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Saenz M, Bloom-Saldana EA, Synold T, Ermel RW, Fueger PT, Finlay JB. Pharmacokinetics of Sustained-release and Extended-release Buprenorphine in Mice after Surgical Catheterization. J Am Assoc Lab Anim Sci 2022; 61:468-474. [PMID: 36008090 PMCID: PMC9536818 DOI: 10.30802/aalas-jaalas-22-000025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Guide for the Care and Use of Laboratory Animals strongly encourages the use of pharmaceutical-grade chemicals and analgesics. Sustained-release buprenorphine (SRB) is administered extralabel to rodents to mitigate moderate to severe pain. An FDA-indexed buprenorphine formulation-extended-release buprenorphine (XRB)-has recently become available and is currently the only pharmaceutical-grade slow-release buprenorphine formulation approved for use in mice and rats. However, no studies have directly compared the pharmacokinetic parameters of SRB and XRB in surgically catheterized mice. To this end, we compared the plasma buprenorphine concentrations and pharmacokinetic parameters of SRB and XRB in mice after surgical catheterization. We hypothesized that mice treated before surgery with SRB or XRB would have circulating buprenorphine concentrations that exceeded the therapeutic threshold for as long as 72 h after surgery. Male and female C57Bl/6J mice were anesthetized, treated with a single dose of either SRB (1 mg/kg SC) or XRB (3.25 mg/kg SC), and underwent surgical catheterization. Arterial blood samples were collected at 6, 24, 48, and 72 h after administration. Weight loss after surgery (mean ± SEM) was similar between groups (SRB: males, 12% ± 2%; females, 8% ± 2%; XRB: males, 12% ± 1%; females, 8% ± 1%). Both SRB and XRB maintained circulating buprenorphine concentrations above the therapeutic level of 1.0 ng/mL for 72 h after administration. Plasma buprenorphine concentrations at 6, 24, and 48 h were significantly greater (3- to 4-fold) with XRB than SRB, commensurate with XRB's higher dose. These results support the use of either SRB or XRB for the alleviation of postoperative pain in mice. The availability of FDA-indexed XRB increases options for safe and effective pharmaceutical-grade analgesia in rodents.
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Affiliation(s)
- Marissa Saenz
- Center for Comparative Medicine,,Department of Molecular and Cellular Endocrinology,,Corresponding author.
| | | | - Tim Synold
- Analytical Pharmacology Core, Beckman Research Institute, City of Hope National Medical Center, Duarte, California
| | | | - Patrick T Fueger
- Department of Molecular and Cellular Endocrinology,,Comprehensive Metabolic Phenotyping Core, and
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Batalla-Covello J, Ngai HW, Flores L, McDonald M, Hyde C, Gonzaga J, Hammad M, Gutova M, Portnow J, Synold T, Curiel DT, Lesniak MS, Aboody KS, Mooney R. Multiple Treatment Cycles of Neural Stem Cell Delivered Oncolytic Adenovirus for the Treatment of Glioblastoma. Cancers (Basel) 2021; 13:6320. [PMID: 34944938 PMCID: PMC8699772 DOI: 10.3390/cancers13246320] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Tumor tropic neural stem cells (NSCs) can improve the anti-tumor efficacy of oncovirotherapy agents by protecting them from rapid clearance by the immune system and delivering them to multiple distant tumor sites. We recently completed a first-in-human trial assessing the safety of a single intracerebral dose of NSC-delivered CRAd-Survivin-pk7 (NSC.CRAd-S-pk7) combined with radiation and chemotherapy in newly diagnosed high-grade glioma patients. The maximum feasible dose was determined to be 150 million NSC.CRAd-Sp-k7 (1.875 × 1011 viral particles). Higher doses were not assessed due to volume limitations for intracerebral administration and the inability to further concentrate the study agent. It is possible that therapeutic efficacy could be maximized by administering even higher doses. Here, we report IND-enabling studies in which an improvement in treatment efficacy is achieved in immunocompetent mice by administering multiple treatment cycles intracerebrally. The results imply that pre-existing immunity does not preclude therapeutic benefits attainable by administering multiple rounds of an oncolytic adenovirus directly into the brain.
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Affiliation(s)
- Jennifer Batalla-Covello
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Hoi Wa Ngai
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Linda Flores
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Marisa McDonald
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Caitlyn Hyde
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Joanna Gonzaga
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Mohamed Hammad
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Margarita Gutova
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Jana Portnow
- Department of Medical Oncology, City of Hope, Duarte, CA 91010, USA;
| | - Tim Synold
- Department of Cancer Biology, City of Hope, Duarte, CA 91010, USA;
| | - David T. Curiel
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Maciej S. Lesniak
- Department of Neurological Surgery, Northwestern University, Chicago, IL 60611, USA;
| | - Karen S. Aboody
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
| | - Rachael Mooney
- Department of Developmental and Stem Cell Biology, City of Hope, Duarte, CA 91010, USA; (J.B.-C.); (H.W.N.); (L.F.); (M.M.); (C.H.); (J.G.); (M.H.); (M.G.)
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Cristea M, Frankel P, Synold T, Stewart D, Wang E, Jung A, Wilczynski S, Tran M, Konecny G, Eng M, Kilpatrick L, Chen YJ, Glaser S, Han E, Dellinger T, Hakim A, Lee S, Morgan R, Rodriguez L, Wakabayashi M. 863P A phase I study of mirvetuximab soravtansine (MIRV) and gemcitabine (G) in pts with selected FRα -positive solid tumours: Results in the endometrial cancer (EC) cohort. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1002] [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: 10/23/2022] Open
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Rosenzweig M, Palmer J, Tsai NC, Synold T, Wu X, Tao S, Hammond SN, Buettner R, Duarte L, Htut M, Karanes C, Nathwani N, Pichiorri F, Sahebi F, Sanchez JF, Chowdhury A, Krishnan A, Forman SJ, Rosen ST. Repurposing leflunomide for relapsed/refractory multiple myeloma: a phase 1 study. Leuk Lymphoma 2020; 61:1669-1677. [PMID: 32268821 DOI: 10.1080/10428194.2020.1742900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/03/2023]
Abstract
The inexpensive, well-tolerated, immunomodulatory agent leflunomide, used extensively for the treatment of rheumatoid arthritis, has been shown to produce significant activity against multiple myeloma (MM) in pre-clinical studies. We conducted a phase 1 study (clinicaltrials.gov: NCT02509052) of single agent leflunomide in patients with relapsed/refractory MM (≥3 prior therapies). At dose levels 1 and 2 (20 and 40 mg), no dose-limiting toxicities (DLTs) were observed. At dose level 3 (60 mg), one patient experienced elevated alanine aminotransferase; an additional three patients were enrolled at this dose level without further DLTs. Overall, toxicities were infrequent and manageable. Nine out of 11 patients achieved stable disease (SD), two subjects experiencing SD for nearly one year or longer. The tolerable safety profile of leflunomide, combined with a potential disease stabilization, is motivating future studies of leflunomide, in combination with other MM drugs, or as an approach to delay progression of smoldering MM.
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Affiliation(s)
- Michael Rosenzweig
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Joycelynne Palmer
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute, City of Hope, Duarte, CA, USA.,Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Ni-Chun Tsai
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Tim Synold
- Department of Cancer Biology, City of Hope, Duarte, CA, USA
| | - Xiwei Wu
- Integrative Genomics Core, City of Hope, Duarte, CA, USA
| | - Shu Tao
- Integrative Genomics Core, City of Hope, Duarte, CA, USA
| | - Samantha N Hammond
- Department of Clinical Protocol Development, City of Hope, Duarte, CA, USA
| | - Ralf Buettner
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Lupe Duarte
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Myo Htut
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Chatchada Karanes
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Nitya Nathwani
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Flavia Pichiorri
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Firoozeh Sahebi
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA.,Southern California Permanente Medical Group, Los Angeles, CA, USA
| | - James F Sanchez
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Arnab Chowdhury
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Amrita Krishnan
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Steven T Rosen
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
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Yuan Y, Frankel P, Synold T, Lee P, Yost S, Martinez N, Tang A, Mendez B, Schmolze D, Apple S, Hurria A, Waisman J, Somlo G, Tank N, Sedrak M, Mortimer J. Abstract OT1-05-02: A phase II clinical trial of the combination of pembrolizumab and selective androgen receptor modulator GTx-024 in patients with advanced androgen receptor positive triple negative breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-05-02] [Citation(s) in RCA: 3] [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: 11/16/2022]
Abstract
Abstract
Background: Androgen receptor (AR) targeted therapy and immunotherapy represent one of the most promising strategies for metastatic triple negative breast cancer (mTNBC), which accounts for 15-20% of all breast cancers. As a nonsteroidal selective androgen receptor modulator (SARM), GTx-024 demonstrated preclinical activity in AR+ TNBC PDX model. Pembrolizumab is a highly selective humanized monoclonal antibody of the programmed cell death 1 receptor (PD-1). The complementary modes of action and low potential for overlapping toxicity make the combination promising in patients with AR+ mTNBC.
Trial Design: This is an open-label Phase 2 study for AR+ mTNBC. Eligible participants receive pembrolizumab 200mg IV every 3 weeks in combination with GTx-024 18mg po daily.
Eligibility Criteria: Eligible patients must have AR+ (>10%, 1+ by IHC) TNBC; failed up to 2 lines of therapy in metastatic setting; and have measurable disease per RECIST1.1. Patients are excluded if they have had prior checkpoint inhibitors or AR targeted agents. Patients with current or prior use of testosterone, testosterone-like agents, androgenic compounds, or anti-androgens (including systemic steroids and immunosuppressive medications)are excluded, as well as current or prior history of noninfectious pneumonitis requiring systemic steroid therapy.
Specific Aims: The primary objective is to evaluate the safety/tolerability of GTx-024 and pembrolizumab and determine the response rate (CR or PR via RECIST 1.1) in patients with advanced AR+ TNBC. We will use clinical benefit rate (CBR), duration of response (DOR), PFS, and OS to test the efficacy of this novel drug combination.
Statistical Design: A Simon's MiniMax two-stage Phase 2 design will be utilized. Based on the previously reported response rate associated with single agent pembrolizumab (19%), we consider a response rate of 19% for the combination as discouraging, and a 39% response rate as encouraging. As a result, we will initially accrue 15 patients (including 6 patients from safety lead-in treated at the tolerable dose). If 2 or fewer patients respond, we will stop accrual for futility. Otherwise, the study will accrue an additional 14 patients for a total of 29 patients. With 29 patients, if only 8 or fewer respond (≤27.6%), the study will be considered discouraging unless secondary evidence of clinical benefit is substantial. With more than 8 patients responding out of the 29 patients, the combination would be considered promising. This design has 85% power to declare a true response rate of 39% as promising (power), and a 10% probability of declaring a true 19% response rate as encouraging (type I error). The probability of early termination if the true response rate is 19% is 44%.
Target Accrual: 29
Study Contact: Yuan Yuan MD PhD, City of Hope Comprehensive Cancer Center; Duarte, CA 91030; Email: yuyuan@coh.org
Citation Format: Yuan Y, Frankel P, Synold T, Lee P, Yost S, Martinez N, Tang A, Mendez B, Schmolze D, Apple S, Hurria A, Waisman J, Somlo G, Tank N, Sedrak M, Mortimer J. A phase II clinical trial of the combination of pembrolizumab and selective androgen receptor modulator GTx-024 in patients with advanced androgen receptor positive triple negative breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-05-02.
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Affiliation(s)
- Y Yuan
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - P Frankel
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - T Synold
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - P Lee
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - S Yost
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - N Martinez
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - A Tang
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - B Mendez
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - D Schmolze
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - S Apple
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - A Hurria
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - J Waisman
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - G Somlo
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - N Tank
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - M Sedrak
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - J Mortimer
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
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Somlo G, Yuan Y, Waisman J, Yeon C, Frankel P, Hou W, Hurria A, Tank N, Sedrak M, Synold T, Mortimer J, Lee P. Abstract P1-08-04: Not presented. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-08-04] [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
This abstract was not presented at the symposium.
