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Singh R, Sperling D, Delicce A, Golec S, Singh S, Zatorski N, Bienstock S, Mitter SS, Lerakis S, Sahni GD. Changes in Global Longitudinal Strain as a Predictor of Cardiotoxicity After Exposure to Carfilzomib. Am J Cardiol 2024; 217:29-30. [PMID: 38432340 DOI: 10.1016/j.amjcard.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/04/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Ranbir Singh
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Dylan Sperling
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anthony Delicce
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sophia Golec
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Supreet Singh
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicole Zatorski
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Solomon Bienstock
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sumeet Singh Mitter
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stamatios Lerakis
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gagan D Sahni
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
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Gibbons T, Perkins A, Barnett J. Safety, biodistribution and radiation dosimetry of the Arg-Gly-Asp peptide 99m Tc-maraciclatide in healthy volunteers. Nucl Med Commun 2024; 45:295-303. [PMID: 38312052 PMCID: PMC10916747 DOI: 10.1097/mnm.0000000000001814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/19/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND 99m Tc-Maraciclatide is a radiolabelled RGD (Arg-Gly-Asp) peptide that binds with high affinity to α v β 3 and α v β 5 integrins, common receptors upregulated in disease states involving angiogenesis and inflammation. As such, it holds promise as a novel diagnostic imaging agent for a range of pathological conditions. The present study provides the safety, biodistribution and radiation dosimetry of 99m Tc-maraciclatide in healthy volunteers. METHODS A phase 1, randomised, placebo-controlled study assessed the safety, biodistribution and radiation dosimetry of 99m Tc-maraciclatide in healthy volunteers. Participants were randomised into three groups receiving 99m Tc-maraciclatide and three chemical amounts of maraciclatide in an escalating dose protocol. Eight participants in each group received the required amount of maraciclatide via intravenous injection, with the remaining two receiving a placebo. Biodistribution was assessed by acquiring scintigraphic images at time points up to 24 h after a bolus injection of 99m Tc-maraciclatide. 99m Tc-maraciclatide activity in plasma and urine was measured up to 7 days post-administration. RESULTS 99m Tc-maraciclatide was safe and well tolerated, with no serious adverse events reported. Initial uptakes of 99m Tc were highest in the gastrointestinal tract (20%), liver (15%), and lungs (9%). Similarly, the regions with the highest normalised cumulated activities were the contents of the urinary bladder and voided urine (3.4 ± 0.4 MBq*h/MBq), the combined walls of the small intestine and upper and lower large intestine (0.9 ± 0.2 MBq*h/MBq), liver (0.8 ± 0.2 MBq*h/MBq), lung (0.4 ± 0.1 MBq*h/MBq). The main route of 99m Tc excretion was renal (55%), with a systemic urinary clearance of approximately 6.7 ml/min/kg. The pharmacokinetic analysis gave a mean apparent terminal elimination half-life of the unlabelled molecular maraciclatide of approximately 1 h, independent of dose. The mean ED per unit injected activity was 7.8 ± 0.8 µSv/MBq. CONCLUSION 99m Tc-maraciclatide is a safe radiopharmaceutical formulation with a dosimetry profile similar to other 99m Tc-based imaging agents.
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Affiliation(s)
- Tatjana Gibbons
- Nuffield Department of Women's and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford
| | - Alan Perkins
- Radiological Sciences, School of Medicine, University of Nottingham, Nottingham and
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Jindal N, Jandial A, Jain A, Lad D, Prakash G, Khadwal A, Nada R, Sethi J, Ahluwalia J, Malhotra P. Carfilzomib-induced Thrombotic Microangiopathy: A Case Based Review. Hematol Oncol Stem Cell Ther 2023; 16:426-431. [PMID: 32735793 DOI: 10.1016/j.hemonc.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 11/16/2022] Open
Abstract
Carfilzomib is an irreversible proteasome inhibitor currently approved for the treatment of relapsed multiple myeloma. It has been implicated as a cause of thrombotic microangiopathy (TMA) in several case reports. The incidence, risk factors, and treatment of carfilzomib-related TMA remain unclear. Here we describe the clinical presentation and outcome of a 58-year-old man with biopsy-proven TMA that occurred following treatment with carfilzomib-based therapy. We also reviewed the published literature with regard to the incidence, risk factors, treatment options, and outcome of carfilzomib-related TMA.
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Affiliation(s)
- Nishant Jindal
- Department of Internal Medicine, 4th floor, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12 Chandigarh (160012), India
| | - Aditya Jandial
- Department of Internal Medicine, 4th floor, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12 Chandigarh (160012), India
| | - Arihant Jain
- Department of Internal Medicine, 4th floor, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12 Chandigarh (160012), India
| | - Deepesh Lad
- Department of Internal Medicine, 4th floor, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12 Chandigarh (160012), India
| | - Gaurav Prakash
- Department of Internal Medicine, 4th floor, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12 Chandigarh (160012), India
| | - Alka Khadwal
- Department of Internal Medicine, 4th floor, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12 Chandigarh (160012), India
| | - Ritambhra Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmine Sethi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmina Ahluwalia
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, 4th floor, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12 Chandigarh (160012), India
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Bahl A, Rajappa S, Rawal S, Bakshi G, Murthy V, Patil K. A review of clinical evidence to assess differences in efficacy and safety of luteinizing hormone-releasing hormone (LHRH) agonist (goserelin) and LHRH antagonist (degarelix). Indian J Cancer 2022; 59:S160-S174. [PMID: 35343199 DOI: 10.4103/ijc.ijc_1415_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Luteinizing hormone-releasing hormone agonist (LHRH-A), goserelin, and antagonist, degarelix, are both indicated for the treatment of advanced prostate cancer (PCa); however, large comparative trials evaluating their efficacy and safety are lacking. In this review, we assessed the available evidence for both the drugs. Although degarelix achieves an early rapid decline in testosterone (T) and prostate-specific antigen (PSA) levels, median T and PSA levels, in addition to prostate volume and International Prostate Symptom Scores, become comparable with goserelin over the remaining treatment period. Degarelix causes no initial flare, therefore it is recommended in patients with spinal metastases or ureteric obstruction. Goserelin achieves lower PSA, improved time to progression, and better survival outcomes when administered adjunctively to radiotherapy compared with radiotherapy alone, with significant results even over long-term follow-up. The evidence supporting adjuvant degarelix use is limited. Goserelin has better injection site safety, single-step delivery, and an efficient administration schedule compared with degarelix, which has significantly higher injection site reactions and less efficient administration mechanism. There is conflicting evidence about the risk of cardiovascular disease (CVD), and caution is required when using LHRH-A in patients with preexisting CVD. There is considerable long-term evidence for goserelin in patients with advanced PCa, with degarelix being a more recent option. The available comparative evidence of goserelin versus degarelix has several inherent limitations related to study design, sample size, conduct, and statistical analyses, and hence warrants robust prospective trials and long-term follow-up.
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Affiliation(s)
- Ankur Bahl
- Senior Consultant, Medical Oncology and Hematology, Max Cancer Centre, New Delhi, India
| | - Senthil Rajappa
- Consultant Medical Oncologist, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
| | - Sudhir Rawal
- Medical Director, Chief Genito Uro-Oncology, RCGI, Delhi, India
| | - Ganesh Bakshi
- Department of Uro oncology, P D Hinduja National Hospital, Mahim, Mumbai, India
| | - Vedang Murthy
- Professor & Radiation Oncologist, Tata Memorial Center, Mumbai, India
| | - Ketaki Patil
- Medical Affairs, AstraZeneca Pharma India Ltd, Manyatha Tech Park, Rachenahalli, Bangalore, India
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Kawaji-Kanayama Y, Muramatsu A, Sasaki N, Shimura K, Kiyota M, Fuchida S, Isa R, Fujino T, Matsumura-Kimoto Y, Tsukamoto T, Chinen Y, Mizutani S, Nakao M, Kaneko H, Kawata E, Hirakawa K, Takahashi R, Shimazaki C, Uchiyama H, Uoshima N, Shimura Y, Kobayashi T, Taniwaki M, Kuroda J. Clinical impacts of frailty, poor performance status, and advanced age in carfilzomib-containing treatment for relapsed/refractory multiple myeloma: post hoc investigation of the KOTOSG multicenter pilot prospective observational study. Int J Hematol 2022; 115:350-362. [PMID: 35072907 DOI: 10.1007/s12185-021-03262-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/01/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 01/13/2023]
Abstract
We conducted a post hoc analysis of our previous pilot observational study on the efficacy and safety of carfilzomib (CFZ)-containing therapy in 50 patients with relapsed/refractory multiple myeloma in routine practice to clarify the relationships between three major criteria for vulnerability (frailty, poor performance status [PS], and advanced age [≥ 75 years]) and their clinical impact on efficacy and adverse events (AEs). Sixteen patients fulfilled at least one and five patients fulfilled all three criteria. The overall response rate was not significantly affected by frailty, poor PS, and/or advanced age; however, frailty and advanced age were significantly associated with shorter progression-free survival (PFS). In contrast, no significant difference in PFS was observed between patients with PS0-1 or PS2-4. The three criteria for vulnerability were associated with more frequent hematologic AEs: frailty, poor PS, and/or advanced age significantly increased the risk of grade 3-4 anemia and lymphopenia. However, these criteria were not associated with increased risk of other non-hematologic AEs except infection. Collectively, these results demonstrate the need to carefully manage severe hematologic AEs in vulnerable patients and perform disease-specific assessment of frailty to predict prognosis.
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Affiliation(s)
- Yuka Kawaji-Kanayama
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ayako Muramatsu
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Nana Sasaki
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Kazuho Shimura
- Department of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Miki Kiyota
- Department of Hematology, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Shinichi Fuchida
- Department of Hematology, Japan Community Health Care Organization, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Reiko Isa
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takahiro Fujino
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yayoi Matsumura-Kimoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Taku Tsukamoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yoshiaki Chinen
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shinsuke Mizutani
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Mitsushige Nakao
- Department of Internal Medicine, Otsu Municipal Hospital, Otsu, Japan
| | - Hiroto Kaneko
- Department of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Eri Kawata
- Department of Hematology, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Koichi Hirakawa
- Department of Hematology, Fukuchiyama City Hospital, Fukuchiyama, Japan
| | - Ryoichi Takahashi
- Department of Hematology, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Chihiro Shimazaki
- Department of Hematology, Japan Community Health Care Organization, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Hitoji Uchiyama
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Nobuhiko Uoshima
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Yuji Shimura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
- Department of Blood Transfusion, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsutomu Kobayashi
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Masafumi Taniwaki
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
- Department of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan
- Center for Molecular Diagnostics and Therapeutics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
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Teoh JYC, Tian XY, Wong CYP, Lau CW, Cheng CK, Tang VWL, Chan RCK, Huang Y, Ng CF. Endothelial dysfunction after androgen deprivation therapy and the possible underlying mechanisms. Prostate 2022; 82:13-25. [PMID: 34570375 DOI: 10.1002/pros.24244] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/28/2021] [Accepted: 09/12/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Androgen deprivation therapy (ADT) is a key treatment modality in the management of prostate cancer (PCa), especially for patients with metastatic disease. Increasing evidences suggest that patients who received ADT have increased incidence of diabetes, myocardial infarction, stroke, and even mortality. It is important to understand the pathophysiological mechanisms on how ADT increases cardiovascular risk and induces cardiovascular events, which would provide important information for potential implementation of preventive measures. METHODS Twenty-six 12-week-old male SD rats were divided into four groups for different types of ADTs including: the bilateral orchidectomy group (Orx), LHRH agonist group (leuprolide), LHRH antagonist group (degarelix), and control group. After treated with drug or adjuvant injection every 3 weeks for 24 weeks, all rats were sacrificed and total blood were collected. Aorta, renal arteries, and kidney were preserved for functional assay, immunohistochemistry, western blot, and quantitative reverse-transcription polymerase chain reaction. RESULTS In vascular reactivity assays, aorta, intrarenal, and coronary arteries of all three ADT groups showed endothelial dysfunction. AT1R and related molecules at protein and messenger RNA (mRNA) level were tested, and AT1R pathway was shown to be activated and played a role in endothelial dysfunction. Both ACE and AT1R mRNA levels were doubled in the aorta in the leuprolide group while Orx and degarelix groups showed upregulation of AT1R in the kidney tissues. By immunohistochemistry, our result showed higher expression of AT1R in the intrarenal arteries of leuprolide and degarelix groups. The role of reactive oxygen species in endothelial dysfunction was confirmed by DHE fluorescence, nitrotyrosine overexpression, and upregulation of NOX2 in the different ADT treatment groups. CONCLUSION ADT causes endothelial dysfunction in male rats. GnRH receptor agonist compared to GnRH receptor antagonist, showed more impairment of endothelial function in the aorta and intrarenal arteries. Such change might be associated with upregulation and activation of AngII-AT1R-NOX2 induced oxidative stress in the vasculature. These results help to explain the different cardiovascular risks and outcomes related to different modalities of ADT treatment.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiao-Yu Tian
- Institute of Vascular Medicine, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Christine Yim-Ping Wong
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Wai Lau
- Institute of Vascular Medicine, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Chak-Kwong Cheng
- Institute of Vascular Medicine, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Victor Wai-Lun Tang
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Ronald Cheong-Kin Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yu Huang
- Institute of Vascular Medicine, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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Freyer CW, Bange EM, Skuli S, Hsu M, Lin J, Cuker A, Cohen AD, Garfall A. Carfilzomib-Induced Atypical Hemolytic Uremic Syndrome in a Patient With Heterozygous CFHR3/CFHR1 Deletion Treated With Eculizumab. Clin Lymphoma Myeloma Leuk 2021; 21:e845-e849. [PMID: 34366267 DOI: 10.1016/j.clml.2021.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Craig W Freyer
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Erin M Bange
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Sarah Skuli
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Miles Hsu
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - John Lin
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Adam Cuker
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Adam D Cohen
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Alfred Garfall
- Hospital of the University of Pennsylvania, Philadelphia, PA
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Camilleri M, Cuadrado M, Phillips E, Wilson W, Jenner R, Pang G, Kamora S, Streetly M, Popat R, Bygrave C, Owen R, Cavenagh J, Chapman M, Sive J, Eccersley L, Sheaff M, Benjamin R, Ramasamy K, Cook G, Virchis A, Chavda SJ, Clifton-Hadley L, Scully MA, Yong K. Thrombotic microangiopathy in untreated myeloma patients receiving carfilzomib, cyclophosphamide and dexamethasone on the CARDAMON study. Br J Haematol 2021; 193:750-760. [PMID: 33650100 DOI: 10.1111/bjh.17377] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
Proteasome inhibitors have been associated with thrombotic microangiopathy (TMA) - a group of disorders characterised by occlusive microvascular thrombosis causing microangiopathic haemolytic anaemia, thrombocytopenia and end-organ damage. To date, carfilzomib-associated TMA has predominantly been described in relapsed/refractory myeloma patients. We report eight patients with newly diagnosed myeloma who experienced TMA events while receiving carfilzomib on the phase II CARDAMON trial. The first three occurred during maintenance single-agent carfilzomib, two occurred at induction with carfilzomib given with cyclophosphamide and dexamethasone (KCd) and three occurred during KCd consolidation. At TMA presentation 6/8 were hypertensive; 7/8 had acute kidney injury and in three, renal impairment persisted after resolution of TMA in other respects. The mechanism of carfilzomib-associated TMA remains unclear, though patients with known hypertension seem particularly susceptible. Given the first three cases occurred during maintenance after a longer than five-week treatment break, a protocol amendment was instituted with: aggressive hypertension management, carfilzomib step-up dosing (20 mg/m2 on day 1) at start of maintenance before dose escalation to 56 mg/m2 maximum, and adding 10 mg dexamethasone as premedication to maintenance carfilzomib infusions. No further TMA events occurred during maintenance following this amendment and the TMA incidence reduced from 4·2 to 1·6 per 1 000 patient cycles.
