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Tai WM, Yong WP, Lim C, Low LS, Tham CK, Koh TS, Ng QS, Wang WW, Wang LZ, Hartono S, Thng CH, Huynh H, Lim KT, Toh HC, Goh BC, Choo SP. A phase Ib study of selumetinib (AZD6244, ARRY-142886) in combination with sorafenib in advanced hepatocellular carcinoma (HCC). Ann Oncol 2018; 29:526. [PMID: 28368515 DOI: 10.1093/annonc/mdx060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Greene J, Nguyen A, Bagby SM, Jones GN, Tai WM, Quackenbush KS, Schreiber A, Messersmith WA, Devaraj KM, Blatchford P, Eckhardt SG, Cadogan EB, Hughes GD, Smith A, Pitts TM, Arcaroli JJ. The novel ATM inhibitor (AZ31) enhances antitumor activity in patient derived xenografts that are resistant to irinotecan monotherapy. Oncotarget 2017; 8:110904-110913. [PMID: 29340025 PMCID: PMC5762293 DOI: 10.18632/oncotarget.22920] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/09/2017] [Indexed: 12/22/2022] Open
Abstract
Irinotecan, a standard of care therapy for CRC, elicits cytotoxic effects by generating double strand breaks resulting in DNA damage. The activation of the ATM pathway plays a fundamental role in regulating the cellular response and repair to DNA damage. The objective of this preclinical study was to determine whether ATM inhibition would enhance sensitivity to irinotecan treatment. Treatment effects of AZ31, irinotecan or AZ31 + irinotecan were investigated in CRC cell lines and CRC patient derived xenografts. Activation of ATM and downstream targets p-RAD50 and p-H2AX were evaluated by immunohistochemistry. Combinational effects were demonstrated in 4 out of 8 CRC explants. Interestingly, each of the combinational sensitive CRC PDX models were shown to be more resistant to irinotecan single agent therapy. Treatment with irinotecan significantly elevated the ATM pathway evident by an increase in the activation of H2AX and RAD50. Combinational therapy reduced the activation of H2AX and RAD50 when compared to irinotecan alone in the combination sensitive CRC098. AZ31 + irinotecan was effective at reducing tumor growth in tumors that exhibited resistance to irinotecan in our CRC PDX model. These findings support further investigation of this combinational therapy for the treatment of CRC patients.
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Affiliation(s)
- Justin Greene
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, USA
| | - Anna Nguyen
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, USA
| | - Stacey M Bagby
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, USA
| | - Gemma N Jones
- Innovative Medicines and Early Development, Oncology, AstraZeneca, Cambridge, UK
| | - W M Tai
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, USA.,Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Kevin S Quackenbush
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, USA
| | - Anna Schreiber
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, USA
| | - Wells A Messersmith
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, USA
| | - Kalpana M Devaraj
- Pathology Department, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Patrick Blatchford
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, USA
| | - S Gail Eckhardt
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, USA
| | - Elaine B Cadogan
- Innovative Medicines and Early Development, Oncology, AstraZeneca, Cambridge, UK
| | - Gareth D Hughes
- Innovative Medicines and Early Development, Oncology, AstraZeneca, Cambridge, UK
| | - Aaron Smith
- Innovative Medicines and Early Development, Oncology, AstraZeneca, Cambridge, UK
| | - Todd M Pitts
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, USA
| | - John J Arcaroli
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO, USA
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Tai WM, Yong WP, Lim C, Low LS, Tham CK, Koh TS, Ng QS, Wang WW, Wang LZ, Hartano S, Thng CH, Huynh H, Lim KT, Toh HC, Goh BC, Choo SP. A phase Ib study of selumetinib (AZD6244, ARRY-142886) in combination with sorafenib in advanced hepatocellular carcinoma (HCC). Ann Oncol 2016; 27:2210-2215. [PMID: 27681866 DOI: 10.1093/annonc/mdw415] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Treatment with sorafenib, although associated with inhibition of tumour growth and angiogenesis in in vivo studies, leads to up-regulation of pERK. The addition of MEK inhibition could potentially abrogate this effect and potentiate anti-tumour activity. This phase I study investigated the maximum tolerated dose (MTD), safety, tolerability, pharmacokinetics (PK) and