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Schulte B, Mohindra N, Milhem M, Attia S, Robinson S, Monga V, Hirbe AC, Oppelt P, Charlson J, Helenowski I, Abbinanti S, Cehic R, Okuno S, Van Tine BA, Agulnik M. Phase II study of pazopanib with oral topotecan in patients with metastatic and non-resectable soft tissue and bone sarcomas. Br J Cancer 2021; 125:528-533. [PMID: 34050255 PMCID: PMC8368095 DOI: 10.1038/s41416-021-01448-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/13/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pazopanib is active in refractory soft-tissue sarcoma (STS) and significantly prolongs PFS. Prior studies of combinations of metronomic topotecan with pazopanib have indicated preclinical evidence of response in patients with sarcoma. METHODS This prospective, single arm, phase II study evaluated the efficacy of the combination of pazopanib with topotecan in patients with metastatic or unresectable non-adipocytic STS. Furthermore, it incorporated exploratory arms for osteosarcoma and liposarcoma. The primary endpoint was progression-free rate at 12 weeks in the non-adipocytic STS cohort. RESULTS 57.5% of patients in the non-adipocytic STS cohort were progression free at 12 weeks, which did not meet the primary endpoint of the study (66%). The exploratory osteosarcoma cohort exceeded previously established phase II trial comparator data benchmark of 12% with a PFR at 12 weeks of 69.55%. Treatment with the combination of pazopanib and topotecan was accompanied by a grade 3 or 4 toxicities in most patients. CONCLUSIONS In this prospective trial in refractory metastatic or unresectable STS and osteosarcoma, the combination of pazopanib with topotecan did not meet its primary endpoint of progression-free rate at 12 weeks. The combination of pazopanib with topotecan was associated with a high degree of toxicity.
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Affiliation(s)
- Brian Schulte
- grid.16753.360000 0001 2299 3507Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Nisha Mohindra
- grid.16753.360000 0001 2299 3507Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Mohammed Milhem
- grid.214572.70000 0004 1936 8294Department of Internal Medicine, Division of Hematology/Oncology and BMT, University of Iowa, Iowa City, IA USA
| | - Steven Attia
- grid.417467.70000 0004 0443 9942Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL USA
| | - Steven Robinson
- grid.66875.3a0000 0004 0459 167XDepartment of Oncology, Mayo Clinic, Rochester, MN USA
| | - Varun Monga
- grid.214572.70000 0004 1936 8294Department of Internal Medicine, Division of Hematology/Oncology and BMT, University of Iowa, Iowa City, IA USA
| | - Angela C. Hirbe
- grid.34477.330000000122986657Division of Medical Oncology at Washington University School of Medicine/Siteman Cancer Center, St Louis, MO USA
| | - Peter Oppelt
- grid.34477.330000000122986657Division of Medical Oncology at Washington University School of Medicine/Siteman Cancer Center, St Louis, MO USA
| | - John Charlson
- grid.30760.320000 0001 2111 8460Department of Medical Oncology, Medical College of Wisconsin, Wauwatosa, WI USA
| | - Irene Helenowski
- grid.16753.360000 0001 2299 3507Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Susan Abbinanti
- grid.16753.360000 0001 2299 3507Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Rasima Cehic
- grid.16753.360000 0001 2299 3507Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Scott Okuno
- grid.66875.3a0000 0004 0459 167XDepartment of Oncology, Mayo Clinic, Rochester, MN USA
| | - Brian A. Van Tine
- grid.34477.330000000122986657Division of Medical Oncology at Washington University School of Medicine/Siteman Cancer Center, St Louis, MO USA
| | - Mark Agulnik
- grid.16753.360000 0001 2299 3507Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL USA ,grid.410425.60000 0004 0421 8357Present Address: Department of Medical Oncology, City of Hope, Duarte, CA USA