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Affiliation(s)
- Marquita Camilleri
- Haematology Department, University College Hospitals, London, UK
- Cancer Institute, University College London, London, UK
| | - Maria Cuadrado
- Haematology Department, University College Hospitals, London, UK
| | - Elizabeth Phillips
- Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester, UK
| | - William Wilson
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Richard Jenner
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Gavin Pang
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Sumaiya Kamora
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Matthew Streetly
- Haematology Department, Guys and St Thomas' NHS Trust, London, UK
| | - Rakesh Popat
- Haematology Department, University College Hospitals, London, UK
- Cancer Institute, University College London, London, UK
| | | | - Roger Owen
- HMDS Laboratory, St James' Institute of Oncology, Leeds, UK
| | - James Cavenagh
- Haematology Department, Barts Health NHS Trust, London, UK
| | - Mike Chapman
- Haematology Department, Cambridge Institute for Medical Research, Cambridge, UK
| | - Jonathan Sive
- Haematology Department, University College Hospitals, London, UK
| | | | - Michael Sheaff
- Cellular Pathology Department, Barts Health NHS Trust, London, UK
| | | | - Karthik Ramasamy
- Haematology Department, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Gordon Cook
- Leeds Institute of Clinical Trial Research, University of Leeds, Leeds, UK
| | - Andres Virchis
- Haematology Department, Royal Free Hospitals NHS Trust, London, UK
| | - Selina J Chavda
- Haematology Department, University College Hospitals, London, UK
- Haematology Department, Guys and St Thomas' NHS Trust, London, UK
| | - Laura Clifton-Hadley
- Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester, UK
| | - Marie Anne Scully
- Haematology Department, University College Hospitals, London, UK
- Cardiometabolic Programme, NIHR UCLH/UCL Biomedical Research Centre, London, UK
| | - Kwee Yong
- Haematology Department, University College Hospitals, London, UK
- Haematology Department, Guys and St Thomas' NHS Trust, London, UK
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Mian HS, Fiala MA, Sanchez L, Vij R, Wildes TM. Renal failure among multiple myeloma patients utilizing carfilzomib and associated factors in the "real world". Ann Hematol 2021; 100:1261-1266. [PMID: 33475778 PMCID: PMC8054467 DOI: 10.1007/s00277-021-04420-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/27/2020] [Accepted: 01/11/2021] [Indexed: 01/17/2023]
Abstract
Carfilzomib, a next-generation proteasome inhibitor, improves outcomes in patients with multiple myeloma (MM); however, a proportion of those treated develop renal failure due to adverse event, comorbidity, or myeloma progression. The rate of renal failure and associated risk factors remains unknown in real-world populations. Adults with relapsed/refractory MM who received carfilzomib between the years 2013 and 2016 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases. Renal failure was defined using the corresponding International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) diagnostic codes and procedure codes for dialysis. Patients with a pre-existing diagnosis of renal failure were excluded to distinguish an adverse event from comorbidity. Multivariate cox regression analysis was performed to identify the variables independently associated with the development of renal failure among MM patients utilizing carfilzomib. A total of 1950 patients were included in the analysis. Renal failure developed in 22% of patients during the study period. The median time to development of renal failure from first carfilzomib administration was 1.6 months (range < 0.1-23.3). Increasing age (adjusted hazard ratio [aHR] 1.01 per year, p = 0.018), pre-existing heart failure (aHR 1.50, p = 0.005), and pre-existing chronic kidney disease (aHR 2.00, p < 0.001) were associated with a higher risk of developing renal failure. Renal failure occurred in up to 22% of patients on carfilzomib therapy. The exact cause and mechanism of renal failure cannot be determined from our study and may be multifactorial. Future studies are needed to further understand the cause of renal failure among patients on carfilzomib and devise strategies to mitigate the risk.
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Affiliation(s)
- Hira S Mian
- Department of Oncology, McMaster University, 699 Concession St., Hamilton, ON, L8V 5C2, Canada.
| | - Mark A Fiala
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Larysa Sanchez
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ravi Vij
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Tanya M Wildes
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
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10
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Nahi H, Walinder G, Patel V, Qu Y, Levine A, Majer I, Kutikova L, Hellqvist Franck E, Svensson MK, Hansson M. Burden of Treatment-Induced Peripheral Neuropathy in Patients with Multiple Myeloma in Sweden. Acta Haematol 2021; 144:519-527. [PMID: 33631745 DOI: 10.1159/000512165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Treatment-induced peripheral neuropathy (TIPN) is a complication of multiple myeloma (MM) treatment. OBJECTIVE This real-world, retrospective study used electronic medical record (EMR) data from 3 Swedish clinics to assess the occurrence and economic burden of TIPN in patients with MM. METHODS Eligible patients had an MM diagnosis in the Swedish Cancer Registry between 2006 and 2015 and initiated treatment during that period. Follow-up was until last EMR visit, death, or study end (April 2017). The current analyses included patients receiving bortezomib, lenalidomide, carfilzomib, or thalidomide at any treatment line. To discern healthcare resource utilization (HCRU) and costs associated with TIPN from other causes, patients with TIPN were matched with those without on baseline characteristics, treatment, and line of therapy. All analyses were descriptive. RESULTS Overall, 457 patients were included; 102 (22%) experienced TIPN. Patients experiencing TIPN during first-line treatment mostly received bortezomib-based regimens (n = 48/57 [84%]); those with TIPN during second- and third/fourth-line treatment mostly received lenalidomide/thalidomide-based regimens (19/31 [61%], 8/14 [57%], respectively). Patients with TIPN had higher HCRU/costs than those without TIPN (mean differences in hospital outpatient visits: 5.2, p = 0.0031; total costs per patient-year: EUR 17,183, p = 0.0007). CONCLUSIONS Effective MM treatments associated with a reduced incidence of TIPN could result in decreased healthcare expenditure.
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Affiliation(s)
- Hareth Nahi
- Haematology Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden,
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden,
| | - Göran Walinder
- Haematology Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | - Maria K Svensson
- Amgen AB, Stockholm, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Markus Hansson
- Department of Hematology, Lund University, Lund, Sweden
- Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Göteborg, Sweden
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11
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Bishnoi R, Xie Z, Shah C, Bian J, Murthy HS, Wingard JR, Farhadfar N. Real-world experience of carfilzomib-associated cardiovascular adverse events: SEER-Medicare data set analysis. Cancer Med 2021; 10:70-78. [PMID: 33169938 PMCID: PMC7826471 DOI: 10.1002/cam4.3568] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/23/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023] Open
Abstract
Carfilzomib was approved for the treatment of multiple myeloma in 2012 and since then there have been concerns for cardiovascular toxicity from its use. With this study, we aim to further study the hazards and underlying risk factors for cardiovascular adverse events associated with carfilzomib. This study was conducted using Surveillance, Epidemiology, and End Results (SEER)-Medicare data set of multiple myeloma from 2001 to 2015. Data were analyzed for hazards ratio of cardiovascular adverse events between carfilzomib users and nonusers. We identified 7330 patients with multiple myeloma of whom 815 were carfilzomib users. Carfilzomib users had a statistically significant hazard ratio of 1.41 with p < 0.0001 for all cardiovascular adverse events as compared to nonusers. Carfilzomib use was significantly associated with increased risk of heart failure (HR 1.47, p = 0.0002), ischemic heart disease (HR 1.45, p = 0.0002), and hypertension (HR 3.33, p < 0.0001), whereas there was no association between carfilzomib use and cardiac conduction disorders (arrhythmia and heart blocks). Carfilzomib users were at higher risk of new-onset edema (HR 5.09, p < 0.0001), syncope (HR 4.27, p < 0.0001), dyspnea (HR 1.33, p < 0.0001), and chest pain (HR 1.18, p < 0.0001) as compared to carfilzomib nonusers. Age above 75 years, preexisting cardiovascular disease, obesity, and twice a week carfilzomib schedule were significant risk factors associated with cardiovascular adverse events in carfilzomib users. The median time of the onset for all cardiovascular adverse events was 3.1 months. This study has identified a significantly higher likelihood of cardiovascular adverse events in elderly Medicare patients receiving carfilzomib.
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Affiliation(s)
- Rohit Bishnoi
- Division of Hematology and OncologyDepartment of MedicineUniversity of FloridaGainesvilleFLUSA
| | - Zhigang Xie
- Department of Health Services Research, Management and PolicyCollege of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFLUSA
| | - Chintan Shah
- Division of Hematology and OncologyDepartment of MedicineUniversity of FloridaGainesvilleFLUSA
| | - Jiang Bian
- Department of Health Outcomes and BioinformaticsCollege of MedicineUniversity of FloridaGainesvilleFLUSA
| | - Hemant S. Murthy
- Division of Hematology/OncologyMayo Clinic Alix School of MedicineMayo Clinic FloridaJacksonvilleFLUSA
| | - John R. Wingard
- Bone Marrow Transplant ProgramUniversity of Florida Health Cancer CenterGainesvilleFLUSA
- Division of Hematology/OncologyUniversity of Florida College of MedicineGainesvilleFLUSA
| | - Nosha Farhadfar
- Division of Hematology/OncologyUniversity of Florida College of MedicineGainesvilleFLUSA
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12
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Jasielec JK, Kubicki T, Raje N, Vij R, Reece D, Berdeja J, Derman BA, Rosenbaum CA, Richardson P, Gurbuxani S, Major S, Wolfe B, Stefka AT, Stephens L, Tinari KM, Hycner T, Rojek AE, Dytfeld D, Griffith KA, Zimmerman TM, Jakubowiak AJ. Carfilzomib, lenalidomide, and dexamethasone plus transplant in newly diagnosed multiple myeloma. Blood 2020; 136:2513-2523. [PMID: 32735641 PMCID: PMC7714092 DOI: 10.1182/blood.2020007522] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/22/2020] [Indexed: 12/22/2022] Open
Abstract
In this phase 2 multicenter study, we evaluated the incorporation of autologous stem cell transplantation (ASCT) into a carfilzomib-lenalidomide-dexamethasone (KRd) regimen for patients with newly diagnosed multiple myeloma (NDMM). Transplant-eligible patients with NDMM received 4 cycles of KRd induction, ASCT, 4 cycles of KRd consolidation, and 10 cycles of KRd maintenance. The primary end point was rate of stringent complete response (sCR) after 8 cycles of KRd with a predefined threshold of ≥50% to support further study. Seventy-six patients were enrolled with a median age of 59 years (range, 40-76 years), and 35.5% had high-risk cytogenetics. The primary end point was met, with an sCR rate of 60% after 8 cycles. Depth of response improved over time. On intent-to-treat (ITT), the sCR rate reached 76%. The rate of minimal residual disease (MRD) negativity using modified ITT was 70% according to next-generation sequencing (<10-5 sensitivity). After median follow-up of 56 months, 5-year progression-free survival (PFS) and overall survival (OS) rates were 72% and 84% for ITT, 85% and 91% for MRD-negative patients, and 57% and 72% for patients with high-risk cytogenetics. For high-risk patients who were MRD negative, 5-year rates were 77% and 81%. Grade 3 to 4 adverse events included neutropenia (34%), lymphopenia (32%), infection (22%), and cardiac events (3%). There was no grade 3 to 4 peripheral neuropathy. Patients with NDMM treated with KRd with ASCT achieved high rates of sCR and MRD-negative disease at the end of KRd consolidation. Extended KRd maintenance after consolidation contributed to deepening of responses and likely to prolonged PFS and OS. Safety and tolerability were manageable. This trial was registered at www.clinicaltrials.gov as #NCT01816971.
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Affiliation(s)
| | - Tadeusz Kubicki
- University of Chicago Medical Center, Chicago, IL
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Noopur Raje
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Ravi Vij
- Section of Stem Cell Transplant and Leukemia, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Donna Reece
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jesus Berdeja
- Sarah Cannon Center for Blood Cancer, Sarah Cannon Research Institute, Nashville, TN
| | | | - Cara A Rosenbaum
- University of Chicago Medical Center, Chicago, IL
- Weill Cornell Medicine, New York, NY
| | - Paul Richardson
- Division of Hematologic Malignancy, Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | | | - Sarah Major
- University of Chicago Medical Center, Chicago, IL
| | | | | | | | | | - Tyler Hycner
- University of Chicago Medical Center, Chicago, IL
| | | | - Dominik Dytfeld
- University of Chicago Medical Center, Chicago, IL
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Kent A Griffith
- Center for Cancer Biostatistics, University of Michigan Health System, Ann Arbor, MI; and
| | - Todd M Zimmerman
- University of Chicago Medical Center, Chicago, IL
- BeiGene, San Mateo, CA
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13
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Wojciechowski P, Andrzejewski K, Kaczyńska K. Intracerebroventricular Neuropeptide FF Diminishes the Number of Apneas and Cardiovascular Effects Produced by Opioid Receptors' Activation. Int J Mol Sci 2020; 21:ijms21238931. [PMID: 33255594 PMCID: PMC7728097 DOI: 10.3390/ijms21238931] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/23/2023] Open
Abstract
The opioid-induced analgesia is associated with a number of side effects such as addiction, tolerance and respiratory depression. The involvement of neuropeptide FF (NPFF) in modulation of pain perception, opioid-induced tolerance and dependence was well documented in contrast to respiratory depression. Therefore, the aim of the present study was to examine the potency of NPFF to block post-opioid respiratory depression, one of the main adverse effects of opioid therapy. Urethane-chloralose anaesthetized Wistar rats were injected either intravenously (iv) or intracerebroventricularly (icv) with various doses of NPFF prior to iv endomorphin-1 (EM-1) administration. Iv NPFF diminished the number of EM-1-induced apneas without affecting their length and without influence on the EM-1 induced blood pressure decline. Icv pretreatment with NPFF abolished the occurrence of post-EM-1 apneas and reduced also the maximal drop in blood pressure and heart rate. These effects were completely blocked by the NPFF receptor antagonist RF9, which was given as a mixture with NPFF before systemic EM-1 administration. In conclusion, our results showed that centrally administered neuropeptide FF is effective in preventing apnea evoked by stimulation of μ-opioid receptors and the effect was due to activation of central NPFF receptors. Our finding indicates a potential target for reversal of opioid-induced respiratory depression.