biomarker correlates of selumetinib combined with sorafenib in patients with advanced hepatocellular carcinoma (HCC). METHODS Patients with Child-Pugh (CP) score ≤7 were treated with 400 mg twice daily of sorafenib with escalating doses of selumetinib in a 3 + 3 study design. The dose-limiting toxicity (DLT) evaluation period was 28 days. PK of selumetinib was determined. Angiogenic effect was evaluated with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). RESULTS Twenty-seven patients of Asian ethnicity were enrolled. The MTD was selumetinib 75 mg daily with sorafenib 400 mg twice daily. DLT included grade 3 transaminitis, diarrhoea and fatigue. Most common treatment-related adverse events at MTD (all grades) were diarrhoea (85%), rash (59%), hypertension (44%), fatigue (30%), anorexia (22%) and hand-foot syndrome (22%). Four patients (15%) had PR and 13 (48%) had SD. PR or SD was observed for ≥6 months in seven patients. The median overall survival was 14.4 months. Selumetinib exposures in combination with sorafenib were comparable to other monotherapy studies. A reduction in permeability-surface area product noted in DCE-MRI with treatment correlated with worse survival outcomes. CONCLUSION The MTD of selumetinib was 75 mg daily when combined with sorafenib 400 mg twice a day in CP ≤7 HCC. Acceptable adverse events and encouraging anti-tumour activity warrant further evaluation. DCE-MRI findings deserve prospective evaluation. CLINICALTRIALSGOV IDENTIFIER NCT01029418.
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Affiliation(s)
- W M Tai
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - W P Yong
- Department of Haematology-Oncology, National University Health System, Singapore
| | - C Lim
- Divisions of Clinical Trials and Epidemiological Sciences
| | - L S Low
- Divisions of Clinical Trials and Epidemiological Sciences
| | - C K Tham
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - T S Koh
- Oncologic Imaging, National Cancer Centre Singapore, Singapore
| | - Q S Ng
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - W W Wang
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - L Z Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - S Hartano
- SingHealth Duke-NUS Radiological Sciences Academic Clinical Program, Singapore
| | - C H Thng
- Oncologic Imaging, National Cancer Centre Singapore, Singapore
| | - H Huynh
- Laboratory of Molecular Endocrinology, Division of Molecular and Cellular Research, National Cancer Centre Singapore, Singapore
| | - K T Lim
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - H C Toh
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - B C Goh
- Department of Haematology-Oncology, National University Health System, Singapore
| | - S P Choo
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
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Arcaroli JJ, Tai WM, McWilliams R, Bagby S, Blatchford PJ, Varella-Garcia M, Purkey A, Quackenbush KS, Song EK, Pitts TM, Gao D, Lieu C, McManus M, Tan AC, Zheng X, Zhang Q, Ozeck M, Olson P, Jiang ZQ, Kopetz S, Jimeno A, Keysar S, Eckhardt G, Messersmith WA. A NOTCH1 gene copy number gain is a prognostic indicator of worse survival and a predictive biomarker to a Notch1 targeting antibody in colorectal cancer. Int J Cancer 2015; 138:195-205. [PMID: 26152787 DOI: 10.1002/ijc.29676] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 06/10/2015] [Accepted: 06/17/2015] [Indexed: 12/28/2022]
Abstract
Dysregulation of the Notch1 receptor has been shown to facilitate the development and progression of colorectal cancer (CRC) and has been identified as an independent predictor of disease progression and worse survival. Although mutations in the NOTCH1 receptor have not been described in CRC, we have previously discovered a NOTCH1 gene copy number gain in a portion of CRC tumor samples. Here, we demonstrated that a NOTCH1 gene copy number gain is significantly associated with worse survival and a high percentage of gene duplication in a cohort of patients with advanced CRC. In our CRC patient-derived tumor xenograft (PDTX) model, tumors harboring a NOTCH1 gain exhibited significant elevation of the Notch1 receptor, JAG1 ligand and cleaved Notch1 activity. In addition, a significant association was identified between a gain in NOTCH1 gene copy number and sensitivity to a Notch1-targeting antibody. These findings suggest that patients with metastatic CRC that harbor a gain in NOTCH1 gene copy number have worse survival and that targeting this patient population with a Notch1 antibody may yield improved outcomes.
