insufficient. NGS was performed using Foundation One (324 genes) or Foundation Liquid (309 genes) panels. Frequencies of disrupted genes and variants were compared in pts with primary versus acquired resistance using Fisher’s exact test. The planned samples size of IRIS is 100 pts. Results: Among the first 35 pts enrolled, 22 (63%) had primary resistance and 13 (37%) had acquired resistance. The most common diagnosis was melanoma (17 pts; 49%); followed by head and neck squamous cell carcinoma (13 pts; 37%); endometrial cancer (2 pts; 6%); pleural mesothelioma, gastroesophageal junction and colorectal cancer (1 pt each; 3%). Foundation One was performed in 23 pts (66%), 22 of them (63%) had biopsies with sufficient quality for NGS, and 1 (3%) had the analysis performed using archival FFPE tissue. The remaining 12 pts (34%) had Foundation Liquid testing done using liquid biopsy. Thirty-three pts (94%) had at least one oncogenic alteration. Genes most frequently altered included: TP53 in 16 patients (46%), TERT promoter in 12 pts (34%), CDKN2A in 9 pts (26%), PIK3CA in 6 pts (17%), and PTEN in 5 pts (14%). At the variant level, the most frequent alterations were: TERT promoter -146C>T mutation in 6 patients (17%), followed by TERT promoter -124C>T mutation in 5 patients (14%), FGF19/FGF4/FGF3 and CCND1 amplifications in 4 pts each (11%), and MDM2 amplification, CDK4 amplification and CDKN2A loss, detected in 3 pts each (9%). Pts with acquired resistance had a higher frequency of TP53 mutations (9/13 = 69%) compared to primary resistance pts (7/22 = 32%), p=0.04; however this was not significant when corrected for multiple testing. Interestingly, amplifications in CDK4, CCND1, FGF 19/FGF 3/FGF 4, MDM2 and mutations in NF1 were only identified in pts with primary resistant tumors. Conclusions: No significant differences in disrupted genes and variants were observed in the current analysis. However, this can be due to the small number of pts analyzed thus far. Accrual to this study is ongoing. A comparison of alterations in oncogenic pathways is planned to further define the genomic landscape of pts with primary versus acquired resistance to anti-PD1/PDL1 blockade.
Citation Format: Sofia Genta, Farnoosh Abbas Aghababazadeh, Ming S Tsao, Aaron R Hansen, Marcus O Butler, Albiruni R Razak, Philippe L Bedard, Ben X Wang, Pugh J Trevor, Sevan Hakgor, Jeffrey Woo, Benjamin Haibe-Kains, Lillian L Siu, Anna Spreafico. Immune resistance interrogation study (IRIS): Initial report of next generation sequencing (NGS) results in patients with primary versus acquired resistance to anti-PD1/L1 antibodies [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr LBA021.
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Affiliation(s)
- Sofia Genta
- 1Princess Margaret Cancer Center- University Health Network, Toronto, ON, Canada,
| | | | - Ming S Tsao
- 2Princess Margaret Cancer Center- University Health Network, Toronto, Canada,
| | - Aaron R Hansen
- 2Princess Margaret Cancer Center- University Health Network, Toronto, Canada,
| | - Marcus O Butler
- 2Princess Margaret Cancer Center- University Health Network, Toronto, Canada,
| | - Albiruni R Razak
- 2Princess Margaret Cancer Center- University Health Network, Toronto, Canada,
| | - Philippe L Bedard
- 3Princess Margaret Cancer Center-University Health Network, Toronto, Canada
| | - Ben X Wang
- 3Princess Margaret Cancer Center-University Health Network, Toronto, Canada
| | - Pugh J Trevor
- 3Princess Margaret Cancer Center-University Health Network, Toronto, Canada
| | - Sevan Hakgor
- 3Princess Margaret Cancer Center-University Health Network, Toronto, Canada
| | - Jeffrey Woo
- 3Princess Margaret Cancer Center-University Health Network, Toronto, Canada
| | | | - Lillian L Siu
- 3Princess Margaret Cancer Center-University Health Network, Toronto, Canada
| | - Anna Spreafico
- 3Princess Margaret Cancer Center-University Health Network, Toronto, Canada
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Genta S, Yee N, Keshavarzi S, Heirali A, Hansen A, Siu L, Saibil S, Stayner LA, Yanekina M, Pimentel Muniz T, Vilbert M, Bedard P, Abdul Razak A, Coburn B, Chruscinski A, Spreafico A. 989P Autoimmune panels as predictors of immune-related adverse events (irAEs) in patients (pts) treated with immune checkpoint inhibitors (ALERT). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Vilbert M, Rose A, Mantle L, King I, Pimentel Muniz T, Genta S, Arteaga D, Singh R, Saeed Kamil Z, Butler M, Saibil S, Easson A, Covelli A, Hogg D, Spreafico A. 1043P NF1 mutations and immune checkpoint inhibitor outcomes in patients with BRAF wildtype melanoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Colombo I, Genta S, Martorana F, Guidi M, Frattini M, Samartzis EP, Brandt S, Gaggetta S, Moser L, Pascale M, Terrot T, Sessa C, Stathis A. Phase I Dose-Escalation Study of the Dual PI3K-mTORC1/2 Inhibitor Gedatolisib in Combination with Paclitaxel and Carboplatin in Patients with Advanced Solid Tumors. Clin Cancer Res 2021; 27:5012-5019. [PMID: 34266890 DOI: 10.1158/1078-0432.ccr-21-1402] [Citation(s) in RCA: 9] [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] [Received: 04/20/2021] [Revised: 05/22/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This phase I study evaluated safety, tolerability, pharmacokinetics, and preliminary activity of the PI3K/mTORC1/2 dual inhibitor gedatolisib combined with carboplatin and paclitaxel. PATIENTS AND METHODS Patients with advanced solid tumors treated with ≤ 2 prior chemotherapies received intravenous gedatolisib on days 1, 8, 15, and 22 (95, 110, or 130 mg according to dose level); carboplatin (AUC5) on day 8 (day 1 following protocol amendment); and paclitaxel at 80 mg/m2 on days 8, 15, and 22 (1, 8, and 15 after amendment), every 28 days. Patients without progressive disease after cycle 6 received maintenance gedatolisib until progression. RESULTS Seventeen patients were enrolled [11 ovarian (10 clear cell ovarian cancer, CCOC), 4 endometrial, 2 lung cancers]. Median number of prior chemotherapies was 1 (range, 0-2). Median number of administered cycles was 6 (range, 2-16). Dose-limiting toxicities occurred in 4 patients: 2 (cycle 2 delay due to G2-G3 neutropenia) at 110 mg leading to a change in the treatment schedule, 2 at 130 mg (G2 mucositis causing failure to deliver ≥ 75% of gedatolisib at cycle 1). The recommended phase II dose is gedatolisib 110 mg on days 1, 8, 15, and 22 with carboplatin AUC5 on day 1 and paclitaxel 80 mg/m2 on days 1, 8, and 15. The most frequent ≥G3 treatment-related adverse events were neutropenia (35%), anemia (18%), and mucositis (12%). The overall response rate was 65% (80% in CCOC). Pharmacokinetic parameters of gedatolisib were consistent with single-agent results. CONCLUSIONS Gedatolisib combined with carboplatin and paclitaxel is tolerable, and preliminary efficacy was observed especially in CCOC.
