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Mizokami H, Okabe A, Choudhary R, Mima M, Saeda K, Fukuyo M, Rahmutulla B, Seki M, Goh BC, Kondo S, Dochi H, Moriyama-Kita M, Misawa K, Hanazawa T, Tan P, Yoshizaki T, Fullwood MJ, Kaneda A. Enhancer infestation drives tumorigenic activation of inactive B compartment in Epstein-Barr virus-positive nasopharyngeal carcinoma. EBioMedicine 2024; 102:105057. [PMID: 38490101 PMCID: PMC10951899 DOI: 10.1016/j.ebiom.2024.105057] [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: 03/25/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) is an Epstein-Barr virus (EBV)-associated malignant epithelial tumor endemic to Southern China and Southeast Asia. While previous studies have revealed a low frequency of gene mutations in NPC, its epigenomic aberrations are not fully elucidated apart from DNA hypermethylation. Epigenomic rewiring and enhancer dysregulation, such as enhancer hijacking due to genomic structural changes or extrachromosomal DNA, drive cancer progression. METHODS We conducted Hi-C, 4C-seq, ChIP-seq, and RNA-seq analyses to comprehensively elucidate the epigenome and interactome of NPC using C666-1 EBV(+)-NPC cell lines, NP69T immortalized nasopharyngeal epithelial cells, clinical NPC biopsy samples, and in vitro EBV infection in HK1 and NPC-TW01 EBV(-) cell lines. FINDINGS In C666-1, the EBV genome significantly interacted with inactive B compartments of host cells; the significant association of EBV-interacting regions (EBVIRs) with B compartment was confirmed using clinical NPC and in vitro EBV infection model. EBVIRs in C666-1 showed significantly higher levels of active histone modifications compared with NP69T. Aberrant activation of EBVIRs after EBV infection was validated using in vitro EBV infection models. Within the EBVIR-overlapping topologically associating domains, 14 H3K4me3(+) genes were significantly upregulated in C666-1. Target genes of EBVIRs including PLA2G4A, PTGS2 and CITED2, interacted with the enhancers activated in EBVIRs and were highly expressed in NPC, and their knockdown significantly reduced cell proliferation. INTERPRETATION The EBV genome contributes to NPC tumorigenesis through "enhancer infestation" by interacting with the inactive B compartments of the host genome and aberrantly activating enhancers. FUNDING The funds are listed in the Acknowledgements section.
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Affiliation(s)
- Harue Mizokami
- Department of Molecular Oncology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan; Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Atsushi Okabe
- Department of Molecular Oncology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan; Health and Disease Omics Center, Chiba University, Chiba, 260-8670, Japan
| | - Ruchi Choudhary
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore, 637551, Singapore
| | - Masato Mima
- Department of Molecular Oncology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan; Department of Otorhinolaryngology/Head and Neck Surgery, Graduate School of Medicine, Hamamatsu University School of Medicine, Shizuoka, 431-3125, Japan
| | - Kenta Saeda
- Department of Molecular Oncology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan; Department of Otorhinolaryngology/Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Masaki Fukuyo
- Department of Molecular Oncology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Bahityar Rahmutulla
- Department of Molecular Oncology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Motoaki Seki
- Department of Molecular Oncology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore, 117599, Singapore; Department of Haematology-Oncology, National University Cancer Institute, Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Blk MD3, 16 Medical Drive, Singapore, 117600, Singapore
| | - Satoru Kondo
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Hirotomo Dochi
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Makiko Moriyama-Kita
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Kiyoshi Misawa
- Department of Otorhinolaryngology/Head and Neck Surgery, Graduate School of Medicine, Hamamatsu University School of Medicine, Shizuoka, 431-3125, Japan
| | - Toyoyuki Hanazawa
- Department of Otorhinolaryngology/Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Patrick Tan
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Tomokazu Yoshizaki
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Melissa Jane Fullwood
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore, 637551, Singapore; Cancer Science Institute of Singapore, Centre for Translational Medicine, National University of Singapore, Singapore, 117599, Singapore; Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A∗STAR), 61 Biopolis Drive, Proteos, Singapore, 138673, Singapore.
| | - Atsushi Kaneda
- Department of Molecular Oncology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan; Health and Disease Omics Center, Chiba University, Chiba, 260-8670, Japan.
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2
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Wang W, Li M, Wang L, Chen L, Goh BC. Curcumin in cancer therapy: Exploring molecular mechanisms and overcoming clinical challenges. Cancer Lett 2023; 570:216332. [PMID: 37541540 DOI: 10.1016/j.canlet.2023.216332] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/06/2023]
Abstract
Cancer poses a significant global health burden, necessitating the widespread use of chemotherapy and radiotherapy as conventional frontline interventions. Although targeted therapy and immunotherapy have shown remarkable advancements, the challenges of resistance development and severe side effects persist in cancer treatment. Consequently, researchers have actively sought more effective alternatives with improved safety profiles. In recent years, curcumin, a natural polyphenolic phytoalexin, has garnered considerable attention due to its broad spectrum of biological effects. This concise review provides valuable insights into the role of curcumin in cancer therapy, with a focus on elucidating its molecular mechanisms in inducing programmed cell death of tumor cells and suppressing tumor cell metastasis potential. Additionally, we discuss the challenges associated with the clinical application of curcumin and explore current endeavors aimed at overcoming these limitations. By shedding light on the promising potential of curcumin, this review contributes to the advancement of cancer treatment strategies.