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Affiliation(s)
- John J Arcaroli
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - W M Tai
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Ryan McWilliams
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Stacey Bagby
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Patrick J Blatchford
- Department of Biostatistics & Informatics, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Marileila Varella-Garcia
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Alicia Purkey
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Kevin S Quackenbush
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Eun-Kee Song
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Todd M Pitts
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Dexiang Gao
- Department of Biostatistics & Informatics, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Chris Lieu
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Martine McManus
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Aik Choon Tan
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Xianxian Zheng
- Pfizer Oncology Research Unit, Translational Research, Pfizer, La Jolla, CA
| | - Qin Zhang
- Pfizer Oncology Research Unit, Translational Research, Pfizer, La Jolla, CA
| | - Mark Ozeck
- Pfizer Oncology Research Unit, Translational Research, Pfizer, La Jolla, CA
| | - Peter Olson
- Pfizer Oncology Research Unit, Translational Research, Pfizer, La Jolla, CA
| | - Zhi-Qin Jiang
- MD Anderson Cancer Center, Texas Medical Center, Houston, TX
| | - Scott Kopetz
- MD Anderson Cancer Center, Texas Medical Center, Houston, TX
| | - Antonio Jimeno
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Stephen Keysar
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Gail Eckhardt
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
| | - Wells A Messersmith
- Division of Medical Oncology, University of Colorado Denver Anschutz Medical Campus and University of Colorado Cancer Center, Aurora, CO
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Song EK, Tai WM, Messersmith WA, Bagby S, Purkey A, Quackenbush KS, Pitts TM, Wang G, Blatchford P, Yahn R, Kaplan J, Tan AC, Atreya CE, Eckhardt G, Kelley RK, Venook A, Kwak EL, Ryan D, Arcaroli JJ. Potent antitumor activity of cabozantinib, a c-MET and VEGFR2 inhibitor, in a colorectal cancer patient-derived tumor explant model. Int J Cancer 2014; 136:1967-75. [PMID: 25242168 DOI: 10.1002/ijc.29225] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/11/2014] [Accepted: 09/03/2014] [Indexed: 12/17/2022]
Abstract
Antiangiogenic therapy is commonly used for the treatment of colorectal cancer (CRC). Although patients derive some clinical benefit, treatment resistance inevitably occurs. The MET signaling pathway has been proposed to be a major contributor of resistance to antiangiogenic therapy. MET is upregulated in response to vascular endothelial growth factor pathway inhibition and plays an essential role in tumorigenesis and progression of tumors. In this study, we set out to determine the efficacy of cabozantinib in a preclinical CRC patient-derived tumor xenograft model. We demonstrate potent inhibitory effects on tumor growth in 80% of tumors treated. The greatest antitumor effects were observed in tumors that possess a mutation in the PIK3CA gene. The underlying antitumor mechanisms of cabozantinib consisted of inhibition of angiogenesis and Akt activation and significantly decreased expression of genes involved in the PI3K pathway. These findings support further evaluation of cabozantinib in patients with CRC. PIK3CA mutation as a predictive biomarker of sensitivity is intriguing and warrants further elucidation. A clinical trial of cabozantinib in refractory metastatic CRC is being activated.
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Affiliation(s)
- Eun-Kee Song
- Division of Medical Oncology, University of Colorado Denver and University of Colorado Cancer Center, Aurora, CO; Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
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Ang SH, Haaland B, Acharyya S, Thu MMM, Krisna SS, Hwang SG, Tan PH, Ng QS, Tan DSW, Tai WM, Tan EH, Lim WT, Ang MK. Interactions between clinical factors, p16, and cyclin-D1 expression and survival outcomes in oropharyngeal and hypopharyngeal squamous cell carcinoma. Head Neck 2014; 37:1650-9. [PMID: 24953865 DOI: 10.1002/hed.23803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/21/2014] [Accepted: 06/18/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND P16 and cyclin-D1 are cell cycle proteins commonly dysregulated in head and neck carcinoma. We assessed their expression, clinicopathological variables, and overall survival (OS) in oropharyngeal and hypopharyngeal squamous cell carcinoma (SCC). METHODS Clinical characteristics and p16 and cyclin-D1 expression were evaluated in 101 patients with oropharyngeal SCC and 75 patients with hypopharyngeal SCC. Associations with OS were assessed using Cox regression and Kaplan-Meier analysis. RESULTS Compared to oropharyngeal SCC, patients with hypopharyngeal SCC were older, men, ever-smokers with higher mean Charlson Comorbidity Index (CCI), lower p16 expression, and poorer median OS (24.8 vs 62.3 months; p < .01). In oropharyngeal SCC, CCI (p < .001), cyclin-D1 (hazard ratio [HR] = 3.55; p = .007), current smoking (HR = 5.72; p = .004), and former smoking (HR = 4.12; p = .035) were independently associated with OS. In hypopharyngeal SCC, only nodal and Eastern Cooperative Oncology Group status were associated with OS. CONCLUSION In oropharyngeal SCC, cyclin-D1 expression is correlated with survival, whereas smoking status and CCI may allow further stratification of outcome.