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Affiliation(s)
- G Somlo
- City of Hope Cancer Center, Duarte, CA
| | - Y Yuan
- City of Hope Cancer Center, Duarte, CA
| | - J Waisman
- City of Hope Cancer Center, Duarte, CA
| | - C Yeon
- City of Hope Cancer Center, Duarte, CA
| | - P Frankel
- City of Hope Cancer Center, Duarte, CA
| | - W Hou
- City of Hope Cancer Center, Duarte, CA
| | - A Hurria
- City of Hope Cancer Center, Duarte, CA
| | - N Tank
- City of Hope Cancer Center, Duarte, CA
| | - M Sedrak
- City of Hope Cancer Center, Duarte, CA
| | - T Synold
- City of Hope Cancer Center, Duarte, CA
| | | | - P Lee
- City of Hope Cancer Center, Duarte, CA
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Yuan Y, Frankel P, Synold T, Yost S, Lee P, Waisman J, Somlo G, Hurria A, Mortimer J. Abstract OT2-01-03: Phase II Trial of the addition of pembrolizumab to letrozole and palbociclib in patients with metastatic estrogen receptor positive breast cancer who have stable disease on letrozole and palbociclib. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot2-01-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The combination of palbociclib and letrozole has become the standard of care for patients with newly diagnosed estrogen receptor positive (ER+) metastatic breast cancer (MBC), with promising prolongation of progression free survival (PFS). However, nearly half of all patients achieved stable disease only after the first 6 months of therapy. Check-point inhibitor pembrolizumab was effective in ER+ MBC with a response rate of 13-17%, this study will evaluate the efficacy of adding pembrolizumab for patients with ER+ MBC who have achieved stable disease (SD) on letrozole and palbociclib.
Trial Design:This is an open-label single institutional study. Patient will receive letrozole (2.5 mg) once a day and palbociclib (125 mg, 100 mg, or 75 mg as established tolerated dose) once a day for 3 weeks on and 1 week off. Pembrolizumab will be given at 200 mg IV every 3 weeks.
Eligibility Criteria: Eligible patients must be postmenopausal women with ER+ MBC with measurable disease by RECIST1.1, ECOG performance status 0-1; must have received letrozole and palbociclib for at least 6 months, and have documented SD per RECIST 1.1. Up to3 lines of previous systemic therapy including endocrine therapy and/or chemotherapy are allowed. Patients are excluded if they had prior treatment with anti--PD1 or anti-PD-L1therapy, immunodeficiency; currently using systemic steroids active tuberculosis infection; major surgery within 28 days; active or untreated CNS metastases; history of interstitial lung disease; active infection requiring systemic therapy; or active cardiac disease.
Specific Aims: The primary objective is to evaluate the objective response rate(ORR). The secondary objective is to determine the safety and tolerability of pembrolizumab plus the letrozole/palbociclib combination. We will use clinical benefit rate (CBR), duration of response (DOR), PFS, and OS to test the efficacy of this novel drug combination.
Statistical Design: We will employ a three-at-risk design (modified rolling design) for the initial cohort of this Phase II study to insure the triplet is well-tolerated. This design permits only 3 patients to be a risk for DLT at any one time during the “safety lead-in” .When the first 6 patients have completed the observation period and treatment with ≤1 DLT, the safety lead-in for the triplet will be considered successful, and accrual will proceed to a total of 18 patients. Response (CR or PR by RECIST version 1.1) in patients who have demonstrated only SD on letrozole and palbociclib can be reasonably attributed to the addition of pembrolizumab. As a result, we set the probability of a response occurring without the addition of pembrolizumab as 3% or less. With 18 patients, a true response rate of 20% would result in at least 2 responders with 90% power and a type I error of 10%. With 18 patients, the response can be estimated with a 95% CI half-width of 23%.
Target Accrual: 18.
Citation Format: Yuan Y, Frankel P, Synold T, Yost S, Lee P, Waisman J, Somlo G, Hurria A, Mortimer J. Phase II Trial of the addition of pembrolizumab to letrozole and palbociclib in patients with metastatic estrogen receptor positive breast cancer who have stable disease on letrozole and palbociclib [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-01-03.
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Yuan Y, Vora N, Feng T, Mortimer J, Luu T, Somlo G, Chao J, Tran V, Mi S, Synold T, Waisman J, Zavala L, Katheria V, Hurria A. Abstract P6-01-07: Association of baseline pro-inflammatory (IL-6, CRP) and coagulation (D-dimer) markers with baseline functional status in women with breast cancer (BC) undergoing chemotherapy. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p6-01-07] [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: Pro-inflammatory and coagulation factors such as IL-6, CRP and D-dimer serve as biomarkers for aging. The utility of these markers as biologic correlates of physical function in patients with BC is not known. This study was performed to determine if baseline serum markers of inflammation (IL-6, CRP) and coagulation (D-dimer) correlate with baseline functional status in women with stage I-III BC requiring chemotherapy (chemo). Methods: This is a prospective longitudinal study that enrolled 153 women across all age groups with BC who had pre-chemotherapy peripheral blood captured for IL-6, CRP, and D-dimer and a baseline assessment of the following functional status measures: activities of daily living (Medical Outcomes Study [MOS] Physical Health); instrumental activities of daily living (IADL); self-rated Karnofsky performance status (KPS); physician-rated KPS; number of falls in last 6 months; and Timed Up and Go (TUG). Peripheral blood samples were collected for measurement of IL-6, CRP and D-dimer. Quantitative IL-6 and CRP levels were obtained using NOVEX® immunoassay (Invitrogen) and D-dimer levels were measured with Nanopia®D-dimer(Sekisui). Univariate analyses were performed to describe correlations of these three biomarkers and 6 measures of physical function. Results: 153 patients (mean age of 57.5 y, range 30-81 y) with stage I- III BC (Stages I [n=35; 23%], II [n=82; 54%], III [n=36; 24%]) were enrolled. Chemo regimens include: doxorubicin+cyclophosphamide/ paclitaxel(AC-T: 44%), docetaxel/cyclophosphamide (TC: 35%), docetaxel/carboplatin/trastuzumab (TCH: 7%) and other regimen(14%). Scores for the physical function measures are as follow: MOS (median 89, range 0-100); IADL (median 14, range 4-14); self-rated KPS (median 90, range 60-100); physician-rated KPS (median 100, range 80-100); TUG (median 9 seconds, range 5-18). Serum biomarkers measurements and distributions are listed in table 1. There were associations between decreased physical function by IADL and increased IL-6 (p<0.01); decreased MOS and increased D-dimer (p<0.01); increased number of falls and increased CRP (p=0.02) and D-dimer (p=0.04); increased TUG and increased IL-6 (p<0.01), CRP (p<0.01) and D-dimer (p=0.06) (Table 2). Physician and patient-rated KPS did not correlate with IL-6, CRP and D-dimer level. Conclusions: Baseline measures of inflammation and coagulation correlate with physical function measures among patients with breast cancer. Future analyses evaluating the association between aging biomarkers and measures of physical function with subsequent risk of chemotherapy toxicity is underway.
Table 1. Serum biomarkers measurement at baseline prior to initiation of chemotherapyBiomarkerMeanStandard DeviationMedianRangeIL-6 (pg/ml)4.35.13.00-48.0CRP(µg/ml)5.77.92.80.1-48.4D-dimer(µg/ml)0.70.60.60.1-3.3
Table 2. Univariate analysis of measures of physical functions versus biomarkersVariablesSpearman Coefficientp valueMOS vs D-dimer-0.21<0.01IADL vs IL-6-0.27<0.01No. of falls vs D-dimer0.160.04No. of falls vs CRP0.190.02TUG vs D-dimer0.150.06TUG vs IL-60.26<0.01TUG vs CRP0.23<0.01
Citation Format: Yuan Yuan, Nilesh Vora, Tao Feng, Joanne Mortimer, Thehang Luu, George Somlo, Joseph Chao, Vivi Tran, Shu Mi, Tim Synold, James Waisman, Laura Zavala, Vani Katheria, Arti Hurria. Association of baseline pro-inflammatory (IL-6, CRP) and coagulation (D-dimer) markers with baseline functional status in women with breast cancer (BC) undergoing chemotherapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-01-07.
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Cristea M, Rivkin S, Lim D, Chung V, Chao J, Wakabayashi M, Paz B, Han E, Lin P, Leong L, Hakim A, Frankel P, Synold T, Carroll M, Openshaw H, Prakash N, Dellinger T, Park M, Morgan R. Phase I Trial of Intraperitoneal Nab-Paclitaxel in the Treatment of Advanced Malignancies Primarily Confined to the Peritoneal Cavity. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu331.37] [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: 11/14/2022] Open
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Aaberg-Jessen C, Fogh L, Halle B, Jensen V, Brunner N, Kristensen BW, Abe T, Momii Y, Watanabe J, Morisaki I, Natsume A, Wakabayashi T, Fujiki M, Aldaz B, Fabius AWM, Silber J, Harinath G, Chan TA, Huse JT, Anai S, Hide T, Nakamura H, Makino K, Yano S, Kuratsu JI, Balyasnikova IV, Prasol MS, Kanoija DK, Aboody KS, Lesniak MS, Barone T, Burkhart C, Purmal A, Gudkov A, Gurova K, Plunkett R, Barton K, Misuraca K, Cordero F, Dobrikova E, Min H, Gromeier M, Kirsch D, Becher O, Pont LB, Kloezeman J, van den Bent M, Kanaar R, Kremer A, Swagemakers S, French P, Dirven C, Lamfers M, Leenstra S, Pont LB, Balvers R, Kloezeman J, Kleijn A, Lawler S, Leenstra S, Dirven C, Lamfers M, Gong X, Andres A, Hanson J, Delashaw J, Bota D, Chen CC, Yao NW, Chuang WJ, Chang C, Chen PY, Huang CY, Wei KC, Cheng Y, Dai Q, Morshed R, Han Y, Auffinger B, Wainwright D, Zhang L, Tobias A, Rincon E, Thaci B, Ahmed A, He C, Lesniak M, Choi YA, Pandya H, Gibo DM, Fokt I, Priebe W, Debinski W, Chornenkyy Y, Agnihotri S, Buczkowicz P, Rakopoulos P, Morrison A, Barszczyk M, Becher O, Hawkins C, Chung S, Decollogne S, Luk P, Shen H, Ha W, Day B, Stringer B, Hogg P, Dilda P, McDonald K, Moore S, Hayden-Gephart M, Bergen J, Su Y, Rayburn H, Edwards M, Scott M, Cochran J, Das A, Varma AK, Wallace GC, Dixon-Mah YN, Vandergrift WA, Giglio P, Ray SK, Patel SJ, Banik NL, Dasgupta T, Olow A, Yang X, Mueller S, Prados M, James CD, Haas-Kogan D, Dave ND, Desai PB, Gudelsky GA, Chow LML, LaSance K, Qi X, Driscoll J, Driscoll J, Ebsworth K, Walters MJ, Ertl LS, Wang Y, Berahovic RD, McMahon J, Powers JP, Jaen JC, Schall TJ, Eroglu Z, Portnow J, Sacramento A, Garcia E, Raubitschek A, Synold T, Esaki S, Rabkin S, Martuza R, Wakimoto H, Ferluga S, Tome CL, Debinski W, Forde HE, Netland IA, Sleire L, Skeie B, Enger PO, Goplen D, Giladi M, Tichon A, Schneiderman R, Porat Y, Munster M, Dishon M, Weinberg U, Kirson E, Wasserman Y, Palti Y, Giladi M, Porat Y, Schneiderman R, Munster M, Weinberg U, Kirson E, Palti Y, Gramatzki D, Staudinger M, Frei K, Peipp M, Weller M, Grasso C, Liu L, Becher O, Berlow N, Davis L, Fouladi