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Affiliation(s)
- Wei Wang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Mingqin Li
- Department of Medical Cardiology, Zhongxiang TCM Hospital of Hubei, Zhongxiang, 431900, China
| | - Lingzhi Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore; National University Cancer Institute, National University of Singapore, 119074, Singapore; NUS Center for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599, Singapore.
| | - Lu Chen
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore; National University Cancer Institute, National University of Singapore, 119074, Singapore; NUS Center for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599, Singapore; Department of Haematology-Oncology, National University Hospital, National University Health System, Singapore, Singapore
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3
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Lim DWT, Kao HF, Suteja L, Li CH, Quah HS, Tan DSW, Tan SH, Tan EH, Tan WL, Lee JN, Wee FYT, Jain A, Goh BC, Chua MLK, Liao BC, Ng QS, Hong RL, Ang MK, Yeong JPS, Iyer NG. Clinical efficacy and biomarker analysis of dual PD-1/CTLA-4 blockade in recurrent/metastatic EBV-associated nasopharyngeal carcinoma. Nat Commun 2023; 14:2781. [PMID: 37188668 PMCID: PMC10184620 DOI: 10.1038/s41467-023-38407-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 05/02/2023] [Indexed: 05/17/2023] Open
Abstract
Single-agent checkpoint inhibitor (CPI) activity in Epstein-Barr Virus (EBV) related nasopharyngeal carcinoma (NPC) is limited. Dual CPI shows increased activity in solid cancers. In this single-arm phase II trial (NCT03097939), 40 patients with recurrent/metastatic EBV-positive NPC who failed prior chemotherapy receive nivolumab 3 mg/kg every 2 weeks and ipilimumab 1 mg/kg every 6 weeks. Primary outcome of best overall response rate (BOR) and secondary outcomes (progression-free survival [PFS], clinical benefit rate, adverse events, duration of response, time to progression, overall survival [OS]) are reported. The BOR is 38% with median PFS and OS of 5.3 and 19.5 months, respectively. This regimen is well-tolerated and treatment-related adverse events requiring discontinuation are low. Biomarker analysis shows no correlation of outcomes to PD-L1 expression or tumor mutation burden. While the BOR does not meet pre-planned estimates, patients with low plasma EBV-DNA titre (<7800 IU/ml) trend to better response and PFS. Deep immunophenotyping of pre- and on-treatment tumor biopsies demonstrate early activation of the adaptive immune response, with T-cell cytotoxicity seen in responders prior to any clinically evident response. Immune-subpopulation profiling also identifies specific PD-1 and CTLA-4 expressing CD8 subpopulations that predict for response to combined immune checkpoint blockade in NPC.
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Affiliation(s)
- Darren Wan-Teck Lim
- National Cancer Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore.
| | - Hsiang-Fong Kao
- National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University Cancer Center, Taipei, Taiwan
| | - Lisda Suteja
- National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Constance H Li
- National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Hong Sheng Quah
- National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Daniel Shao-Weng Tan
- National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Sze-Huey Tan
- National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Eng-Huat Tan
- National Cancer Centre Singapore, Singapore, Singapore
| | - Wan-Ling Tan
- National Cancer Centre Singapore, Singapore, Singapore
| | - Justina Nadia Lee
- Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | | | - Amit Jain
- National Cancer Centre Singapore, Singapore, Singapore
| | - Boon-Cher Goh
- National University Health System, Singapore, Singapore
| | - Melvin L K Chua
- National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Bin-Chi Liao
- National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University Cancer Center, Taipei, Taiwan
| | - Quan Sing Ng
- National Cancer Centre Singapore, Singapore, Singapore
| | - Ruey-Long Hong
- National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University Cancer Center, Taipei, Taiwan
| | - Mei-Kim Ang
- National Cancer Centre Singapore, Singapore, Singapore
| | - Joe Poh-Sheng Yeong
- Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
- Singapore General Hospital, Singapore, Singapore
| | - N Gopalakrishna Iyer
- National Cancer Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- Singapore General Hospital, Singapore, Singapore.