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14
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Takezako N, Shibayama H, Handa H, Hagiwara S, Ozaki S, Suzuki K, Kosugi H, Ri M, Sugiura I, Choi I, Miyamoto T, Iida S. Once-weekly vs. twice-weekly carfilzomib dosing in a subgroup of Japanese relapsed and refractory multiple myeloma patients from a randomized phase 3 trial (A.R.R.O.W.) and comparison with ENDEAVOR. Int J Hematol 2020; 113:219-230. [PMID: 33037990 PMCID: PMC7547551 DOI: 10.1007/s12185-020-03013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/26/2020] [Accepted: 09/24/2020] [Indexed: 12/01/2022]
Abstract
A.R.R.O.W. evaluated the superiority of once-weekly carfilzomib plus dexamethasone (Kd) 20/70 mg/m2 vs. twice-weekly Kd 20/27 mg/m2 based on progression-free survival (PFS) in relapsed and/or refractory multiple myeloma patients. Forty Japanese patients (once-weekly arm, n = 26; twice-weekly arm, n = 14) were randomized in A.R.R.O.W. In the Japanese subgroup of A.R.R.O.W., median PFS was 14.8 months (95% confidence interval [CI], 7.5-not evaluable [NE]) and 9.7 months (95% CI, 3.8-NE) in the once- and twice-weekly arms, respectively. The overall response rate (ORR) was 73.1% (19/26; 95% CI, 52.2-88.4) and 57.1% (8/14; 95% CI, 28.9-82.3) in each arm. The adverse events (AEs) incidence was 100% in both arms. Grade ≥ 3 AE incidence was 80.8% (21/26) and 78.6% (11/14) in each arm. Two fatal treatment-related AEs (acute lung injury and acute respiratory distress syndrome) occurred in the once-weekly arm. In exploratory unadjusted analyses of A.R.R.O.W. (once-weekly Kd 20/70 mg/m2) vs. ENDEAVOR (twice-weekly Kd 20/56 mg/m2), median PFS was 14.8 months vs. NE due to not yet being reached, and ORR was 73.1% (19/26) vs. 42.9% (3/7). In the Japanese subgroup, once-weekly Kd tended to improve ORR vs. twice-weekly Kd. Results from A.R.R.O.W. tended to be consistent with results from ENDEAVOR.
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Affiliation(s)
- Naoki Takezako
- National Hospital Organization Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo, 190-0014, Japan.
| | | | | | | | - Shuji Ozaki
- Tokushima Prefectural Central Hospital, Tokushima, Japan
| | | | | | - Masaki Ri
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Ilseung Choi
- National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | | | - Shinsuke Iida
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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15
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Ailawadhi S, Sexton R, Lentzsch S, Abidi MH, Voorhees PM, Cohen AD, Rohren EM, Heitner S, Kelly K, Mackler NJ, Baer DM, Hoering A, Durie B, Orlowski RZ. Low-dose versus High-dose Carfilzomib with Dexamethasone (S1304) in Patients with Relapsed-Refractory Multiple Myeloma. Clin Cancer Res 2020; 26:3969-3978. [PMID: 32299820 PMCID: PMC7415520 DOI: 10.1158/1078-0432.ccr-19-1997] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/22/2019] [Accepted: 04/09/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Treatment of multiple myeloma has evolved tremendously and optimal utilization of available therapies will ensure maximal patient benefits. PATIENTS AND METHODS We report the Southwest Oncology Group randomized phase II trial (S1304) comparing twice weekly low-dose (27 mg/m2; arm 1) to high-dose carfilzomib (56 mg/m2; arm 2), both with dexamethasone, administered for 12 cycles (11 months) for relapsed and/or refractory multiple myeloma with up to six prior lines of therapy (NCT01903811). The primary endpoint was progression-free survival (PFS), and patients on arm 1 could cross-over to arm 2 after progression on treatment. RESULTS Among 143 enrolled patients, of whom 121 were eligible and analyzable, the overall response rate was 42.8%, with no significant difference between the arms (P = 0.113). Also, neither the median PFS [5 months and 8 months, respectively; HR, 1.061; 80% Wald confidence interval (CI), 0.821-1.370; P = 0.384] nor the median overall survival were significantly different (26 and 22 months, respectively; HR, 1.149, 80% Wald CI, 0.841-.571; P = 0.284). Sixteen patients crossed over to arm 2 with a median PFS benefit of 3 months. Certain adverse events (AE) were more frequent in arm 2, including fatigue, thrombocytopenia, and peripheral neuropathy, but there was no significant difference in cardiopulmonary AEs. CONCLUSIONS This randomized trial did not support a benefit of fixed duration, twice weekly 56 mg/m2 dosing of carfilzomib over the 27 mg/m2 dose for the treatment of relapsed and/or refractory multiple myeloma. However, treatment to progression in earlier patient populations with high-dose carfilzomib using different schedules should still be considered as part of the standard of care.
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Affiliation(s)
| | | | | | - Muneer H Abidi
- Spectrum Health/Michigan State University, Grand Rapids, Michigan
| | | | - Adam D Cohen
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Kevin Kelly
- Norris Comprehensive Cancer Center, Los Angeles, California
| | | | | | - Antje Hoering
- Cancer Research and Biostatistics, Seattle, Washington
| | - Brian Durie
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, California
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16
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Huang PA, Beedie SL, Chau CH, Venzon DJ, Gere S, Kazandjian D, Korde N, Mailankody S, Landgren O, Figg WD. Cereblon gene variants and clinical outcome in multiple myeloma patients treated with lenalidomide. Sci Rep 2019; 9:14884. [PMID: 31619706 PMCID: PMC6795854 DOI: 10.1038/s41598-019-51446-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/03/2019] [Indexed: 12/20/2022] Open
Abstract
Carfilzomib-lenalidomide-dexamethasone (KRd) therapy has yielded promising results in patients with newly diagnosed multiple myeloma (NDMM). Cereblon (CRBN) is the direct molecular target of lenalidomide and genetic polymorphisms in CRBN have been associated with lenalidomide efficacy. In this study, we assessed the correlation of five single nucleotide variants (SNVs) in the CRBN gene with clinical response and outcomes in patients with NDMM administered KRd therapy with lenalidomide maintenance, achieving favorable trial endpoints in a prospective Phase II study (NCT01402284). Of the observed SNVs, no associations with KRd therapy response were found in this patient cohort, although strong trends in hypoalbuminemia grade and hyperbilirubinemia grade emerged across the CRBN rs1672753 genotype (P = 0.0008) and the rs1714327 genotype (P = 0.0010), respectively. Our results do not provide conclusive support for the predictive utility of CRBN gene polymorphisms as potential biomarkers of clinical response to lenalidomide-based therapy in our patient population. However, these findings remain to be validated in prospective studies using larger patient populations.
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Affiliation(s)
- Phoebe A Huang
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Shaunna L Beedie
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Cindy H Chau
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - David J Venzon
- Biostatistics and Data Management Section, National Cancer Institute, Bethesda, MD, USA
| | - Sheryl Gere
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dickran Kazandjian
- Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William D Figg
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
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17
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Kågedal M, Samineni D, Gillespie WR, Lu D, Fine BM, Girish S, Li C, Jin JY. Time-to-Event Modeling of Peripheral Neuropathy: Platform Analysis of Eight Valine-Citrulline-Monomethylauristatin E Antibody-Drug Conjugates. CPT Pharmacometrics Syst Pharmacol 2019; 8:606-615. [PMID: 31207190 PMCID: PMC6709423 DOI: 10.1002/psp4.12442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/01/2019] [Indexed: 12/28/2022] Open
Abstract
Peripheral neuropathy (PN) is a common long-term debilitating toxicity of antimicrotubule agents. PN was the most frequent adverse event resulting in dose modifications and/or discontinuation of treatment for valine-citrulline-monomethylauristatin E antibody-drug conjugates (ADCs) developed at Genentech. A pooled time-to-event analysis across eight ADCs (~700 patients) was performed to evaluate the relationship between the ADC exposure and the risk for developing a clinically significant (grade ≥ 2) PN. In addition, the impact of demographic and pathophysiological risk factors on the risk for PN was explored. The time-to-event analysis suggested that the development of PN risk increased with ADC exposure, treatment duration, body weight, and previously reported PN. This model can be used to inform clinical strategies such as adaptations to dosing regimen and/or treatment duration as well as inform clinical eligibility to reduce the incidence of grade ≥ 2 PN.
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Affiliation(s)
| | | | | | - Dan Lu
- Genentech Inc.South San FranciscoCaliforniaUSA
| | | | | | - Chunze Li
- Genentech Inc.South San FranciscoCaliforniaUSA
| | - Jin Y. Jin
- Genentech Inc.South San FranciscoCaliforniaUSA
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18
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George G, Scailteux L, Garmo H, Balusson F, Cardwell C, Coster GD, Schutter HD, Kuiper JG, McMenamin Ú, Verbeeck J, Van Hemelrijck M. Real-world insights into risk of developing cardiovascular disease following GnRH agonists versus antagonists for prostate cancer: a methodological protocol to a study using five European databases. Fundam Clin Pharmacol 2019; 33:479-499. [PMID: 30776136 PMCID: PMC6850363 DOI: 10.1111/fcp.12454] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 01/23/2019] [Accepted: 02/15/2019] [Indexed: 12/13/2022]
Abstract
One of the more recently investigated adverse long-term side effects of gonadotropin-releasing hormone (GnRH) agonists for prostate cancer (PCa) is cardiovascular disease (CVD). Studies suggest lower risk of CVD following GnRH antagonists (degarelix) than GnRH agonists. This protocol describes precise codes used to extract variables from five European databases for a study that compares risk of CVD following GnRH agonists and antagonists for PCa. PCa men on primary GnRH agonists or antagonists were identified from the UK THIN (The Health Improvement Network) database, National Health Service (NHS) Scotland, Belgian Cancer Registry (BCR), Dutch PHARMO Database Network and French National Database (SNIIRAM). Cohort entry was defined as date of treatment initiation. CVD event was defined as any first incident or fatal CVD after cohort entry. Readcodes in THIN and ICD codes in NHS Scotland, BCR, PHARMO and SNIIRAM were used to extract variables. Risk of Bias in Non-randomised studies of Interventions (ROBINS-I) tool was used to assess the potential risk of biases in this study. 51 572 men with a median follow-up time of 2 years started on GnRH agonists and 2 417 men with a median follow-up time of 1 year started on GnRH antagonists between 2010 and 2017 in the UK, Scotland, Belgium, the Netherlands and France. Data from five countries improved the study power and internal validity required to compare risk of CVD between GnRH agonists and antagonists, the latter being a fairly new drug with limited data in individual countries.
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Affiliation(s)
- Gincy George
- Translational Oncology and Urology ResearchKing's College LondonLondonUK
| | - Lucie‐Marie Scailteux
- Pharmacovigilance, Pharmacoepidemiology and Drug Information CenterRennes Hospital UniversityRennesFrance
- REPERES (Pharmacoepidemiology and Heath Services Research)Rennes UniversityEA 7449, F‐35000RennesFrance
| | - Hans Garmo
- Translational Oncology and Urology ResearchKing's College LondonLondonUK
| | - Frédéric Balusson
- REPERES (Pharmacoepidemiology and Heath Services Research)Rennes UniversityEA 7449, F‐35000RennesFrance
| | - Christopher Cardwell
- Centre for Public HealthInstitute for Health SciencesQueen's University BelfastBelfastNorthern Ireland
| | | | | | | | - Úna McMenamin
- Centre for Public HealthInstitute for Health SciencesQueen's University BelfastBelfastNorthern Ireland
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Abstract
For decades, the pathogenesis of a variety of human diseases has been attributed to increased intestinal paracellular permeability even though scientific evidence supporting this hypothesis has been tenuous. Nevertheless, during the past decade, there have been a growing number of publications focused on human genetics, the gut microbiome, and proteomics, suggesting that loss of mucosal barrier function, particularly in the gastrointestinal tract, may substantially affect antigen trafficking, ultimately causing chronic inflammation, including autoimmunity, in genetically predisposed individuals. The gut mucosa works as a semipermeable barrier in that it permits nutrient absorption and also regulates immune surveillance while retaining potentially harmful microbes and environmental antigens within the intestinal lumen. Celiac disease (CD), a systemic, immune-mediated disorder triggered by gluten in genetically susceptible individuals, is associated with altered gut permeability. Pre-clinical and clinical studies have shown that gliadin, a prolamine component of gluten that is implicated in CD pathogenesis, is capable to disassembling intercellular junctional proteins by upregulating the zonulin pathway, which can be inhibited by the zonulin antagonist larazotide acetate. In this review, we will focus on CD as a paradigm of chronic inflammatory diseases in order to outline the contribution of gut paracellular permeability toward disease pathogenesis; moreover, we will summarize current evidence derived from available clinical trials of larazotide acetate in CD.
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Affiliation(s)
- Francesco Valitutti
- Pediatric Gastroenterology and Liver Unit, Department of "Maternal-and-Child Health" and Urology, Sapienza University of Rome, Rome, Italy
| | - Alessio Fasano
- Mucosal Immunology and Biology Research Center, Center for Celiac Research and Treatment and Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, 175 Cambridge Street, CPZS - 574, Boston, MA, 02114, USA.
- European Biomedical Research Institute of Salerno, Salerno, Italy.
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Biran N, Siegel D, Berdeja JG, Raje N, Cornell RF, Alsina M, Kovacsovics T, Fang B, Kimball AS, Landgren O. Weekly carfilzomib, lenalidomide, and dexamethasone in relapsed or refractory multiple myeloma: A phase 1b study. Am J Hematol 2019; 94:794-802. [PMID: 31021005 PMCID: PMC6593978 DOI: 10.1002/ajh.25498] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/27/2019] [Accepted: 04/22/2019] [Indexed: 01/24/2023]
Abstract
Twice‐weekly carfilzomib (27 mg/m2) with lenalidomide‐dexamethasone (KRd) is a standard‐of‐care in relapsed or refractory multiple myeloma (RRMM). This phase 1b study evaluated KRd with once‐weekly carfilzomib in RRMM. Patients received carfilzomib (30‐minute infusion; 56 or 70mg/m2) on days 1, 8, and 15; lenalidomide 25 mg on days 1‐21; and dexamethasone 40 mg on days 1, 8, 15, and 22 (day 22 omitted for cycles 9+) of 28‐day cycles. Primary objective was safety/tolerability; efficacy was a secondary objective. Fifty‐six RRMM patients enrolled: 22 during dose evaluation (56‐mg/m2, n = 10; 70‐mg/m2, n = 12) and 34 during dose expansion (all initiated dosing at 70 mg/m2). After 2 fatal adverse events (AEs) during 70‐mg/m2 dose expansion, dosage reduction to 56 mg/m2 was permitted. Results are presented for carfilzomib 56‐mg/m2 (n = 10) and 70‐mg/m2 groups (dose evaluation/expansion; n = 46). Median carfilzomib dose was 53.2 mg/m2 (56‐mg/m2 group) and 62.4 mg/m2 (70‐mg/m2 group). Grade ≥3 AE rates were 70.0% (56 mg/m2) and 69.6% (70 mg/m2). Overall response rates were 90.0% (56 mg/m2) and 89.1% (70 mg/m2); ≥very good partial response rates were 50.0% (56 mg/m2) and 73.9% (70 mg/m2). Once‐weekly KRd was active with acceptable toxicity in RRMM, supporting further evaluation of this regimen.
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Affiliation(s)
- Noa Biran
- Myeloma DivisionJohn Theurer Cancer Center, Hackensack University Medical CenterHackensackNew Jersey
| | - David Siegel
- Myeloma DivisionJohn Theurer Cancer Center, Hackensack University Medical CenterHackensackNew Jersey
| | - Jesus G. Berdeja
- Department of MedicineSarah Cannon Research InstituteNashvilleTennessee
| | - Noopur Raje
- Department of Hematology and OncologyMassachusetts General Hospital Cancer CenterBostonMassachusetts
| | - Robert Frank Cornell
- Division of Hematology and OncologyVanderbilt University Medical CenterNashvilleTennessee
| | - Melissa Alsina
- Department of Blood and Marrow TransplantationMoffit Cancer CenterTampaFlorida
| | - Tibor Kovacsovics
- Division of Hematology and Hematologic Malignancies, Department of Internal MedicineHuntsman Cancer Institute, University of Utah School of MedicineSalt Lake CityUtah
| | - Belle Fang
- Global Biostatistical ScienceAmgen Inc.Thousand OaksCalifornia
| | | | - Ola Landgren
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew York CityNew York
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Abstract
Although multiple myeloma (MM) had been an incurable hematological malignancy with a poor prognosis, recent advances in novel anti-neoplastic agents, including carfilzomib (a proteasome inhibitor), have improved the prognosis. We herein report two cases of congestive heart failure in patients treated with carfilzomib. Although there are some reports on the cardiotoxicity of carfilzomib, to our knowledge, this is the first report on the cardiac involvement of carfilzomib in Japanese MM patients. We review the critical points from our two cases, with the aim of avoiding carfilzomib-associated heart failure in MM patients.