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Affiliation(s)
- Ilaria Colombo
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Sofia Genta
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Federica Martorana
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Monia Guidi
- Service of Clinical Pharmacology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Milo Frattini
- Molecular Pathology Laboratory, Cantonal Institute of Pathology, Locarno, Switzerland
| | | | - Simone Brandt
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Sheila Gaggetta
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Laura Moser
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Mariarosa Pascale
- Clinical Trial Unit, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Tatiana Terrot
- Clinical Trial Unit, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Cristiana Sessa
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Anastasios Stathis
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland. .,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Genta S, Ghilardi G, Cascione L, Juskevicius D, Tzankov A, Schär S, Giovanella L, Hayoz S, Mamot C, Dirnhofer S, Zucca E, Ceriani L. INTEGRATION OF BASELINE METABOLIC PARAMETERS AND MUTATIONAL PROFILE PREDICTS OUTCOME IN DLBCL PATIENTS. A
POST HOC
ANALYSIS OF SAKK38/07 STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.18_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Genta
- Oncology Institute of Southern Switzerland Clinic of Medical Oncology Bellinzona Switzerland
| | - G Ghilardi
- Oncology Institute of Southern Switzerland Clinic of Hematology Bellinzona Switzerland
| | - L Cascione
- Università della Svizzera Italiana Institute of Oncology Research Faculty of Biomedical Sciences Bellinzona Switzerland
| | - D Juskevicius
- University Hospital Basel, University of Basel Institute of Medical Genetics and Pathology Basel Switzerland
| | - A Tzankov
- University Hospital Basel, University of Basel Institute of Medical Genetics and Pathology Basel Switzerland
| | - S Schär
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center Coordinating Center Bern Switzerland
| | - L Giovanella
- Imaging Institute of Southern Switzerland Ente Ospedaliero Cantonale Clinic of Nuclear Medicine and PET/CT Center Bellinzona Switzerland
| | - S Hayoz
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center Coordinating Center Bern Switzerland
| | - C Mamot
- Cantonal Hospital Aarau Division of Oncology Aarau Switzerland
| | - S Dirnhofer
- University Hospital Basel, University of Basel Institute of Medical Genetics and Pathology Basel Switzerland
| | - E Zucca
- Oncology Institute of Southern Switzerland Clinic of Medical Oncology Bellinzona Switzerland
| | - L Ceriani
- Imaging Institute of Southern Switzerland Ente Ospedaliero Cantonale Clinic of Nuclear Medicine and PET/CT Center Bellinzona Switzerland
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Genta S, Tsao MS, Wang BX, Hansen AR, Pugh TJ, Lupien M, Coburn B, Diaz-Mejia J, Butler MO, Bedard PL, Abdul Razak AR, Hakgor S, Speers V, Wagner H, Tamblyn L, Ketela T, Torti D, Radulovich N, Siu LL, Spreafico A. Immune Resistance Interrogation Study (IRIS): A prospective comprehensive multi-omic analysis in patients with intrinsic and acquired resistance to immunotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps2679] [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
TPS2679 Background: Immune checkpoint inhibitors (ICI) have demonstrated efficacy in a wide variety of cancers. Nevertheless, only a small proportion of patients derive a durable benefit. Mechanisms underlying primary and acquired resistance are still incompletely understood. They comprise tumor-intrinsic factors such as genomic and transcriptomic changes; upregulation of immunosuppressive subsets; T cell exhaustion; and promotion of an immune-tolerant tumor microenvironment. The collection of tumor biopsy at disease progression (PD) is challenging both in clinical and research settings as this often occurs at the time of treatment discontinuation. However, the analysis of these samples can lead to novel strategies to prevent or reverse immune resistance. Thus, the current approach to begin a profiling study with patients at the time of PD on ICI enables access and interrogation of such samples. Methods: IRIS is a prospective, investigator-initiated trial at the Princess Margaret Cancer Centre that aims to extensively characterize the genomic, transcriptomic, epigenetic and immunophenotypic profiles of tumors with primary versus acquired resistance to ICI-based therapy. Primary resistance is defined as PD at the first on-treatment imaging, whereas acquired resistance is defined as PD occurring after an initial partial or complete response or following disease stability lasting ≥6 months. Additional objectives include the evaluation of radiomic parameters on standard radiological imaging, investigation of fecal microbiome, generation of patient-derived organoids and facilitation of data and sample sharing with the research community. The planned samples size is 100 patients. A one-time fresh tumor biopsy, blood and stool samples and archival tissue (when available) are collected at the time of PD on ICI (baseline) from all the participants. Longitudinal blood samples are obtained every 2-3 months (around the time of tumor imaging) until PD in patients receiving a subsequent treatment. Subjects who are not amenable for therapy undergo blood collections at the time of further PD. Molecular characterization of tumor samples includes: DNA/RNA sequencing, Assay of Transposase Accessible Chromatin (ATAC)-sequencing, Cellular Indexing of Transcriptomes and Epitopes (CITE)-sequencing, multiplexed immunohistochemistry and flow cytometry. Results of NGS performed on the first biopsy core are returned to patient and physician. Key eligibility criteria include diagnosis of solid tumor, progression to ICI as the most recent line of treatment and disease amenable to core needle biopsy. The IRIS trial, activated in October 2020, is currently open to enrollment. As of January 2021, 21 patients have been enrolled and a total of 92 tissue cores, 42 blood and 20 stool samples have been collected. Clinical trial information: NCT04243720.
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Affiliation(s)
- Sofia Genta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ming Sound Tsao
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Ben X Wang
- Princess Margaret-University Health Network, Toronto, ON, Canada
| | - Aaron Richard Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Trevor John Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mathieu Lupien
- Princess Margaret Cancer Centre / University Health Network, Toronto, ON, Canada
| | - Bryan Coburn
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Javier Diaz-Mejia
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada, Toronto, ON, Canada
| | - Marcus O. Butler
- Tumor Immunotherapy Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | | | - Sevan Hakgor
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Heidi Wagner
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada, Toronto, ON, Canada
| | - Laura Tamblyn
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada, Toronto, ON, Canada
| | - Troy Ketela
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada, Toronto, ON, Canada
| | - Dax Torti
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Nikolina Radulovich
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada, Toronto, ON, Canada
| | - Lillian L. Siu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Pimentel Muniz T, Lone H, Arteaga DP, Gray D, Silveira Vilbert Pereira MT, Mantle L, Singh R, Genta S, Saibil S, Hogg D, Spreafico A, Butler MO. Outcomes of non-treatment naive melanoma patients with central nervous system relapse. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9557] [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