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4
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Chee CE, Ooi M, Lee SC, Sundar R, Heong V, Yong WP, Ng CH, Wong A, Lim JSJ, Tan DSP, Soo R, Tan JTC, Yang S, Thura M, Al-Aidaroos AQ, Chng WJ, Zeng Q, Goh BC. A Phase I, First-in-Human Study of PRL3-zumab in Advanced, Refractory Solid Tumors and Hematological Malignancies. Target Oncol 2023; 18:391-402. [PMID: 37060431 DOI: 10.1007/s11523-023-00962-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Phosphatase of regenerating liver-3 (PRL-3) is involved in cellular processes driving metastasis, cell proliferation, invasion, motility and survival. It has been shown to be upregulated and overexpressed in cancer tissue, in contrast to low or no expression in most normal tissue. PRL3-zumab is a first-in-class humanized antibody that specifically binds to PRL-3 oncotarget with high affinity and has been shown to reduce tumor growth and increase survival. OBJECTIVE In the study, we aimed to determine the safety and efficacy of PRL3-zumab in patients with advanced solid tumors and hematological malignancies. METHODS We conducted a phase I, first-in-human study in advanced solid tumors and hematological malignancies to investigate the safety, tolerability and efficacy of PRL3-zumab. Response rates were evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) for solid tumors. For acute myeloid leukemia (AML) patients, bone marrow response criteria based on the European Leukaemia Network (ELN) 2017 guidelines for AML were used. We also explored the pharmacokinetics and pharmacodynamic relationships of PRL3-zumab in patients. This study was registered with ClinicalTrials.gov: NCT03191682. RESULTS In the dose-escalation cohort, 11 patients with advanced solid tumors were enrolled into the study. An additional 12 patients with solid tumors and four patients with AML were enrolled in the dose-expansion cohort. Maximum tolerability was not achieved in this study, as there were no dose-limiting toxicities. Potential treatment-emergent adverse events were grade 1 increased stoma output and fatigue and grade 2 vomiting. Best response observed was stable disease in three solid-tumor patients (11.1%). The pharmacokinetics of PRL3-zumab were dose proportional, consistent with an IgG type monoclonal antibody. CONCLUSIONS PRL3-zumab, a first-in-class humanized antibody, was safe and tolerable in solid tumors and hematological malignancies.
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Affiliation(s)
- Cheng E Chee
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Melissa Ooi
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Soo-Chin Lee
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Raghav Sundar
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Valerie Heong
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
| | - Wei-Peng Yong
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Chin Hin Ng
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
| | - Andrea Wong
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
| | - Joline S J Lim
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David S P Tan
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Ross Soo
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
| | - Joshua T C Tan
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
| | - Song Yang
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
| | - Min Thura
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore, 138673, Singapore
| | - Abdul Qader Al-Aidaroos
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore, 138673, Singapore
| | - Wee Joo Chng
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Qi Zeng
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore, 138673, Singapore
| | - Boon-Cher Goh
- Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
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5
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Loh J, Wu J, Chieng J, Chan A, Yong WP, Sundar R, Lee SC, Wong A, Lim JSJ, Tan DSP, Soo R, Goh BC, Tai BC, Chee CE. Clinical outcome and prognostic factors for Asian patients in Phase I clinical trials. Br J Cancer 2023; 128:1514-1520. [PMID: 36797357 PMCID: PMC10070409 DOI: 10.1038/s41416-023-02193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/15/2023] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Patient selection is key in Phase I studies, and prognosis can be difficult to estimate in heavily pre-treated patients. Previous prognostic models like the Royal Marsden Hospital (RMH) score or using the neutrophil-lymphocyte ratio (NLR) have not been validated in current novel therapies nor in the Asian Phase I population. METHODS We conducted a retrospective review of 414 patients with solid tumours participating in Phase I studies at our centre between October 2013 and December 2020. RESULTS The RMH model showed poorer prognosis with increasing scores [RMH score 1, HR 1.28 (95% CI: 0.96-1.70); RMH score 2, HR 2.27 (95% CI: 1.62-3.17); RMH score 3, HR 4.14 (95% CI: 2.62-6.53)]. NLR did not improve the AUC of the model. Poorer ECOG status (ECOG 1 vs. 0: HR = 1.59 (95% CI = 1.24-2.04), P < 0.001) and primary tumour site (GI vs. breast cancer: HR = 3.06, 95% CI = 2.16-4.35, P < 0.001) were prognostic. CONCLUSIONS We developed a NCIS prognostic score with excellent prognostic ability for both short-term and longer-term survival (iAUC: 0.71 [95% CI 0.65-0.76]), and validated the RMH model in the largest Asian study to date.