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Affiliation(s)
| | - Benjamin Haaland
- Centre of Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Sanchalika Acharyya
- Centre of Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Minn M M Thu
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
- Department of Pathology, Singapore General Hospital, Singapore
| | - Sai-Sakktee Krisna
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
- Department of Pathology, Singapore General Hospital, Singapore
| | - Siok-Gek Hwang
- Department of Pathology, Singapore General Hospital, Singapore
| | - Puay-Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore
| | - Quan-Sing Ng
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Daniel S W Tan
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Wai-Meng Tai
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Eng-Huat Tan
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Wan-Teck Lim
- Duke-NUS Graduate Medical School, Singapore
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Mei-Kim Ang
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
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Tai WM, Quackenbush K, Purkey A, Bagby S, Messersmith W, Song EK, Pitts T, Arcaroli JJ. Abstract B30: KRAS wild type tumors exhibit increased efficacy to the combination of AZ1 (a tankyrase inhibitor) + irinotecan in a patient-derived CRC explant model. Mol Cancer Ther 2013. [DOI: 10.1158/1535-7163.targ-13-b30] [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: Dysregulation of the canonical Wnt signaling pathway has been implicated in colorectal cancer (CRC) development as well as incipient stages of malignant transformation. An important regulator of the Wnt pathway are tankyrases that function in reducing Axin2 levels which is an essential protein in the β-catenin destruction complex. Targeting this pathway with a potent tankyrase inhibitor presents a plausible approach in drug development. In this study, we evaluated the antitumor effects AZ1 (a novel tankyrase 1/2 inhibitor which also carries PARP1 activity) as a single agent and in combination with irinotecan in our patient derived CRC explant xenograft models.
Methods: Twenty patient derived CRC explant xenografts were treated with vehicle, AZ1 (50mg/kg/day), irinotecan (30mg/kg/week) or AZ1 (50mg/kg/day) + irinotecan (30mg/kg/week) for 28 days. Pharmacokinetic effect of AZ1 was determined in plasma and tumor over 24h. Both pharmacodynamic effects (Axin2 levels) and changes in biomarkers relevant to the Wnt pathway were determined by Western blotting. Intra-nuclear β-catenin levels were evaluated by immunohistochemistry. A tumor growth index (TGI) was calculated as the ratio in tumour volumes in the treated animals and the control animals (T/C) on the last day of drug treatment to determine efficacy. TGI≤ 50% was considered sensitive and TGI > 50% was resistant.
Results: Three out of 20 CRC explants showed some tumour growth inhibition with AZ1. In animals bearing CRC40 xenografts, AZ1 showed a Tmax of 1 hour in plasma and 30 minutes in tumor. In addition, Axin2 stabilization post AZ1 started 15 minutes after drug administration, with the maximum stabilization observed at 8 hours. Treatment with AZ1 + irinotecan resulted in a greater anti-tumor effect (achieving stasis or better) than either agent alone in 4 out of 20 CRC xenografts. A significant association (fisher exact test: p= 0.007) was identified between combinational sensitivity and KRAS wild type. Evaluation of tumors after treatment showed marked stabilization of Tankyrase 1/2 and Axin2; however, active β-catenin levels were not changed. Also, there were no changes to intra-nuclear β-catenin (IHC) levels after treatment. Interestingly, NuMa, a protein involved in maintenance of the mitotic spindle and a target of Tankyrase 1/2 increased following irinotecan in 3 models, 2 showing a combination effect and 1 which did not. Numa levels decreased with the combination of AZ1 and irinotecan compared to irinotecan alone in 2 models showing a significant combination effect.