M, Gajjar A, Hawkins C, Huang E, Hulleman E, Hutt M, Keller C, Li XN, Meltzer P, Quezado M, Quist M, Raabe E, Spellman P, Truffaux N, van Vurden D, Wang N, Warren K, Pal R, Grill J, Monje M, Green AL, Ramkissoon S, McCauley D, Jones K, Perry JA, Ramkissoon L, Maire C, Shacham S, Ligon KL, Kung AL, Zielinska-Chomej K, Grozman V, Tu J, Viktorsson K, Lewensohn R, Gupta S, Mladek A, Bakken K, Carlson B, Boakye-Agyeman F, Kizilbash S, Schroeder M, Reid J, Sarkaria J, Hadaczek P, Ozawa T, Soroceanu L, Yoshida Y, Matlaf L, Singer E, Fiallos E, James CD, Cobbs CS, Hashizume R, Tom M, Ihara Y, Ozawa T, Santos R, Torre JDL, Lepe E, Waldman T, Prados M, James D, Hashizume R, Ihara Y, Huang X, Yu-Jen L, Tom M, Mueller S, Gupta N, Solomon D, Waldman T, Zhang Z, James D, Hayashi T, Adachi K, Nagahisa S, Hasegawa M, Hirose Y, Gephart MH, Moore S, Bergen J, Su YS, Rayburn H, Scott M, Cochran J, Hingtgen S, Kasmieh R, Nesterenko I, Figueiredo JL, Dash R, Sarkar D, Fisher P, Shah K, Horne E, Diaz P, Stella N, Huang C, Yang H, Wei K, Huang T, Hlavaty J, Ostertag D, Espinoza FL, Martin B, Petznek H, Rodriguez-Aguirre M, Ibanez C, Kasahara N, Gunzburg W, Gruber H, Pertschuk D, Jolly D, Robbins J, Hurwitz B, Yoo JY, Bolyard C, Yu JG, Wojton J, Zhang J, Bailey Z, Eaves D, Cripe T, Old M, Kaur B, Serwer L, Yoshida Y, Le Moan N, Santos R, Ng S, Butowski N, Krtolica A, Ozawa T, Cary SPL, James CD, Johns T, Greenall S, Donoghue J, Adams T, Karpel-Massler G, Westhoff MA, Kast RE, Dwucet A, Wirtz CR, Debatin KM, Halatsch ME, Karpel-Massler G, Kast RE, Westhoff MA, Merkur N, Dwucet A, Wirtz CR, Debatin KM, Halatsch ME, Kievit F, Stephen Z, Wang K, Kolstoe D, Silber J, Ellenbogen R, Zhang M, Kitange G, Schroeder M, Sarkaria J, Kleijn A, Haefner E, Leenstra S, Dirven C, Lamfers M, Knubel K, Pernu BM, Sufit A, Pierce AM, Nelson SK, Keating AK, Jensen SS, Kristensen BW, Lachowicz J, Demeule M, Regina A, Tripathy S, Curry JC, Nguyen T, Castaigne JP, Le Moan N, Serwer L, Yoshida Y, Ng S, Davis T, Santos R, Davis A, Tanaka K, Keating T, Getz J, Kapp GT, Romero JM, Ozawa T, James CD, Krtolica A, Cary SPL, Lee S, Ramisetti S, Slagle-Webb B, Sharma A, Connor J, Lee WS, Maire C, Kluk M, Aster JC, Ligon K, Sun S, Lee D, Ho ASW, Pu JKS, Zhang ZQ, Lee NP, Day PJR, Leung GKK, Liu Z, Liu X, Madhankumar AB, Miller P, Webb B, Connor JR, Yang QX, Lobo M, Green S, Schabel M, Gillespie Y, Woltjer R, Pike M, Lu YJ, Torre JDL, Waldman T, Prados M, Ozawa T, James D, Luchman HA, Stechishin O, Nguyen S, Cairncross JG, Weiss S, Lun X, Wells JC, Hao X, Zhang J, Grinshtein N, Kaplan D, Luchman A, Weiss S, Cairncross JG, Senger D, Robbins S, Madhankumar A, Slagle-Webb B, Rizk E, Payne R, Park A, Pang M, Harbaugh K, Connor J, Wilisch-Neumann A, Pachow D, Kirches E, Mawrin C, McDonell S, Liang J, Piao Y, Nguyen N, Yung A, Verhaak R, Sulman E, Stephan C, Lang F, de Groot J, Mizobuchi Y, Okazaki T, Kageji T, Kuwayama K, Kitazato KT, Mure H, Hara K, Morigaki R, Matsuzaki K, Nakajima K, Nagahiro S, Kumala S, Heravi M, Devic S, Muanza T, Nelson SK, Knubel KH, Pernu BM, Pierce AM, Keating AK, Neuwelt A, Nguyen T, Wu YJ, Donson A, Vibhakar R, Venkatamaran S, Amani V, Neuwelt E, Rapkin L, Foreman N, Ibrahim F, New P, Cui K, Zhao H, Chow D, Stephen W, Nozue-Okada K, Nagane M, McDonald KL, Ogawa D, Chiocca E, Godlewski J, Ozawa T, Yoshida Y, Santos R, James D, Pang M, Liu X, Madhankumar AB, Slagle-Webb B, Patel A, Miller P, Connor J, Pasupuleti N, Gorin F, Valenzuela A, Leon L, Carraway K, Ramachandran C, Nair S, Quirrin KW, Khatib Z, Escalon E, Melnick S, Phillips A, Boghaert E, Vaidya K, Ansell P, Shalinsky D, Zhang Y, Voorbach M, Mudd S, Holen K, Humerickhouse R, Reilly E, Huang T, Parab S, Diago O, Espinoza FL, Martin B, Ibanez C, Kasahara N, Gruber H, Pertschuk D, Jolly D, Robbins J, Ryken T, Agarwal S, Al-Keilani M, Alqudah M, Sibenaller Z, Assemolt M, Sai K, Li WY, Li WP, Chen ZP, Saito R, Sonoda Y, Kanamori M, Yamashita Y, Kumabe T, Tominaga T, Sarkar G, Curran G, Jenkins R, Scharnweber R, Kato Y, Lin J, Everson R, Soto H, Kruse C, Kasahara N, Liau L, Prins R, Semenkow S, Chu Q, Eberhart C, Sengupta R, Marassa J, Piwnica-Worms D, Rubin J, Serwer L, Kapp GT, Le Moan N, Yoshida Y, Romero JM, Ng S, Davis A, Ozawa T, Krtolica A, James CD, Cary SPL, Shai R, Pismenyuk T, Moshe I, Fisher T, Freedman S, Simon A, Amariglio N, Rechavi G, Toren A, Yalon M, Shen H, Decollogne S, Dilda P, Chung S, Luk P, Hogg P, McDonald K, Shimazu Y, Kurozumi K, Ichikawa T, Fujii K, Onishi M, Ishida J, Oka T, Watanabe M, Nasu Y, Kumon H, Date I, Sirianni RW, McCall RL, Spoor J, van der Kaaij M, Kloezeman J, Geurtjens M, Dirven C, Lamfers M, Leenstra S, Stephen Z, Veiseh O, Kievit F, Fang C, Leung M, Ellenbogen R, Silber J, Zhang M, Strohbehn G, Atsina KK, Patel T, Piepmeier J, Zhou J, Saltzman WM, Takahashi M, Valdes G, Inagaki A, Kamijima S, Hiraoka K, Micewicz E, McBride WH, Iwamoto KS, Gruber HE, Robbins JM, Jolly DJ, Kasahara N, Warren K, McCully C, Bacher J, Thomas T, Murphy R, Steffen-Smith E, McAllister R, Pastakia D, Widemann B, Wei K, Yang H, Huang C, Chen P, Hua M, Liu H, Woolf EC, Abdelwahab MG, Fenton KE, Liu Q, Turner G, Preul MC, Scheck AC, Yoshida Y, Ozawa T, Butowski N, Shen W, Brown D, Pedersen H, James D, Zhang J, Hariono S, Yao TW, Sidhu A, Hashizume R, James CD, Weiss WA, Nicolaides TP, Olusanya T. EXPERIMENTAL THERAPEUTICS AND PHARMACOLOGY. Neuro Oncol 2013; 15:iii37-iii61. [PMCID: PMC3823891 DOI: 10.1093/neuonc/not176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
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Abstract
Prostate cancer (PC) is both an age- and an androgen-dependent disease. Paradoxically, systemic levels of androgens decline with age as the risk of PC rises. While there is no correlation between systemic androgen levels and the risk of PC, systemic androgen levels do not reflect the levels of androgens in prostate tissue. In metastatic PC, changes in the androgen biosynthesis pathway during hormone therapy result in increased levels of androgens in cancer tissue and contribute to continued androgen receptor (AR) signaling. It is possible that similar changes occur in normal prostate tissue as androgen levels decline with age and that this contributes to tumorigenesis. In the present study, we sought to determine whether the rat prostate is able to maintain functional levels of androgens despite low serum testosterone levels. Rats were castrated and implanted with capsules to achieve castrate, normal, sub-physiological, and supra-physiological levels of testosterone. After 6 weeks of treatment, LC-MS/MS was used to quantify the levels of testosterone and dihydrotestosterone (DHT) in the serum and prostate tissue. Quantitative RT-PCR was used to quantify the expression of genes involved in the androgen/AR signaling axis. Despite significantly different levels of testosterone and DHT being present in the serum, testosterone and DHT concentrations in prostate tissue from different testosterone-treatment groups were very similar. Furthermore, the expression of androgen-regulated genes in the prostate was similar among all the testosterone-treatment groups, demonstrating that the rat prostate can maintain a functional level of androgens despite low serum testosterone levels. Low-testosterone treatment resulted in significant alterations in the expression of androgen biosynthesis genes, which may be related to maintaining functional androgen levels.
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Affiliation(s)
- Ye Zhou
- Department of Molecular Pharmacology, Beckman Research Institute, City of Hope National Medical Center, 1500 E Duarte Road, Beckman 2310, Duarte, California 91010, USA
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Park CK, Kim YH, Kim JW, Kim TM, Choi SH, Kim YJ, Choi BS, Lee SH, Kim CY, Kim IH, Lee DZ, Kheder A, Forbes M, Craven I, Hadjivassiliou M, Shonka NA, Kessinger A, Aizenberg MR, Weller M, Meisner C, Platten M, Simon M, Nikkhah G, Papsdorf K, Sabel M, Braun C, Reifenberger G, Wick W, Alexandru D, Haghighi B, Muhonen MG, Chamberlain MC, Sumrall AL, Burri S, Brick W, Asher A, Murillo-Medina K, Guerrero-Maldonado A, Ramiro AJ, Cervantes-Sanchez G, Erazo-Valle-Solis AA, Garcia-Navarro V, Sperduto PW, Shanley R, Luo X, Kased N, Sneed PK, Roberge D, Chao S, Weil R, Suh J, Bhatt A, Jensen A, Brown PD, Shih H, Kirkpatrick J, Gaspar LE, Fiveash J, Chiang V, Knisely J, Sperduto CM, Lin N, Mehta MP, Anderson MD, Raghunathan A, Aldape KD, Fuller GN, Gilbert MR, Robins HI, Wang M, Gilbert MR, Chakravarti A, Grimm S, Penas-Prado M, Chaudhary R, Anderson PJ, Elinzano H, Gilbert RA, Mehta M, Aoki T, Ueba T, Arakawa Y, Miyatake SI, Tsukahara T, Miyamoto S, Nozaki K, Taki W, Matsutani M, Shakur SF, Bit-Ivan E, Watkin WG, Farhat HI, Merrell RT, Zwinkels H, Dorr J, Kloet A, Taphoorn MJ, Vecht CJ, Bogdahn U, Stockhammer G, Mahapatra A, Hau P, Schuknecht B, van den Bent M, Heinrichs H, Yust-Katz S, Liu V, Sanghee K, Groves M, Puduvalli V, Levin V, Conrad C, Colman H, Hsu S, Yung AW, Gilbert MR, Kunz M, Armbruster L, Thon N, Jansen N, Lutz J, Herms J, Egensperger R, Eigenbrod S, Kretzschmar H, La CF, Tonn JC, Kreth FW, Brandes AA, Franceschi E, Agati R, Poggi R, Dall'Occa P, Bartolotti M, Di Battista M, Marucci G, Girardi F, Ermani M, Sherman W, Raizer J, Grimm S, Ruckser R, Tatzreiter G, Pfisterer W, Oberhauser G, Honigschnabel S, Aboul-Enein F, Ausch C, Kitzweger E, Hruby W, Sebesta C, Green RM, Woyshner EA, Suchorska B, Jansen NL, Janssen H, Kretzschmar H, Simon M, Hentschel B, Poepperl G, Kreth FW, Linn J, LaFougere C, Weller M, Tonn JC, Suchorska B, Jansen NL, Graute V, Eigenbrod S, Bartenstein P, Kreth FW, LaFougere C, Tonn JC, Hassanzadeh B, Tohidi V, Levacic D, Landolfi JC, Singer S, DeBraganca K, Omuro A, Grommes C, Omar AI, Jalan P, Pandav V, Bekker S, Fuente MIDL, Kaley T, Zhao S, Chen X, Soffietti R, Magistrello M, Bertero L, Bosa C, Crasto SG, Garbossa D, Lolli I, Trevisan E, Ruda R, Ruda R, Bertero L, Bosa C, Trevisan E, Pace A, Carapella C, Dealis C, Caroli M, Faedi M, Bomprezzi C, Thomas AA, Dalmau J, Gresa-Arribas N, Fadul CE, Kumthekar PU, Raizer J, Grimm S, Herrada J, Antony N, Richards M, Gupta A, Landeros M, Arango C, Campos-Gines AF, Friedman P, Wilson H, Streeter JC, Cohen A, Gilreath J, Sageser D, Ye X, Bell SD, McGregor J, Bourekas E, Cavaliere R, Newton H, Sul J, Odia Y, Zhang W, Shih J, Butman JA, Hammoud D, Kreisl TN, Iwamoto F, Fine HA, Berriel LG, Santos FN, Levy AC, Fanelli MF, Chinen LT, da Costa AA, Bourekas E, Wayne Slone H, Bell SD, McGregor J, Bokstein F, Blumenthal DT, Shpigel S, Phishniak L, Yust-Katz S, Garciarena P, Liue D, Yuan Y, Groves MD, Wong ET, Villano JL, Engelhard HH, Ram Z, Sahebjam S, Millar BA, Sahgal A, Laperriere N, Mason W, Levin VA, Hess KR, Choucair AK, Flynn PJ, Jaeckle KA, Kyritsis AP, Yung WKA, Prados MD, Bruner JM, Ictech S, Nghiemphu PL, Lai A, Green RM, Cloughesy TF, Zaky W, Gilles F, Grimm J, Bluml S, Dhall G, Rosser T, Randolph L, Wong K, Olch A, Krieger M, Finlay J, Capellades J, Verger E, Medrano S, Gonzalez S, Gil M, Reynes G, Ribalta T, Gallego O, Segura PP, Balana C, Gwak HS, Joo J, Kim S, Yoo