9557 Background: Melanoma has a high probability of central nervous system (CNS) spread. Although first line nivolumab and ipilimumab resulted in 56% response rate and 29.2 months median overall survival (OS) in patients with melanoma brain metastases (MBM), there is paucity of data for patients who develop MBM after prior systemic therapy. As this subgroup is often underrepresented in clinical trials, we aimed to evaluate the OS of non-treatment naïve patients who develop MBM and identify factors related to survival. Methods: In this single-center, retrospective study, consecutive melanoma patients with > 90 days from exposure to either immune checkpoint inhibitor (ICI), targeted therapy (TT), or chemotherapy, to CNS relapse were included. OS was defined as the time between CNS relapse and death by any cause. The Log-Rank method was used to calculate OS. Cox regression analysis was used to identify differences between subgroups. Variables with a p value < 0.1 were included in a multivariate model. A p value < 0.05 was considered statistically significant. Results: Between 2012 and 2018, 135 patients were identified. Median age was 57 (29-92) years, 92 (68%) were male, and median number of prior systemic therapies was 2 (1-6). One-hundred and nine (81%) patients had cutaneous melanoma; acral lentiginous melanoma (ALM) comprised 11 (8%) patients. Molecular studies were available for 123 patients, of whom 61 (50%) were BRAF V600 mutant. Eighty-nine (66%) patients had prior ICI, of whom 33 (37%) had prior exposure to both anti-PD1 and anti-CTLA-4, either as monotherapy or combination. Amongst the BRAF V600 mutant population, 48 (79%) had prior TT. Radiotherapy was given to 112 patients, of whom 55 (49%) had SRS. Median follow-up was 41 (95% CI 30-51) months. Median OS was 6.4 (95% CI 5.3-7.5) months. Patients with ALM, > 3 MBM, ECOG 2-4 and active treatment at CNS relapse (< 30 days from last dose of treatment to MBM diagnosis) were at increased risk of death, whilst subsequent treatment with ICI was related to better survival (Table). On multivariate analyses, age ( p = 0.007), subtype ( p = 0.04), number of MBM ( p = 0.01), active treatment at CNS relapse ( p < 0.001) and subsequent ICI ( p = 0.002) remained statistically significant. Exploratory analyses suggested subsequent treatment with anti-PD1 + anti-CTLA-4 (n = 42) compared favourably to subsequent anti-CTLA-4 only (n = 21) (13 x 7 months, p = 0.004), and was independent of prior ICI. Conclusions: Previously treated melanoma patients who develop MBM have a poor prognosis, but subsequent ICI therapy seems to be associated with better OS. Further clinical investigation to identify optimal anti-PD1-based therapies is warranted for non-treatment naïve patients who develop MBM.[Table: see text]
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Affiliation(s)
- Thiago Pimentel Muniz
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Hadee Lone
- School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Diana Paola Arteaga
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Diana Gray
- Tumor Immunotherapy Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Luke Mantle
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Raviya Singh
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sofia Genta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Samuel Saibil
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Hogg
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marcus O. Butler
- Tumor Immunotherapy Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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22
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Govindan R, Townsend AR, Miller KD, Mehmi I, Kuboki Y, Dumbrava EE, Hamilton EP, Vuu I, Rasmussen E, Mileshkin LR, Genta S, Iwata H, Adams S, Fujii H, Chawla SP. Trial in progress: A phase 1, multicenter, open-label, dose-exploration and dose-expansion study evaluating the safety, tolerability, pharmacokinetics, and efficacy of AMG650 in subjects with advanced solid tumors. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps5600] [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
TPS5600 Background: KIF18A is a mitotic kinesin motor protein that regulates chromosome positioning during cell division and is overexpressed in a subset of human cancers. TP53 mutant unstable aneuploid cancer cells with chromosomal instability (CIN) features are dependent on KIF18A motor activity to prevent lethal multipolar cell division. Preclinical data demonstrate that treatment with AMG 650; an oral, first in class, selective small molecule inhibitor of KIF18A may be safe and tolerable. We are conducting a first-in-human phase 1 study with AMG 650 in adult subjects with locally advanced or metastatic solid tumors with TP53MUT, triple negative breast cancer (TNBC), high grade serous ovarian cancer (HGSOC) or serous like endometrial cancers and other solid tumors. Methods: In this phase 1, multicentric, dose escalation and dose expansion study we evaluate the safety and tolerability of AMG 650 monotherapy in patients with advanced/metastatic solid tumors (NCT04293094). The main objective is to determine the maximum tolerated dose (MTD) and/or recommended phase 2 dose (RP2D) based on emerging safety, efficacy, and pharmacodynamics (PD) data prior to reaching the MTD. Key inclusion criteria include the presence of measurable disease and diagnosis of advanced/metastatic triple negative breast cancer (TNBC), high-grade serous ovarian cancer (HGSOC), serous-like endometrial cancer or other solid tumors with documented TP53 mutations. In the dose expansion phase, participants with locally advanced or metastatic TNBC or HGSOC will be treated with the preliminary RP2D identified from the dose exploration part of the study. Primary endpoints include the incidence of Dose Limiting Toxicities (DLTs),Treatment-Emergent Adverse Events (TEAEs), Serious Adverse Events (SAEs), Treatment-related Adverse Events and the evaluation of the number of participants who experience a clinically significant change from baseline in vital signs, electrocardiogram and laboratory tests parameters. Secondary endpoints include Objective Response Rate, Duration of Response, Progression-free Survival, Clinical Benefit Rate, Time to Response, Time to Progression, Overall Survival (OS), Maximum Plasma Concentration (Cmax) of AMG 650, Time to Maximum Plasma Concentration (Tmax) of AMG 650 as well as Area Under the Plasma Concentration-time Curve (AUC) Over the Dosing Interval for AMG 650. Continuous monitoring of toxicity is conducted. The study began enrolling pts in March 2020 and is ongoing. For more information, please contact Amgen Medical Information: medinfo@amgen.com Clinical trial information: NCT04293094.
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Affiliation(s)
| | | | - Kathy D. Miller
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Inderjit Mehmi
- The Angeles Clinic and Research Institute, An Affiliate of Cedar-Sinai, Los Angeles, WV
| | - Yasutoshi Kuboki
- Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | | | - Erika P. Hamilton
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | | | | | - Linda R. Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sofia Genta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Sylvia Adams
- New York University Cancer Institute, New York, NY
| | - Hisaki Fujii
- Amgen Inc San Francisco, South San Francisco, CA
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Pimentel Muniz T, Araujo DV, Savage KJ, Cheng T, Saha M, Song X, Gill S, Monzon JG, Grenier D, Genta S, Spreafico A, Hogg D. Pan-Canadian cohort of immune checkpoint inhibitor-induced insulin-dependent diabetes mellitus (CANDIED). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.2640] [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
2640 Background: Endocrine immune-related adverse events (irAEs) are frequent with immune checkpoint inhibitors (ICIs); however, ICI-related insulin-dependent diabetes mellitus (IDDM) is a rare but serious endocrine irAE. We describe the characteristics of patients who developed ICI-related IDDM across five academic Canadian cancer centres. Methods: In this multicentre, retrospective study, we included both patients who developed IDDM and patients with non-IDDM (NIDDM) or pre-DM who became insulin-dependent while on treatment with ICI. We collected data on primary tumor type, ICI regimen (single agent or combination), time to development of IDDM from ICI initiation, comorbidities, laboratory parameters at the time of IDDM diagnosis, tumor response and survival. A p value < 0.05 was considered statistically significant. Results: We identified 27 patients between July 2016 and August 2019. Median age was 60 (39-79) years, 20 (74%) were male, 15 (55%) had melanoma and 4 each (15%) non-small cell lung cancer (NSCLC) and renal cell carcinoma. Seven (26%) patients had prior NIDDM or pre-DM; 5 (18%) had an auto-immune disease (2 psoriasis, 2 inflammatory bowel disease, and 1 systemic lupus erythematosus). Laboratory parameters at presentation and management of IDDM are presented in the Table. Mean A1c was not statistically different between patients with or without prior NIDDM or pre-DM (8.4% vs. 8.6%; p = 0.9). All IDDM events were irreversible; 1 (4%) patient died of diabetic ketoacidosis. At time of IDDM diagnosis, 17 (63%) patients were receiving single agent anti-PD1 and 10 (37%) anti-PD1-based combinations (7 anti-CTLA-4, and 3 other compounds). Median time for development of IDDM from ICI initiation was 2.7 months (95% CI 0.2-5.3). Patients receiving combination ICI developed IDDM earlier than those treated with single agent (1.4 vs 4.8 months; p = 0.05). Amongst patients with metastatic disease (n = 24), 9 (38%) had a complete response and 7 (29%) had a partial response. Two patients (8%) were treated in the adjuvant setting; 1 (4%) received consolidation ICI. IDDM led to ICI discontinuation in 12 (44%) patients. After a median follow up of 21 months from ICI initiation, median survival was 30 months (95% CI NE) and was not reached in patients with melanoma and NSCLC. Conclusions: ICI-related IDDM is a rare and typically irreversible irAE that occurs early in the course of treatment and develops earlier with combination ICI. In this cohort, patients who developed ICI-related IDDM had a high tumor response rate and prolonged survival, especially melanoma and NSCLC patients. Prospective evaluation of autoantibodies to predict development of IDDM is ongoing.[Table: see text]