Conclusion: Combination AZ1 and irinotecan achieved greater anti-tumor effect compared to monotherapy in 4 out of 20 CRC xenografts. Activity was limited to CRC xenografts with KRAS WT status. Further studies are warranted to validate these findings in KRAS WT patients and to understanding the specific mechanisms in tumors that responded to combinational therapy.
Citation Information: Mol Cancer Ther 2013;12(11 Suppl):B30.
Citation Format: WM Tai, Kevin Quackenbush, Alicia Purkey, Stacey Bagby, Wells Messersmith, Eun Kee Song, Todd Pitts, John J. Arcaroli. KRAS wild type tumors exhibit increased efficacy to the combination of AZ1 (a tankyrase inhibitor) + irinotecan in a patient-derived CRC explant model. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr B30.
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Affiliation(s)
- WM Tai
- Univ. of Colorado Denver, Aurora, CO
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Chia WK, Teo M, Wang WW, Lee B, Ang SF, Tai WM, Chee CL, Ng J, Kan R, Lim WT, Tan SH, Ong WS, Cheung YB, Tan EH, Connolly JE, Gottschalk S, Toh HC. Adoptive T-cell transfer and chemotherapy in the first-line treatment of metastatic and/or locally recurrent nasopharyngeal carcinoma. Mol Ther 2013; 22:132-9. [PMID: 24297049 PMCID: PMC3978790 DOI: 10.1038/mt.2013.242] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/09/2013] [Indexed: 02/08/2023] Open
Abstract
The outcomes for patients with metastatic or locally recurrent Epstein-Barr virus (EBV)-positive nasopharyngeal carcinoma (NPC) remain poor. Adoptive immunotherapy with EBV-specific cytotoxic T lymphocytes (EBV-CTLs) has proven clinical efficacy, but it has never been evaluated in the first-line treatment setting in combination with chemotherapy. To evaluate the safety and efficacy of a chemotherapy in combination with adoptive EBV-CTL transfer, we conducted a phase 2 clinical trial consisting of four cycles of gemcitabine and carboplatin (GC) followed by up to six doses of EBV-CTL. Thirty-eight patients were enrolled, and 35 received GC and EBV-CTL. GC-CTL therapy resulted in a response rate of 71.4% with 3 complete responses and 22 partial responses. With a median follow up of 29.9 months, the 2-year and 3-year overall survival (OS) rate was 62.9 and 37.1%, respectively. Five patients did not require further chemotherapy for more than 34 months since initiation of CTL. Infusion of CTL products containing T cells specific for LMP2 positively correlated with OS (hazard ratio: 0.35; 95% confidence interval: 0.14-0.84; P = 0.014). Our study achieved one of the best survival outcomes in patients with advanced NPC, setting the stage for a future randomized study of chemotherapy with and without EBV-CTL.