H, Shin SH, Han JY, Kim HT, Yun T, Lee JS, Lee SH, Kim W, Vogelbaum MA, Wang M, Peereboom DM, Macdonald DR, Giannini C, Suh JH, Jenkins RB, Laack NN, Brackman DG, Shrieve DC, Souhami L, Mehta MP, Leibetseder A, Wohrer A, Ackerl M, Flechl B, Sax C, Spiegl-Kreinecker S, Pichler J, Widhalm G, Dieckmann K, Preusser M, Marosi C, Sebastian C, Alejandro M, Bernadette C, Naomi A, Kavan P, Sahebjam S, Garoufalis E, Guiot MC, Muanza T, Del Maestro R, Petrecca K, Sharma R, Curry R, Joyce J, Rosenblum M, Jaffe E, Matasar M, Lin O, Fisher R, Omuro A, Yin C, Iwamoto FM, Fraum TJ, Nayak L, Diamond EL, DeAngelis LM, Pentsova E, Vera-Bolanos E, Gilbert MR, Aldape K, Necesito-Reyes MJ, Fouladi M, Gajjar A, Goldman S, Metellus P, Mikkelsen T, Omuro A, Packer R, Partap S, Pollack IF, Prados M, Ian Robins H, Soffietti R, Wu J, Armstrong TS, Nakada M, Hayashi Y, Miyashita K, Kinoshita M, Furuta T, Sabit H, Kita D, Hayashi Y, Uchiyam N, Kawakami K, Minamoto T, Hamada JI, Diamond EL, Rosenblum M, Heaney M, Carrasquillo J, Krauthammer A, Nolan C, Kaley TJ, Gil MJ, Fuster J, Balana C, Benavides M, Mesia C, Etxaniz O, Canellas J, Perez-Martin X, Hunter K, Johnston SK, Bridge CA, Rockne RC, Guyman L, Baldock AL, Rockhill JK, Mrugala MM, Beard BC, Adair JE, Kiem HP, Swanson KR, Ranjan T, Desjardins A, Peters KB, Alderson L, Kirkpatrick J, Herndon J, Bailey L, Sampson J, Friedman AH, Friedman H, Vredenburgh JJ, Theeler BJ, Ellezam B, Melguizo-Gavilanes I, Shonka NA, Bruner JM, Puduvalli VK, Taylor JW, Flanagan E, O'Neill B, Seigal T, Omuro A, DeAngelis L, Baerhing J, Hoang-Xuan K, Chamberlain M, Batchelor T, Nishikawa R, Pinto F, Blay JY, Korfel A, Schiff D, Fu BD, Kong XT, Bota D, Omuro A, Beal K, Ivy P, Gutin P, Wu N, Kaley T, Karimi S, DeAngelis L, Pentsova H, Nolan C, Grommes C, Chan T, Mathew R, Droms L, Shimizu F, Tabar V, Grossman S, Yovino S, Campian J, Wild A, Herman J, Brock M, Balmanoukian A, Ye X, Portnow J, Badie B, Synold T, Lacey S, D'Apuzzo M, Frankel P, Chen M, Aboody K, Letarte N, Gabay MP, Bressler LR, Stachnik JM, Villano JL, Jaeckle KA, Anderson SK, Willson A, Moreno-Aspitia A, Colon-Otero G, Patel T, Perez E, Peters KB, Reardon DA, Vredenburgh JJ, Desjardins A, Herndon JE, Coan A, McSherry F, Lipp E, Brickhouse A, Massey W, Friedman HS, Alderson LM, Desjardins A, Ranjan T, Peters KB, Friedman HS, Vredenburgh JJ, Ranjan T, Desjardins A, Peters KB, Alderson L, Kirkpatrick J, Herndon J, Bailey L, Sampson J, Friedman AH, Friedman H, Vredenburgh J, Welch MR, Omuro A, Grommes C, Westphal M, Bach F, Reuter D, Ronellenfitsch M, Steinbach J, Pietsch T, Connelly J, Hamza MA, Puduvalli V, Neal ML, Trister AD, Ahn S, Bridge C, Lange J, Baldock A, Rockne R, Mrugala M, Rockhill JK, Lai A, Cloughesy T, Swanson KR, Neuwelt AJ, Nguyen TM, Tyson RM, Nasseri M, Neuwelt EA, Bubalo JS, Barnes PD, Phuphanich S, Hu J, Rudnick J, Chu R, Yu J, Naruse R, Ljubimova J, Sanchez C, Guevarra A, Naor R, Black K, Mahta A, Bhavsar TM, Herath K, Huang C, McClain J, Rizzo K, Sheehan J, Chamberlain M, Glantz M, McClain J, Glantz MJ, Zoccoli C, Nicholas MK, Xie T, White D, Liker S, Gajewski T, Selfridge J, Piccioni DE, Zurayk M, Mody R, Quan J, Li S, Chen W, Chou A, Liau L, Green R, Cloughesy T, Lai A, Gomez-Molinar V, Ruiz-Gonzalez S, Valdez-Vazquez R, Arrieta O, Stenner JI. CLIN-NEURO/MEDICAL ONCOLOGY. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos229] [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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Hurria A, Synold T, Blanchard S, Wong C, Mortimer J, Luu T, Chung C, Ramani R, Katheria V, Hansen K, Jayani R, Brown J, Williams B, Rotter A, Somlo G. P5-19-05: Age-Related Changes in the Pharmacokinetics (pK), Response, and Toxicity of Weekly nab-Paclitaxel in Patients with Metastatic Breast Cancer (MBC). Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-19-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Although cancer is a disease of aging, few studies have evaluated the association between patient age and the pK or pharmacodynamics (pD) of cancer therapeutics. The goals of this study were 1) to evaluate the age-related changes in the pK and pD of weekly nab-paclitaxel in patients with MBC; 2) to determine response rate; and 3) to explore the relationship of age with pK and pD parameters (i.e., dose reductions, dose delays and grade ≥ 3 toxicities). Patients and Methods: Forty patients with MBC, receiving 1st or 2nd line chemotherapy, entered an IRB approved protocol to evaluate the age-related changes in the pK of weekly nab-paclitaxel administered at 100 mg/m2 IV for 3 weeks followed by a 1-week break. Patients were accrued from 4 age strata <50, 50–60, 60–70, and >70 years of age. Blood samples were collected for pK analysis with the first dose of nab-paclitaxel. Response was assessed every 2 cycles. Toxicity was graded using the NCI Common Toxicity Criteria for Adverse Events (v 3.0) and was adjudicated as attributable to nab-paclitaxel if it was possibly, probably, or definitely related. Linear regression analysis was used to examine the strength of the relationship between patient age and natural logarithm of 24 hour area under the curve (AUC). Two-sided two-sample t-tests were used to assess if there was a difference in mean age based on the presence of pD variables (i.e., dose reductions, dose delays and grade ≥ 3 toxicities). The significance level was set to 0.05.
Results: Of the 40 patients who entered the study, 39 (98%) were evaluable with a mean age of 60 (SD=13.4; min=30; max=81). Patients were accrued in the following age cohorts: <50 (n= 10; 26%), 50–60 (n= 5; 13%), 60–70 (n= 15; 38%), and >70 (n= 9; 23%) years of age. The median number of courses completed was 4 (min=1, max=21). The response rate was: 0% (n=0) CR, 31% (n=12) PR, 38% (n=15) SD. Grade 3 toxicity was experienced by 26% (n=10). We observed 8% (n=3) grade 3 hematological toxicities [neutrophils (n=1; 3%), leukocytes (n=2; 5%)] and 18% (n=7) grade 3 non-hematological toxicities [nausea and hypophosphatemia (n=1; 3%), diarrhea and infection without neutropenia (n=1; 3%), fatigue (n=2; 5%), hyponatremia (n=1; 3%), and infections without neutropenia (n=2; 5%)]. There were no cases of grade 4 or 5 toxicity. Grade 2 sensory neuropathy was experienced by 8% (n=3; no cases in the 70+ age cohort). Dose reductions or course delays were experienced by 62% (n=24) and 21% (n=8), respectively. There was a borderline significant positive association between age and natural logarithm of total nab-paclitaxel 24 hour AUC (coef=.01; se=.006; p=0.055; n=36). There were no differences in the mean ages based on the presence of grade 3 or higher toxicity (p =0.75), need for dose reductions (p=0.48), or need for dose delays (p=0.61).
Discussion: There is a borderline statistically significant relationship between age and 24 hour AUC but no differences in mean age based on pD variables (i.e., dose reductions, dose delays and grade ≥ 3 toxicities) were identified. The treatment is well-tolerated across all age groups.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-19-05.
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Affiliation(s)
| | | | | | - C Wong
- 1City of Hope, Duarte, CA
| | | | - T Luu
- 1City of Hope, Duarte, CA
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Kirschbaum MH, Synold T, Stein AS, Tuscano J, Zain JM, Popplewell L, Karanes C, O'Donnell MR, Pulone B, Rincon A, Wright J, Frankel P, Forman SJ, Newman EM. A phase 1 trial dose-escalation study of tipifarnib on a week-on, week-off schedule in relapsed, refractory or high-risk myeloid leukemia. Leukemia 2011; 25:1543-7. [PMID: 21625235 PMCID: PMC3165084 DOI: 10.1038/leu.2011.124] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Inhibition of farnesyltransferase (FT) activity has been associated with in vitro and in vivo anti-leukemia activity. We report the results of a phase 1 dose escalation study of tipifarnib, an oral FT inhibitor, in patients with relapsed, refractory, or newly diagnosed (if over age 70) acute myelogenous leukemia (AML), on a week-on, week-off schedule. Forty-four patients were enrolled, 2 patients were newly diagnosed, the rest were relapsed or refractory to previous treatment, with a median age of 61 (range 33–79). The maximum tolerated dose was determined to be 1200 mg given orally twice-daily (bid) on this schedule. Cycle one dose-limiting toxicities were hepatic and renal. There were 3 complete remissions seen, 2 at the 1200 mg bid dose and one at the 1000 mg bid dose, with minor responses seen at the 1400 mg bid dose level. Pharmacokinetic studies performed at doses of 1400 mg bid showed linear behavior with minimal accumulation between days 1–5. Tipifarnib administered on a week-on week-off schedule shows activity at higher doses, and represents an option for future clinical trials in AML.
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Affiliation(s)
- M H Kirschbaum
- Department of Hematology/HCT, City of Hope, Duarte, CA, USA.
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Guan M, Fousek K, Jiang C, Guo S, Synold T, Xi B, Shih CC, Chow WA. Nelfinavir induces liposarcoma apoptosis through inhibition of regulated intramembrane proteolysis of SREBP-1 and ATF6. Clin Cancer Res 2011; 17:1796-806. [PMID: 21355074 DOI: 10.1158/1078-0432.ccr-10-3216] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We previously reported that nelfinavir (NFV) induces G(1) cell-cycle block and apoptosis selectively in liposarcoma cell lines due to increased SREBP-1 (sterol regulatory element binding protein-1) expression in the absence of increased transcription. We postulate that NFV interferes with regulated intramembrane proteolysis of SREBP-1 and ATF6 (activating transcription factor 6). EXPERIMENTAL DESIGN Time-lapse, confocal microscopic studies show that NFV inhibits the nuclear translocation of full-length SREBP-1-EGFP and ATF6-EGFP fusion proteins. siRNA-mediated knockdown of site-1 protease (S1P) and/or site-2 protease (S2P) leads to inhibition of SREBP-1 intracellular trafficking to the nucleus and reduces liposarcoma cell proliferation. Treatment of LiSa-2 liposarcoma cells with 3,4-dichloroisocoumarin, a serine protease inhibitor of S1P, did not affect SREBP-1 processing. In contrast, 1,10-phenanthroline, an S2P-specific inhibitor, reproduces the molecular and biological phenotypes observed in NFV-treated cells, which implicates S2P as a target of NFV. In vivo evaluation of NFV in a murine liposarcoma xenograft model leads to inhibition of tumor growth without significant toxicity. RESULTS NFV-induced upregulation of SREBP-1 and ATF6 results from inhibition of S2P, which together with S1P mediates regulated intramembrane proteolysis from their precursor to their transcriptionally active forms. The resulting endoplasmic reticulum (ER) stress and concurrent inhibition of the unfolded protein response induce caspase-mediated apoptosis. CONCLUSIONS These results provide new insight into the mechanism of NFV-mediated induction of ER stress and cell death in liposarcomas and are the first to report targeting S2P for cancer therapy.