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Affiliation(s)
- Takenori Ikoma
- Department of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | - Masao Saotome
- Department of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | - Makoto Sano
- Department of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | - Kenichiro Suwa
- Department of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | - Yoshihisa Naruse
- Department of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | - Hayato Ohtani
- Department of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | - Tsuyoshi Urushida
- Department of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | - Yasuyuki Nagata
- Department of Hematology, Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | - Takaaki Ono
- Department of Hematology, Internal Medicine 3, Hamamatsu University School of Medicine, Japan
| | - Yuichiro Maekawa
- Department of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, Japan
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Rousseau E, Lau J, Kuo HT, Zhang Z, Merkens H, Hundal-Jabal N, Colpo N, Lin KS, Bénard F. Monosodium Glutamate Reduces 68Ga-PSMA-11 Uptake in Salivary Glands and Kidneys in a Preclinical Prostate Cancer Model. J Nucl Med 2018; 59:1865-1868. [PMID: 30097503 PMCID: PMC6278899 DOI: 10.2967/jnumed.118.215350] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/20/2018] [Indexed: 01/28/2023] Open
Abstract
We evaluated the ability of monosodium glutamate (MSG) to reduce salivary and kidney uptake of a prostate-specific membrane antigen (PSMA) radioligand without affecting tumor uptake. Methods: LNCaP tumor-bearing mice were intraperitoneally injected with MSG (657, 329, or 164 mg/kg) or phosphate-buffered saline (PBS). Fifteen minutes later, the mice were intravenously administered 68Ga-PSMA-11. PET/CT imaging and biodistribution studies were performed 1 h after administration. Results: Tumor uptake (percentage injected dose per gram [%ID]) was not statistically different between groups, at 8.42 ± 1.40 %ID in the 657 mg/kg group, 7.19 ± 0.86 %ID in the 329 mg/kg group, 8.20 ± 2.44 %ID in the 164 mg/kg group, and 8.67 ± 1.97 %ID in the PBS group. Kidney uptake was significantly lower in the 657 mg/kg group (85.8 ± 24.2 %ID) than in the 329 mg/kg (159 ± 26.2 %ID), 164 mg/kg (211 ± 27.4 %ID), and PBS groups (182 ± 33.5 %ID) (P < 0.001). Salivary gland uptake was lower in the 657 mg/kg (3.72 ± 2.12 %ID) and 329 mg/kg (5.74 ± 0.62 %ID) groups than in the PBS group (10.04 ± 2.52 %ID) (P < 0.01). Conclusion: MSG decreased salivary and kidney uptake of 68Ga-PSMA-11 in a dose-dependent manner, whereas tumor uptake was unaffected.
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Affiliation(s)
- Etienne Rousseau
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Joseph Lau
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Hsiou-Ting Kuo
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Zhengxing Zhang
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Helen Merkens
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Navjit Hundal-Jabal
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Nadine Colpo
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
| | - Kuo-Shyan Lin
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - François Bénard
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada; and
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Fernández-Crehuet P, Ruiz-Villaverde R. DRESS syndrome induced by telaprevir: a potentially fatal adverse event in chronic hepatitis C therapy. Cutis 2018; 102:E4-E6. [PMID: 30566559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Chari A, Stewart AK, Russell SD, Moreau P, Herrmann J, Banchs J, Hajek R, Groarke J, Lyon AR, Batty GN, Ro S, Huang M, Iskander KS, Lenihan D. Analysis of carfilzomib cardiovascular safety profile across relapsed and/or refractory multiple myeloma clinical trials. Blood Adv 2018; 2:1633-1644. [PMID: 29991494 PMCID: PMC6039655 DOI: 10.1182/bloodadvances.2017015545] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 05/23/2018] [Indexed: 01/10/2023] Open
Abstract
Carfilzomib is a selective proteasome inhibitor approved for the treatment of relapsed and/or refractory multiple myeloma (RRMM). It has significantly improved outcomes, including overall survival (OS), and shown superiority vs standard treatment with lenalidomide plus dexamethasone and bortezomib plus dexamethasone. The incidence rate of cardiovascular (CV) events with carfilzomib treatment has varied across trials. This analysis evaluated phase 1-3 trials with >2000 RRMM patients exposed to carfilzomib to describe the incidence of CV adverse events (AEs). In addition, the individual CV safety data of >1000 patients enrolled in the carfilzomib arm of phase 3 studies were compared with the control arms to assess the benefit-risk profile of carfilzomib. Pooling data across carfilzomib trials, the CV AEs (grade ≥3) noted included hypertension (5.9%), dyspnea (4.5%), and cardiac failure (4.4%). Although patients receiving carfilzomib had a numeric increase in the rates of any-grade and grade ≥3 cardiac failure, dyspnea, and hypertension, the frequency of discontinuation or death due to these cardiac events was low and comparable between the carfilzomib and control arms. Serial echocardiography in a blinded cardiac substudy showed no objective evidence of cardiac dysfunction in the carfilzomib and control arms. Moreover, carfilzomib had no significant effect on cardiac repolarization. Our results, including the OS benefit, showed that the benefit of carfilzomib treatment in terms of reducing progression or death outweighed the risk for developing cardiac failure or hypertension in most patients. Appropriate carfilzomib administration and risk factor management are recommended for elderly patients and patients with underlying risk factors.
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Affiliation(s)
- Ajai Chari
- Hematology/Oncology, Mount Sinai School of Medicine, New York, NY
| | - A Keith Stewart
- Division of Hematology/Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Stuart D Russell
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Philippe Moreau
- Department of Hematology, University Hospital Hotel-Dieu, Nantes, France
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Phoenix, AZ
| | - Jose Banchs
- Department of Cardiology, Division of Internal Medicine, MD Anderson Cancer Center, Houston, TX
| | - Roman Hajek
- Department of Haematooncology, Faculty of Medicine, University of Ostrava and University Hospital Ostrava, Ostrava, Czech Republic
| | - John Groarke
- Department of Cardiology, Division of Internal Medicine, Partners/Brigham and Women's Hospital, Boston, MA
| | - Alexander R Lyon
- Department of Cardiology, Imperial College London, London, United Kingdom
- Cardiology, Royal Brompton Hospital, London, United Kingdom
| | | | | | | | | | - Daniel Lenihan
- Cardiovascular Division, Washington University in St. Louis, St. Louis, MO
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Kim DU, Chung HC, Choi J, Sakai Y, Lee BY. Oral Intake of Low-Molecular-Weight Collagen Peptide Improves Hydration, Elasticity, and Wrinkling in Human Skin: A Randomized, Double-Blind, Placebo-Controlled Study. Nutrients 2018; 10:nu10070826. [PMID: 29949889 PMCID: PMC6073484 DOI: 10.3390/nu10070826] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/29/2022] Open
Abstract
Collagen-peptide supplementation could be an effective remedy to improve hydration, elasticity, and wrinkling in human skin. The aim of this study was to conduct a double-blind, randomized, placebo-controlled trial to clinically evaluate the effect on human skin hydration, wrinkling, and elasticity of Low-molecular-weight Collagen peptide (LMWCP) with a tripetide (Gly-X-Y) content >15% including 3% Gly-Pro-Hyp. Individuals (n = 64) were randomly assigned to receive either placebo or 1000 mg of LMWCP once daily for 12 weeks. Parameters of skin hydration, wrinkling, and elasticity were assessed at baseline and after 6 weeks and 12 weeks. Compared with the placebo group, skin-hydration values were significantly higher in the LMWCP group after 6 weeks and 12 weeks. After 12 weeks in the LMWCP group, visual assessment score and three parameters of skin wrinkling were significantly improved compared with the placebo group. In case of skin elasticity, one parameter out of three was significantly improved in the LMWCP group from the baseline after 12 weeks, while, compared with the placebo group, two parameters out of three in the LMWCP group were higher with significance after 12 weeks. In terms of the safety of LMWCP, none of the subjects presented adverse symptoms related to the test material during the study period. These results suggest that LMWCP can be used as a health functional food ingredient to improve human skin hydration, elasticity, and wrinkling.
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Affiliation(s)
- Do-Un Kim
- Newtree, Seongnam 13207, Gyeonggi, Korea.
| | | | - Jia Choi
- Department of Food Science and Biotechnology, College of Life Science, CHA University, Seongnam 13488, Gyeonggi, Korea.
| | - Yasuo Sakai
- Central Research Institute, Jellice, Sakae, Tagajo 985-0833, Japan.
| | - Boo-Yong Lee
- Department of Food Science and Biotechnology, College of Life Science, CHA University, Seongnam 13488, Gyeonggi, Korea.
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Castro-Alonso FJ, Dominguez-Pineda J, Rosales-Sotomayor G, Flaig TW, Bourlon MT. Initiation of ADT in a Man With Locally Advanced Prostate Cancer and Multiple Cardiovascular Risk Factors. Oncology (Williston Park) 2018; 32:243-246. [PMID: 29847858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Mushtaq A, Kapoor V, Latif A, Iftikhar A, Zahid U, McBride A, Abraham I, Riaz IB, Anwer F. Efficacy and toxicity profile of carfilzomib based regimens for treatment of multiple myeloma: A systematic review. Crit Rev Oncol Hematol 2018; 125:1-11. [PMID: 29650268 PMCID: PMC5901887 DOI: 10.1016/j.critrevonc.2018.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 08/13/2017] [Revised: 02/09/2018] [Accepted: 02/17/2018] [Indexed: 12/20/2022] Open
Abstract
Standard induction therapy for multiple myeloma is three-drug combination based on following classes of drugs: proteasome inhibitors, immunomodulators and steroids. Despite its notable efficacy, bortezomib has side effects like peripheral neuropathy (PNP) with reported incidence of grade ≥3 PNP between 2%-23% Schlafer et al., 2017. Carfilzomib (CFZ) has high selectivity and minimal off-target adverse effects including lower rates of PNP. CFZ is already approved for treatment of relapsed and refractory multiple myeloma (RRMM) as single agent as well as in combination with lenalidomide and/or dexamethasone. Extensive literature search identified a total of 1839 articles. Twenty-six articles (n = 5980) met the inclusion criteria, 15 in newly diagnosed multiple myeloma (NDMM) and 11 in RRMM group. CFZ demonstrates comparable or even better efficacy to bortezomib with much favorable AE profile. Deep, rapid and sustainable response using KRd with safer toxicity profile supports extension of KRd therapy to frontline therapy for all risk categories of MM. High incidence of grade ≥3 HTN underscores the importance of serial BP monitoring. In RRMM, CFZ has documented efficacy with standard 20-27mg/m2 dose. Further large-scale trials are needed to study benefit-to-risk profile of 20-56 and 20-70 mg/m2 dose of CFZ vs standard 20-27 mg/m2 dose in NDMM and RRMM.
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Affiliation(s)
- Adeela Mushtaq
- Department of Medicine, Hematology and Oncology, University of Arizona, Tucson, AZ, United States
| | - Vikas Kapoor
- Department of Medicine, Hematology and Oncology, University of Arizona, Tucson, AZ, United States
| | - Azka Latif
- Department of Medicine, Hematology and Oncology, University of Arizona, Tucson, AZ, United States
| | - Ahmad Iftikhar
- Department of Medicine, Hematology and Oncology, University of Arizona, Tucson, AZ, United States
| | - Umar Zahid
- Department of Medicine, Hematology and Oncology, University of Arizona, Tucson, AZ, United States; College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Ali McBride
- College of Pharmacy, Arizona Cancer center, University of Arizona, Tucson, AZ, 85721, United States
| | - Ivo Abraham
- Center for Health Outcomes & Pharmaco-Economic Research, UA College of Pharmacy, United States
| | - Irbaz Bin Riaz
- Mayo Clinic, Department of Hematology and Oncology, Rochester, MN, United States
| | - Faiz Anwer
- Department of Medicine, Hematology and Oncology, University of Arizona, Tucson, AZ, United States.
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Karaa A, Haas R, Goldstein A, Vockley J, Weaver WD, Cohen BH. Randomized dose-escalation trial of elamipretide in adults with primary mitochondrial myopathy. Neurology 2018; 90:e1212-e1221. [PMID: 29500292 PMCID: PMC5890606 DOI: 10.1212/wnl.0000000000005255] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 12/12/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To assess the safety and efficacy of elamipretide, an aromatic-cationic tetrapeptide that readily penetrates cell membranes and transiently localizes to the inner mitochondrial membrane where it associates with cardiolipin, in adults with primary mitochondrial myopathy (PMM). METHODS A Study Investigating the Safety, Tolerability, and Efficacy of MTP-131 for the Treatment of Mitochondrial Myopathy (MMPOWER) was a phase I/II multicenter, randomized, double-blind, placebo-controlled trial of elamipretide in 36 participants with genetically confirmed PMM. Participants were randomized to intravenous elamipretide (0.01, 0.1, and 0.25 mg/kg/h or placebo for 2 hours in a dose-escalating sequence). The primary efficacy measure was the change in distance walked in the 6-minute walk test (6MWT) after 5 days of treatment. Other efficacy measures included changes in cardiopulmonary exercise testing parameters, in participant-reported symptoms, and in serum and urinary biomarkers. Safety, tolerability, and pharmacokinetics were also measured. RESULTS Participants who received the highest dose of elamipretide walked a mean of 64.5 m farther at day 5 compared to a change of 20.4 m in the placebo group (p = 0.053). In addition, there was a dose-dependent increase in distance walked on the 6MWT with elamipretide treatment (p = 0.014). In a model that adjusted for additional covariates possibly affecting response, the adjusted change for the highest dose of elamipretide was 51.2 vs 3.0 m in the placebo group (p = 0.0297). No significant differences were observed in other efficacy and safety endpoints. CONCLUSIONS Elamipretide increased exercise performance after 5 days of treatment in patients with PMM without increased safety concerns. These findings, as well as additional functional and patient-reported measures, remain to be tested in larger trials with longer treatment periods to detect other potential therapeutic benefits in individuals affected by this condition. CLASSIFICATION OF EVIDENCE This trial provides Class I evidence that for patients with PMM, elamipretide improved the distance walked on the 6MWT.