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Affiliation(s)
- Thiago Pimentel Muniz
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Kerry J. Savage
- Division of Medical Oncology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Tina Cheng
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Moumita Saha
- School of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Xinni Song
- Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Sabrina Gill
- Division of Endocrinology & Metabolism, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Debjani Grenier
- Department of Medical Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Sofia Genta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Hogg
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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24
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Rose AAN, Ayodele O, Genta S, Pimentel Muniz T, Kelly D, Hodgson K, King I, Stockley T, Pugh TJ, Saeed Kamil Z, Butler MO, Shepherd FA, Bedard PL, Leighl NB, Abdul Razak AR, Hansen AR, Saibil S, Cescon DW, Siu LL, Spreafico A. Preliminary results of BEAVER: An investigator-initiated phase II study of binimetinib and encorafenib for the treatment of advanced solid tumors with non-V600E BRAF mutations (mts). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e15038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15038 Background: Recurring oncogenic non-V600E BRAF mts have been identified in many cancer types. Preclinical data indicate that some BRAF non-V600E mts can be targeted with BRAF + MEK inhibitors. BEAVER is an investigator-initiated study designed to test the safety and efficacy of binimetinib and encorafenib (B+E) in patients (pts) with non-V600E BRAF mts. Methods: Key eligibility criteria are: pts with advanced solid tumors with BRAF non-V600E activating (class 1 and 2) or inhibitory (class 3) mts, and no prior BRAF/MEK inhibitors. Pts receive binimetinib (45mg PO BID) and encorafenib (450mg PO daily) on a 28-day cycle until intolerable toxicity or progression. The primary objective is OR rate (ORR) as per RECIST 1.1. In this Simon 2-stage trial, ≥1 of 7 pts need to have an objective response (OR) before commencing second stage of study (26 pts total). Secondary objectives include: safety, DCR, PFS, and OS. Exploratory objectives include: genomic profiling of tumors, evaluating circulating tumor DNA dynamics and development of patient derived xenograft (PDX) models. Results: From June 2019 to Feb 2021, 12 pts were screened and 9 pts enrolled; 9 are evaluable for safety and 8 for efficacy. Tumor types were melanoma and colon (n=2 each), as well as gallbladder, lung, breast and uterine cancers (n=1 each). Median age was 62 yrs (range 40-72). Median number of prior treatments was 2 (range 0-6). 1 pt had a class 1, 3 pts had class 2, and 5 pts had class 3, non-V600E BRAF mts. The median number of cycles was 2 (range: 1-7). Common treatment-related adverse events were mostly grade ≤ 2, and included: Blurred vision (78%), fatigue (67%), nausea (44%), vomiting (33%), and rash (33%). Dose reductions were required in 4/9 pts (44%) due to: blurred vision (22%), central serous retinopathy (11%), malaise (11%) and increased lipase (11%). Drug-related grade 3 AEs occurred in 2/9 pts and included: malaise (11%), confusion (11%), fatigue (11%) and increased lipase (11%). All eye toxicities were reversible with dose interruption. ORR was 12.5% (1/8) with one unconfirmed PR in a melanoma pt (BRAF G469S), treated for 6.5 months. One gallbladder cancer pt (BRAF D594N) had SD, and 6 pts had PD as best response. Genomic profiling was performed on archival tumors for 8 pts. Two PDX models were established. Responses to B+E in PDX models mirrored responses in 2 corresponding pts who had PD. Genomic and molecular profiling of pt tumors and corresponding PDXs identified multiple potential mechanisms of B+E resistance including: activation of EGFR and Akt pathways and inactivation of NF1 and Rb1. Conclusions: Preliminary data confirmed the safety of B+E and showed preliminary evidence of anti-tumor activity in advanced cancer pts with non-V600E BRAF mts. This study met the criterion for advancing to stage 2. Enrolment in the BEAVER trial and correlative biomarker analyses are ongoing. Clinical trial information: NCT03839342.
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Affiliation(s)
- April A. N. Rose
- Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada
| | | | - Sofia Genta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Thiago Pimentel Muniz
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Deirdre Kelly
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | - Ian King
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Tracy Stockley
- University Health Network, Genome Diagnostics, Laboratory Medicine Program, Toronto, ON, Canada
| | | | - Zaid Saeed Kamil
- Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marcus O. Butler
- Tumor Immunotherapy Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Frances A. Shepherd
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Natasha B. Leighl
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - Aaron Richard Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Samuel Saibil
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David W. Cescon
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Lillian L. Siu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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25
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Mittica G, Goia M, Gambino A, Scotto G, Fonte M, Senetta R, Aglietta M, Borella F, Sapino A, Katsaros D, Maggiorotto F, Ghisoni E, Giannone G, Tuninetti V, Genta S, Eusebi C, Momi M, Cassoni P, Valabrega G. Validation of Androgen Receptor loss as a risk factor for the development of brain metastases from ovarian cancers. J Ovarian Res 2020; 13:53. [PMID: 32366278 PMCID: PMC7199337 DOI: 10.1186/s13048-020-00655-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/24/2020] [Indexed: 12/21/2022] Open
Abstract
Background Central nervous system (CNS) spreading from epithelial ovarian carcinoma (EOC) is an uncommon but increasing phenomenon. We previously reported in a small series of 11 patients a correlation between Androgen Receptor (AR) loss and localization to CNS. Aims of this study were: to confirm a predictive role of AR loss in an independent validation cohort; to evaluate if AR status impacts on EOC survival. Results We collected an additional 29 cases and 19 controls as validation cohort. In this independent cohort at univariate analysis, cases exhibited lower expression of AR, considered both as continuous (p < 0.001) and as discrete variable (10% cut-off: p < 0.003; Immunoreactive score: p < 0.001). AR negative EOC showed an odds ratio (OR) = 8.33 for CNS dissemination compared with AR positive EOC. Kaplan-Meier curves of the combined dataset, combining data of new validation cohort with the previously published cohort, showed that AR < 10% significantly correlates with worse outcomes (p = 0.005 for Progression Free Survival (PFS) and p = 0.002 for brain PFS (bPFS) respectively). Comparison of AR expression between primary tissue and paired brain metastases in the combined dataset did not show any statistically significant difference. Conclusions We confirmed AR loss as predictive role for CNS involvement from EOC in an independent cohort of cases and controls. Early assessment of AR status could improve clinical management and patients’ prognosis.
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Affiliation(s)
- Gloria Mittica
- Unit of Oncology, ASL Verbano Cusio Ossola (VCO), Domodossola, Italy
| | - Margherita Goia
- Unit of Pathology, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Angela Gambino
- Department Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Giulia Scotto
- Department of Oncology, University of Torino, Turin, Italy. .,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy.