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Affiliation(s)
- Jerold Loh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Jiaxuan Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jenny Chieng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Aurora Chan
- NUS Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Wei-Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrea Wong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Joline S J Lim
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David S P Tan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ross Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Bee-Choo Tai
- NUS Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Cheng E Chee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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6
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Thuya WL, Kong LR, Syn NL, Ding LW, Cheow ESH, Wong RTX, Wang T, Goh RMWJ, Song H, Jayasinghe MK, Le MT, Hu JC, Yong WP, Lee SC, Wong ALA, Sethi G, Hung HT, Ho PCL, Thiery JP, Sze SK, Guo T, Soo RA, Yang H, Lim YC, Wang L, Goh BC. FAM3C in circulating tumor-derived extracellular vesicles promotes non-small cell lung cancer growth in secondary sites. Theranostics 2023; 13:621-638. [PMID: 36632230 PMCID: PMC9830426 DOI: 10.7150/thno.72297] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/07/2022] [Indexed: 01/04/2023] Open
Abstract
Rationale: Metastasis is a complex process with a molecular underpinning that remains unclear. We hypothesize that cargo proteins conducted by extracellular vesicles (EVs) released from tumors may confer growth and metastasis potential on recipient cells. Here, we report that a cytokine-like secreted protein, FAM3C, contributes to late-stage lung tumor progression. Methods: EV protein profiling was conducted with an unbiased proteomic mass spectrometry analysis on non-small cell lung cancer (NSCLC) and normal lung fibroblast cell lines. Expression of FAM3C was confirmed in a panel of NSCLC cell lines, and correlated to the invasive and metastatic potentials. Functional phenotype of endogenous FAM3C and tumor-derived EVs (TDEs) were further investigated using various biological approaches in RNA and protein levels. Metastasis potential of TDEs secreted by FAM3C-overexpressing carcinoma cells was validated in mouse models. Results: Transcriptomic meta-analysis of pan-cancer datasets confirmed the overexpression of FAM3C - a gene encoding for interleukin-like EMT inducer (ILEI) - in NSCLC tumors, with strong association with poor patient prognosis and cancer metastasis. Aberrant expression of FAM3C in lung carcinoma cells enhances cellular transformation and promotes distant lung tumor colonization. In addition, higher FAM3C concentrations were detected in EVs extracted from plasma samples of NSCLC patients compared to those of healthy subjects. More importantly, we defined a hitherto-unknown mode of microenvironmental crosstalk involving FAM3C in EVs, whereby the delivery and uptake of FAM3C via TDEs enhances oncogenic signaling - in recipient cells that phenocopies the cell-endogenous overexpression of FAM3C. The oncogenicity transduced by FAM3C is executed via a novel interaction with the Ras-related protein RalA, triggering the downstream activation of the Src/Stat3 signaling cascade. Conclusions: Our study describes a novel mechanism for FAM3C-driven carcinogenesis and shed light on EV FAM3C as a driver for metastatic lung tumors that could be exploited for cancer therapeutics.
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Affiliation(s)
- Win Lwin Thuya
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599
| | - Li Ren Kong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas L Syn
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, China
| | - Ling-Wen Ding
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Esther Sok Hwee Cheow
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599
| | - Regina Tong Xin Wong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599
| | - Tingting Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599
| | | | - Hongyan Song
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599
| | - Migara K Jayasinghe
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Minh Tn Le
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jian Cheng Hu
- NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei-Peng Yong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599.,NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Soo-Chin Lee
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599.,NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Andrea Li-Ann Wong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599.,NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Gautam Sethi
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Huynh The Hung
- Division of Cellular and Molecular Research, National Cancer Centre, Singapore
| | - Paul Chi-Lui Ho
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Jean-Paul Thiery
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599.,INSERM Unit 1186, Comprehensive Cancer Center, Institut Gustave Roussy, Villejuif, France
| | - Siu Kwan Sze
- Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore
| | - Tiannan Guo
- Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, China.,Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, China
| | - Ross A Soo
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599.,Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Henry Yang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599
| | - Yaw Chyn Lim
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599
| | - Lingzhi Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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7
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Foo MA, You M, Chan SL, Sethi G, Bonney GK, Yong WP, Chow EKH, Fong ELS, Wang L, Goh BC. Clinical translation of patient-derived tumour organoids- bottlenecks and strategies. Biomark Res 2022; 10:10. [PMID: 35272694 PMCID: PMC8908618 DOI: 10.1186/s40364-022-00356-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
Multiple three-dimensional (3D) tumour organoid models assisted by multi-omics and Artificial Intelligence (AI) have contributed greatly to preclinical drug development and precision medicine. The intrinsic ability to maintain genetic and phenotypic heterogeneity of tumours allows for the reconciliation of shortcomings in traditional cancer models. While their utility in preclinical studies have been well established, little progress has been made in translational research and clinical trials. In this review, we identify the major bottlenecks preventing patient-derived tumour organoids (PDTOs) from being used in clinical setting. Unsuitable methods of tissue acquisition, disparities in establishment rates and a lengthy timeline are the limiting factors for use of PDTOs in clinical application. Potential strategies to overcome this include liquid biopsies via circulating tumour cells (CTCs), an automated organoid platform and optical metabolic imaging (OMI). These proposed solutions accelerate and optimize the workflow of a clinical organoid drug screening. As such, PDTOs have the potential for potential applications in clinical oncology to improve patient outcomes. If remarkable progress is made, cancer patients can finally benefit from this revolutionary technology.
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Affiliation(s)
- Malia Alexandra Foo
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Mingliang You
- Hangzhou Cancer Institute, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Hangzhou, 31002, China.,Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou, 31002, China
| | - Shing Leng Chan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Surgery, National University Hospital, Singapore, Singapore
| | - Gautam Sethi
- NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Glenn K Bonney
- Department of Surgery, National University Hospital, Singapore, Singapore.,NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei-Peng Yong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Haematology-Oncology, National University Hospital, National University Health System, Singapore, Singapore
| | - Edward Kai-Hua Chow
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Eliza Li Shan Fong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Lingzhi Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore. .,NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore. .,NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Department of Haematology-Oncology, National University Hospital, National University Health System, Singapore, Singapore.