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Affiliation(s)
- Amel Karaa
- From the Genetics Unit (A.K.), Massachusetts General Hospital, Boston; UC San Diego School of Medicine (R.H.), La Jolla, CA; Children's Hospital of Pittsburgh (A.G., J.V.), PA; Stealth BioTherapeutics (W.D.W.), Newton, MA; and Akron Children's Hospital (B.H.C.), OH.
| | - Richard Haas
- From the Genetics Unit (A.K.), Massachusetts General Hospital, Boston; UC San Diego School of Medicine (R.H.), La Jolla, CA; Children's Hospital of Pittsburgh (A.G., J.V.), PA; Stealth BioTherapeutics (W.D.W.), Newton, MA; and Akron Children's Hospital (B.H.C.), OH
| | - Amy Goldstein
- From the Genetics Unit (A.K.), Massachusetts General Hospital, Boston; UC San Diego School of Medicine (R.H.), La Jolla, CA; Children's Hospital of Pittsburgh (A.G., J.V.), PA; Stealth BioTherapeutics (W.D.W.), Newton, MA; and Akron Children's Hospital (B.H.C.), OH
| | - Jerry Vockley
- From the Genetics Unit (A.K.), Massachusetts General Hospital, Boston; UC San Diego School of Medicine (R.H.), La Jolla, CA; Children's Hospital of Pittsburgh (A.G., J.V.), PA; Stealth BioTherapeutics (W.D.W.), Newton, MA; and Akron Children's Hospital (B.H.C.), OH
| | - W Douglas Weaver
- From the Genetics Unit (A.K.), Massachusetts General Hospital, Boston; UC San Diego School of Medicine (R.H.), La Jolla, CA; Children's Hospital of Pittsburgh (A.G., J.V.), PA; Stealth BioTherapeutics (W.D.W.), Newton, MA; and Akron Children's Hospital (B.H.C.), OH
| | - Bruce H Cohen
- From the Genetics Unit (A.K.), Massachusetts General Hospital, Boston; UC San Diego School of Medicine (R.H.), La Jolla, CA; Children's Hospital of Pittsburgh (A.G., J.V.), PA; Stealth BioTherapeutics (W.D.W.), Newton, MA; and Akron Children's Hospital (B.H.C.), OH
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29
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Tosco L, Laenen A, Gevaert T, Salmon I, Decaestecker C, Davicioni E, Buerki C, Claessens F, Swinnen J, Goffin K, Oyen R, Everaerts W, Moris L, De Meerleer G, Haustermans K, Joniau S. Neoadjuvant degarelix with or without apalutamide followed by radical prostatectomy for intermediate and high-risk prostate cancer: ARNEO, a randomized, double blind, placebo-controlled trial. BMC Cancer 2018; 18:354. [PMID: 29606109 PMCID: PMC5879743 DOI: 10.1186/s12885-018-4275-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 03/21/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recent retrospective data suggest that neoadjuvant androgen deprivation therapy can improve the prognosis of high-risk prostate cancer (PCa) patients. Novel androgen receptor pathway inhibitors are nowadays available for treatment of metastatic PCa and these compounds are promising for early stage disease. Apalutamide is a pure androgen antagonist with a very high affinity with the androgen receptor. The combination of apalutamide with degarelix, an LHRH antagonist, could increase the efficacy compared to degarelix alone. OBJECTIVE The primary objective is to assess the difference in proportions of minimal residual disease at prostatectomy specimen between apalutamide + degarelix vs placebo + degarelix. Various secondary endpoints are assessed: variations of different biomarkers at the tumour level (tissue microarrays to evaluate DNA-PKs, PARP, AR and splice variants, PSMA, etc.), whole transcriptome sequencing, exome sequencing and clinical (PSA and testosterone kinetics, early biochemical recurrence free survival, quality of life, safety, etc.) and radiological endpoints. METHODS ARNEO is a single centre, phase II, randomized, double blind, placebo-controlled trial. The plan is to include at least 42 patients per each of the two study arms. Patients with intermediate/high-risk PCa and who are amenable for radical prostatectomy with pelvic lymph node dissection can be included. After signing an informed consent, every patient will undergo a pelvic 68Ga -PSMA-11 PSMA PET/MR and receive degarelix at standard dosage and start assuming apalutamide/placebo (60 mg 4 tablets/day) for 12 weeks. Within thirty days from the last study medication intake the same imaging will be repeated. Every patient will undergo PSA and testosterone testing the day of randomization, before the first drug intake, and after the last dose. Formalin fixed paraffin embedded tumour samples will be collected and used for transcriptome analysis, exome sequencing and immunohistochemistry. DISCUSSION ARNEO will allow us to answer, first, whether the combined treatment can result in an increased proportion of patients with minimal residual disease. Secondly, It will enable the study of the molecular consequences at the level of the tumour. Thirdly, what the consequences are of new generation androgen receptor pathway inhibitors on 68Ga -PSMA-11 PET/MR. Finally, various clinical, safety and quality of life data will be collected. TRIAL REGISTRATION EUDRaCT number: 2016-002854-19 (authorization date 3rd August 2017). clinicalTrial.gov: NCT03080116 .
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Affiliation(s)
- Lorenzo Tosco
- Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Center, KU Leuven, Leuven, Belgium
| | - Thomas Gevaert
- Laboratory of Experimental Urology, Organ Systems, KU Leuven, Leuven, Belgium
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Pathology, AZ Klina, Brasschaat, Belgium
| | - Isabelle Salmon
- DIAPath, Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles (ULB), Gosselies, Belgium
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Decaestecker
- DIAPath, Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles (ULB), Gosselies, Belgium
- Laboratories of Image, Signal processing & Acoustics, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | | | - Frank Claessens
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Molecular Endocrinology, Leuven, Belgium
| | - Johan Swinnen
- Laboratory of Lipid Metabolism and Cancer, Department of Oncology, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, KU Leuven, University of Leuven, Leuven, Belgium
| | - Karolien Goffin
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, UZ Leuven, Leuven, Belgium
| | - Raymond Oyen
- Department of Radiology Gasthuisberg University Hospitals Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | - Lisa Moris
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Molecular Endocrinology, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium.
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Uysal A, Akad Soyer N, Özkan M, Şahin F, Vural F, Töbü M, Tombuloğlu M, Saydam G. Carfilzomib experience in relapsed/refractory multiple myeloma: a single-center experience. Turk J Med Sci 2018; 48:80-83. [PMID: 29479960 DOI: 10.3906/sag-1611-97] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: Carfilzomib (CFZ) is a new-generation proteasome inhibitor with significant activity in relapsed or refractory multiple myeloma (R/R-MM). We have retrospectively evaluated R/R-MM patients who were treated with CFZ plus dexamethasone. Materials and methods: Twenty-one R/R-MM patients who were treated with CFZ plus dexamethasone between October 2013 and January 2016 were screened. The patients were followed until March 2016 after CFZ treatment. Results: Ten (47.6%) of the patients were female and 11 (52.4%) of them were male. The median age was 62 (47-76) years. The median number of prior treatment lines was 3 (2-7). The median number of administered cycles of treatment for CFZ was 4 (1-10). The median overall response rate was 26.3%. The most common hematological adverse events were anemia and thrombocytopenia (38%). The most common nonhematological adverse event was fatigue (71.4%). One patient died because of a cerebrovascular event and 1 patient died because of pneumonia during the treatment period. The median duration of response rate and time to next therapy were 8 (7-9) and 3 (2-16) months, respectively. The median overall survival was 8 (0.5-33) months. Conclusion: Despite the small number of patients, our results suggest that CFZ provides acceptable responses in heavily pretreated R/R-MM patients.
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Katakami N, Uchino J, Yokoyama T, Naito T, Kondo M, Yamada K, Kitajima H, Yoshimori K, Sato K, Saito H, Aoe K, Tsuji T, Takiguchi Y, Takayama K, Komura N, Takiguchi T, Eguchi K. Anamorelin (ONO-7643) for the treatment of patients with non-small cell lung cancer and cachexia: Results from a randomized, double-blind, placebo-controlled, multicenter study of Japanese patients (ONO-7643-04). Cancer 2018; 124:606-616. [PMID: 29205286 PMCID: PMC5814824 DOI: 10.1002/cncr.31128] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cachexia, described as weight loss (mainly in lean body mass [LBM]) and anorexia, is common in patients with advanced cancer. This study examined the efficacy and safety of anamorelin (ONO-7643), a novel selective ghrelin receptor agonist, in Japanese cancer patients with cachexia. METHODS This double-blind clinical trial (ONO-7643-04) enrolled 174 patients with unresectable stage III/IV non-small cell lung cancer (NSCLC) and cachexia in Japan. Patients were randomized to daily oral anamorelin (100 mg) or a placebo for 12 weeks. The primary endpoint was the change from the baseline LBM (measured with dual-energy x-ray absorptiometry) over 12 weeks. The secondary endpoints were changes in appetite, body weight, quality of life, handgrip strength (HGS), and 6-minute walk test (6MWT) results. RESULTS The least squares mean change (plus or minus the standard error) in LBM from the baseline over 12 weeks was 1.38 ± 0.18 and -0.17 ± 0.17 kg in the anamorelin and placebo groups, respectively (P < .0001). Changes from the baseline in LBM, body weight, and anorexia symptoms showed significant differences between the 2 treatment groups at all time points. Anamorelin increased prealbumin at weeks 3 and 9. No changes in HGS or 6MWT were detected between the groups. Twelve weeks' treatment with anamorelin was safe and well tolerated in NSCLC patients. CONCLUSIONS Anamorelin significantly increased LBM and improved anorexia symptoms and the nutritional state, but not motor function, in Japanese patients with advanced NSCLC. Because no effective treatment for cancer cachexia is currently available, anamorelin can be a beneficial treatment option. Cancer 2018;124:606-16. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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Affiliation(s)
- Nobuyuki Katakami
- Division of Integrated Oncology, Institute of Biomedical Research and InnovationKobeJapan
| | - Junji Uchino
- Department of Pulmonary MedicineKyoto Prefectural University of MedicineKyotoJapan
- Department of Respiratory MedicineFukuoka University School of MedicineFukuokaJapan
| | - Takuma Yokoyama
- Department of Respiratory MedicineKyorin University HospitalMitakaJapan
| | - Tateaki Naito
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Masashi Kondo
- Department of Respiratory Medicine Graduate School of MedicineNagoya UniversityNagoyaJapan
- Department of Respiratory MedicineFujita Health UniversityToyoakeJapan
| | - Kouzo Yamada
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Hiromoto Kitajima
- Department of Respiratory MedicineNational Hospital Organization Shikoku Cancer CenterMatsuyamaJapan
| | - Kozo Yoshimori
- Department of Clinical Oncology, Japan Anti‐Tuberculosis AssociationFukujuji HospitalKiyoseJapan
| | - Kazuhiro Sato
- Department of Respiratory MedicineNagaoka Red Cross HospitalNagaokaJapan
| | - Hiroshi Saito
- Department of Respiratory MedicineAichi Cancer Center Aichi HopitalAichiJapan
| | - Keisuke Aoe
- Department of Medical OncologyNational Hospital Organization Yamaguchi‐Ube Medical CenterUbeJapan
| | - Tetsuya Tsuji
- Department of Rehabilitation MedicineKeio University School of MedicineTokyoJapan
| | - Yuichi Takiguchi
- Department of Medical OncologyGraduate School of Medicine, Chiba UniversityChibaJapan
| | - Koichi Takayama
- Department of Pulmonary MedicineKyoto Prefectural University of MedicineKyotoJapan
| | | | | | - Kenji Eguchi
- Health Science on Supportive Medicine for Intractable DiseasesTeikyo University School of MedicineTokyoJapan
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Camilleri M, McCallum RW, Tack J, Spence SC, Gottesdiener K, Fiedorek FT. Efficacy and Safety of Relamorelin in Diabetics With Symptoms of Gastroparesis: A Randomized, Placebo-Controlled Study. Gastroenterology 2017; 153:1240-1250.e2. [PMID: 28760384 PMCID: PMC5670003 DOI: 10.1053/j.gastro.2017.07.035] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Gastroparesis is a complication of diabetes with few treatment options. Relamorelin (also referred to as RM-131) is a selective, prokinetic agonist of ghrelin. We aimed to evaluate the efficacy of relamorelin on symptoms and gastric emptying (GE) in a 12-week, phase 2B study of diabetic patients with moderate to severe gastroparesis symptoms (DG). METHODS We performed a study of 393 patients with DG (37.7% male; 9.9% with type 1 diabetes; median age, 58.2 years [range 20-76]; median body mass index, 31.4 kg/m2 [range, 18.2-60.1]; HbA1c level, 7.6%, [range, 5.2-11.0]). All participants had 13C-spirulina GE breath test T1/2 values of 79 minutes or more (with 89.8% delayed relative to 90th %ile of normal, 85.75 minutes), recent vomiting, and gastroparesis cardinal symptom index-daily diary scores of 2.6 or more. Patients were randomly assigned to groups given placebo (n=104) or relamorelin (10 μg [n=98], 30 μg [n=109], or 100 μg [n=82] twice daily) for 12 weeks, following a 2-week, single-blind, placebo run-in period. Patient-reported outcomes were determined from DG Symptom Severity daily e-diaries, in which patients recorded vomiting frequency and symptom scores (nausea, abdominal pain, postprandial fullness, and bloating) on a 0-10 scale. Endpoints were change from baseline in vomiting frequency, composite DG Symptom Severity score, GE, and safety. We performed longitudinal, mixed-effects model analysis using repeated measures, with baseline and baseline-by-week interaction values as covariates. RESULTS Patients given relamorelin had a 75% reduction in vomiting frequency compared with baseline, but this difference was not significant compared with the placebo group. All 4 symptoms of DG (composite or individual symptoms) were significantly reduced over the 12-week study period in all 3 relamorelin dose groups compared with the placebo group (all P < .05, based on longitudinal analysis over 12 weeks). Relamorelin significantly accelerated GE from baseline compared with placebo (by 12%, P < .05 for the 10 μg and 30 μg groups; P = .051 for the 100 μg group). Dose-related worsening of glycemic control was noted in 14.5% of patients who received relamorelin; some required insulin or other diabetes drug dosage adjustments. CONCLUSIONS In a phase 2B randomized trial of patients with moderate to severe DG, relamorelin significantly reduced core symptoms of DG and overall composite score compared with placebo, accelerated GE, and was generally safe and well tolerated. ClinicalTrials.gov Identifier: NCT02357420.
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Affiliation(s)
| | - Richard W McCallum
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Jan Tack
- University Hospital, Leuven, Belgium
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Cotter G, Davison BA, Butler J, Collins SP, Ezekowitz JA, Felker GM, Filippatos G, Levy PD, Metra M, Ponikowski P, Teerlink JR, Voors AA, Senger S, Bharucha D, Goin K, Soergel DG, Pang PS. Relationship between baseline systolic blood pressure and long-term outcomes in acute heart failure patients treated with TRV027: an exploratory subgroup analysis of BLAST-AHF. Clin Res Cardiol 2017; 107:170-181. [PMID: 28986703 DOI: 10.1007/s00392-017-1168-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/22/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION TRV027, a 'biased' ligand of the angiotensin II type 1 receptor (AT1R), did not affect a composite clinical outcome at 30 days in a phase 2b acute heart failure (AHF) trial (BLAST-AHF). METHODS Post-hoc analyses from BLAST-AHF (n = 618) examined the effects of TRV027 by baseline systolic blood pressure (SBP) on changes in renal function and 180-day outcomes. Interactions between baseline SBP and select endpoints were identified utilizing a subpopulation treatment effect pattern plots (STEPP) analysis, then grouping of patients by SBP tertile: < 127, ≥ 127 to < 140, and ≥ 140 mmHg. RESULTS A trend towards increased creatinine in the first 3 days was noted in the lower SBP tertile, while in those in the higher two tertiles, TRV027, especially the 1 mg/h dose, reduced creatinine at days 5 and 30. Beneficial effects on 180-day all-cause mortality and cardiovascular (CV) death or readmission were observed in the two higher SBP tertiles (SBP ≥ 127 mmHg) in the TRV027 1 mg/h dose group (all-cause mortality HR 0.39, 95% CI 0.14-1.06, p = 0.056; CV death or HF/RF rehospitalization HR 0.53, 95% CI 0.28-1.01, p = 0.049), while more adverse outcomes were observed in patients in the lower SBP tertile. CONCLUSIONS This post-hoc analysis of the BLAST-AHF study suggests contrasting effects of TRV027 by baseline SBP, with trends towards lower 180-day event rates in patients enrolled with higher baseline SBP, especially when given lower doses of TRV027.