| | - Mattia Fonte
- Department of Oncology, University of Torino, Turin, Italy
| | - Rebecca Senetta
- Unit of Pathology, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Fulvio Borella
- Department of Surgical Sciences, Gynecology, AOU, Città della Salute e della Scienza, Turin, Italy
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Dionyssios Katsaros
- Department of Surgical Sciences, Gynecology, AOU, Città della Salute e della Scienza, Turin, Italy
| | | | - Eleonora Ghisoni
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Gaia Giannone
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Valentina Tuninetti
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Sofia Genta
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
| | - Chiara Eusebi
- Department Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Marina Momi
- Department Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Paola Cassoni
- Unit of Pathology, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
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26
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Capellero S, Erriquez J, Melano C, Mesiano G, Genta S, Pisacane A, Mittica G, Ghisoni E, Olivero M, Di Renzo MF, Aglietta M, Sangiolo D, Valabrega G. Preclinical immunotherapy with Cytokine-Induced Killer lymphocytes against epithelial ovarian cancer. Sci Rep 2020; 10:6478. [PMID: 32296104 PMCID: PMC7160190 DOI: 10.1038/s41598-020-63634-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 04/02/2020] [Indexed: 02/07/2023] Open
Abstract
Despite improvements in surgery and medical treatments, epithelial ovarian cancer (EOC) remains the most lethal gynaecological malignancy. Aim of this study is to investigate the preclinical immunotherapy activity of cytokine-induced killer lymphocytes (CIK) against epithelial ovarian cancers, focusing on platinum-resistant settings. We generated CIK ex vivo starting from human peripheral blood samples (PBMCs) collected from EOC patients. Their antitumor activity was tested in vitro and in vivo against platinum-resistant patient-derived ovarian cancer cells (pdOVCs) and a Patient Derived Xenograft (PDX), respectively. CIK were efficiently generated (48 fold median ex vivo expansion) from EOC patients; pdOVCs lines (n = 9) were successfully generated from metastatic ascites; the expression of CIK target molecules by pdOVC confirmed pre and post treatment in vitro with carboplatin. The results indicate that patient-derived CIK effectively killed autologous pdOVCs in vitro. Such intense activity was maintained against a subset of pdOVC that survived in vitro treatment with carboplatin. Moreover, CIK antitumor activity and tumor homing was confirmed in vivo within an EOC PDX model. Our preliminary data suggest that CIK are active in platinum resistant ovarian cancer models and should be therefore further investigated as a new therapeutic option in this extremely challenging setting.
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Affiliation(s)
- S Capellero
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - J Erriquez
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - C Melano
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - G Mesiano
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - S Genta
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - A Pisacane
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - G Mittica
- Unit of Oncology, ASL Verbano Cusio Ossola (VCO), Verbania, Italy
| | - E Ghisoni
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - M Olivero
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - M F Di Renzo
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - M Aglietta
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - D Sangiolo
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - G Valabrega
- Department of Oncology, University of Torino, Torino, Italy. .,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy.
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27
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Giannone G, Attademo L, Scotto G, Genta S, Ghisoni E, Tuninetti V, Aglietta M, Pignata S, Valabrega G. Endometrial Cancer Stem Cells: Role, Characterization and Therapeutic Implications. Cancers (Basel) 2019; 11:cancers11111820. [PMID: 31752447 PMCID: PMC6896186 DOI: 10.3390/cancers11111820] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 09/30/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 02/06/2023] Open
Abstract
Endometrial cancer (EC) is the most frequent gynecological cancer. In patients with relapsed and advanced disease, prognosis is still dismal and development of resistance is common. In this context, endometrial Cancer Stem Cells (eCSC), stem-like cells capable to self-renewal and differentiation in mature cancer cells, represent a potential field of expansion for drug development. The aim of this review is to characterize the role of eCSC in EC, their features and how they could be targeted. CSC are involved in progression, invasiveness and metastasis (though epithelial to mesenchimal transition, EMT), as well as chemoresistance in EC. Nevertheless, isolation of eCSC is still controversial. Indeed, CD133, Aldheyde dehydrogenase (ALDH), CD117, CD55 and CD44 are enriched in CSCs but there is no universal marker nowadays. The most frequently activated pathways in eCSC are Wingless-INT (Wnt)/β-catenin, Notch1, and Hedghog, with a high expression of self-renewal transcription factors like Octamer binding transcription factor 4 (OCT), B Lymphoma Mo-MLV Insertion Region 1 Homolog (BMI1), North American Network Operations Group Homebox protein (NANOG), and SRY-Box 2 (SOX2). These pathways have been targeted with selective drugs alone or in combination with chemotherapy and immunotherapy. Unfortunately, although preclinical results are encouraging, few clinical data are available.
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Affiliation(s)
- Gaia Giannone
- Department of Oncology, University of Torino, 10124 Torino, Italy; (G.S.); (S.G.); (E.G.); (V.T.); (M.A.); (G.V.)
- Candiolo Cancer Institute, FPO - IRCCS - Str. Prov.le 142, km. 3,95, 10060 Candiolo (TO), Italy
- Correspondence: ; Tel.: +390-119933253; Fax: +390-119933275
| | - Laura Attademo
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, 80131 Napoli, Italy; (L.A.); (S.P.)
| | - Giulia Scotto
- Department of Oncology, University of Torino, 10124 Torino, Italy; (G.S.); (S.G.); (E.G.); (V.T.); (M.A.); (G.V.)
- Candiolo Cancer Institute, FPO - IRCCS - Str. Prov.le 142, km. 3,95, 10060 Candiolo (TO), Italy
| | - Sofia Genta
- Department of Oncology, University of Torino, 10124 Torino, Italy; (G.S.); (S.G.); (E.G.); (V.T.); (M.A.); (G.V.)
- Candiolo Cancer Institute, FPO - IRCCS - Str. Prov.le 142, km. 3,95, 10060 Candiolo (TO), Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Torino, 10124 Torino, Italy; (G.S.); (S.G.); (E.G.); (V.T.); (M.A.); (G.V.)
- Candiolo Cancer Institute, FPO - IRCCS - Str. Prov.le 142, km. 3,95, 10060 Candiolo (TO), Italy
| | - Valentina Tuninetti
- Department of Oncology, University of Torino, 10124 Torino, Italy; (G.S.); (S.G.); (E.G.); (V.T.); (M.A.); (G.V.)
- Candiolo Cancer Institute, FPO - IRCCS - Str. Prov.le 142, km. 3,95, 10060 Candiolo (TO), Italy
| | - Massimo Aglietta
- Department of Oncology, University of Torino, 10124 Torino, Italy; (G.S.); (S.G.); (E.G.); (V.T.); (M.A.); (G.V.)
- Candiolo Cancer Institute, FPO - IRCCS - Str. Prov.le 142, km. 3,95, 10060 Candiolo (TO), Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, 80131 Napoli, Italy; (L.A.); (S.P.)
| | - Giorgio Valabrega
- Department of Oncology, University of Torino, 10124 Torino, Italy; (G.S.); (S.G.); (E.G.); (V.T.); (M.A.); (G.V.)
- Candiolo Cancer Institute, FPO - IRCCS - Str. Prov.le 142, km. 3,95, 10060 Candiolo (TO), Italy
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Ghisoni E, Giannone G, Tuninetti V, Genta S, Scotto G, Aglietta M, Sangiolo D, Mittica G, Valabrega G. Veliparib: a new therapeutic option in ovarian cancer? Future Oncol 2019; 15:1975-1987. [DOI: 10.2217/fon-2018-0883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The role of poly ADP ribose polymerase inhibitors in ovarian cancer is rapidly evolving. Three different poly ADP ribose polymerase inhibitors (olaparib, niraparib and rucaparib) have been already approved as maintenance after response to platinum-based chemotherapy; two of them (olaparib and rucaparib) also as single agents. Veliparib, a novel PARPI, showed promising results in preclinical and early clinical settings. The aim of this review is to discuss veliparib’s mechanisms of action, to provide a clinical update on its safety and activity in ovarian cancer, and to highlight future perspectives for its optimal use. Veliparib favorable toxicity profile encourages its use either as monotherapy or in combination. Its peculiar neuroprotective and radio-sensitizing effect warrant further investigation.