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Affiliation(s)
- Min Guan
- Department of Molecular Pharmacology, Beckman Research Institute of the City of Hope, Duarte, California 91010, USA
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Venkatakrishnan K, Kramer W, Synold T, Goodman D, Oliva C. 661 A pharmacokinetic, pharmacodynamic and electrocardiographic study of L-MTP-PE in healthy volunteers. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)72368-5] [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: 10/18/2022] Open
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Quinn D, Aparicio A, Tsao-Wei D, Groshen S, Synold T, Stadler W, Massopust K, Gandara D, Lara P, Newman E. 7163 Phase II study of eribulin (Halichondrin B analogue, E7389) in patients with advanced urothelial cancer (AUC) – California Cancer Consortium led NCI/CTEP-sponsored trial. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71496-x] [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: 10/20/2022] Open
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18
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Chew HK, Doroshow JH, Frankel P, Margolin KA, Somlo G, Lenz HJ, Gordon M, Zhang W, Yang D, Russell C, Spicer D, Synold T, Bayer R, Hantel A, Stiff PJ, Tetef ML, Gandara DR, Albain KS. Phase II studies of gemcitabine and cisplatin in heavily and minimally pretreated metastatic breast cancer. J Clin Oncol 2009; 27:2163-9. [PMID: 19307510 DOI: 10.1200/jco.2008.17.4839] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cisplatin and gemcitabine have single-agent activity in metastatic breast cancer, and preclinical data support synergy of the combination. Two parallel, phase II trials were conducted to evaluate the response rate, response duration, and toxicities of the combination. Genetic polymorphisms were analyzed for correlation with outcomes. PATIENTS AND METHODS Eligible women had measurable disease and heavily or minimally pretreated metastatic breast cancer. The heavily pretreated protocol required prior anthracycline and taxane therapy; cisplatin as part of high-dose therapy was allowed. All patients received cisplatin 25 mg/m(2) on days 1 through 4 and gemcitabine 1,000 mg/m(2) on days 2 and 8 of a 21-day cycle with prophylactic granulocyte colony-stimulating factor in the heavily pretreated group. Sera from a subset of patients were evaluated by polymerase chain reaction restriction fragment length polymorphism for polymorphisms in 10 genes of interest. RESULTS Of 136 women enrolled, 74 were heavily pretreated. Both protocols accrued to their two-stage design. The response rate for both the heavily and minimally pretreated cohorts was 26%, and the median durations of response were 5.3 and 5.9 months, respectively. In a multivariate analysis, hormone receptor-negative disease was associated with a higher response rate. The most common grades 3 or 4 toxicities were thrombocytopenia (71%), neutropenia (66%), and anemia (38%). In a subset of 55 patients, the xeroderma pigmentosum group D (XPD)-751, x-ray cross-complementing group 3 (XRCC3) and cytidine deaminase polymorphisms were significantly associated with clinical outcomes. CONCLUSION Combination cisplatin and gemcitabine is active in metastatic breast cancer regardless of prior therapy. Genetic polymorphisms may tailor which patients benefit from this regimen.
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Affiliation(s)
- Helen K Chew
- Department of Internal Medicine, Division of Hematology/Oncology, University of California Davis, Sacramento, CA 95817, USA.
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Beringer PM, Kriengkauykiat J, Zhang X, Hidayat L, Liu S, Louie S, Synold T, Burckart GJ, Rao PA, Shapiro B, Gill M. Lack of Effect of P-glycoprotein Inhibition on Renal Clearance of Dicloxacillin in Patients with Cystic Fibrosis. Pharmacotherapy 2008; 28:883-94. [DOI: 10.1592/phco.28.7.883] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Yen Y, Synold T, Schluep T, Hwang J, Oliver J, Davis ME. First-in-human phase I trial of a cyclodextrin-containing polymer-camptothecin nanoparticle in patients with solid tumors. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14078] [Citation(s) in RCA: 9] [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
14078 Background: IT-101 is a de novo designed experimental therapeutic comprised of linear, cyclodextrin(CD)-containing polymer conjugates of camptothecin(CPT) that assemble into ca. 40 nm diameter nanoparticles via polymer-polymer interactions that involve inclusion complex formation between the CPT and the CD. Particle size, near neutral surface charge and CPT release rate were specifically designed into IT-101. Published pre-clinical animal studies show extended circulation times (t1/2 of ca. 20 h in rodents), tumor accumulation, slow release of the CPT and anti-tumor efficacy that directly correlate to the properties of the nanoparticle. Release of CPT can disassemble the nanoparticle into individual polymer chains that have size ca. 10 nm that are capable of renal clearance (t1/2 of several minutes in rodents). Methods: Patients with relapsed or refractory cancer were evaluated every two cycles of therapy (90 minute IV infusions of IT- 101 in D5W on days 1, 8 and 15 of a 28 day cycle). Three dose levels of 6, 12 and 18 mg CPT eq./m2 have been tested. Results: At the time of this interim analysis, eight patients have been enrolled and five evaluated. In general, IT-101 is well tolerated and pancytopenia is the DLT. The expected MTD is 12 mg/ m2.Three out of five patients demonstrated stable disease on CT scan evaluation. One pancreatic cancer patient remains stable for 6 months. PK data are available from the first 5 patients. Total and free CPT display biphasic elimination from plasma with mean terminal elimination half lives of 38±3.7 and 61±43 hours, respectively. The mean Vd and CLsys of total CPT are 6.1±1.4 L and 0.1±0.03 L/h and are unrelated to dose over the range tested, with a mean total-to-free AUC ratio of 10.7±3.7. Conclusions: These first in human PK data for IT-101 confirm that 40 nm particles with near neutral surface charge provide favorable PK properties. The stable disease rate, although not yet conclusive, is consistent with promising efficacy. The preliminary results of this phase I study warrant continued enrollment that is ongoing. No significant financial relationships to disclose.
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Affiliation(s)
- Y. Yen
- City of Hope National Medical Center, Duarte, CA; Insert Therapeutics, Inc., Pasadena, CA; Peptagen, Inc, Raleigh, NC; California Institute of Technology, Pasadena, CA
| | - T. Synold
- City of Hope National Medical Center, Duarte, CA; Insert Therapeutics, Inc., Pasadena, CA; Peptagen, Inc, Raleigh, NC; California Institute of Technology, Pasadena, CA
| | - T. Schluep
- City of Hope National Medical Center, Duarte, CA; Insert Therapeutics, Inc., Pasadena, CA; Peptagen, Inc, Raleigh, NC; California Institute of Technology, Pasadena, CA
| | - J. Hwang
- City of Hope National Medical Center, Duarte, CA; Insert Therapeutics, Inc., Pasadena, CA; Peptagen, Inc, Raleigh, NC; California Institute of Technology, Pasadena, CA
| | - J. Oliver
- City of Hope National Medical Center, Duarte, CA; Insert Therapeutics, Inc., Pasadena, CA; Peptagen, Inc, Raleigh, NC; California Institute of Technology, Pasadena, CA
| | - M. E. Davis
- City of Hope National Medical Center, Duarte, CA; Insert Therapeutics, Inc., Pasadena, CA; Peptagen, Inc, Raleigh, NC; California Institute of Technology, Pasadena, CA
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Morgan R, Valdes-Albini F, Synold T, Somlo G, Shibata S, Chow WA, Lim D, Koehler S, Frankel P, Doroshow J. Phase I trial of bortezomib in combination with topotecan in advanced solid tumor malignancies. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.12004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12004 Background: Bortezomib (B) and topotecan (T) have been shown in pre-clinical testing to be synergistic. Based on this data we have performed a phase I study to determine the maximally tolerated dose and toxicities (tox) of B and T delivered sequentially. Methods: 24 pts (KPS<ECOG 3) with advanced malignancies were treated with T (2.0, 2.5, 3.0 or 3.5 mg/m2 in sequential cohorts) IV on days 1 and 8 of each three week cycle. B 1.3 mg/m2 iv was administered six hours following T on days 1 and 8, and alone on days 4 and 12. Pts were treated in cohorts of 3, the MTD dose was expanded to include 10 additional pts for PK analysis. There was no limit on prior therapies. DLT was defined as any gr 3 or 4 non-hematologic toxicity not reversible in 48h or any gr 3 thrombocytopenia lasting >7 days or associated with bleeding or any gr 4. Results: Tumor types included: breast (4), ovary (5), lung (3), others (12). 24 pts were entered (11M 13F). The median age was 55 (range: 34–83). DLT was thrombocytopenia, observed in two pts at 3.5 mg/m2 and one pt at 3.0 mg/m2 (MTD). Other grade 3 or 4 tox included fatigue, lymphopenia, hypomagnesemia, and hypertriglyceridemia. Of the 24 enrolled pts, stable disease was observed in 4 (4 or 5 cycles), 9 progressed, 5 were inevaluable and 6 are too early. PK analysis is pending. Conclusions: T and B delivered sequentially are well tolerated on a weekly schedule. DLT is thrombocytopenia. PK will be presented.(Supported by NCI Grant CA33572). [Table: see text]
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Affiliation(s)
- R. Morgan
- City of Hope, Duarte, CA; National Cancer Institute, Bethesda, MD
| | - F. Valdes-Albini
- City of Hope, Duarte, CA; National Cancer Institute, Bethesda, MD
| | - T. Synold
- City of Hope, Duarte, CA; National Cancer Institute, Bethesda, MD
| | - G. Somlo
- City of Hope, Duarte, CA; National Cancer Institute, Bethesda, MD
| | - S. Shibata
- City of Hope, Duarte, CA; National Cancer Institute, Bethesda, MD
| | - W. A. Chow
- City of Hope, Duarte, CA; National Cancer Institute, Bethesda, MD
| | - D. Lim
- City of Hope, Duarte, CA; National Cancer Institute, Bethesda, MD
| | - S. Koehler
- City of Hope, Duarte, CA; National Cancer Institute, Bethesda, MD
| | - P. Frankel
- City of Hope, Duarte, CA; National Cancer Institute, Bethesda, MD
| | - J. Doroshow
- City of Hope, Duarte, CA; National Cancer Institute, Bethesda, MD
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El-Khoueiry AB, Iqbal S, Singh DA, D’Andre S, Ramanathan RK, Shibata S, Yang DY, Lenz HJ, Synold T, Gandara DR. A randomized phase II non-comparative study of Ispinesib given weekly or every three weeks in metastatic colorectal cancer. A California Cancer Consortium Study (CCC-P). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3595] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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