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Affiliation(s)
- Gad Cotter
- Momentum Research Inc., Suite 801, 3100 Tower Blvd, Durham, NC, 27707, USA.
| | - Beth A Davison
- Momentum Research Inc., Suite 801, 3100 Tower Blvd, Durham, NC, 27707, USA
| | - Javed Butler
- SUNY Stony Brook School of Medicine, New York, NY, USA
| | | | | | - G Michael Felker
- Duke University School of Medicine and the Duke Clinical Research Institute, Durham, NC, USA
| | - Gerasimos Filippatos
- Department of Cardiology, School of Medicine, Heart Failure Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Phillip D Levy
- Wayne State University School of Medicine and Cardiovascular Research Institute, Detroit, MI, USA
| | - Marco Metra
- Cardiology, University of Brescia, Brescia, Italy
| | | | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Stefanie Senger
- Momentum Research Inc., Suite 801, 3100 Tower Blvd, Durham, NC, 27707, USA
| | | | | | | | - Peter S Pang
- Indiana University School of Medicine and Regenstrief Institute, Indianapolis, IN, USA
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Tzogani K, Camarero Jiménez J, Garcia I, Sancho-López A, Martin M, Moreau A, Demolis P, Salmonson T, Bergh J, Laane E, Ludwig H, Gisselbrecht C, Pignatti F. The European Medicines Agency Review of Carfilzomib for the Treatment of Adult Patients with Multiple Myeloma Who Have Received at Least One Prior Therapy. Oncologist 2017; 22:1339-1346. [PMID: 28935772 PMCID: PMC5679835 DOI: 10.1634/theoncologist.2017-0184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/20/2017] [Indexed: 11/17/2022] Open
Abstract
This article summarizes the scientific review of the application leading to regulatory approval of carfilzomib in combination with lenalidomide and dexamethasone in the European Union. On November 19, 2015, a marketing authorization valid through the European Union was issued for carfilzomib in combination with lenalidomide and dexamethasone for the treatment of adult patients with multiple myeloma (MM) who have received at least one prior therapy. In a phase III trial in patients with relapsed MM, median progression‐free survival (PFS) for patients treated with carfilzomib in combination with lenalidomide and dexamethasone (CRd) was 26.3 months versus 17.6 months for those receiving lenalidomide and dexamethasone alone (hazard ratio = 0.69; 95% confidence interval, 0.57–0.83; one‐sided log‐rank p value < .0001). The most frequently observed toxicity (grade ≥3, treatment arm vs. control arm) in the phase III trial included neutropenia (29.6% vs. 26.5%), anemia (17.9% vs. 17.7%), thrombocytopenia (16.8% vs. 12.3%), pneumonia (12.5% vs. 10.5%), fatigue (7.7% vs. 6.4%), hypertension (4.6% vs. 2.1%), diarrhea (3.8% vs. 4.1%), and respiratory tract infection (4.1% vs. 2.1%). The objective of this article is to summarize the scientific review of the application leading to regulatory approval in the European Union. The scientific review concluded that the gain in PFS of 8.7 months observed with the combination of CRd was considered clinically meaningful and was supported by a clear trend in overall survival benefit, although the data were not mature. The delay in disease progression appeared superior to available alternatives in the setting of relapsed MM at the time of the marketing authorization of carfilzomib. Therefore, given the overall accepted safety profile, which was considered manageable in the current context, the benefit risk for CRd was considered positive. Implications for Practice. Carfilzomib (Kyprolis) was approved in the European Union in combination with lenalidomide and dexamethasone for the treatment of adult patients with multiple myeloma who have received at least one prior therapy. The addition of carfilzomib to lenalidomide and dexamethasone resulted in a clinically meaningful and statistically significant improvement of progression‐free survival compared with lenalidomide and dexamethasone, which was supported by a clear trend in overall survival benefit, although the data were not mature. At the time of the marketing authorization of carfilzomib, the delay in disease progression appeared superior to available alternatives in the setting of relapsed multiple myeloma. In terms of safety, the overall accepted safety profile was considered manageable.
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Affiliation(s)
| | - Jorge Camarero Jiménez
- European Medicines Agency, London, United Kingdom
- Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain
| | - Isabel Garcia
- European Medicines Agency, London, United Kingdom
- Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain
| | - Arantxa Sancho-López
- European Medicines Agency, London, United Kingdom
- Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain
| | - Marc Martin
- European Medicines Agency, London, United Kingdom
- French National Agency for Medicines and Health Products Safety, Saint-Denis Cedex, France
| | - Alexandre Moreau
- European Medicines Agency, London, United Kingdom
- French National Agency for Medicines and Health Products Safety, Saint-Denis Cedex, France
| | - Pierre Demolis
- European Medicines Agency, London, United Kingdom
- French National Agency for Medicines and Health Products Safety, Saint-Denis Cedex, France
| | - Tomas Salmonson
- European Medicines Agency, London, United Kingdom
- Läkemedelsverket, Medicinal Products Agency, Uppsala, Sweden
| | - Jonas Bergh
- European Medicines Agency, London, United Kingdom
- Karolinska Institutet, Stockholm, Sweden
| | - Edward Laane
- European Medicines Agency, London, United Kingdom
- North Estonia Regional Hospital, Tallinn, Estonia
| | - Heinz Ludwig
- European Medicines Agency, London, United Kingdom
- Wilhelminen Cancer Research Institute, Vienna, Austria
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Goel G, King T, Daveson AJ, Andrews JM, Krishnarajah J, Krause R, Brown GJE, Fogel R, Barish CF, Epstein R, Kinney TP, Miner PB, Tye-Din JA, Girardin A, Taavela J, Popp A, Sidney J, Mäki M, Goldstein KE, Griffin PH, Wang S, Dzuris JL, Williams LJ, Sette A, Xavier RJ, Sollid LM, Jabri B, Anderson RP. Epitope-specific immunotherapy targeting CD4-positive T cells in coeliac disease: two randomised, double-blind, placebo-controlled phase 1 studies. Lancet Gastroenterol Hepatol 2017; 2:479-493. [PMID: 28506538 PMCID: PMC5676538 DOI: 10.1016/s2468-1253(17)30110-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [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] [Received: 03/01/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND A gluten-free diet is the only means to manage coeliac disease, a permanent immune intolerance to gluten. We developed a therapeutic vaccine, Nexvax2, designed to treat coeliac disease. Nexvax2 is an adjuvant-free mix of three peptides that include immunodominant epitopes for gluten-specific CD4-positive T cells. The vaccine is intended to engage and render gluten-specific CD4-positive T cells unresponsive to further antigenic stimulation. We assessed the safety and pharmacodynamics of the vaccine in patients with coeliac disease on a gluten-free diet. METHODS We did two randomised, double-blind, placebo-controlled, phase 1 studies at 12 community sites in Australia, New Zealand, and the USA, in HLA-DQ2·5-positive patients aged 18-70 years who had coeliac disease and were on a gluten-free diet. In the screening period for ascending dose cohorts, participants were randomly assigned (1:1) by central randomisation with a simple block method to a double-blind crossover, placebo-controlled oral gluten challenge. Participants with a negative interferon γ release assay to Nexvax2 peptides after the screening oral gluten challenge were discontinued before dosing. For the biopsy cohorts, the screening period included an endoscopy, and participants with duodenal histology who had a Marsh score of greater than 1 were discontinued before dosing. Participants were subsequently randomly assigned to either Nexvax2 or placebo in ascending dose cohorts (2:1) and in biopsy cohorts (1:1) by central randomisation with a simple block method. In the three-dose study, participants received either Nexvax2 60 μg, 90 μg, or 150 μg weekly, or placebo over 15 days; in a fourth biopsy cohort, patients received either Nexvax2 at the maximum tolerated dose (MTD) or placebo. In the 16-dose study, participants received Nexvax2 150 μg or 300 μg or placebo twice weekly over 53 days; in a third biopsy cohort, patients also received either Nexvax2 at the MTD or placebo. In the 4-week post-treatment period, ascending dose cohorts underwent a further double-blind crossover, placebo-controlled oral gluten challenge, which had a fixed sequence, and biopsy cohorts had a gastroscopy with duodenal biopsies and quantitative histology within 2 weeks without oral gluten challenge. Participants, investigators, and study staff were masked to the treatment assignment, except for the study pharmacist. The primary endpoint was the number and percentage of adverse events in the treatment period in an intention-to-treat analysis. Both trials were completed and closed before data analysis. Trials were registered with the Australian New Zealand Clinical Trials Registry, numbers ACTRN12612000355875 and ACTRN12613001331729. FINDINGS Participants were enrolled from Nov 28, 2012, to Aug 14, 2014, in the three-dose study, and from Aug 3, 2012, to Sept 10, 2013, in the 16-dose study. Overall, 62 (57%) of 108 participants were randomly assigned after oral gluten challenge and 20 (71%) of 28 participants were randomly assigned after endoscopy. In the three-dose study, nine participants were randomly allocated to Nexvax2 60 μg and three to placebo (first cohort), nine were allocated to Nexvax2 90 μg and four to placebo (second cohort), eight were allocated to Nexvax2 150 μg and four to placebo (third cohort), and three were allocated to Nexvax2 150 μg and three to placebo (biopsy cohort). In the 16-dose study, eight participants were randomly allocated to Nexvax2 150 μg and four to placebo (first cohort), ten were allocated to Nexvax2 300 μg and three to placebo (second cohort), and seven were allocated to Nexvax2 150 μg and seven to placebo (biopsy cohort). The MTD for Nexvax2 was 150 μg because of transient, acute gastrointestinal adverse events with onset 2-5 h after initial doses of the vaccine, similar to those caused by gluten ingestion. In the ascending dose cohorts in the three-dose study, six (55%) of 11 placebo recipients, five (56%) of nine who received Nexvax2 60 μg, seven (78%) of nine who received Nexvax2 90 μg, and five (63%) of eight who received Nexvax2 150 μg had at least one treatment-emergent adverse event, as did all three (100%) placebo recipients and one (33%) of three Nexvax2 150 μg recipients in the biopsy cohort. In the ascending dose cohorts of the 16-dose study, five (71%) of seven placebo-treated participants, six (75%) of eight who received Nexvax2 150 μg, and all ten (100%) who received Nexvax2 300 μg had at least one treatment-emergent adverse event, as did six (86%) of seven placebo recipients and five (71%) of seven Nexvax2 150 μg recipients in the biopsy cohort. Vomiting, nausea, and headache were the only treatment-emergent adverse events that occurred in at least 5% of participants in either study. Among participants given the MTD, eight gastrointestinal treatment-emergent adverse events occurred in four (50%) of eight participants in the third cohort and none (0%) of three participants in the biopsy cohort in the three-dose study, and five events occurred in five (63%) of eight participants in the first cohort and three events in two (29%) of seven participants in the biopsy cohort of the 16-dose study. Median villous height to crypt depth ratio in distal duodenal biopsies was not significantly different between those who received the vaccine at the MTD on either schedule and those who received placebo. Of the participants who completed the post-treatment oral gluten challenge per protocol, interferon γ release assay to Nexvax2 peptides was negative (responders to treatment) in two (22%) of nine placebo-treated participants in the three-dose study versus two (33%) of six who received Nexvax2 60 μg, five (63%) of eight who received Nexvax2 90 μg, and six (100%) of six who received Nexvax2 150 μg (p=0·007); in the 16-dose study, none (0%) of five placebo-treated participants had a negative assay versus six (75%) of eight who received Nexvax2 150 μg (p=0·021). INTERPRETATION The MTD of Nexvax2 was 150 μg for twice weekly intradermal administration over 8 weeks, which modified immune responsiveness to Nexvax2 peptides without deterioration in duodenal histology. The gastrointestinal symptoms that followed the first intradermal administration of the vaccine resembled those associated with oral gluten challenge. These findings support continued clinical development of this potential therapeutic vaccine for coeliac disease. FUNDING ImmusanT.
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Affiliation(s)
- Gautam Goel
- Division of Gastroenterology and Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA, USA; Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tim King
- Department of Gastroenterology, Auckland City Hospital, Auckland, New Zealand
| | - A James Daveson
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Jane M Andrews
- Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | | | - Gregor J E Brown
- Department of Gastroenterology, Alfred Hospital, Prahran, VIC, Australia
| | - Ronald Fogel
- Clinical Research Institute of Michigan, Chesterfield, MI, USA
| | - Charles F Barish
- University of North Carolina School of Medicine, Chapel Hill, NC, USA; Wake Gastroenterology and Wake Research Associates, Raleigh, NC, USA
| | | | | | - Philip B Miner
- Oklahoma Foundation for Digestive Research, Oklahoma City, OK, USA
| | - Jason A Tye-Din
- Immunology Division, Walter and Eliza Hall Institute of Medical Research, Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute and Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Adam Girardin
- Immunology Division, Walter and Eliza Hall Institute of Medical Research, Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Juha Taavela
- Tampere Center for Child Health Research and Department of Pediatrics, University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - Alina Popp
- Tampere Center for Child Health Research and Department of Pediatrics, University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland; Alfred Rusescu Institute for Mother and Child Care and Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - John Sidney
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - Markku Mäki
- Tampere Center for Child Health Research and Department of Pediatrics, University of Tampere Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | | | | | | | | | | | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - Ramnik J Xavier
- Division of Gastroenterology and Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA, USA; Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ludvig M Sollid
- Centre for Immune Regulation, KG Jebsen Coeliac Disease Research Centre, and Department of Immunology, University of Oslo, Oslo, Norway; Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Bana Jabri
- Department of Pediatrics, Department of Medicine, University of Chicago, Chicago, IL, USA
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Lee SK, Xing J, Catlett IM, Adamczyk R, Griffies A, Liu A, Murthy B, Nowak M. Safety, pharmacokinetics, and pharmacodynamics of BMS-986142, a novel reversible BTK inhibitor, in healthy participants. Eur J Clin Pharmacol 2017; 73:689-698. [PMID: 28265691 PMCID: PMC5423977 DOI: 10.1007/s00228-017-2226-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/21/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE BMS-986142 is an oral, small-molecule reversible inhibitor of Bruton's tyrosine kinase. The main objectives of our phase I studies were to characterize the safety and tolerability, pharmacokinetics, and pharmacodynamics of BMS-986142 in healthy participants, and to investigate the potential for the effect of BMS-986142 on the PK of methotrexate (MTX) in combination. METHODS In a combined single ascending dose and multiple ascending dose study, the safety, pharmacokinetics, and pharmacodynamics of BMS-986142 were assessed in healthy non-Japanese participants following administration of a single dose (5-900 mg) or multiple doses (25-350 mg, once daily for 14 days). In a drug-drug interaction study, the effect of BMS-986142 (350 mg, once daily for 5 days) on the single-dose pharmacokinetics of MTX (7.5 mg) was assessed in healthy participants. RESULTS BMS-986142 was generally well tolerated, alone and in combination with MTX. BMS-986142 was rapidly absorbed with peak concentrations occurring within 2 h, and was eliminated with a mean half-life ranging from 7 to 11 h. Exposure of BMS-986142 appeared dose proportional within the dose ranges tested. A dose- and concentration-dependent inhibition of CD69 expression was observed following administration of BMS-986142. BMS-986142 did not affect the pharmacokinetics of MTX. CONCLUSIONS BMS-986142 was well tolerated at the doses tested, had pharmacokinetic and pharmacodynamic profiles which support once-daily dosing, and can be coadministered with MTX without the pharmacokinetic interaction of BMS-986142 on MTX.