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Affiliation(s)
- Eleonora Ghisoni
- Candiolo Cancer Institute FPO/IRCCS, Strada provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Torino, Italy
| | - Gaia Giannone
- Candiolo Cancer Institute FPO/IRCCS, Strada provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Torino, Italy
| | - Valentina Tuninetti
- Candiolo Cancer Institute FPO/IRCCS, Strada provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Torino, Italy
| | - Sofia Genta
- Candiolo Cancer Institute FPO/IRCCS, Strada provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Torino, Italy
| | - Giulia Scotto
- Candiolo Cancer Institute FPO/IRCCS, Strada provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Torino, Italy
| | - Massimo Aglietta
- Candiolo Cancer Institute FPO/IRCCS, Strada provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Torino, Italy
| | - Dario Sangiolo
- Candiolo Cancer Institute FPO/IRCCS, Strada provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Torino, Italy
| | - Gloria Mittica
- Candiolo Cancer Institute FPO/IRCCS, Strada provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
| | - Giorgio Valabrega
- Candiolo Cancer Institute FPO/IRCCS, Strada provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Torino, Italy
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29
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Mittica G, Ghisoni E, Giannone G, Genta S, Aglietta M, Sapino A, Valabrega G. PARP Inhibitors in Ovarian Cancer. Recent Pat Anticancer Drug Discov 2018; 13:392-410. [PMID: 29512470 DOI: 10.2174/1574892813666180305165256] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [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: 01/16/2018] [Revised: 02/27/2018] [Accepted: 02/27/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Treatment of Epithelial Ovarian Cancer (EOC), historically based on surgery and platinum doublet chemotherapy, is associated with high risk of relapse and poor prognosis for recurrent disease. In this landscape, the innovative treatment with PARP inhibitors (PARPis) demonstrated an outstanding activity in EOC, and is currently changing clinical practice in BRCA mutant patients. OBJECTIVES The study aimed to highlight the mechanism of action, pharmacokinetics, clinical activity, indications and current strategies of development of Olaparib, Niraparib, Rucaparib, Talazoparib and Veliparib, the 5 most relevant PARPis. METHODS We performed a review on Pubmed using 'ovarian cancer' and the name of each PARPi (PARP inhibitor) discussed in the review as Medical Subject Headings (MeSH) keywords. The same search was performed on "clinicaltrial.gov" to identify ongoing clinical trials and on "google. com/patents" and "uspto.gov" for recent patents exploring PARPIs in ovarian cancer. RESULTS Olaparib, Niraparib and Rucaparib are already approved for the treatment of recurrent EOC and their indications are partially overlapping. Talazoparib and Veliparib are promising PARPis, but currently under investigation in early phase trials. Several studies are evaluating PARPis in monotherapy or in associations, in a wide range of settings (i.e. first line, neoadjuvant, platinum-sensitive and resistant disease). CONCLUSION PARPis are valuable options in patients with recurrent ovarian cancer with promising activity in different stages of this disease. Further studies are required to better define optimal clinical settings, predictors of response beyond BRCA mutations and strategies to overcome secondary resistance of PARPis therapy in EOC.
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Affiliation(s)
- Gloria Mittica
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute-FPO-IRCCS, Candiolo, Torino, Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute-FPO-IRCCS, Candiolo, Torino, Italy
| | - Gaia Giannone
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute-FPO-IRCCS, Candiolo, Torino, Italy
| | - Sofia Genta
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute-FPO-IRCCS, Candiolo, Torino, Italy
| | | | - Anna Sapino
- Candiolo Cancer Institute-FPO-IRCCS, Candiolo, Torino, Italy.,Department of Medical Sciences, University of Torino, Torino, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Torino, Torino, Italy.,Candiolo Cancer Institute-FPO-IRCCS, Candiolo, Torino, Italy
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30
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Ghisoni E, Katsaros D, Maggiorotto F, Aglietta M, Vaira M, De Simone M, Mittica G, Giannone G, Robella M, Genta S, Lucchino F, Marocco F, Borella F, Valabrega G, Ponzone R. A predictive score for optimal cytoreduction at interval debulking surgery in epithelial ovarian cancer: a two- centers experience. J Ovarian Res 2018; 11:42. [PMID: 29843747 PMCID: PMC5975698 DOI: 10.1186/s13048-018-0415-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 02/21/2018] [Accepted: 05/16/2018] [Indexed: 02/05/2023] Open
Abstract
Background Optimal cytoreduction (macroscopic Residual Tumor, RT = 0) is the best survival predictor factor in epithelial ovarian cancer (EOC). It doesn’t exist a consolidated criteria to predict optimal surgical resection at interval debulking surgery (IDS). The aim of this study is to develop a predictive model of complete cytoreduction at IDS. Methods We, retrospectively, analyzed 93 out of 432 patients, with advanced EOC, underwent neoadjuvant chemotherapy (NACT) and IDS from January 2010 to December 2016 in two referral cancer centers. The correlation between clinical-pathological variables and residual disease at IDS has been investigated with univariate and multivariate analysis. A predictive score of cytoreduction (PSC) has been created by combining all significant variables. The performance of each single variable and PSC has been reported and the correlation of all significant variables with progression free survival (PFS) has been assessed. Results At IDS, 65 patients (69,8%) had complete cytoreduction with no residual disease (R = 0). Three criteria independently predicted R > 0: age ≥ 60 years (p = 0.014), CA-125 before NACT > 550 UI/dl (p = 0.044), and Peritoneal Cancer Index (PCI) > 16 (p < 0.001). A PSC ≥ 3 has been associated with a better accuracy (85,8%), limiting the number of incomplete surgeries to 16,5%. Moreover, a PCI > 16, a PSC ≥ 3 and the presence of R > 0 after IDS were all significantly associated with shorter PFS (p < 0.001, p < 0.001 and p = 0.004 respectively). Conclusions Our PSC predicts, in a large number of patients, complete cytoreduction at IDS, limiting the rate of futile extensive surgeries in case of presence of residual tumor (R > 0). The PSC should be prospectively validated in a larger series of EOC patients undergoing NACT-IDS.
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Affiliation(s)
- Eleonora Ghisoni
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | - Dionyssios Katsaros
- Department of Surgical Sciences, Gynecology, AOU, Città della Salute e della Scienza, Turin, Italy
| | - Furio Maggiorotto
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - Massimo Aglietta
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | - Marco Vaira
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - Michele De Simone
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - Gloria Mittica
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | - Gaia Giannone
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | - Manuela Robella
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - Sofia Genta
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | - Fabiola Lucchino
- Department of Surgical Sciences, Gynecology, AOU, Città della Salute e della Scienza, Turin, Italy
| | - Francesco Marocco
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - Fulvio Borella
- Department of Surgical Sciences, Gynecology, AOU, Città della Salute e della Scienza, Turin, Italy
| | - Giorgio Valabrega
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy. .,Department of Oncology, University of Torino, Turin, Italy.