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Agulnik M, Schulte B, Robinson S, Hirbe AC, Kozak K, Chawla SP, Attia S, Rademaker A, Zhang H, Abbinanti S, Cehic R, Monga V, Milhem M, Okuno S, Van Tine BA. An open-label single-arm phase II study of regorafenib for the treatment of angiosarcoma. Eur J Cancer 2021; 154:201-208. [PMID: 34284255 DOI: 10.1016/j.ejca.2021.06.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Angiosarcomas represents a diverse group of aggressive high-grade vascular tumours with limited therapeutic options. We sought to determine the safety and efficacy of regorafenib, a small-molecule multikinase inhibitor, in the treatment of metastatic or locally advanced unresectable angiosarcoma. PATIENTS AND METHODS In this single-arm multicentre, open-label phase II clinical trial, 31 patients were enrolled and received regorafenib 160 mg PO daily for 21 days of a 28-day cycle. The primary endpoint for the study was progression-free survival at 4 months. Secondary endpoints included overall survival, response rate, and safety. Patients (≥18 years) with an Eastern Cooperative Oncology Group (ECOG) score of 0-1, a life expectancy of at least 4 months who had progressed on at least one but no more than 4 prior lines of therapy were eligible. RESULTS Of the 23 patients evaluable for efficacy, 2 had a complete response (8.7%), and 2 had a partial response (8.7%), for a total overall response rate of 17.4%. Median PFS was 5.5 months, and 12/23 patients (52.2%) had a PFS of greater than 4 months. 10/31 (32.3%) patients evaluable for toxicity had a grade 3 or higher adverse events. CONCLUSIONS Regorafenib is a safe and active treatment for refractory metastatic and unresectable angiosarcoma. Rates of adverse events were comparable to prior studies of regorafenib for other tumour types. Regorafenib, the single agent, could be considered as therapy for patients with metastatic or unresectable AS.
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Affiliation(s)
- Mark Agulnik
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago IL, USA.
| | - Brian Schulte
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - Steven Robinson
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Angela C Hirbe
- Siteman Cancer Center, St Louis, MO, USA; Washington University in St. Louis School of Medicine, St Louis MO, USA; St Louis Children's Hospital, Department id Pediatrics, St Louis, MO, 63110, USA
| | - Kevin Kozak
- Department of Radiation Oncology, Mercy Health System, Janesville, WI, USA
| | | | - Steven Attia
- Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Alfred Rademaker
- Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL, USA
| | - Hui Zhang
- Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL, USA
| | - Susan Abbinanti
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - Rasima Cehic
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - Varun Monga
- Department of Hematology/Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mohammed Milhem
- Department of Hematology/Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Scott Okuno
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Brian A Van Tine
- Siteman Cancer Center, St Louis, MO, USA; Washington University in St. Louis School of Medicine, St Louis MO, USA; St Louis Children's Hospital, Department id Pediatrics, St Louis, MO, 63110, USA
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Lambden JP, Kelsten MF, Schulte BC, Abbinanti S, Hayes JP, Villaflor V, Agulnik M. Metastatic Myxofibrosarcoma with Durable Response to Temozolomide Followed by Atezolizumab: A Case Report. Oncologist 2021; 26:549-553. [PMID: 33594725 DOI: 10.1002/onco.13728] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/01/2021] [Indexed: 01/10/2023] Open
Abstract
Myxofibrosarcoma (MFS) is a well-recognized histotype of soft tissue sarcomas that generally presents with localized disease. Herein, we describe the case of a patient with metastatic MFS who experienced durable response to sixth-line therapy with temozolomide. Upon further progression, his tumor was notable for a high tumor mutational burden, and he was subsequently treated with seventh-line immunotherapy, atezolizumab, achieving a second durable response. This case highlights the role of immunotherapy after administration of alkylating agents. Review of the literature indicates that recurrent tumors treated with alkylating agents often experience hypermutation as a means of developing resistance and that checkpoint inhibitors are subsequently effective in these tumors. KEY POINTS: To the authors' knowledge, this is the first report of a patient with myxofibrosarcoma with high tumor mutational burden after administration of temozolomide monotherapy. Hypermutation may be a resistance mechanism for patients with soft tissue sarcoma who develop resistance to alkylating agents. Checkpoint inhibition may be effective therapy in patients with soft tissue sarcoma with high tumor mutational burden as a consequence of alternate systemic therapy resistance.