3595 Background: Ispinesib(SB-715992) is a polycyclic, nitrogen-containing heterocycle that inhibits the mitotic kinesin spindle protein (KSP). KSP is essential for mitotic spindle assembly and function during mitosis, and is a rational target of anti-cancer therapy. This phase II study used two different dosing schedules; the primary objective was to determine the response rate (RR) and the secondary objectives were to determine time to tumor progression (TTP), progression free survival (PFS), overall survival (OS) and toxicity. Methods: Patients (pts) were randomized to receive (Arm A) ispinesib 7 mg/m2 every week for 3 weeks, every 28 days or (Arm B) 18 mg/m2 every 21 days. Response was assessed every 6 weeks. Chemotherapy was administered until disease progression or intolerance. Results: A total of 64 pts were accrued. The median number of cycles was 2 for both arms. Five pts had stable disease and 48 had progressive disease. PFS was 49 days in Arm A (44 to 51) and 37 days in Arm B (35 to 42 days). The most common grade 3/4 toxicities in arms A and B respectively included neutropenia (3 and 20), nausea and vomiting (3 and 1), neurologic (1 and 2). Of these, only 1 pt had febrile neutropenia and 1 pt had peripheral sensory neuropathy. The toxicity data is not available on 2 patients. Eleven pts are not evaluable for response yet. Conclusions: Ispinesib did not demonstrate significant activity in heavily pretreated patients with advanced/metastatic colorectal cancer at the dose and schedule employed in this trial. Correlative studies are in progress. Supported by NO1 CM17101 [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- A. B. El-Khoueiry
- University of Chicago/Phase II Consortium, Chicago, IL; University of California Davis, Sacramento, CA; University of Pittsburgh Cancer Centers, Pittsburgh, PA; City of Hope National Medical Center, Duarte, CA; University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - S. Iqbal
- University of Chicago/Phase II Consortium, Chicago, IL; University of California Davis, Sacramento, CA; University of Pittsburgh Cancer Centers, Pittsburgh, PA; City of Hope National Medical Center, Duarte, CA; University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - D. A. Singh
- University of Chicago/Phase II Consortium, Chicago, IL; University of California Davis, Sacramento, CA; University of Pittsburgh Cancer Centers, Pittsburgh, PA; City of Hope National Medical Center, Duarte, CA; University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - S. D’Andre
- University of Chicago/Phase II Consortium, Chicago, IL; University of California Davis, Sacramento, CA; University of Pittsburgh Cancer Centers, Pittsburgh, PA; City of Hope National Medical Center, Duarte, CA; University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - R. K. Ramanathan
- University of Chicago/Phase II Consortium, Chicago, IL; University of California Davis, Sacramento, CA; University of Pittsburgh Cancer Centers, Pittsburgh, PA; City of Hope National Medical Center, Duarte, CA; University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - S. Shibata
- University of Chicago/Phase II Consortium, Chicago, IL; University of California Davis, Sacramento, CA; University of Pittsburgh Cancer Centers, Pittsburgh, PA; City of Hope National Medical Center, Duarte, CA; University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - D. Y. Yang
- University of Chicago/Phase II Consortium, Chicago, IL; University of California Davis, Sacramento, CA; University of Pittsburgh Cancer Centers, Pittsburgh, PA; City of Hope National Medical Center, Duarte, CA; University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - H. J. Lenz
- University of Chicago/Phase II Consortium, Chicago, IL; University of California Davis, Sacramento, CA; University of Pittsburgh Cancer Centers, Pittsburgh, PA; City of Hope National Medical Center, Duarte, CA; University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - T. Synold
- University of Chicago/Phase II Consortium, Chicago, IL; University of California Davis, Sacramento, CA; University of Pittsburgh Cancer Centers, Pittsburgh, PA; City of Hope National Medical Center, Duarte, CA; University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - D. R. Gandara
- University of Chicago/Phase II Consortium, Chicago, IL; University of California Davis, Sacramento, CA; University of Pittsburgh Cancer Centers, Pittsburgh, PA; City of Hope National Medical Center, Duarte, CA; University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
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23
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Gordon MA, Zhang W, Yang D, Spicer D, Doroshow J, Margolin K, Synold T, Albain K, Chew H, Gandara D, Lenz HJ. Polymorphisms of DNA-repair genes associated with clinical outcome in metastatic breast cancer (MBC) patients treated with gemcitabine/cisplatin (GC) (California Cancer Consortium). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.675] [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
675 Background: DNA repair enzymes may play an important role in determining efficacy of chemotherapy in MBC. In particular, GC combination therapy may be dependent on activity of DNA repair enzymes in host cells, since cisplatin acts by inducing DNA damage. Cancer cells with increased DNA repair capacity may be resistant to GC, and specific genes may be responsible for this increased repair capacity. We examined whether polymorphisms in genes related to DNA repair were associated with clinical outcome in MBC patients treated with GC, enrolled in a parent phase II clinical trial (Ph II-14 A & B). Methods: Fifty-five patients with MBC were evaluated. Patients received the following regimen: 25 mg/m2 cisplatin on days 1–4; 1000 mg/m2 gemcitabine on days 2 and 8 of 21-day cycle. Thirteen polymorphisms in 10 cancer-related genes were tested for association with overall survival, time to tumor progression, and tumor response using a PCR RFLP based assay. Results: Of 55 patients evaluated, there were 17 responders (31%) and 33 non-responders (60%). Five patients (9%) inevaluable for response. Of 33 non-responders, 15 had stable disease, 18 had progressive disease. Median survival: 11.7 months with median follow-up 32.4 months for 4 patients alive at time of analysis. Median progression-free survival: 4.2 months. XPD Lys751Gln polymorphism was associated with overall survival and time to tumor progression (p=0.0003, p=0.006, respectively, log-rank test). Thirty-five patients carried Lys/Lys genotype, of which 29% resopnded. Fourteen patients carried Lys/Gln genotype, of which 54% resopnded. Five patients carried Gln/Gln genotype, with no responders. XRCC3 Thr241Met polymorphism was associated with time to tumor progression and tumor response (p=0.03, p=0.002, respectively). Eighteen patients had Met/Met genotype, of which 47% responded. Twenty-six patients had heterozygous genotype, of which 17% responded. Five patients had homozygous Thr/Thr, of which 100% responded. Conclusions: Our results suggest that polymorphisms in DNA repair genes XPD and XRCC3 may be important markers in predicting clinical outcome in MBC patients treated with GC. Supported by the following NCI grant: N01 CM1701. [Table: see text]
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Affiliation(s)
- M. A. Gordon
- University of Southern California, Los Angeles, CA; City of Hope National Medical Center, Duarte, CA; Loyola University Medical Center, Maywood, IL; University of California Davis, Davis, CA
| | - W. Zhang
- University of Southern California, Los Angeles, CA; City of Hope National Medical Center, Duarte, CA; Loyola University Medical Center, Maywood, IL; University of California Davis, Davis, CA
| | - D. Yang
- University of Southern California, Los Angeles, CA; City of Hope National Medical Center, Duarte, CA; Loyola University Medical Center, Maywood, IL; University of California Davis, Davis, CA
| | - D. Spicer
- University of Southern California, Los Angeles, CA; City of Hope National Medical Center, Duarte, CA; Loyola University Medical Center, Maywood, IL; University of California Davis, Davis, CA
| | - J. Doroshow
- University of Southern California, Los Angeles, CA; City of Hope National Medical Center, Duarte, CA; Loyola University Medical Center, Maywood, IL; University of California Davis, Davis, CA
| | - K. Margolin
- University of Southern California, Los Angeles, CA; City of Hope National Medical Center, Duarte, CA; Loyola University Medical Center, Maywood, IL; University of California Davis, Davis, CA
| | - T. Synold
- University of Southern California, Los Angeles, CA; City of Hope National Medical Center, Duarte, CA; Loyola University Medical Center, Maywood, IL; University of California Davis, Davis, CA
| | - K. Albain
- University of Southern California, Los Angeles, CA; City of Hope National Medical Center, Duarte, CA; Loyola University Medical Center, Maywood, IL; University of California Davis, Davis, CA
| | - H. Chew
- University of Southern California, Los Angeles, CA; City of Hope National Medical Center, Duarte, CA; Loyola University Medical Center, Maywood, IL; University of California Davis, Davis, CA
| | - D. Gandara
- University of Southern California, Los Angeles, CA; City of Hope National Medical Center, Duarte, CA; Loyola University Medical Center, Maywood, IL; University of California Davis, Davis, CA
| | - H. J. Lenz
- University of Southern California, Los Angeles, CA; City of Hope National Medical Center, Duarte, CA; Loyola University Medical Center, Maywood, IL; University of California Davis, Davis, CA
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Stein A, O’Donnell M, Dagis A, Krishnan A, Nademanee A, Nakamura R, Parker P, Popplewell L, Pullarkat V, Rodriguez R, Rosenthal J, Smith E, Snyder D, Spielberger R, Synold T, Vora N, Zain J, Sarkodee-Adoo C, Forman S. Phase 2 study of targeted intravenous busulfan (IV BU) combined with fractionated total body irradiation (FTBI) and etoposide (VP-16) as preparative regimen for allogeneic peripheral blood stem cell transplant (PBSCT) for patients with poor risk leukemia. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.108] [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: 11/29/2022]
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Margolin K, Longmate J, Baratta T, Synold T, Christensen S, Weber J, Gajewski T, Quirt I, Doroshow JH. CCI-779 in metastatic melanoma: a phase II trial of the California Cancer Consortium. Cancer 2005; 104:1045-8. [PMID: 16007689 DOI: 10.1002/cncr.21265] [Citation(s) in RCA: 197] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND CCI-779 is an analog of the immunosuppressive agent, rapamycin, that has demonstrated activity against melanoma in preclinical models and shown clinical benefit in patients with breast and renal carcinoma. CCI-779 is not immunosuppressive when administered on an intermittent schedule, and its toxicity is modest, consisting of nausea, diarrhea, hypertriglyceridemia, thrombocytopenia, asthenia, and follicular dermatitis. METHODS The current trial was designed to detect a median time to disease progression of >18 weeks in patients with metastatic melanoma treated with a 250-mg weekly dose of CCI-779 administered intravenously after diphenhydramine premedication. Patients with measurable disease, no more than one previous chemotherapy regimen for metastatic disease, and normal organ function were eligible, and patients with central nervous system involvement, P450-inducing or P450-suppressing drugs, or hypertriglyceridemia were excluded. RESULTS Thirty-three patients (21 males) were treated, 21 of whom had been treated previously with chemotherapy and/or biologic agents for advanced-stage disease. One patient had a partial response lasting 2 months. The median time to disease progression and overall survival were 10 weeks and 5 months, respectively. Toxicity was mild and predominantly mucocutaneous (stomatitis, diarrhea, and rash). Hyperlipidemia was cumulative and was managed with lipid-lowering agents. CONCLUSIONS CCI-779 was not sufficiently active in melanoma to warrant further testing as a single agent.
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Affiliation(s)
- Kim Margolin
- Division of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California 91010, USA.