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Affiliation(s)
- Whay-Kuang Chia
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Marissa Teo
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Who-Whong Wang
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Bernett Lee
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Soo-Fan Ang
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Wai-Meng Tai
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Chit-Lai Chee
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Joanna Ng
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Rebecca Kan
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Wan-Teck Lim
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Sze-Huey Tan
- Division of Clinical Trials and Epidemiological Research, National Cancer Centre, Singapore
| | - Whee-Sze Ong
- Division of Clinical Trials and Epidemiological Research, National Cancer Centre, Singapore
| | | | - Eng-Huat Tan
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - John E Connolly
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Stephen Gottschalk
- Center for Cell and Gene Therapy, Texas Children's Hospital, The Methodist Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Han-Chong Toh
- Division of Medical Oncology, National Cancer Centre, Singapore
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Huynh H, Choo SP, Toh HC, Tai WM, Chung AYF, Chow PKH, Ong R, Soo KC. Comparing the efficacy of sunitinib with sorafenib in xenograft models of human hepatocellular carcinoma: mechanistic explanation. Curr Cancer Drug Targets 2012; 11:944-53. [PMID: 21834756 DOI: 10.2174/156800911797264716] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 04/27/2011] [Accepted: 07/27/2011] [Indexed: 11/22/2022]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common and third deadliest malignancy. Sorafenib has demonstrated 44% survival advantage over placebo and has emerged as a standard of care in advanced HCC. The therapeutic effects of sorafenib are however transient and hence additional treatment options are warranted. In this study, we aimed to compare the efficacy of sunitinib relative to sorafenib, two potent inhibitors of protein tyrosine kinases involved in tumor growth, metastasis, or angiogenesis. We reported that sorafenib and sunitinib suppressed tumor growth, angiogenesis, cell proliferation, and induced apoptosis in both orthotopic and ectopic models of HCC. However, the antitumor effect of 50 mg/kg sorafenib was greater than that of 40 mg/kg sunitinib. Sorafenib inhibited p-eIF4E Ser209, p-p38 Thr180/Tyr182 and reduced survivin expression. This was not seen with sunitinib. In addition, the antitumor and apoptotic effects of sorafenib, which are associated with upregulation of fast migrating Bim and ASK1 and downregulation of survivin, were greater than that of sunitinib. These observations explained in part the apparent superior anti-tumor activity of sorafenib compared to sunitinib. In conclusion, sunitinib demonstrated an inferior anti-tumor activity compared to sorafenib in ectopic and orthotopic models of human HCC. It remains to be seen whether such observations would be recapitulated in humans.
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Affiliation(s)
- H Huynh
- Laboratory of Molecular Endocrinology, Division of Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research, National Cancer Centre, 11 Hospital Drive, Singapore.
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Chia WK, Wang WW, Teo M, Tai WM, Lim WT, Tan EH, Leong SS, Sun L, Chen JJ, Gottschalk S, Toh HC. A phase II study evaluating the safety and efficacy of an adenovirus-ΔLMP1-LMP2 transduced dendritic cell vaccine in patients with advanced metastatic nasopharyngeal carcinoma. Ann Oncol 2011; 23:997-1005. [PMID: 21821548 DOI: 10.1093/annonc/mdr341] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Individuals with metastatic Epstein-Barr virus (EBV)-positive nasopharyngeal carcinoma (NPC) continue to have poor outcomes. To evaluate the ability of a dendritic cell (DC) vaccine to target subdominant EBV antigens LMP1 and LMP2 expressed by NPC cells, we vaccinated patients using autologous DCs transduced with an adenovirus encoding a truncated LMP1 (ΔLMP1) and full-length LMP2 (Ad-ΔLMP1-LMP2). MATERIALS AND METHODS Sixteen subjects with metastatic NPC received Ad-ΔLMP1-LMP2 DC vaccines i.d. biweekly for up to five doses. Toxicity, immune responses and clinical responses were determined. RESULTS Most patients had extensive disease, with a median of three visceral sites of involvement (range 1-7). No significant toxicity was observed. Ad-ΔLMP1-LMP2 DCs induced delayed type hypersensitivity responses in 9 out of 12 patients, but although these DCs activated LMP1/2-specific T cells in vitro, no such increase in the frequency of peripheral LMP1/2-specific T cells was detected. Three patients had clinical responses including one with partial response (for 7½ months) and two with stable disease (for 6½ and 7½ months). CONCLUSIONS Ad-ΔLMP1-LMP2 transduced DCs can be successfully generated and safely administered to patients with advanced NPC. Since efficacy was limited, future studies should focus on DC vaccines with greater potency administered to subjects with less tumor burden.