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Affiliation(s)
- Jason P Lambden
- McGaw Medical Center of Northwestern University, Chicago, Illinois, USA
| | - Max F Kelsten
- McGaw Medical Center of Northwestern University, Chicago, Illinois, USA
| | - Brian C Schulte
- McGaw Medical Center of Northwestern University, Chicago, Illinois, USA
| | - Susan Abbinanti
- McGaw Medical Center of Northwestern University, Chicago, Illinois, USA
| | - John P Hayes
- McGaw Medical Center of Northwestern University, Chicago, Illinois, USA
| | | | - Mark Agulnik
- City of Hope National Medical Center, Duarte, California, USA
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Agulnik M, Costa RLB, Milhem M, Rademaker AW, Prunder BC, Daniels D, Rhodes BT, Humphreys C, Abbinanti S, Nye L, Cehic R, Polish A, Vintilescu C, McFarland T, Skubitz K, Robinson S, Okuno S, Van Tine BA. A phase II study of tivozanib in patients with metastatic and nonresectable soft-tissue sarcomas. Ann Oncol 2017; 28:121-127. [PMID: 27771610 DOI: 10.1093/annonc/mdw444] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Soft tissue sarcomas (STSs) overexpress vascular endothelial growth factors (VEGF) and VEGF-receptors (VEGFR) activation have been associated with tumor aggressiveness. Tivozanib is a potent small molecule tyrosine kinase inhibitor against VEGFR1-3, with activity against PDGFRα/β and cKIT. The primary endpoint of this study was progression free survival (PFS) rate at 16 weeks. Secondary end points were overall survival (OS), response rate, safety and correlative studies. Patients and methods A Simon two-stage phase II trial was performed using tivozanib given orally at 1.5 mg daily, 3 week on 1 week off on a 28 day cycle until disease progression or intolerable toxicity. Results Fifty-eight patients were enrolled and treated with tivozanib. Leiomyosarcoma was the most common STS histological type in our cohort (47%) and 27 patients (46%) had received at least 3 lines of therapy prior to study entry. Up to 24 patients (41%) had prior VEGF targeted therapies. Partial response and stable disease were observed in 2 (3.6%) and 30 (54.5%) patients. The 16 week PFS rate was 36.4% [95% confidence interval (CI) 23.7-49.1] and a median PFS of 3.5 months (95% CI 1.8-3). Median OS observed was 12.2 months (95% CI 8.1-16.8). The most frequent all grade toxicities were fatigue (48.3%), hypertension (43.1%), nausea (31%) and diarrhea (27.6%). The most common grade three toxicity was hypertension (22.4%). Correlative studies demonstrate no correlation between the expression of VEGFR 1, 2 or 3, PDGFRα/β or FGF, and activity of tivozanib. Conclusion Tivozanib was well tolerated and showed antitumor activity with a promising median PFS and PFS rate at 4 months in a heavily pretreated population of metastatic STSs. Our results support further studies to assess the clinical efficacy of tivozanib in STS. Clinical Trial Number NCT01782313.
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Affiliation(s)
- M Agulnik
- Division of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Chicago, USA
| | - R L B Costa
- Division of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Chicago, USA
| | - M Milhem
- Division of Hematology/Oncology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - A W Rademaker
- Division of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Chicago, USA
| | - B C Prunder
- Division of Hematology/Oncology, Washington University in St. Louis, St Louis, USA
| | - D Daniels
- Division of Hematology/Oncology, Washington University in St. Louis, St Louis, USA
| | - B T Rhodes
- Division of Hematology/Oncology, Washington University in St. Louis, St Louis, USA
| | - C Humphreys
- Division of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Chicago, USA
| | - S Abbinanti
- Division of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Chicago, USA
| | - L Nye
- Division of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Chicago, USA
| | - R Cehic
- Division of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Chicago, USA
| | - A Polish
- Division of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Chicago, USA
| | - C Vintilescu
- Division of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Chicago, USA
| | - T McFarland
- Division of Hematology/Oncology, University of Wisconsin, Madison, USA
| | - K Skubitz
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, USA
| | - S Robinson
- Division of Hematology/Oncology, Mayo Clinic, Rochester, USA
| | - S Okuno
- Division of Hematology/Oncology, Mayo Clinic, Rochester, USA
| | - B A Van Tine
- Division of Hematology/Oncology, Washington University in St. Louis, St Louis, USA
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