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Margolin KA, Lara P, Quinn D, Dutcher J, Frankel P, Doroshow J, Gandara D, Synold T, Lacey SF. G3139 plus α-Interferon (IFN) in metastatic renal cancer (RCC): A phase II study of the California Cancer Consortium. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- K. A. Margolin
- City of Hope, Duarte, CA; Univ of CA, Davis Cancer Ctr, Davis, CA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Our Lady of Mercy, Bronx NY Cancer Ctr, Bronx, NY; City of Hope, Duarte, CA
| | - P. Lara
- City of Hope, Duarte, CA; Univ of CA, Davis Cancer Ctr, Davis, CA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Our Lady of Mercy, Bronx NY Cancer Ctr, Bronx, NY; City of Hope, Duarte, CA
| | - D. Quinn
- City of Hope, Duarte, CA; Univ of CA, Davis Cancer Ctr, Davis, CA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Our Lady of Mercy, Bronx NY Cancer Ctr, Bronx, NY; City of Hope, Duarte, CA
| | - J. Dutcher
- City of Hope, Duarte, CA; Univ of CA, Davis Cancer Ctr, Davis, CA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Our Lady of Mercy, Bronx NY Cancer Ctr, Bronx, NY; City of Hope, Duarte, CA
| | - P. Frankel
- City of Hope, Duarte, CA; Univ of CA, Davis Cancer Ctr, Davis, CA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Our Lady of Mercy, Bronx NY Cancer Ctr, Bronx, NY; City of Hope, Duarte, CA
| | - J. Doroshow
- City of Hope, Duarte, CA; Univ of CA, Davis Cancer Ctr, Davis, CA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Our Lady of Mercy, Bronx NY Cancer Ctr, Bronx, NY; City of Hope, Duarte, CA
| | - D. Gandara
- City of Hope, Duarte, CA; Univ of CA, Davis Cancer Ctr, Davis, CA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Our Lady of Mercy, Bronx NY Cancer Ctr, Bronx, NY; City of Hope, Duarte, CA
| | - T. Synold
- City of Hope, Duarte, CA; Univ of CA, Davis Cancer Ctr, Davis, CA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Our Lady of Mercy, Bronx NY Cancer Ctr, Bronx, NY; City of Hope, Duarte, CA
| | - S. F. Lacey
- City of Hope, Duarte, CA; Univ of CA, Davis Cancer Ctr, Davis, CA; USC/Norris Comprehensive Cancer Ctr, Los Angeles, CA; Our Lady of Mercy, Bronx NY Cancer Ctr, Bronx, NY; City of Hope, Duarte, CA
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Twardowski P, Chow W, Koczywas M, Leong L, Lim D, Margolin K, Morgan R, Ruel C, Shibata S, Synold T, Doroshow J. Phase I trial of oral cyclophosphamide in combination with celecoxib in patients with advanced malignancies. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - W. Chow
- City of Hope Cancer Ctr, Duarte, CA
| | | | - L. Leong
- City of Hope Cancer Ctr, Duarte, CA
| | - D. Lim
- City of Hope Cancer Ctr, Duarte, CA
| | | | | | - C. Ruel
- City of Hope Cancer Ctr, Duarte, CA
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Luu TH, Twardowski P, Leong L, Lim D, Morgan R, McNamara M, Portnow J, Ruel C, Shibata S, Synold T, Doroshow J. Phase I trial of oral etoposide in combination with celecoxib in patients with advanced malignancies. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T. H. Luu
- City of Hope Natl Medcl Ctr, Duarte, CA
| | | | - L. Leong
- City of Hope Natl Medcl Ctr, Duarte, CA
| | - D. Lim
- City of Hope Natl Medcl Ctr, Duarte, CA
| | - R. Morgan
- City of Hope Natl Medcl Ctr, Duarte, CA
| | | | | | - C. Ruel
- City of Hope Natl Medcl Ctr, Duarte, CA
| | | | - T. Synold
- City of Hope Natl Medcl Ctr, Duarte, CA
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Bolotin E, Cooper L, Synold T, Sweetman R, Mao J, Palmer J, Rosenthal J. Low transplant-related mortality after stem cell transplantation with IV busulfan-based conditioning in pediatric patients. Biol Blood Marrow Transplant 2005. [DOI: 10.1016/j.bbmt.2004.12.248] [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: 11/27/2022]
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Iqbal S, Cole S, Yang D, Lara PN, Gumerlock PH, Shibata S, Synold T, Doroshow JH, Gandara D, Lenz HJ. Phase I study of PS-341 (bortezomib) with 5-fluorouracil/leucovorin (5-FU/LV) in advanced solid tumors: A California Cancer Consortium study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.2057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Iqbal
- University of Southern California, Los Angeles, CA; University of California, Davis, Sacramento, CA; City of Hope, Duarte, CA
| | - S. Cole
- University of Southern California, Los Angeles, CA; University of California, Davis, Sacramento, CA; City of Hope, Duarte, CA
| | - D. Yang
- University of Southern California, Los Angeles, CA; University of California, Davis, Sacramento, CA; City of Hope, Duarte, CA
| | - P. N. Lara
- University of Southern California, Los Angeles, CA; University of California, Davis, Sacramento, CA; City of Hope, Duarte, CA
| | - P. H. Gumerlock
- University of Southern California, Los Angeles, CA; University of California, Davis, Sacramento, CA; City of Hope, Duarte, CA
| | - S. Shibata
- University of Southern California, Los Angeles, CA; University of California, Davis, Sacramento, CA; City of Hope, Duarte, CA
| | - T. Synold
- University of Southern California, Los Angeles, CA; University of California, Davis, Sacramento, CA; City of Hope, Duarte, CA
| | - J. H. Doroshow
- University of Southern California, Los Angeles, CA; University of California, Davis, Sacramento, CA; City of Hope, Duarte, CA
| | - D. Gandara
- University of Southern California, Los Angeles, CA; University of California, Davis, Sacramento, CA; City of Hope, Duarte, CA
| | - H. J. Lenz
- University of Southern California, Los Angeles, CA; University of California, Davis, Sacramento, CA; City of Hope, Duarte, CA
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Margolin KA, Longmate J, Baratta T, Synold T, Weber J, Gajewski T, Quirt I, Christensen S, Doroshow JH. CCI-779 in metastatic melanoma: A phase II trial of the California Cancer Consortium. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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)
- K. A. Margolin
- City of Hope, Duarte, CA; USC-Norris Cancer Center, Los Angeles, CA; University of Chicago Medical School, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada; University of California, Davis, Sacramento, CA
| | - J. Longmate
- City of Hope, Duarte, CA; USC-Norris Cancer Center, Los Angeles, CA; University of Chicago Medical School, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada; University of California, Davis, Sacramento, CA
| | - T. Baratta
- City of Hope, Duarte, CA; USC-Norris Cancer Center, Los Angeles, CA; University of Chicago Medical School, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada; University of California, Davis, Sacramento, CA
| | - T. Synold
- City of Hope, Duarte, CA; USC-Norris Cancer Center, Los Angeles, CA; University of Chicago Medical School, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada; University of California, Davis, Sacramento, CA
| | - J. Weber
- City of Hope, Duarte, CA; USC-Norris Cancer Center, Los Angeles, CA; University of Chicago Medical School, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada; University of California, Davis, Sacramento, CA
| | - T. Gajewski
- City of Hope, Duarte, CA; USC-Norris Cancer Center, Los Angeles, CA; University of Chicago Medical School, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada; University of California, Davis, Sacramento, CA
| | - I. Quirt
- City of Hope, Duarte, CA; USC-Norris Cancer Center, Los Angeles, CA; University of Chicago Medical School, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada; University of California, Davis, Sacramento, CA
| | - S. Christensen
- City of Hope, Duarte, CA; USC-Norris Cancer Center, Los Angeles, CA; University of Chicago Medical School, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada; University of California, Davis, Sacramento, CA
| | - J. H. Doroshow
- City of Hope, Duarte, CA; USC-Norris Cancer Center, Los Angeles, CA; University of Chicago Medical School, Chicago, IL; Princess Margaret Hospital, Toronto, ON, Canada; University of California, Davis, Sacramento, CA
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Juhasz A, Frankel P, Cheng C, Rivera H, Vishwanath R, Chiu A, Margolin K, Yen Y, Newman EM, Synold T, Wilczynski S, Lenz HJ, Gandara D, Albain KS, Longmate J, Doroshow JH. Quantification of chemotherapeutic target gene mRNA expression in human breast cancer biopsies: comparison of real-time reverse transcription-PCR vs. relative quantification reverse transcription-PCR utilizing DNA sequencer analysis of PCR products. J Clin Lab Anal 2003; 17:184-94. [PMID: 12938148 PMCID: PMC6808165 DOI: 10.1002/jcla.10091] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 08/06/2002] [Accepted: 04/04/2003] [Indexed: 11/09/2022] Open
Abstract
The solid tumor mRNA expression of genes related to the mechanism of action of certain antineoplastic agents is often predictive of clinical efficacy. We report here on the development of a rapid and practical real-time RT-PCR method to quantify genetic expression in solid tumors. The genes examined are related to the intracellular pharmacology of gemcitabine and cisplatin, two drugs that are used in the treatment of several types of advanced cancer. We evaluated target gene mRNA levels from breast tumor samples using two quantitative RT-PCR methods: 1) an improved relative RT-PCR method using fluorescence-labeled primers, automated PCR set up, and GeneScan analysis software; and 2) real-time RT-PCR with redesigned primers using an ABI 7900HT instrument, with additional postprocessing of the data to adjust for efficiency differences across the target genes. Using these methods, we quantified mRNA expression levels of deoxycytidine kinase (dCK), deoxycytidylate deaminase (dCDA), the M1 and M2 subunits of ribonucleotide reductase (RRM1, RRM2), and excision cross complementation group 1 (ERCC1) in 35 human "fresh" frozen breast cancer biopsies. While both assay methods were substantially more rapid than traditional RT-PCR, real-time RT-PCR appeared to be superior to the amplification end-point measurement in terms of precision and high throughput, even when a DNA sequencer was used to assess fluorescence-labeled PCR products. This reproducible, highly sensitive real-time RT-PCR method for the detection and quantification of the mRNAs for dCK, dCDA, RRM1, RRM2, and ERCC1 in human breast cancer biopsies appears to be more informative and less time-consuming than either classical radioisotope-dependent RT-PCR or the technique utilizing GeneScan analysis described herein. By allowing the measurement of intratumoral target gene expression, these new methods may prove useful in predicting the clinical utility of gemcitabine- and platinum-containing chemotherapy programs in patients with solid tumors.
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Affiliation(s)
- Agnes Juhasz
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California 91010, USA.
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Abstract
PURPOSE The objective of this report is to review the research methods that have been used in the design, analysis, and reporting of Phase I dose-escalation studies of high-dose chemotherapy (HDCT) with bone marrow or stem cell support and to propose new guidelines for such studies that incorporate emerging principles of pharmacology, toxicity assessment, statistical design, and long-term follow-up. METHODS We performed a search of original, English-language, peer-reviewed full-length reports of HDCT (with or without radiotherapy) and unmanipulated hematopoietic precursor support (autologous bone marrow or stem cells or allogeneic bone marrow) in which one or more drug doses were escalated to identify dose-limiting toxicities needed for the design of subsequent Phase II trials. We reviewed the design, execution, analysis, and reporting of these trials to develop a coherent set of guidelines for the initiation of new HDCT regimens. The primary elements included in our analysis were the technique of dose escalation, the choice and application of toxicity grading scale, and the pharmacologic correlates of dose escalation. We also evaluated the methods employed to define dose-limiting toxicities and to select the maximum tolerated dose and the dose recommended for further study. We then examined whether subsequent Phase II trials based on these definitions corroborated the findings from the prior Phase I studies and summarized the findings from pharmacologic analyses that were reported from a subset of these investigations. RESULTS Thirty-five reports met the criteria for our literature review. Two standard methods of dose escalation (fixed increments or modified Fibonacci increments) were described in detail and were employed in the majority (30/35) of the studies. In 5 studies, the details of dose escalation were either not provided or not adequately referenced. There was marked heterogeneity among toxicity grading methods; scales used included the National Cancer Institute Common Toxicity Criteria (or similar scales such as the United States cooperative group or World Health Organization scales) as well as substantially modified versions of those instruments. Wide variations in the methods used to identify dose-limiting toxicities were observed. Statistical considerations, applied to the identification of the maximum tolerated or Phase II recommended dose, were similarly heterogeneous. Phase II trial designs varied from a simple expansion of the Phase I trial to separate, formally conducted studies. Nine Phase I trials featured pharmacologic analyses, and these ranged from simple pharmacokinetic evaluations to more complex analyses of the relationship between drug dose and the molecular targets of drug action. CONCLUSIONS Phase I clinical trials in the HDCT setting have been designed, analyzed, and reported using heterogeneous methods that limited their application to Phase II and II investigations. Moreover, correlative pharmacologic analyses have not been routinely undertaken during this critical Phase I stage. We propose guidelines for the design of new Phase I studies of HDCT based on 4 essential elements: (1) rational preclinical and clinical pharmacologic foundation for the regimen and for the agent selected for dose escalation; (2) incorporation of analytical pharmacology in the design and analysis of the regimen under investigation; (3) clear, prospective definitions of the dose- or exposure-limiting toxicities that can be distinguished from modality-dependent toxicities; selection of an appropriate toxicity grading scale, including an assessment of cumulative, delayed, and long-term effects of HDCT, particularly when designing tandem or repetitive cycle regimens; and (4) statistical input into the design, execution, analysis, interpretation, and reporting of these studies.
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Affiliation(s)
- K Margolin
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California USA.
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Somlo G, Doroshow JH, Synold T, Longmate J, Reardon D, Chow W, Forman SJ, Leong LA, Margolin KA, Morgan RJ, Raschko JW, Shibata SI, Tetef ML, Yen Y, Kogut N, Schriber J, Alvarnas J. High-dose paclitaxel in combination with doxorubicin, cyclophosphamide and peripheral blood progenitor cell rescue in patients with high-risk primary and responding metastatic breast carcinoma: toxicity profile, relationship to paclitaxel pharmacokinetics and short-term outcome. Br J Cancer 2001; 84:1591-8. [PMID: 11401310 PMCID: PMC2363687 DOI: 10.1054/bjoc.2001.1835] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We assessed the feasibility and pharmacokinetics of high-dose infusional paclitaxel in combination with doxorubicin, cyclophosphamide, and peripheral blood progenitor cell rescue. Between October 1995 and June 1998, 63 patients with high-risk primary [stage II with >or= 10 axillary nodes involved, stage IIIA or stage IIIB inflammatory carcinoma (n = 53)] or with stage IV responsive breast cancer (n = 10) received paclitaxel 150-775 mg/m(2)infused over 24 hours, doxorubicin 165 mg/m(2)as a continuous infusion over 96 hours, and cyclophosphamide 100 mg kg(-1). There were no treatment-related deaths. Dose-limiting toxicity was reversible, predominantly sensory neuropathy following administration of paclitaxel at the 775 mg/m(2) dose level. Paclitaxel pharmacokinetics were non-linear at higher dose levels; higher paclitaxel dose level, AUC, and peak concentrations were associated with increased incidence of paraesthesias. No correlation between stomatitis, haematopoietic toxicities, and paclitaxel dose or pharmacokinetics was found. Kaplan-Meier estimates of 30-month event-free and overall survival for patients with primary breast carcinoma are 65% (95% CI; 51-83%) and 77% (95% CI; 64-93%). Paclitaxel up to 725 mg/m(2) infused over 24 hours in combination with with doxorubicin 165 mg/m(2) and cyclophosphamide 100 mg kg(-1) is tolerable. A randomized study testing this regimen against high-dose carboplatin, thiotepa and cyclophosphamide (STAMP V) is currently ongoing.