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8
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Ma Z, Woon CYN, Liu CG, Cheng JT, You M, Sethi G, Wong ALA, Ho PCL, Zhang D, Ong P, Wang L, Goh BC. Repurposing Artemisinin and its Derivatives as Anticancer Drugs: A Chance or Challenge? Front Pharmacol 2022; 12:828856. [PMID: 35035355 PMCID: PMC8758560 DOI: 10.3389/fphar.2021.828856] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022] Open
Abstract
Cancer has become a global health problem, accounting for one out of six deaths. Despite the recent advances in cancer therapy, there is still an ever-growing need for readily accessible new therapies. The process of drug discovery and development is arduous and takes many years, and while it is ongoing, the time for the current lead compounds to reach clinical trial phase is very long. Drug repurposing has recently gained significant attention as it expedites the process of discovering new entities for anticancer therapy. One such potential candidate is the antimalarial drug, artemisinin that has shown anticancer activities in vitro and in vivo. In this review, major molecular and cellular mechanisms underlying the anticancer effect of artemisinin and its derivatives are summarised. Furthermore, major mechanisms of action and some key signaling pathways of this group of compounds have been reviewed to explore potential targets that contribute to the proliferation and metastasis of tumor cells. Despite its established profile in malaria treatment, pharmacokinetic properties, anticancer potency, and current formulations that hinder the clinical translation of artemisinin as an anticancer agent, have been discussed. Finally, potential solutions or new strategies are identified to overcome the bottlenecks in repurposing artemisinin-type compounds as anticancer drugs.
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Affiliation(s)
- Zhaowu Ma
- School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, China
| | - Clariis Yi-Ning Woon
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Chen-Guang Liu
- School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, China
| | - Jun-Ting Cheng
- School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, China
| | - Mingliang You
- Hangzhou Cancer Institute, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Hangzhou, China.,Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Gautam Sethi
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrea Li-Ann Wong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Paul Chi-Lui Ho
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Daping Zhang
- School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, China
| | - Peishi Ong
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Lingzhi Wang
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Boon-Cher Goh
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
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9
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Li J, Zhang G, Liu CG, Xiang X, Le MT, Sethi G, Wang L, Goh BC, Ma Z. The potential role of exosomal circRNAs in the tumor microenvironment: insights into cancer diagnosis and therapy. Am J Cancer Res 2022; 12:87-104. [PMID: 34987636 PMCID: PMC8690929 DOI: 10.7150/thno.64096] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/21/2021] [Indexed: 12/11/2022] Open
Abstract
Exosomes are multifunctional regulators of intercellular communication by carrying various messages under both physiological and pathological status of cancer patients. Accumulating studies have identified the presence of circular RNAs (circRNAs) in exosomes with crucial regulatory roles in diverse pathophysiological processes. Exosomal circRNAs derived from donor cells can modulate crosstalk with recipient cells locally or remotely to enhance cancer development and propagation, and play crucial roles in the tumor microenvironment (TME), leading to significant enhancement of tumor immunity, metabolism, angiogenesis, drug resistance, epithelial mesenchymal transition (EMT), invasion and metastasis. In this review, we describe the advances of exosomal circRNAs and their roles in modulating cancer hallmarks, especially those in the TME. Moreover, clinical application potential of exosomal circRNAs in cancer diagnosis and therapy are highlighted, bridging the gap between basic knowledge and clinical practice.