| | - Riccardo Ponzone
- Candiolo Cancer Institute FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
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Perez Garcia JM, Cortés J, Stathis A, Mous R, López-Miranda E, Azaro A, Genta S, Nuciforo P, Vivancos A, Ferrarotto R, Bertoni F, Rossi D, Spardy Burr N, Schönborn-Kellenberger O, Jorga K, Beni L, Lehal R, Bauer M, Weber D, Garralda E. First-in-human phase 1-2A study of CB-103, an oral Protein-Protein Interaction Inhibitor targeting pan-NOTCH signalling in advanced solid tumors and blood malignancies. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps2619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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)
| | - Javier Cortés
- Ramon y Cajal University Hospital, Madrid, and Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Anastasios Stathis
- IOSI - Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Rogier Mous
- UMC Utrecht Cancer Center, Utrecht, Netherlands
| | | | - Analía Azaro
- Medical Oncology Department, Vall d’Hebron University Hospital; Molecular Therapeutics Research Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Sofia Genta
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Paolo Nuciforo
- Molecular Pathology Laboratory, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Francesco Bertoni
- Università della Svizzera italiana, Institute of Oncology Research, Bellinzona, Switzerland
| | - Davide Rossi
- Institute of Oncology Research and Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | | | - Karin Jorga
- Karin Jorga Life Science Consulting GmbH, Basel, Switzerland
| | - Laura Beni
- Cellestia Biotech AG, Basel, Switzerland
| | | | | | - Dirk Weber
- Cellestia Biotech AG, Basel, Switzerland
| | - Elena Garralda
- Medical Oncology Department, Vall d’Hebron University Hospital; Molecular Therapeutics Research Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Mittica G, Senetta R, Scotto G, Aglietta M, Maggiorotto F, Ghisoni E, Genta S, Boldorini R, Manini C, Morra I, Buosi R, Sapino A, Cassoni P, Valabrega G. Androgen receptor status predicts development of brain metastases in ovarian cancers. Oncotarget 2018; 8:41143-41153. [PMID: 28467804 PMCID: PMC5522232 DOI: 10.18632/oncotarget.17068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/17/2017] [Indexed: 12/20/2022] Open
Abstract
Brain metastases are uncommon localizations in epithelial ovarian cancer (EOC), their reported incidence is increasing and no predictive biomarkers have been identified yet. Goals of this study were: i) to define a possible association between Estrogen Receptor (ER), Progesterone Receptor (PR), Androgen Receptor (AR), human EGF receptor 2 (HER2) and brain progression in EOC patients, and ii) to identify differences in ER, PR, AR and HER2 protein expression from primary EOC and its matched resected brain metastasis. A retrospective series of 11 EOC with matched brain metastasis surgically removed was collected. For comparison, a “Control dataset” of 22 patients, without evidence of brain involvement after an adequate follow up was matched. ER, PR, AR and HER2 status were analyzed by means of immunohistochemistry forCases (both primary and metastatic lesions) and Controls. Univariate analysis showed that AR status was significantly associated with brain localization, both considered as discrete variable (cut-off: 10%, p=0.013) and as continuous one (p=0.035). Multivariate analysis confirmed this trend (p=0.053). When considered as continuous variables, ER and AR showed greater expression in primary tumors in comparison with brain metastases (p=0.013 and p=0.032, respectively). In our series, AR predicts brain involvement, with a 9.5 times higher propensity for AR-negative EOC. Moreover, brain dissemination is probably the result of progressive dedifferentiation of primary tumor, shown by reduction of ER and AR expression in metastases. Further studies are required, in order to anticipate and improve multimodal treatment of brain metastases.
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Affiliation(s)
- Gloria Mittica
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Rebecca Senetta
- Unit of Pathology Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Giulia Scotto
- Department of Oncology, University of Turin, Turin, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Furio Maggiorotto
- Division of Gynecologic Oncology, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Sofia Genta
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Renzo Boldorini
- Department of Health Science, University of Eastern Piedmont "Amedeo Avogadro", Novara, Italy
| | - Claudia Manini
- Unit of Pathology, Giovanni Bosco Hospital, Turin, Italy
| | - Isabella Morra
- Unit of Pathology, Città della Salute e della Scienza, Turin, Italy
| | - Roberta Buosi
- Division of Oncology, Santo Spirito Hospital, Casale Monferrato, Italy
| | - Anna Sapino
- Unit of Pathology Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paola Cassoni
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Turin, Turin, Italy.,Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
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Abstract
INTRODUCTION Epithelial ovarian cancer (EOC) is the most common cause of death among gynecological malignancies. Despite surgical and pharmacological efforts to improve patients' outcome, persistent and recurrent EOC remains an un-eradicable disease. Chimeric associated antigens (CAR) T cells are T lymphocytes expressing an engineered T cell receptor that activate the immune response after an MHC unrestricted recognition of specific antigens, including tumor associated antigens (TAAs). CART cells have been shown to be effective in the treatment of hematologic tumors even if frequently associated with potentially severe toxicity and high production costs. AREAS COVERED In this review, we will focus on preclinical and clinical studies evaluating CART activity in EOC in order to identify possible difficulties and advantages of their use in this particular setting. EXPERT OPINION The pattern of diffusion within the peritoneal cavity, the tumor microenvironment and the high rate of TAAs make EOC a particularly interesting model for CART cells use. Data from preclinical studies indicate a potential activity of CARTs in EOC, but robust clinical data are still awaited. Further studies are needed to determine the best methods of administration and the most effective CAR type to treat EOC patients.
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Affiliation(s)
- Sofia Genta
- a Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy .,b Department of Oncology , University of Torino , Turin , Italy
| | - Eleonora Ghisoni
- a Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy .,b Department of Oncology , University of Torino , Turin , Italy
| | - Gaia Giannone
- a Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy .,b Department of Oncology , University of Torino , Turin , Italy
| | - Gloria Mittica
- a Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy .,b Department of Oncology , University of Torino , Turin , Italy
| | - Giorgio Valabrega
- a Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy .,b Department of Oncology , University of Torino , Turin , Italy
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Mittica G, Ghisoni E, Giannone G, Aglietta M, Genta S, Valabrega G. Checkpoint inhibitors in endometrial cancer: preclinical rationale and clinical activity. Oncotarget 2017; 8:90532-90544. [PMID: 29163851 PMCID: PMC5685772 DOI: 10.18632/oncotarget.20042] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [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: 06/08/2017] [Accepted: 07/26/2017] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Treatment of advanced and recurrent endometrial cancer (EC) is still an unmet need for oncologists and gynecologic oncologists. The Cancer Genome Atlas Research Network (TCGA) recently provided a new genomic classification, dividing EC in four subgroups. Two types of EC, the polymerase epsilon (POLE)-ultra-mutated and the microsatellite instability-hyper-mutated (MSI-H), are characterized by a high mutation rate providing the rationale for a potential activity of checkpoint inhibitors. MATERIALS AND METHODS We analyzed all available evidence supporting the role of tumor microenvironment (TME) in EC development and the therapeutic implications offered by immune checkpoint inhibitors in this setting. We performed a review on Pubmed with Mesh keywords 'endometrial cancer' and the name of each checkpoint inhibitor discussed in the article. The same search was operated on clinicaltrial.gov to identify ongoing clinical trials exploring PD-1/PD-L1 and CTLA-4 axis in EC, particularly focusing on POLE-ultra-muted and MSI-H cancer types. RESULTS POLE-ultra-mutated and MSI-H ECs showed an active TME expressing high number of neo-antigens and an elevated amount of tumor infiltrating lymphocytes (TILs). Preliminary results from a phase-1 clinical trial (KEYNOTE-028) demonstrated antitumor activity of Pembrolizumab in EC. Moreover, both Pembrolizumab and Nivolumab reported durable clinical responses in POLE-ultra-mutated patients. CONCLUSIONS Immune checkpoint inhibitors are an attractive option in POLE-ultra-mutated and MSI-H ECs. Future investigations in these subgroups include combinations of checkpoints inhibitors with chemotherapy and small tyrosine kinase inhibitors (TKIs) to enhance a more robust intra-tumoral immune response.
