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Abstract
INTRODUCTION Hemophilia A is a severe bleeding disorder affecting about 1 in 5,000 males. The gold standard for prophylaxis and treatment of acute bleeding has been factor (F) VIII concentrate. A multitude of treatment modalities are now available and under clinical investigation. AREAS COVERED This review discusses ongoing/recently completed early-phase clinical trials registered on ClinicalTrials.gov in patients with hemophilia A through April 2022. These new pipeline therapies are focused on addressing the safety and efficacy of new factor-related products, non-factor related products, and gene therapy options for hemophilia. EXPERT OPINION Current standard of care effectively prevents and treats acute bleeding and has significantly improved the quality of life in hemophilia. The biggest challenges in the improvement of care are treatment-related burden and the burden of cost in developing countries. New drugs under development are likely to enter practice by the end of this decade and address many of the unmet needs particularly of those with severe disease. Data is limited in unique populations (e.g. congenital/inherited FVIII inhibitors, non-severe hemophilia A, women/girls with hemophilia and children) which are important areas for future research; additional clinical trials and long-term outcome data are necessary prior to incorporating these new therapies in our treatment arsenal.
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Affiliation(s)
- Gianna M Guzzardo
- Pediatric Hematology Oncology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Robert Sidonio
- Pediatric Hematology Oncology, Emory University and Aflac Cancer and Blood Disorders, Atlanta, GA, USA
| | - Michael U Callaghan
- Agios Pharmaceuticals, Cambridge, MA, USA.,Department of Pediatrics, Central Michigan University School of Medicine, Mount Pleasant, MI, USA
| | - Katherine Regling
- Pediatric Hematology Oncology, Children's Hospital of Michigan, Detroit, MI, USA.,Department of Pediatrics, Central Michigan University School of Medicine, Mount Pleasant, MI, USA
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Frenel JS, Carreira S, Goodall J, Roda D, Perez-Lopez R, Tunariu N, Riisnaes R, Miranda S, Figueiredo I, Nava-Rodrigues D, Smith A, Leux C, Garcia-Murillas I, Ferraldeschi R, Lorente D, Mateo J, Ong M, Yap TA, Banerji U, Gasi Tandefelt D, Turner N, Attard G, de Bono JS. Serial Next-Generation Sequencing of Circulating Cell-Free DNA Evaluating Tumor Clone Response To Molecularly Targeted Drug Administration. Clin Cancer Res 2015; 21:4586-96. [PMID: 26085511 PMCID: PMC4580992 DOI: 10.1158/1078-0432.ccr-15-0584] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [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: 03/12/2015] [Accepted: 05/26/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE We evaluated whether next-generation sequencing (NGS) of circulating cell-free DNA (cfDNA) could be used for patient selection and as a tumor clone response biomarker in patients with advanced cancers participating in early-phase clinical trials of targeted drugs. EXPERIMENTAL DESIGN Plasma samples from patients with known tumor mutations who completed at least two courses of investigational targeted therapy were collected monthly, until disease progression. NGS was performed sequentially on the Ion Torrent PGM platform. RESULTS cfDNA was extracted from 39 patients with various tumor types. Treatments administered targeted mainly the PI3K-AKT-mTOR pathway (n = 28) or MEK (n = 7). Overall, 159 plasma samples were sequenced with a mean sequencing coverage achieved of 1,685X across experiments. At trial initiation (C1D1), 23 of 39 (59%) patients had at least one mutation identified in cfDNA (mean 2, range 1-5). Out of the 44 mutations identified at C1D1, TP53, PIK3CA and KRAS were the top 3 mutated genes identified, with 18 (41%), 9 (20%), 8 (18%) different mutations, respectively. Out of these 23 patients, 13 received a targeted drug matching their tumor profile. For the 23 patients with cfDNA mutation at C1D1, the monitoring of mutation allele frequency (AF) in consecutive plasma samples during treatment with targeted drugs demonstrated potential treatment associated clonal responses. Longitudinal monitoring of cfDNA samples with multiple mutations indicated the presence of separate clones behaving discordantly. Molecular changes at cfDNA mutation level were associated with time to disease progression by RECIST criteria. CONCLUSIONS Targeted NGS of cfDNA has potential clinical utility to monitor the delivery of targeted therapies.
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Affiliation(s)
- Jean Sebastien Frenel
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom. Institut de Cancerologie de l'Ouest, Nantes-Saint Herblain, France
| | - Suzanne Carreira
- The Institute of Cancer Research, Sutton, Surrey, London, United Kingdom
| | - Jane Goodall
- The Institute of Cancer Research, Sutton, Surrey, London, United Kingdom
| | - Desam Roda
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom
| | - Raquel Perez-Lopez
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom
| | - Nina Tunariu
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom
| | - Ruth Riisnaes
- The Institute of Cancer Research, Sutton, Surrey, London, United Kingdom
| | - Susana Miranda
- The Institute of Cancer Research, Sutton, Surrey, London, United Kingdom
| | - Ines Figueiredo
- The Institute of Cancer Research, Sutton, Surrey, London, United Kingdom
| | | | - Alan Smith
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom
| | - Christophe Leux
- Département de Santé Publique, CHU de Nantes, Nantes Cedex 1, France
| | - Isaac Garcia-Murillas
- The Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, United Kingdom
| | - Roberta Ferraldeschi
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom
| | - David Lorente
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom
| | - Joaquin Mateo
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom
| | - Michael Ong
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom
| | - Timothy A Yap
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom
| | - Udai Banerji
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom
| | | | - Nick Turner
- The Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, United Kingdom
| | - Gerhardt Attard
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom
| | - Johann S de Bono
- The Institute of Cancer Research and the Royal Marsden Hospital, Sutton, Surrey, London, United Kingdom.
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van Meer L, Moerland M, Cohen AF, Burggraaf J. Urinary kidney biomarkers for early detection of nephrotoxicity in clinical drug development. Br J Clin Pharmacol 2015; 77:947-57. [PMID: 24219059 DOI: 10.1111/bcp.12282] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 10/31/2013] [Indexed: 01/09/2023] Open
Abstract
Early detection of drug-induced kidney injury is vital in drug development. Generally accepted biomarkers such as creatinine and blood urea nitrogen (BUN) lack sensitivity and early injury responses are missed. Many new biomarkers to detect nephrotoxicity for pre-clinical utilization have been described and their use is adopted in regulatory guidelines. However, guidance on appropriate biomarkers for clinical trials is minimal. We provide an overview of potentially useful kidney biomarkers that can be used in clinical trials. This includes guidance to select biomarkers suitable to capture specific characteristics of the (expected) kidney injury. We conclude that measurement of urinary kidney injury marker-1 (KIM-1) serves many purposes and is often an appropriate choice. Cystatin C captures effects on glomerular filtration rate (GFR), but this marker should preferably be combined with more specific markers to localize the origin of the observed effect. Untoward effects on tubules can be captured relatively well with several markers. Direct detection of glomerular injury is currently impossible since specific biomarkers are lacking. Indirect assessment of toxic effects on glomeruli is possible by using carefully selected panels of other injury markers. We conclude that it is possible to obtain appropriate information on nephrotoxicity in clinical drug development by using carefully selected panels of injury markers and suggest that identification and validation of specific glomerular biomarkers could be of great value.
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