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Affiliation(s)
- G Somlo
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
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Morgan RJ, Synold T, Carr BI, Doroshow JH, Womack EP, Shibata S, Somlo G, Raschko J, Leong L, McNamara M, Chow W, Tetef M, Margolin K, Akman S, Longmate J. Continuous infusion prochlorperazine: pharmacokinetics, antiemetic efficacy, and feasibility of high-dose therapy. Cancer Chemother Pharmacol 2001; 47:327-32. [PMID: 11345649 DOI: 10.1007/s002800000232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of these sequential phase I studies was to evaluate the antiemetic efficacy and pharmacokinetics of high-dose continuous infusion prochlorperazine. METHODS A total of 52 patients with advanced cancer were treated in two sequential phase I studies utilizing high-dose prochlorperazine. In study 1, designed to investigate the antiemetic effects of dose-intensive prochlorperazine, various cisplatin-based multiagent chemotherapeutic regimens were administered in combination with escalating doses of prochlorperazine. In study 2, a fixed dose of cisplatin (60 mg/m2) was administered over 24 h as a continuous intravenous infusion in combination with infusional high-dose prochlorperazine. Antiemetic efficacy in the first trial was assessed in terms of the number of episodes of nausea, retching, and/or emesis during the 24 h following cisplatin administration. The pharmacokinetics of high-dose prochlorperazine were evaluated in eight patients treated in study 2 at the two dose levels below those at which dose-limiting toxicity was noted. RESULTS The maximally tolerated dose of prochlorperazine in combination with cisplatin (60 mg/m2 administered as a continuous infusion over 24 h) was 24 mg/h. The dose-limiting toxicity was grade 4 agitation and confusion noted in one patient treated at 26 mg/h. This patient died 3 days following cessation of chemotherapy due to the toxicity of the regimen in combination with the debilitating pulmonary effects of the disease. The mean end of infusion prochlorperazine level at the 24 mg/h dose level was 1.1 microM, a concentration previously reported to be consistent with the reversal of the multidrug resistance phenotype. Two partial responses were observed in study 2. CONCLUSIONS We conclude that the antiemetic efficacy of high-dose infusional prochlorperazine does not appear to be improved over more convenient bolus administration. However, prochlorperazine levels consistent with those required in vitro for drug resistance reversal are attainable within the dose range having a tolerable toxicity profile.
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Affiliation(s)
- R J Morgan
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, 1500 E. Duarte Rd., Duarte, CA 91010, USA
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Lara PN, Gandara DR, Wurz GT, Lau D, Uhrich M, Turrell C, Raschko J, Edelman MJ, Synold T, Doroshow J, Muggia F, Perez EA, DeGregorio M. High-dose toremifene as a cisplatin modulator in metastatic non-small cell lung cancer: targeted plasma levels are achievable clinically. Cancer Chemother Pharmacol 2001; 42:504-8. [PMID: 9788578 DOI: 10.1007/s002800050852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The triphenylethylenes tamoxifen and toremifene have been reported to enhance the cytotoxicity of cisplatin by inhibition of protein kinase C (PKC) signal transduction pathways. However, the concentrations of tamoxifen and toremifene required for chemosensitization in preclinical models are generally > or =5 microM, at least tenfold higher than plasma levels observed in patients receiving these agents as antiestrogenic therapy. As part of a translational phase II trial investigating the efficacy and potential molecular mechanism of high-dose toremifene as a cisplatin modulator in metastatic non-small-cell lung cancer, plasma concentrations of toremifene and its active metabolite N-desmethyltoremifene were measured to determine whether targeted levels could be achieved clinically. METHODS Treatment consisted of toremifene, 600 mg orally on days 1-7, and cisplatin, 50 mg/m2 intravenously on days 4 and 11, repeated every 28 days. Toremifene and N-desmethyltoremifene were measured by reverse-phase HPLC assay on days 4 and 11 prior to cisplatin infusion. RESULTS In the initial 14 patients, the mean total plasma concentrations of toremifene plus its N-desmethyl metabolite on days 4 and 11 were 14.04 (+/- 8.6) microM and 9.8 (+/- 4.4) microM, respectively. Variability in concentrations achieved did not correlate with renal or hepatic function, gender, or body surface area. Levels of N-desmethyltoremifene were higher on day 11 relative to toremifene concentrations. CONCLUSIONS We conclude that plasma levels achieved compare favorably with the levels required for cisplatin chemosensitization and PKC modulation in vitro. Targeted toremifene levels can be achieved clinically with 600 mg orally daily in combination with cisplatin and are well tolerated.
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Affiliation(s)
- P N Lara
- University of California Davis Cancer Center, Sacramento 95817, USA
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Roberts JD, Poplin EA, Tombes MB, Kyle B, Spicer DV, Grant S, Synold T, Moran R. Weekly lometrexol with daily oral folic acid is appropriate for phase II evaluation. Cancer Chemother Pharmacol 2000; 45:103-10. [PMID: 10663624 DOI: 10.1007/s002800050017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Lometrexol [(6R)-5,10-dideaza-5,6,7,8-tetrahydrofolate] is the prototype folate antimetabolite that targets the de novo purine synthesis pathway. Early phase I trials were confounded by cumulative myelosuppression that prevented repetitive administration. Subsequent preclinical and clinical studies suggested that coadministration of folic acid might favorably modulate lometrexol toxicity without eliminating potential antitumor activity. We set out to determine if concurrent folic acid would allow administration of lometrexol on a weekly schedule, and, if so, to identify an appropriate dose combination for phase II trials. Pharmacokinetic and metabolism studies were undertaken in an attempt to improve our understanding of lometrexol pharmacodynamics. METHODS Patients with advanced cancer received daily oral folic acid beginning 7 days before lometrexol and continuing for 7 days beyond the last lometrexol dose. Lometrexol was administered by short i.v. infusion weekly for 8 weeks. Scheduled lometrexol doses were omitted for toxicity of more than grade 2 present on the day of treatment, and dose-limiting toxicity was prospectively defined in terms of frequency of dose omission as well as the occurrence of severe toxic events. Plasma and whole blood total lometrexol contents (lometrexol plus lometrexol polyglutamates) were measured in samples taken just prior to each lometrexol dose. RESULTS A total of 18 patients were treated at five lometrexol dose levels. The maximum tolerated dose was identified by frequent dose omission due to thrombocytopenia and mucositis. The recommended phase II dose combination is lometrexol 10.4 mg/m(2) per week i.v. with folic acid 3 mg/m(2) per day orally. One patient with melanoma experienced a partial response, and three patients, two with melanoma and one with renal cell carcinoma, experienced stable disease. Lometrexol was not detectable in any predose plasma sample tested. The total red blood cell content of lometrexol increased over several weeks and then appeared to plateau. CONCLUSIONS Weekly administration of lometrexol is feasible and well-tolerated when coadministered with daily oral folic acid. The nature of the interaction between natural folates and lometrexol that renders this schedule feasible remains unclear. A definition of dose-limiting toxicity that incorporated attention to dose omissions allowed efficient identification of a recommended phase II dose that reflects the maximum feasible dose intensity for a weekly schedule. Lometrexol is a promising, anticancer agent.
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Affiliation(s)
- J D Roberts
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298-0037, USA.
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Pui CH, Boyett JM, Hughes WT, Rivera GK, Hancock ML, Sandlund JT, Synold T, Relling MV, Ribeiro RC, Crist WM, Evans WE. Human granulocyte colony-stimulating factor after induction chemotherapy in children with acute lymphoblastic leukemia. N Engl J Med 1997; 336:1781-7. [PMID: 9187068 DOI: 10.1056/nejm199706193362503] [Citation(s) in RCA: 126] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recombinant human granulocyte colony-stimulating factor PO1 CA-20180ilgrastim) hastens the recovery from neutropenia after P30 CA-21765emotherapy, but its role in the management of childhood leukemia is unclear. METHODS We randomly assigned 164 patients with acute lymphoblastic leukemia (age range, 2 months to 17 years) to receive placebo or G-CSF (10 microg per kilogram of body weight per day subcutaneously), beginning one day after the completion of remission-induction therapy and continuing until the neutrophil count was greater than or equal to 1000 per cubic millimeter for two days. The clinical and laboratory effects of this therapy were documented for 21 days. The area under the plasma G-CSF concentration-time curve was measured on days 1 and 7 in both groups. RESULTS Responses to the growth factor could be assessed in 148 patients (73 in the G-CSF group and 75 in the placebo group). G-CSF treatment did not significantly lower the rate of hospitalization for febrile neutropenia (58 percent in the G-CSF group vs. 68 percent in the placebo group; relative risk, 0.85; 95 percent confidence interval, 0.59 to 1.16), increase the likelihood of event-free survival at three years (83 percent in both groups), or decrease the number of severe infections (five in the G-CSF group vs. six in the placebo group). Patients treated with G-CSF had shorter median hospital stays (6 days vs. 10 days, P=0.011) and fewer documented infections (12 vs. 27, P=0.009). The median total costs of supportive care were similar in the G-CSF and placebo groups ($8,768 and $8,616, respectively). Among patients who did not have febrile neutropenia during the first week of G-CSF or placebo injections, higher systemic exposure to the growth factor on day 7 was significantly related to a lower probability of subsequent hospitalization (P=0.049). CONCLUSIONS G-CSF treatment had some clinical benefit in children who received induction chemotherapy for acute lymphoblastic leukemia, but it did not reduce the rate of hospitalization for febrile neutropenia, prolong survival, or reduce the cost of supportive care.
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Affiliation(s)
- C H Pui
- St. Jude Children's Research Hospital and the University of Tennessee, Memphis, Colleges of Medicine, 38105-0318, USA
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Crom WR, de Graaf SS, Synold T, Uges DR, Bloemhof H, Rivera G, Christensen ML, Mahmoud H, Evans WE. Pharmacokinetics of vincristine in children and adolescents with acute lymphocytic leukemia. J Pediatr 1994; 125:642-9. [PMID: 7931891 DOI: 10.1016/s0022-3476(94)70027-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We studied the pharmacokinetics of vincristine in children with acute lymphocytic leukemia by means of a specific high-performance liquid chromatographic assay with ultraviolet and electrochemical detection and a limited sampling strategy. Our objectives were to characterize the disposition of vincristine in pediatric patients, to determine clinical, demographic, or biochemical variables related to variability in vincristine pharmacokinetic parameters, and to assess the relationship between pharmacokinetic parameters and vincristine neurotoxicity. Plasma samples were collected at 5 and 30 minutes, and 1, 3, and 24 hours after a rapid intravenous injection during 3 minutes. Vincristine-induced neurotoxicity was retrospectively evaluated by chart review. Pharmacokinetic studies were completed for 64 doses in 54 children between 2 months and 18 years of age (median, 4.3 years), including 2-month-old monozygous twin girls. Vincristine clearance, estimated by Bayesian methods, was highly variable, with a mean (SD) clearance of 19.9 (14.9) ml/min per kilogram or 482 (342) ml/min per square meter. Mean clearance for all subjects was faster than in published studies of adults, which may be related in part to the greater specificity of the assay used in our study, as well as to age-related differences in drug disposition. Vincristine-associated neurotoxicity was frequent but mild and was not predicted by vincristine systemic exposure; however, neurotoxicity may have been underestimated. Clearance in one patient who received concomitant treatment with pentobarbital exceeded the 75th percentile for all patients, and four of five patients receiving concomitant histamine2 antagonists had clearances below the 25th percentile for all subjects, suggesting that drugs that induce or inhibit hepatic cytochrome P-450 enzymes may affect vincristine disposition. Further studies are needed to identify the factors responsible for interpatient variability in vincristine disposition and to develop improved dosing guidelines.
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Affiliation(s)
- W R Crom
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
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Miaskowski C, Nichols R, Brody R, Synold T. Assessment of patient satisfaction utilizing the American Pain Society's Quality Assurance Standards on acute and cancer-related pain. J Pain Symptom Manage 1994; 9:5-11. [PMID: 8169462 DOI: 10.1016/0885-3924(94)90140-6] [Citation(s) in RCA: 169] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An evaluation of patient satisfaction with pain management is one component of a total quality assurance program on pain management recommended by the American Pain Society. This study utilized the patient satisfaction survey recommended by the Quality Assurance Committee of the American Pain Society and was conducted in an acute care, municipal hospital. Seventy-two medical-surgical patients were interviewed about their pain management. Data from the survey suggest that while patients experienced moderate-to-severe pain and had to wait relatively long periods of time for pain medications, in most cases they were satisfied with their overall pain management. Recommendations for conducting patient satisfaction surveys of pain management in acute care settings are reviewed, and methods for interpreting data from these types of surveys are discussed.
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Affiliation(s)
- C Miaskowski
- Department of Physiological Nursing, University of California, San Francisco 94143
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