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Affiliation(s)
- Sun Ku Lee
- Bristol-Myers Squibb, 3551 Lawrenceville Rd, Princeton, NJ, 08540, USA.
| | - Jun Xing
- Bristol-Myers Squibb, 3551 Lawrenceville Rd, Princeton, NJ, 08540, USA
| | - Ian M Catlett
- Bristol-Myers Squibb, 3551 Lawrenceville Rd, Princeton, NJ, 08540, USA
| | - Robert Adamczyk
- Bristol-Myers Squibb, 3551 Lawrenceville Rd, Princeton, NJ, 08540, USA
| | - Amber Griffies
- Bristol-Myers Squibb, 3551 Lawrenceville Rd, Princeton, NJ, 08540, USA
| | - Ang Liu
- Bristol-Myers Squibb, 3551 Lawrenceville Rd, Princeton, NJ, 08540, USA
| | - Bindu Murthy
- Bristol-Myers Squibb, 3551 Lawrenceville Rd, Princeton, NJ, 08540, USA
| | - Miroslawa Nowak
- Bristol-Myers Squibb, 3551 Lawrenceville Rd, Princeton, NJ, 08540, USA
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Shapiro GI, Vaishampayan UN, LoRusso P, Barton J, Hua S, Reich SD, Shazer R, Taylor CT, Xuan D, Borghaei H. First-in-human trial of an anti-5T4 antibody-monomethylauristatin conjugate, PF-06263507, in patients with advanced solid tumors. Invest New Drugs 2017; 35:315-323. [PMID: 28070718 PMCID: PMC5418317 DOI: 10.1007/s10637-016-0419-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/22/2016] [Indexed: 12/20/2022]
Abstract
Background The antibody-drug conjugate PF-06263507 targets the cell-surface, tumor-associated antigen 5T4 and consists of a humanized IgG1 conjugated to the microtubule-disrupting agent monomethylauristatin-F by a non-cleavable maleimidocaproyl linker. In this first-in-human, dose-finding trial (NCT01891669), we evaluated safety, pharmacokinetics, and preliminary antitumor activity of PF-06263507 in pretreated patients with advanced solid tumors, unselected for 5T4 expression. starting at 0.05 mg/kg, with 25, 56, and 95% dose increments, depending on observed dose-limiting toxicities (DLTs), applying a modified continual reassessment method. Results Twenty-six patients received PF-06263507 at 0.05 to 6.5 mg/kg. The first DLT, grade 3 photophobia, occurred at 4.34 mg/kg and two additional DLTs, grade 2 keratitis and grade 1 limbal stem cell deficiency (> 2-week dosing delay), at 6.5 mg/kg. The most common adverse events (AEs) were fatigue (38.5%), photophobia (26.9%), and decreased appetite, dry eye, nausea, and thrombocytopenia (23.1% each). No treatment-related grade 4-5 AEs were reported. Systemic exposure of PF-06263507 increased in a dose-related manner. At the maximum tolerated dose (MTD, 4.34 mg/kg), mean terminal half-life for PF-06263507 and unconjugated payload were ~6 and 3 days, respectively. Payload serum concentrations were substantially lower compared with PF-06263507. No objective responses were observed. Conclusions The MTD and recommended phase II dose were determined to be 4.34 mg/kg. Ocular toxicities accounted for the DLTs observed, as previously reported with monomethylauristatin-F payloads. Further studies are warranted to investigate clinical activity of this agent in patients with 5T4-expressing tumors.Trial registration ID: NCT01891669.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antigens, Neoplasm/adverse effects
- Antigens, Neoplasm/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/pharmacokinetics
- Antineoplastic Agents, Immunological/therapeutic use
- Female
- Humans
- Immunoconjugates/adverse effects
- Immunoconjugates/pharmacokinetics
- Immunoconjugates/therapeutic use
- Keratitis/chemically induced
- Male
- Maximum Tolerated Dose
- Membrane Glycoproteins/antagonists & inhibitors
- Middle Aged
- Neoplasms/drug therapy
- Neoplasms/metabolism
- Oligopeptides/adverse effects
- Oligopeptides/pharmacokinetics
- Oligopeptides/therapeutic use
- Photophobia/chemically induced
- Treatment Outcome
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Affiliation(s)
- Geoffrey I Shapiro
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Mayer 446, Boston, MA, 02215, USA.
| | | | | | | | | | | | | | - Carrie T Taylor
- Pfizer Oncology, La Jolla, CA, USA.
- Pfizer Early Oncology Development and Clinical Research, 10777 Science Center Drive, CB-1, San Diego, CA, 92121, USA.
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Norrby M, Vesikari T, Lindqvist L, Maeurer M, Ahmed R, Mahdavifar S, Bennett S, McClain JB, Shepherd BM, Li D, Hokey DA, Kromann I, Hoff ST, Andersen P, de Visser AW, Joosten SA, Ottenhoff THM, Andersson J, Brighenti S. Safety and immunogenicity of the novel H4:IC31 tuberculosis vaccine candidate in BCG-vaccinated adults: Two phase I dose escalation trials. Vaccine 2017; 35:1652-1661. [PMID: 28216183 DOI: 10.1016/j.vaccine.2017.01.055] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 12/28/2016] [Accepted: 01/20/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Novel vaccine strategies are required to provide protective immunity in tuberculosis (TB) and prevent development of active disease. We investigated the safety and immunogenicity of a novel TB vaccine candidate, H4:IC31 (AERAS-404) that is composed of a fusion protein of M. tuberculosis antigens Ag85B and TB10.4 combined with an IC31® adjuvant. METHODS BCG-vaccinated healthy subjects were immunized with various antigen (5, 15, 50, 150μg) and adjuvant (0, 100, 500nmol) doses of the H4:IC31 vaccine (n=106) or placebo (n=18) in two randomized, double-blind, placebo-controlled phase I studies conducted in a low TB endemic setting in Sweden and Finland. The subjects were followed for adverse events and CD4+ T cell responses. RESULTS H4:IC31 vaccination was well tolerated with a safety profile consisting of mostly mild to moderate self-limited injection site pain, myalgia, arthralgia, fever and post-vaccination inflammatory reaction at the screening tuberculin skin test injection site. The H4:IC31 vaccine elicited antigen-specific CD4+ T cell proliferation and cytokine production that persisted 18weeks after the last vaccination. CD4+ T cell expansion, IFN-γ production and multifunctional CD4+ Th1 responses were most prominent after two doses of H4:IC31 containing 5, 15, or 50μg of H4 in combination with the 500nmol IC31 adjuvant dose. CONCLUSIONS The novel TB vaccine candidate, H4:IC31, demonstrated an acceptable safety profile and was immunogenic, capable of triggering multifunctional CD4+ T cell responses in previously BCG-vaccinated healthy individuals. These dose-escalation trials provided evidence that the optimal antigen-adjuvant dose combinations are 5, 15, or 50μg of H4 and 500nmol of IC31. TRIAL REGISTRATION ClinicalTrials.gov, NCT02066428 and NCT02074956.
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Affiliation(s)
- Maria Norrby
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Timo Vesikari
- Vaccine Research Center, University of Tampere, Tampere, Finland
| | - Lars Lindqvist
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Markus Maeurer
- TIM, Department of Laboratory Medicine and CAST, Karolinska Institutet, Stockholm, Sweden
| | - Raija Ahmed
- TIM, Department of Laboratory Medicine and CAST, Karolinska Institutet, Stockholm, Sweden
| | - Shahnaz Mahdavifar
- TIM, Department of Laboratory Medicine and CAST, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | - Adriëtte W de Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Simone A Joosten
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Andersson
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Center for Infectious Medicine (CIM), Karolinska Institutet, Stockholm, Sweden
| | - Susanna Brighenti
- Center for Infectious Medicine (CIM), Karolinska Institutet, Stockholm, Sweden.
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Wang Z, Zhang X. Isolation and identification of anti-proliferative peptides from Spirulina platensis using three-step hydrolysis. J Sci Food Agric 2017; 97:918-922. [PMID: 27218227 DOI: 10.1002/jsfa.7815] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 04/28/2016] [Accepted: 05/15/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Spirulina platensis is an excellent source of proteins (>60%) that can be hydrolyzed into bioactive peptides. RESULTS In this study, whole proteins of Spirulina platensis were extracted and hydrolyzed using three gastrointestinal endopeptidases (pepsin, trypsin and chymotrypsin). Subsequently, gel filtration chromatography was employed to separate hydrolysates, and four fractions (Tr1-Tr4) were obtained. Among them, Tr2 showed the strongest anti-proliferation activities on three cancer cells (MCF-7, HepG-2 and SGC-7901), with IC50 values of <31.25, 36.42 and 48.25 µg mL-1 , respectively. Furthermore, a new peptide, HVLSRAPR, was identified from fraction Tr1. This peptide exhibited strong inhibition on HT-29 cancer cells with an IC50 value of 99.88 µg mL-1 . CONCLUSION Taken together, these peptides possessed anti-proliferation activities on cancer cells and low cytotoxicity on normal cells, suggesting that they might serve as a natural anticancer agent for nutraceutical and pharmaceutical industries. © 2016 Society of Chemical Industry.
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Affiliation(s)
- Zhujun Wang
- College of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Xuewu Zhang
- College of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China
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Wanchoo R, Abudayyeh A, Doshi M, Edeani A, Glezerman IG, Monga D, Rosner M, Jhaveri KD. Renal Toxicities of Novel Agents Used for Treatment of Multiple Myeloma. Clin J Am Soc Nephrol 2017; 12:176-189. [PMID: 27654928 PMCID: PMC5220662 DOI: 10.2215/cjn.06100616] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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] [Indexed: 12/15/2022]
Abstract
Survival for patients with multiple myeloma has significantly improved in the last decade in large part due to the development of proteasome inhibitors and immunomodulatory drugs. These next generation agents with novel mechanisms of action as well as targeted therapies are being used both in the preclinical and clinical settings for patients with myeloma. These agents include monoclonal antibodies, deacetylase inhibitors, kinase inhibitors, agents affecting various signaling pathways, immune check point inhibitors, and other targeted therapies. In some cases, off target effects of these therapies can lead to unanticipated effects on the kidney that can range from electrolyte disorders to AKI. In this review, we discuss the nephrotoxicities of novel agents currently in practice as well as in development for the treatment of myeloma.
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Affiliation(s)
- Rimda Wanchoo
- Division of Nephrology, Hofstra Northwell School of Medicine, Great Neck, New York
| | - Ala Abudayyeh
- Division of Internal Medicine, Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mona Doshi
- Division of Nephrology, Wayne State University School of Medicine, Detroit, Michigan
| | - Amaka Edeani
- Kidney Diseases Branch, National Institute of Diabetes, Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland
| | - Ilya G. Glezerman
- Department of Medicine, Renal Service, Memorial Sloan Kettering Cancer Center and Department of Medicine, Weill Cornell Medical Center, New York, New York
| | - Divya Monga
- Nephrology Division, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Mitchell Rosner
- Division of Nephrology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Kenar D. Jhaveri
- Division of Nephrology, Hofstra Northwell School of Medicine, Great Neck, New York
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41
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Yu Z, Zhao W, Ding L, Wang Y, Chen F, Liu J. Short- and long-term antihypertensive effect of egg protein-derived peptide QIGLF. J Sci Food Agric 2017; 97:551-555. [PMID: 27097525 DOI: 10.1002/jsfa.7762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/13/2015] [Accepted: 04/15/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The present study aimed to investigate the in vivo antihypertensive effect on spontaneously hypertensive rats (SHRs) induced by egg protein-derived peptide QIGLF, which has been previously characterized in vitro as a potent angiotensin-converting enzyme inhibitor. RESULTS In vivo antihypertensive effect of QIGLF orally administered was evaluated by the tail-cuff method. The systolic blood pressure and the diastolic blood pressure of rats were measured 0, 5, 10, 15 and 20 h after administration every day. Subsequently, the effect of QIGLF on angiotensin-converting enzyme mRNA expression in the kidney of SHRs was evaluated by a polymerase chain reaction. Systolic blood pressure was found to be reduced markedly in the SHRs after a single oral administration. CONCLUSION The results show that the effect of QIGLF (50 mg kg-1 body weight) was similar to that of captopril (10 mg kg-1 body weight) with respect to lowering systolic blood pressure in SHRs. Therefore, egg white protein-derived peptide QIGLF may be useful in the prevention or treatment of hypertension. © 2016 Society of Chemical Industry.
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Affiliation(s)
- Zhipeng Yu
- College of Food Science and Engineering, Bohai University, Jinzhou, 121013, P.R. China
- Department of Food, Nutrition and Packaging Sciences, Clemson University, Clemson, SC 29634, USA
| | - Wenzhu Zhao
- College of Food Science and Engineering, Bohai University, Jinzhou, 121013, P.R. China
| | - Long Ding
- Laboratory of Nutrition and Functional Food, Jilin University, Changchun, 130062, P.R. China
| | - Yaqi Wang
- Department of Food, Nutrition and Packaging Sciences, Clemson University, Clemson, SC 29634, USA
| | - Feng Chen
- Department of Food, Nutrition and Packaging Sciences, Clemson University, Clemson, SC 29634, USA
| | - Jingbo Liu
- Laboratory of Nutrition and Functional Food, Jilin University, Changchun, 130062, P.R. China
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Abstract
Alzheimer’s disease (AD) is characterised by a progressive loss of cognitive functions. Histopathologically, AD is defined by the presence of extracellular amyloid plaques containing Aβ and intracellular neurofibrillary tangles composed of hyperphosphorylated tau proteins. According to the now well-accepted amyloid cascade hypothesis is the Aβ pathology the primary driving force of AD pathogenesis, which then induces changes in tau protein leading to a neurodegenerative cascade during the progression of disease. Since many earlier drug trials aiming at preventing Aβ pathology failed to demonstrate efficacy, tau and microtubules have come into focus as prominent downstream targets. The article aims to develop the current concept of the involvement of tau in the neurodegenerative triad of synaptic loss, cell death and dendritic simplification. The function of tau as a microtubule-associated protein and versatile interaction partner will then be introduced and the rationale and progress of current tau-directed therapy will be discussed in the biological context.
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Affiliation(s)
- Lidia Bakota
- Department of Neurobiology, University of Osnabrück, Barbarastrasse 11, 49076, Osnabrück, Germany
| | - Roland Brandt
- Department of Neurobiology, University of Osnabrück, Barbarastrasse 11, 49076, Osnabrück, Germany.
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Andoh T, Yamamoto A, Haza S, Yuhki KI, Ushikubi F, Narumiya S, Kuraishi Y. Thromboxane A2 is Involved in Itch-associated Responses in Mice with Atopic Dermatitis-like Skin Lesions. Acta Derm Venereol 2016; 96:899-904. [PMID: 27066774 DOI: 10.2340/00015555-2437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To investigate the mechanisms underlying itching in atopic dermatitis, we examined whether thromboxane (TX) A2, an arachidonic acid metabolite, is involved in spontaneous scratching, an itch-related response, in NC mice with atopic dermatitis-like skin lesions. The TXA2 receptor (TP) antagonist ONO-3708 inhibited the spontaneous scratching. The mRNA expression of TX synthase (TXSyn) distributed mainly in epidermis and the concentration of TXB2, a metabolite of TXA2, were increased in lesional skin. Scratching caused by the PAR2 agonist SLIGRL-NH2 was suppressed by ONO-3708. SLIGRL-NH2-induced scratching decreased approximately 75% in TP-deficient mice, compared to wild-type mice. In primary cultures of mouse keratinocytes, SLIGRL-NH2 induced the production of TXA2, as evidenced by the increased TXB2, which was inhibited by the TXSyn inhibitor sodium ozagrel and a PAR2-neutralizing antibody. Taken together, these results suggest that epidermal TXA2, which may be produced via PAR2 activation, is involved in itching in atopic dermatitis.