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10
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Goh BC. Refining dosing strategies: lessons from Singapore's health care system. Clin Adv Hematol Oncol 2021; 19:756-759. [PMID: 34928929] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Boon-Cher Goh
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
- Cancer Science Institute of Singapore, National University Hospital, Singapore
- Department of Pharmacology & Department of Medicine, National University of Singapore, Singapore
- Physician Leadership and Organisation Development Office, National University Health System, Singapore
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11
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Jain SR, Sim W, Ng CH, Chin YH, Lim WH, Syn NL, Kamal NHBA, Gupta M, Heong V, Lee XW, Sapari NS, Koh XQ, Isa ZFA, Ho L, O'Hara C, Ulagapan A, Gu SY, Shroff K, Weng RC, Lim JSY, Lim D, Pang B, Ng LK, Wong A, Soo RA, Yong WP, Chee CE, Lee SC, Goh BC, Soong R, Tan DSP. Statistical Process Control Charts for Monitoring Next-Generation Sequencing and Bioinformatics Turnaround in Precision Medicine Initiatives. Front Oncol 2021; 11:736265. [PMID: 34631570 PMCID: PMC8498582 DOI: 10.3389/fonc.2021.736265] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/08/2021] [Indexed: 02/04/2023] Open
Abstract
Purpose Precision oncology, such as next generation sequencing (NGS) molecular analysis and bioinformatics are used to guide targeted therapies. The laboratory turnaround time (TAT) is a key performance indicator of laboratory performance. This study aims to formally apply statistical process control (SPC) methods such as CUSUM and EWMA to a precision medicine programme to analyze the learning curves of NGS and bioinformatics processes. Patients and Methods Trends in NGS and bioinformatics TAT were analyzed using simple regression models with TAT as the dependent variable and chronologically-ordered case number as the independent variable. The M-estimator "robust" regression and negative binomial regression were chosen to serve as sensitivity analyses to each other. Next, two popular statistical process control (SPC) approaches which are CUSUM and EWMA were utilized and the CUSUM log-likelihood ratio (LLR) charts were also generated. All statistical analyses were done in Stata version 16.0 (StataCorp), and nominal P < 0.05 was considered to be statistically significant. Results A total of 365 patients underwent successful molecular profiling. Both the robust linear model and negative binomial model showed statistically significant reductions in TAT with accumulating experience. The EWMA and CUSUM charts of overall TAT largely corresponded except that the EWMA chart consistently decreased while the CUSUM analyses indicated improvement only after a nadir at the 82nd case. CUSUM analysis found that the bioinformatics team took a lower number of cases (54 cases) to overcome the learning curve compared to the NGS team (85 cases). Conclusion As NGS and bioinformatics lead precision oncology into the forefront of cancer management, characterizing the TAT of NGS and bioinformatics processes improves the timeliness of data output by potentially spotlighting problems early for rectification, thereby improving care delivery.
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Affiliation(s)
- Sneha Rajiv Jain
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wilson Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | | | - Mehek Gupta
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Valerie Heong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Xiao Wen Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Nur Sabrina Sapari
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Xue Qing Koh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Zul Fazreen Adam Isa
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Lucius Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Caitlin O'Hara
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Arvindh Ulagapan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shi Yu Gu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kashyap Shroff
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rei Chern Weng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joey S Y Lim
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Diana Lim
- Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.,Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Brendan Pang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.,Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Lai Kuan Ng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Andrea Wong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Ross Andrew Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Cheng Ean Chee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Richie Soong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore.,Pascific Laboratories, Singapore, Singapore
| | - David S P Tan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
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12
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Shermane Lim YW, Xiang X, Garg M, Le MT, Li-Ann Wong A, Wang L, Goh BC. The double-edged sword of H19 lncRNA: Insights into cancer therapy. Cancer Lett 2020; 500:253-262. [PMID: 33221454 DOI: 10.1016/j.canlet.2020.11.006] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/25/2020] [Accepted: 11/06/2020] [Indexed: 01/03/2023]
Abstract
H19 long non-coding RNA (lncRNA) has many functions in cancer. Some studies have reported that H19 acts as an oncogene and is involved in cancer progression by activating epithelial-mesenchymal transition (EMT), the cell cycle and angiogenesis via mechanisms like microRNA (miRNA) sponging - the binding to and inhibition of miRNA activity. This makes H19 lncRNA a potential target for cancer therapeutics. However, several conflicting studies have also found that H19 suppresses tumour development. In this review, we shed light on the possible reasons for these conflicting findings. We also summarise the current literature on the applications of H19 lncRNA in cancer therapy in many cancers and explore new avenues for future research. This includes the use of H19 in recombinant vectors, chemoresistance, epigenetic regulation, tumour microenvironment alteration and cancer immunotherapy. The relationship between H19 and the master tumour suppressor gene p53 is also explored. In most studies, H19 knockdown via RNA interference (RNAi) or epigenetic silencing inhibits cancer development. Thus, H19 lncRNA could be a promising target for the development of cancer therapeutics. This warrants further investigations into its translational research to improve cancer therapy outcomes.
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Affiliation(s)
- Yun Wei Shermane Lim
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore; Institute for Digital Medicine and Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
| | - Xiaoqiang Xiang
- Department of Clinical Pharmacy, School of Pharmacy, Fudan University, Shanghai, 201203, China.
| | - Manoj Garg
- Amity Institute of Molecular Medicine & Stem Cell Research (AIMMSCR), Amity University, Sector-125, Noida, 201313, India
| | - Minh Tn Le
- Institute for Digital Medicine and Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
| | - Andrea Li-Ann Wong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore; Department of Haematology-Oncology, National University Cancer Institute, Singapore, 119228, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
| | - Lingzhi Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore; Institute for Digital Medicine and Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore.
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore; Institute for Digital Medicine and Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore; Department of Haematology-Oncology, National University Cancer Institute, Singapore, 119228, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore.