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Affiliation(s)
- W K Chia
- Department of Medical Oncology, National Cancer Centre, Singapore
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Tai WM, Tang PL, Koo YX, Hou X, Tay KW, Quek R, Tao M, Lim ST. Do We Have the Right Prognostic Index for Diffuse Large B Cell Lymphoma (DLBCL) in the Era of Rituximab? Proceedings of Singapore Healthcare 2011. [DOI: 10.1177/201010581102000108] [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] Open
Abstract
Introduction: Whilst the addition of rituximab, a humanized monoclonal antibody to standard CHOP chemotherapy (R-CHOP) has improved the outcomes of DLBCL, the validity of the previously identified prognostic index based on clinical parameters is questioned. It is conceivable that prognostic model may alter with introduction of new therapeutics with differing efficacy and mechanisms of action. Methods: We conducted a retrospective analysis comparing the relevance of International Prognostic Index (IPI), Age-adjusted IPI and Revised International Prognostic Index (R-IPI) in 320 consecutive patients with DLBCL from 2003–2008 treated with R-CHOP chemotherapy with curative intent. We evaluated the prognostic factors determinant of survival in our group of patients. Results: Patients were followed up for a median of 2.70 years. IPI was only able to stratify patients into 3 main risk groups instead of 4. In addition, among patients <60, aa-IPI no longer seem a robust prognostic model. We showed that R-IPI was able to separate patients into 3 different prognostic groups and perhaps most relevant in the era of chemo-immunotherapy. Significant prognostic factors identified in multivariate analysis were performance status (P=0.004) and bone marrow involvement (P=0.026). Conclusion: The most robust prognostic index for patients with DLBCL in the era of rituximab remains uncertain. Incorporation of molecular markers into clinical parameters should be evaluated, a study we are embarking on.
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Affiliation(s)
- WM Tai
- Department of Medical Oncology, National Cancer Centre Singapore
| | - PL Tang
- Department of Medical Oncology, National Cancer Centre Singapore
| | - YX Koo
- Department of Medical Oncology, National Cancer Centre Singapore
| | - X Hou
- Division of Clinical Trials and Epidemiology Science
| | - KW Tay
- Department of Medical Oncology, National Cancer Centre Singapore
| | - R Quek
- Department of Medical Oncology, National Cancer Centre Singapore
| | - M Tao
- Department of Medical Oncology, National Cancer Centre Singapore
| | - ST Lim
- Department of Medical Oncology, National Cancer Centre Singapore
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Tai WM, Chung J, Tang PL, Koo YX, Hou X, Tay KW, Quek R, Tao M, Lim ST. Central nervous system (CNS) relapse in diffuse large B cell lymphoma (DLBCL): pre- and post-rituximab. Ann Hematol 2011. [PMID: 21229246 DOI: 10.1007/s00277‐010‐1150‐7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Central nervous system (CNS)-directed prophylactic intrathecal (IT) therapy is indicated in patients with Burkitt and acute lymphoblastic lymphoma. Its role in diffuse large B cell lymphoma (DLBCL), a heterogeneous subtype, is less well defined. While addition of rituximab to standard cyclophosphamide-hydroxydaunorubicin-oncovin-prednisone (CHOP) chemotherapy (R-CHOP) has improved the outcomes of DLBCL patients, its role in reducing CNS relapse is unclear. We aim to (1) evaluate the clinical risk factors predictive of CNS relapse, (2) the role of rituximab in influencing CNS relapse, and (3) role of intrathecal prophylaxis. Four hundred ninety-nine patients with DLBCL from 2000 to 2008 were included (CHOP 179 vs. R-CHOP 320). IT prophylaxis was administered to 82 patients based on our institution's guidelines. Baseline characteristics between CHOP- and R-CHOP-treated patients were similar. Although R-CHOP significantly increased the complete remission rate from 71% to 81% (P < 0.01), CNS relapse rates remained unchanged (R-CHOP 6% vs. CHOP 5.1%). On multivariate analysis, poor performance status (Eastern Cooperative Oncology Group >1; hazard ratio (HR) = 2.01, 95% confidence interval (CI) 1.29-3.14), failure to attain remission (non-complete response (CR) vs. CR: HR = 2.39, 95% CI = 1.03 to 5.51), testicular (HR = 6.67, 95% CI = 1.62 to 27.53), kidney (HR = 20.14, 95% CI = 5.23 to 77.46), and breast involvement (HR = 6.14, 95% CI = 1.61 to 23.37) were each independently predictive of CNS relapse. Use of IT prophylaxis did not appear to decrease CNS relapse. Median survival after CNS relapse was 3.2 months. CNS relapse, a fatal event, remains a challenge in R-CHOP-treated patients. IT prophylaxis may not be sufficient to reduce CNS relapse, and strategies including systemic agents with high CNS penetration should be evaluated in high-risk patients identified in this study.
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Affiliation(s)
- W M Tai
- Department of Medical Oncology, National Cancer Centre, 11 Hospital Drive, Singapore, 169610, Singapore.