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Affiliation(s)
- Tsugunobu Andoh
- Department of Applied Pharmacology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
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Scholpa NE, Kolli RT, Moore M, Arnold RD, Glenn TC, Cummings BS. Nephrotoxicity of epigenetic inhibitors used for the treatment of cancer. Chem Biol Interact 2016; 258:21-9. [PMID: 27543423 PMCID: PMC5045804 DOI: 10.1016/j.cbi.2016.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/29/2016] [Revised: 07/21/2016] [Accepted: 08/15/2016] [Indexed: 12/25/2022]
Abstract
This study determined the anti-neoplastic activity and nephrotoxicity of epigenetic inhibitors in vitro. The therapeutic efficacy of epigenetic inhibitors was determined in human prostate cancer cells (PC-3 and LNCaP) using the DNA methyltransferase inhibitor 5-aza-2'-deoxycytidine (5-Aza) and the histone deacetylase inhibitor trichostatin A (TSA). Cells were also treated with carbamazepine (CBZ), an anti-convulsant with histone deacetylase inhibitor-like properties. 5-Aza, TSA or CBZ alone did not decrease MTT staining in PC-3 or LNCaP cells after 48 h. In contrast, docetaxel, a frontline chemotherapeutic induced concentration-dependent decreases in MTT staining. Pretreatment with 5-Aza or TSA increased docetaxel-induced cytotoxicity in LNCaP cells, but not PC-3 cells. TSA pretreatment also increased cisplatin-induced toxicity in LNCaP cells. Carfilzomib (CFZ), a protease inhibitor approved for the treatment of multiple myeloma had minimal effect on LNCaP cell viability, but reduced MTT staining 50% in PC-3 cells compared to control, and pretreatment with 5-Aza further enhanced toxicity. Treatment of normal rat kidney (NRK) and human embryonic kidney 293 (HEK293) cells with the same concentrations of epigenetic inhibitors used in prostate cancer cells significantly decreased MTT staining in all cell lines after 48 h. Interestingly, we found that the toxicity of epigenetic inhibitors to kidney cells was dependent on both the compound and the stage of cell growth. The effect of 5-Aza and TSA on DNA methyltransferase and histone deacetylase activity, respectively, was confirmed by assessing the methylation and acetylation of the CDK inhibitor p21. Collectively, these data show that combinatorial treatment with epigenetic inhibitors alters the efficacy of chemotherapeutics in cancer cells in a compound- and cell-specific manner; however, this treatment also has the potential to induce nephrotoxic cell injury.
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Affiliation(s)
- N E Scholpa
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, Athens, GA 30602, USA
| | - R T Kolli
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, Athens, GA 30602, USA
| | - M Moore
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, Athens, GA 30602, USA
| | - R D Arnold
- Department of Drug Discovery and Development, Auburn University, Auburn, AL 36849, USA
| | - T C Glenn
- Department of Environmental Health Science, University of Georgia, Athens, GA 30602, USA
| | - B S Cummings
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, Athens, GA 30602, USA.
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Kudrimoti M, Curtis A, Azawi S, Worden F, Katz S, Adkins D, Bonomi M, Elder J, Sonis ST, Straube R, Donini O. Dusquetide: A novel innate defense regulator demonstrating a significant and consistent reduction in the duration of oral mucositis in preclinical data and a randomized, placebo-controlled phase 2a clinical study. J Biotechnol 2016; 239:115-125. [PMID: 27746305 DOI: 10.1016/j.jbiotec.2016.10.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/07/2016] [Accepted: 10/12/2016] [Indexed: 01/22/2023]
Abstract
Dusquetide, a novel Innate Defense Regulator, modulates the innate immune system at a key convergence point in intracellular signaling pathways and has demonstrated activity in both reducing inflammation and increasing clearance of bacterial infection. Innate immunity has also been implicated in the pathogenesis of oral mucositis (OM), a universal toxicity of chemoradiation therapy (CRT). Testing the hypothesis that dusquetide can mitigate the development and duration of OM, preclinical studies have been completed and correlated with interim results from a Phase 2 clinical study in patients undergoing CRT for head and neck cancer. Dusquetide reduced the duration of OM in mouse and hamster models by approximately 50%, which was recapitulated by the 50% reduction of severe OM (SOM) in the Phase 2 trial. A reduction in the clinical rate of infection was also observed, consistent with previously reported preclinical studies. In aggregate, these results not only demonstrate the safety and efficacy of dusquetide in addressing this unmet medical need, but also provide proof of concept for the translation of dusquetide action between animal models and the human clinical setting, and further support the contention that innate immunity is an important driver for the initiation and continued impact of OM.
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Affiliation(s)
- Mahesh Kudrimoti
- Radiation Oncology, University of Kentucky, 800 Rose Street, Lexington, KY, 40536, USA
| | - Amarintha Curtis
- Gibbs Cancer Center, Spartanburg Regional Hospital, 101 E Wood, Spartanburg, SC, 29303, USA
| | - Samar Azawi
- Veteran's Affairs Long Beach Hospital, 5901 E 7th Street, Mail Code 114A, Long Beach, CA, 98022, USA
| | - Francis Worden
- Department of Medicine, University of Michigan Health System, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Sanford Katz
- Department of Radiation Oncology, Willis-Knighton Cancer Center, 2600 Kings Highway, Shreveport, LA,71103, USA
| | - Douglas Adkins
- Division of Hematology and Oncology, Washington University, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA
| | - Marcelo Bonomi
- Department of Hematology and Oncology, Wake Forest Health Sciences Medical Center, 1 Medical Center Blvd., Winston-Salem, NC, 27157, USA
| | - Jenna Elder
- PharPoint Research, 5003S Miami Blvd. #100, Durham, NC, 27703, USA
| | - Stephen T Sonis
- Division of Oral Medicine, Brigham and Women's Hospital and the Dana-Farber Cancer Institute, Boston MA, USA; Biomodels LLC, 313 Pleasant Street, Watertown, MA 02472, USA
| | - Richard Straube
- Soligenix Inc., 29 Emmons Drive, Suite C-10, Princeton, NJ, 08540, USA
| | - Oreola Donini
- Soligenix Inc., 29 Emmons Drive, Suite C-10, Princeton, NJ, 08540, USA.
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Krupina NA, Khlebnikova NN. Omega-3 polyunsaturated fatty acids when administered to lactating rats modify the development of experimental anxiety-depressive state in the rat pups exposed to the dipeptidyl peptidase-IV inhibitor diprotin A on the second - third weeks after the birth. Patol Fiziol Eksp Ter 2016; 60:9-19. [PMID: 29244917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Omega-3 polyunsaturated fatty acids (PUFAs) belong to the hypolipidemic drugs, exhibit antioxidant properties and are used in the clinic for secondary prevention of several diseases. The effects of omega-3 PUFAs on the course of the stress-induced and endogenous depression are under investigation. We have previously demonstrated that synthetic inhibitors of prolyl endopeptidase (PEP; EC 3.4.21.26) exhibit antidepressant-like properties in different experimental models of emotional and motivational disorders. It is known that omega-3 PUFAs show PEP inhibitory activity. The purpose of this work was to study the effects of the drug Omacor (Abbot, Germany) containing omega-3 PUFAs, when administered to the lactating Wistar rats, on the emotional and motivational behavior of the offspring with the experimental anxiety-depressive disorder caused by the inhibitor of dipeptidyl peptidase IV (DPP- IV; CD 26; EC 3.4.14.5) diprotin A on postnatal day (PND) 5-18 (second - third weeks of postnatal development). METHODS We used conventional methods of assessing the emotional and motivational behavior and sensorimotor reactivity in animals. Omega-3 PUFAs were administered to lactating rats at a dose 0.3 g / kg, per os, for 28 days starting from the next day after the birthing. Diprotin A was administered systemically at a dose of 2 mg/kg. RESULTS Omega-3 PUFAs when administered to the lactating females, prevented the development of depressive-like behavior in adolescent rats neonatally exposed to DPP-IV inhibitor diprotin A, and contributed to the formation of antidepressive phenotype in control rats. However, under these circumstances, the omega-3 PUFAs increased anxiety and did not prevent an increase in aggression in rats with the experimental anxiety-depressive disorder and increased anxiety and stress-provoked aggression in the controls. CONCLUSION The results support the hypothesis on the involvement of proline-specific peptidases DPP-IV and PEP in the mechanisms of emotional and motivational disturbances and expand the spectrum of omega-3 PUFAs action.
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Chen R, Chen B, Zhang X, Gao C. Efficacy of carfilzomib in the treatment of relapsed and (or) refractory multiple myeloma: a meta-analysis of data from clinical trials. Discov Med 2016; 22:189-199. [PMID: 27875670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Recently, carfilzomib has become a promising therapeutic approach for relapsed and (or) refractory multiple myeloma (RRMM), but no study has summarized the overall effect of carfilzomib in RRMM. To explore the role of carfilzomib, we performed a meta-analysis of all known prospective clinical trials to assess the efficacy of carfilzomib in patients with RRMM. METHODS AND MATERIALS A systematic review of publications was performed on December 15, 2015. Eight studies including 1,446 patients were identified. Meta-analyses were carried out to calculate the overall response rate (ORR), complete response rate (CRR), and clinical benefit rate (CBR) of carfilzomib for RRMM. RESULTS In patients with RRMM, ORR was 0.44, CRR was 0.13, and CBR was 0.54. High heterogeneity between studies was observed, and funnel plots were symmetrical, negating publication bias. Carfilzomib was generally well tolerated by patients reported in the studies though some manageable adverse effects occurred. CONCLUSION Our analysis revealed a promising benefit of carfilzomib in the treatment of RRMM.
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Affiliation(s)
- Runzhe Chen
- Department of Hematology and Oncology (Key Department of Jiangsu Medicine), Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu 210009, China
| | - Baoan Chen
- Department of Hematology and Oncology (Key Department of Jiangsu Medicine), Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu 210009, China
| | - Xiaoping Zhang
- Department of Hematology and Oncology (Key Department of Jiangsu Medicine), Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu 210009, China
| | - Chong Gao
- Department of Hematology and Oncology (Key Department of Jiangsu Medicine), Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu 210009, China
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Chadwick PW, Heymann WR. Eruptive seborrheic keratoses secondary to telaprevir-related dermatitis. Cutis 2016; 98:E20-E21. [PMID: 27622264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Preston W Chadwick
- Division of Dermatology, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Warren R Heymann
- Division of Dermatology, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Zeuzem S, Mantry P, Soriano V, Buynak RJ, Dufour JF, Pockros PJ, Wright D, Angus P, Buti M, Stern JO, Kadus W, Vinisko R, Böcher W, Mensa FJ. Short article: Faldaprevir, deleobuvir and ribavirin in IL28B non-CC patients with HCV genotype-1a infection included in the SOUND-C3 phase 2b study. Eur J Gastroenterol Hepatol 2016; 28:923-6. [PMID: 27140229 DOI: 10.1097/meg.0000000000000649] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND SOUND-C3 was a multicentre, open-label, phase 2b study exploring the safety and efficacy of the interferon-free combination of faldaprevir (an NS3/A4 protease inhibitor), deleobuvir (BI 207127, a non-nucleoside polymerase inhibitor) and ribavirin in treatment-naive patients with chronic hepatitis C virus (HCV) genotype-1 infection. Results in patients with HCV genotype-1b and in IL28B CC genotype patients with HCV genotype-1a have been described previously. This report describes the results in IL28B non-CC genotype patients with HCV genotype-1a. METHODS Patients were randomized to receive faldaprevir 120 mg once daily with deleobuvir at either 800 mg twice daily (b.i.d.; N=26) or 600 mg three times daily (t.i.d.; N=25), and weight-based ribavirin for 24 weeks. The primary endpoint was sustained virological response 12 weeks after treatment (SVR12). RESULTS In each group, five patients completed 24 weeks of treatment. SVR12 rates were 19% (5/26) and 8% (2/25) in the b.i.d. and t.i.d. groups, respectively. On-treatment breakthrough [50% (13/26) and 68% (17/25) in the b.i.d. and t.i.d. groups, respectively] was the most frequent reason for not achieving SVR12. Adverse events led to premature treatment discontinuation in six (23%) patients in the b.i.d. group and in two patients (8%) in the t.i.d. group. The majority of adverse events were mild or moderate; the most frequently reported were nausea (67%), fatigue (35%) and diarrhoea (35%). CONCLUSION In this small study, the interferon-free regimen of faldaprevir, deleobuvir and ribavirin resulted in high rates of virological breakthrough and low rates of SVR12 in IL28B non-CC genotype patients infected with genotype-1a HCV (http://www.clinicaltrials.gov NCT01132313).
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Affiliation(s)
- Stefan Zeuzem
- aJ.W. Goethe University Hospital, Frankfurt am Main bBoehringer Ingelheim Pharma GmbH & Co. KG, Biberach cBoehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany dThe Liver Institute at Methodist Dallas Medical Center, Dallas eCentral Texas Clinical Research, Austin, Texas fNorthwest Indiana Center for Clinical Research, Valparaiso, Indiana gScripps Clinic, La Jolla, California hBoehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, USA iHospital Carlos III, Madrid jHospital Universitario Valle de Hebrón and CIBERehd del Instituto Carlos III, Barcelona, Spain kUniversity Clinic for Visceral Surgery and Medicine, University of Bern, Bern, Switzerland lAustin Health, Heidelberg, Victoria, Australia
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Krupina NA, Khlebnikova NN, Orlova IN. [Emotional Motivational Disorders in Rats as a Result of Diprotin A and Sitagliptin Administration in the First Postnatal Week]. Zh Vyssh Nerv Deiat Im I P Pavlova 2016; 66:367-381. [PMID: 30695419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The inhibitors of proline specific peptidase dipeptidyl peptidase-IV (DPP-IV, CD 26; EC 3.4.14.5) diprotin A (2 mg/kg) and sitagliptin (4 mg/kg) upon daily systemic exposure in rat pups on postnatal days 1-7 induced emotional and motivational disorders in one- and two-month-old rats. In adolescent rats, both the inhibitors produced a decreased locomotion in the automated open field test and an in- creased depression-like behavior in the Forced Swimming Test. At the same time, diprotin A increased sucrose consumption (a percent of the body weight) while sitagliptin decreased anxiety in the Elevated Plus Maze (EPM). In adult rats, diprotin A caused an increase in anxiety according to the reduced pref- erence for open arms of the maze and both the inhibitors decreased the percentage of rats entering open. arms in the EPM. Adult diprotin A-treated animals demonstrated increased aggression in social contact test. as compared to sitagliptin-treated rats. The one-and two-month-old animals in both experimental groups exhibited a decreased weight as compared to the controls. The results of the study show that diprotin A compared with sitagliptin negatively affects emotional and motivational behavior in adolescent and adult rats by increased number of indices increasing depression, anxiety, and aggression, while the main result of sitagliptin is increased depression when the animals were treated with the DPP-IV inhibitors in the first postnatal week. The findings support the hypothesis that DPPIV is involved in the genesis of emotional-motivational disorders.
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