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13
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Ma Z, Xiang X, Li S, Xie P, Gong Q, Goh BC, Wang L. Targeting hypoxia-inducible factor-1, for cancer treatment: Recent advances in developing small-molecule inhibitors from natural compounds. Semin Cancer Biol 2020; 80:379-390. [PMID: 33002608 DOI: 10.1016/j.semcancer.2020.09.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/06/2020] [Accepted: 09/17/2020] [Indexed: 12/24/2022]
Abstract
Rapid progress in molecular cancer biology coupled with the discovery of novel oncology drugs has opened new horizons for cancer target discovery. As one of the crucial signaling pathways related to tumorigenesis, hypoxia-inducible factor-1 (HIF-1) coordinates the activity of many transcription factors and their downstream molecules that impact tumor growth and metastasis. Accumulating evidence suggests that the transcriptional responses to acute hypoxia are mainly attributable to HIF-1α. Moreover, the overexpression of HIF-1α in several solid cancers has been found to be strongly associated with poor prognosis. Thus, pharmacological targeting of the HIF-1 signaling pathways has been considered as a new strategy for cancer therapy in the recent years. Although over the past decade, tremendous efforts have been made in preclinical studies to develop new HIF-1 inhibitors from natural products (reservoirs of novel therapeutic agents), to date, these efforts have not been successfully translated into clinically available treatments. In this review, we provide new insights into the bio-pharmacological considerations for selecting natural compounds as potential HIF-1 inhibitors to accelerate anti-cancer drug development. In addition, we highlighted the importance of assessing the dependency of cancer on HIF1A to shortlist cancer types as suitable disease models. This may subsequently lead to new paradigms for discovering more HIF-1 inhibitors derived from natural products and facilitate the development of potent therapeutic agents targeting specific cancer types.
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Affiliation(s)
- Zhaowu Ma
- School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei 434023, China; The First School of Clinical Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei 434023k, China
| | - Xiaoqiang Xiang
- School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Shiya Li
- Dyson School of Design Engineering, Imperial College London, London SW7 2AZ, United Kingdom
| | - Peng Xie
- School of Pharmacy, Fudan University, Shanghai 201203, China; China State Institute of Pharmaceutical Industry, Shanghai 201203, China
| | - Quan Gong
- School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei 434023, China; The First School of Clinical Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei 434023k, China.
| | - Boon-Cher Goh
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore; Department of Haematology-Oncology, National University Cancer Institute, Singapore 119228, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore.
| | - Lingzhi Wang
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore.
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14
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Lim DWT, Ng QS, Hong RL, Tan DS, Tan EH, Goh BC, Tan WL, Chan SLL, Tan SH, Kao HF, Iyer GN, Ang MK. Abstract CT203: A phase II trial of ipilimumab in combination with nivolumab in EBV-associated advanced nasopharyngeal carcinoma (NCT03097939). Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct203] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Single agent PD-1/PD-L1 studies in previously treated EBV-associated nasopharyngeal carcinoma (NPC) demonstrate clinical outcomes inferior to salvage combination chemotherapy. Dual blockade of PD-1/CTLA4 is a viable treatment strategy in other solid tumors. We hypothesized that this strategy would also be feasible and efficacious in NPC.
Materials and Methods: A single arm phase 2 study using a Simon 2-stage design was used. Nivolumab was dosed at 3 mg/kg q2 weeks, and Ipilimumab was dosed at 1 mg/kg q6 weeks. Eligible pts had EBER-ISH positive NPC, measurable plasma EBV DNA, no more than 1 prior line of chemotherapy, ECOG 0-1, and adequate organ function. All pts who met the eligibility criteria and received at least one dose of the combination were included in the safety and efficacy analysis. The primary efficacy endpoint was best overall response (BOR) by RECIST 1.1. Toxicity was assessed using CTCAE criteria. Pretreatment EBV DNA load was used to discriminate EBVhi from EBVlo at a threshold of 30,000 copies/ml, and sub-group analyses were carried out for BOR, time to progression, progression-free survival and overall survival based on this cutoff. Paired tumor and blood sampling were done at baseline and on-treatment and results are presented separately.
Results: A total of 28 patients were enrolled and 26 were evaluable. Two patients were excluded from analysis for eligibility reason and consent withdrawal. Median age of pts was 56 years (range 23-73). Most patients (85%) were of Chinese ethnicity and 19 patients (73%) were male. The median number of cycles received was 4. Three patients remain on treatment. Twenty-one patients (81%) experienced any grade treatment-related adverse events (trAE). Common trAEs were maculopapular rash (n=8; 31%) and hypothyroidism (n=8; 31%). Three pts (11%) required treatment discontinuation due to grade 3/4 AE, including pneumonitis and myasthenia gravis. In stage one, of 15 pts recruited, 7 reported BOR of PR (47%) and another 11 patients were recruited into stage two. In total, 8 out of 26 patients achieved PR (BOR 31%; 95% CI 14.3% to 51.8%). Median duration of response (DOR) was 5.9 mths (95% CI 3.9 to 9.0). With a median follow up of 10.6 mths, median PFS was 5.3 mths (95% CI 2.8 to 6.4). Of EBVlo pts, 8 experienced a PR (53%; 95% CI 26.6% to 78.7%). No responses were observed in EBVhi pts. EBVlo pts had a median PFS of 6.8 mths (95% CI 2.8 to 10.4) compared to EBVhi 2.7 mths (95% CI 1.7 to 5.2).