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Tai WM, Chung J, Tang PL, Koo YX, Hou X, Tay KW, Quek R, Tao M, Lim ST. Central nervous system (CNS) relapse in diffuse large B cell lymphoma (DLBCL): pre- and post-rituximab. Ann Hematol 2011; 90:809-18. [PMID: 21229246 DOI: 10.1007/s00277-010-1150-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 12/22/2010] [Indexed: 11/24/2022]
Abstract
Central nervous system (CNS)-directed prophylactic intrathecal (IT) therapy is indicated in patients with Burkitt and acute lymphoblastic lymphoma. Its role in diffuse large B cell lymphoma (DLBCL), a heterogeneous subtype, is less well defined. While addition of rituximab to standard cyclophosphamide-hydroxydaunorubicin-oncovin-prednisone (CHOP) chemotherapy (R-CHOP) has improved the outcomes of DLBCL patients, its role in reducing CNS relapse is unclear. We aim to (1) evaluate the clinical risk factors predictive of CNS relapse, (2) the role of rituximab in influencing CNS relapse, and (3) role of intrathecal prophylaxis. Four hundred ninety-nine patients with DLBCL from 2000 to 2008 were included (CHOP 179 vs. R-CHOP 320). IT prophylaxis was administered to 82 patients based on our institution's guidelines. Baseline characteristics between CHOP- and R-CHOP-treated patients were similar. Although R-CHOP significantly increased the complete remission rate from 71% to 81% (P < 0.01), CNS relapse rates remained unchanged (R-CHOP 6% vs. CHOP 5.1%). On multivariate analysis, poor performance status (Eastern Cooperative Oncology Group >1; hazard ratio (HR) = 2.01, 95% confidence interval (CI) 1.29-3.14), failure to attain remission (non-complete response (CR) vs. CR: HR = 2.39, 95% CI = 1.03 to 5.51), testicular (HR = 6.67, 95% CI = 1.62 to 27.53), kidney (HR = 20.14, 95% CI = 5.23 to 77.46), and breast involvement (HR = 6.14, 95% CI = 1.61 to 23.37) were each independently predictive of CNS relapse. Use of IT prophylaxis did not appear to decrease CNS relapse. Median survival after CNS relapse was 3.2 months. CNS relapse, a fatal event, remains a challenge in R-CHOP-treated patients. IT prophylaxis may not be sufficient to reduce CNS relapse, and strategies including systemic agents with high CNS penetration should be evaluated in high-risk patients identified in this study.
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Affiliation(s)
- W M Tai
- Department of Medical Oncology, National Cancer Centre, 11 Hospital Drive, Singapore, 169610, Singapore.
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Toh HC, Chia WK, Sun L, Thng CH, Soe Y, Phoon YP, Yap SP, Lim WT, Tai WM, Hee SW, Tan SH, Leong SS, Tan EH. Graft-vs-tumor effect in patients with advanced nasopharyngeal cancer treated with nonmyeloablative allogeneic PBSC transplantation. Bone Marrow Transplant 2010; 46:573-9. [PMID: 20661236 PMCID: PMC3072519 DOI: 10.1038/bmt.2010.161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
While nonmyeloablative peripheral blood stem cell transplantation (NST) has shown efficacy against several solid tumors, it is untested in nasopharyngeal cancer (NPC). In a phase II clinical trial, 21 patients with pretreated metastatic NPC underwent NST with sibling PBSC allografts, using CY conditioning, thymic irradiation and in vivo T-cell depletion with thymoglobulin. Stable lymphohematopoietic chimerism was achieved in most patients and prophylactic CYA was tapered at a median of day +30. Seven patients (33%) showed partial response and three (14%) achieved stable disease. Four patients were alive at 2 years and three showed prolonged disease control of 344, 525 and 550 days. With a median follow-up of 209 (4-1147) days, the median PFS was 100 days (95% confidence interval (CI), 66-128 days), and median OS was 209 days (95% CI, 128-236 days). Patients with chronic GVHD had better survival-median OS 426 days (95% CI, 194-NE days) vs 143 days (95% CI, 114-226 days) (P=0.010). Thus, NST may induce meaningful clinical responses in patients with advanced NPC.
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Affiliation(s)
- H C Toh
- Department of Medical Oncology, National Cancer Centre, Singapore, Singapore.
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