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Affiliation(s)
- Gloria Mittica
- Department of Oncology, University of Turin, Turin, Italy
- Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Turin, Turin, Italy
- Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Gaia Giannone
- Department of Oncology, University of Turin, Turin, Italy
- Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, Turin, Italy
- Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Sofia Genta
- Department of Oncology, University of Turin, Turin, Italy
- Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Turin, Turin, Italy
- Division of Medical Oncology-1, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Italy
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35
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Giannone G, Milani A, Ghisoni E, Genta S, Mittica G, Montemurro F, Valabrega G. Oral etoposide in heavily pretreated metastatic breast cancer: a retrospective analysis of efficacy and safety. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Genta S, Mittica G, Giannone G, Ghisoni E, Valabrega G. Are cyclin-dependent kinases 4/6 inhibitors ready for prime time in estrogen-receptor positive metastatic breast cancer? Transl Cancer Res 2017. [DOI: 10.21037/tcr.2017.02.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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37
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Martinello R, Genta S, Galizia D, Geuna E, Milani A, Zucchini G, Valabrega G, Montemurro F. New and developing chemical pharmacotherapy for treating hormone receptor-positive/HER2-negative breast cancer. Expert Opin Pharmacother 2016; 17:2179-2189. [PMID: 27646965 DOI: 10.1080/14656566.2016.1236914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Endocrine therapy is the mainstay of treatment for a substantial proportion of hormone receptor positive (HR+) breast cancer (BC). Indeed, patients with metastatic disease not immediately life threatening may experience long disease control across several lines of endocrine therapy. The major limitation of this therapeutic approach is primary or acquired resistance. A better understanding of endocrine resistance has resulted in newer targeted agents to be added to endocrine therapy. Areas covered: This review highlights new findings in the treatment of HR+/HER2- BC, with a particular focus on new drugs from phase 3 development onwards. Expert opinion: Combining endocrine therapy with agents targeting putative mechanisms of endocrine resistance is a newer treatment paradigm in HR+ BC. Adding a biologically targeted agent to endocrine therapy results in improved response rate, and clinical benefit rate, and prolonged progression-free survival. A clear advantage in overall survival has not yet been reported. Combination therapy allows to delay chemotherapy but increases toxicities and costs, which are critical factors in decision making in the clinical practice. Moreover, identification and validation of biomarkers of response are needed. Ongoing and future trials should elucidate the role of these compounds in the treatment of HR+/HER2- BC.
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Affiliation(s)
- Rossella Martinello
- a Investigative Clinical Oncology (INCO) , Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy
| | - Sofia Genta
- b Medical Oncology 1 , Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy.,c Department of Oncology , University of Torino , Turin , Italy
| | - Danilo Galizia
- a Investigative Clinical Oncology (INCO) , Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy
| | - Elena Geuna
- a Investigative Clinical Oncology (INCO) , Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy
| | - Andrea Milani
- a Investigative Clinical Oncology (INCO) , Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy
| | - Giorgia Zucchini
- a Investigative Clinical Oncology (INCO) , Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy
| | - Giorgio Valabrega
- b Medical Oncology 1 , Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy.,c Department of Oncology , University of Torino , Turin , Italy
| | - Filippo Montemurro
- a Investigative Clinical Oncology (INCO) , Candiolo Cancer Institute-FPO- IRCCS , Turin , Italy
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Mittica G, Capellero S, Genta S, Cagnazzo C, Aglietta M, Sangiolo D, Valabrega G. Adoptive immunotherapy against ovarian cancer. J Ovarian Res 2016; 9:30. [PMID: 27188274 PMCID: PMC4869278 DOI: 10.1186/s13048-016-0236-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 03/14/2016] [Accepted: 04/21/2016] [Indexed: 01/16/2023] Open
Abstract
The standard front-line therapy for epithelial ovarian cancer (EOC) is combination of debulking surgery and platinum-based chemotherapy. Nevertheless, the majority of patients experience disease recurrence. Although extensive efforts to find new therapeutic options, cancer cells invariably develop drug resistance and disease progression. New therapeutic strategies are needed to improve prognosis of patients with advanced EOC. Recently, several preclinical and clinical studies investigated feasibility and activity of adoptive immunotherapy in EOC. Our aim is to highlight prospective of adoptive immunotherapy in EOC, focusing on HLA-restricted Tumor Infiltrating Lymphocytes (TILs), and MHC-independent immune effectors such as natural killer (NK), and cytokine-induced killer (CIK). Adoptive cell therapy (ACT) has shown activity in several pre-clinical models. Available preclinical and clinical data suggest that adoptive cell therapy may provide the best benefit in settings of low tumor burden, minimal residual disease, or maintenance therapy. Further studies are needed to better define the optimal clinical setting.
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Affiliation(s)
- Gloria Mittica
- Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | | | - Sofia Genta
- Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | | | - Massimo Aglietta
- Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | - Dario Sangiolo
- Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy.,Department of Oncology, University of Torino, Turin, Italy
| | - Giorgio Valabrega
- Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy. .,Department of Oncology, University of Torino, Turin, Italy. .,Division of Medical Oncology-1, Candiolo Cancer Institute- FPO- IRCCS, Strada Provinciale 142 km 3.95, Candiolo, 10060, Turin, Italy.
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Marocco F, Vaira M, Milani A, Genta S, Maggiorotto F, Magistris A, Cinquegrana A, Robella M, De Simone M, Aglietta M, Ponzone R, Valabrega G. Secondary cytoreductive surgery, hyperthermic intraperitoneal intraoperative chemotherapy, and chemotherapy alone: a retrospective comparison of alternative approaches in relapsed platinum sensitive ovarian cancer. EUR J GYNAECOL ONCOL 2016; 37:638-643. [PMID: 29787001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The best treatment for relapsed platinum sensitive epithelial ovarian cancer (EOC) is controversial. The aim of the study was to compare progression-free survival (PFS) and overall survival (OS) in platinum-sensitive EOC patients treated with chemotherapy alone (CTA), secondary cytoreductive surgery (SCR) or SCR plus hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC). MATERIALS AND METHODS Retrospective analysis of the clinical outcome of 46 EOC patients with at least 30 months of follow-up. RESULTS Median follow-up time was 32 months for the CTA group, 30 months for the SCR group, and 45 months for the SCR + HIPEC group. Fifteen recurrences were observed in the CTA group, seven in the SCR group, and 16 in the SCR + HIPEC group. The median time elapsed between first and second recurrence (PFI-2) was significantly higher among patients treated with SCR + HIPEC, in comparison with patients treated with CTA (p = 0.012 andp = 0.017, respectively). On the contrary, PFI-2 did not significantly differ between the SCR and SCR + HIPEC groups (p = 0.877). A statistically significant difference in OS favouring SCR + HIPEC in comparison with CTA (p = 0.04) was observed. CONCLUSIONS SCR HIPEC compared with CTA improves PFI-2 in patients with platinum-sensitive EOC recurrence. SCR + HIPEC might also improve OS in comparison with CTA. No improvement in favor of SCR + HIPEC vs SCR was observed,. These results further support the need of a randomized trial comparing chemotherapy with SCR ± HIPEC in this setting.
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Cabrera W, Genta S, Said A, Farag A, Rashed K, Sánchez S. Hypoglycemic activity of Ailanthus excelsa
leaves in normal and streptozotocin-induced diabetic rats. Phytother Res 2007; 22:303-7. [DOI: 10.1002/ptr.2311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
Although the nephrotoxic effects of lead are well documented, the subcellular mechanisms of its action on the kidney remain unclear. The aim of the present work was to investigate the effects of chronic lead exposure on the expression of laminin-1 and fibronectin in the kidney of lead-treated rats. Western immunoblotting of the kidney extracts revealed that experimental exposure to lead resulted in a marked decrease in the intensity of the bands corresponding to laminin-1 and an increase in the intensity of the band corresponding to fibronectin. Immunohistochemical studies demonstrated a weak labelling to laminin-1 and a strong labelling to fibronectin in all renal basement membranes together with a decrease in their thickness. Other ultrastructural alterations found were a diminution in the amount of endothelial fenestrae, an increased fusion of foot processes in epithelial cells of the glomerulus and the presence of intranuclear inclusion bodies in the proximal tubule cells. Lead intoxication might be responsible for the above alterations in the renal extracellular matrix that could play an important role in the pathogenesis of lead nephropathy.
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Affiliation(s)
- S Sánchez
- Departamento de Biología del Desarrollo, Instituto Superior de Investigaciones Biológicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Tucumán, 4000 San Miguel de Tucumán, Tucumán, Argentina.
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Nakamura K, Genta S, Hataya S, Asano H. [Science of symptomatology: hemorrhage. Hemostatic therapy and nursing care in rupture of esophageal varices--use of a Sengstaken-Blakemore tube]. Kango Gijutsu 1981; 27:941-6. [PMID: 6973043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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