Conclusions: Dual PD-1/CTLA4 blockade is safe and feasible in NPC, achieving durable responses in pts with lower plasma EBV DNA. Efficacy was comparable to that seen in other solid tumors using this combination. The trial has been expanded to further study efficacy of this combination in NPC.
Citation Format: Darren Wan-Teck Lim, Quan Sing Ng, Ruey-Long Hong, Daniel S. Tan, Eng-Huat Tan, Boon-Cher Goh, Wan Ling Tan, Stella Li-Li Chan, Sze-Huey Tan, Hsiang-Fong Kao, Gopalakishna N. Iyer, Mei-Kim Ang. A phase II trial of ipilimumab in combination with nivolumab in EBV-associated advanced nasopharyngeal carcinoma (NCT03097939) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT203.
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Affiliation(s)
| | - Quan Sing Ng
- 1National Cancer Center Singapore, Singapore, Singapore
| | | | - Daniel S. Tan
- 1National Cancer Center Singapore, Singapore, Singapore
| | - Eng-Huat Tan
- 1National Cancer Center Singapore, Singapore, Singapore
| | - Boon-Cher Goh
- 3National University Health Systems, Singapore, Singapore
| | - Wan Ling Tan
- 1National Cancer Center Singapore, Singapore, Singapore
| | | | - Sze-Huey Tan
- 1National Cancer Center Singapore, Singapore, Singapore
| | | | | | - Mei-Kim Ang
- 1National Cancer Center Singapore, Singapore, Singapore
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15
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Chin TM, Boopathy GTK, Man EP, Clohessy JG, Csizmadia E, Quinlan MP, Putti T, Wan SC, Xie C, Ali A, Wai FC, Ong YS, Goh BC, Settleman J, Hong W, Levantini E, Tenen DG. Targeting microtubules sensitizes drug resistant lung cancer cells to lysosomal pathway inhibitors. Am J Cancer Res 2020; 10:2727-2743. [PMID: 32194831 PMCID: PMC7052910 DOI: 10.7150/thno.38729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/24/2019] [Indexed: 12/20/2022] Open
Abstract
Oncogene-addicted cancers are predominantly driven by specific oncogenic pathways and display initial exquisite sensitivity to designer therapies, but eventually become refractory to treatments. Clear understanding of lung tumorigenic mechanisms is essential for improved therapies. Methods: Lysosomes were analyzed in EGFR-WT and mutant cells and corresponding patient samples using immunofluorescence or immunohistochemistry and immunoblotting. Microtubule organization and dynamics were studied using immunofluorescence analyses. Also, we have validated our findings in a transgenic mouse model that contain EGFR-TKI resistant mutations. Results: We herein describe a novel mechanism that a mutated kinase disrupts the microtubule organization and results in a defective endosomal/lysosomal pathway. This prevents the efficient degradation of phosphorylated proteins that become trapped within the endosomes and continue to signal, therefore amplifying downstream proliferative and survival pathways. Phenotypically, a distinctive subcellular appearance of LAMP1 secondary to microtubule dysfunction in cells expressing EGFR kinase mutants is seen, and this may have potential diagnostic applications for the detection of such mutants. We demonstrate that lysosomal-inhibitors re-sensitize resistant cells to EGFR tyrosine-kinase inhibitors (TKIs). Identifying the endosome-lysosome pathway and microtubule dysfunction as a mechanism of resistance allows to pharmacologically intervene on this pathway. Conclusions: We find that the combination of microtubule stabilizing agent and lysosome inhibitor could reduce the tumor progression in EGFR TKI resistant mouse models of lung cancer.
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16
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Walsh R, Goh BC. Population diversity in oncology drug responses and implications to drug development. Chin Clin Oncol 2019; 8:24. [PMID: 31311278 DOI: 10.21037/cco.2019.05.01] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/27/2019] [Indexed: 11/06/2022]
Abstract
Cancer drug development is proceeding at a rapid pace, with drug approvals in oncology outpacing the other disease indications. With high population growth and economic development of Asian countries, access to cancer drugs becomes a paramount necessity. Approval of these drugs is dependent on establishing their safety and efficacy in populations living in these countries. Ethnic and racial differences in drug pharmacokinetics, or drug receptor sensitivities may lead to differences in drug responses between populations. These differences may be due to intrinsic or extrinsic factors, and understanding of the magnitude of these differences and their etiologies is important. One key pharmacogenetic reason for ethnic variability of drug response arises from the different allelic frequencies of polymorphic drug-metabolising enzyme genes, resulting in altered drug disposition. Using race or ethnicity as a "biomarker" for pharmacotherapeutics is fraught with issues as they are difficult to define scientifically, and are considered more social constructs. Nonetheless, studying the genetics of ethno-geographical variability of drug response will allow genetic biomarkers to be uncovered, which would greatly facilitate precision medicine, and should justify broadening the involvement and accrual of patients from global diverse populations during the early phases of drug development for an oncology drug.
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Affiliation(s)
- Robert Walsh
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore; Cancer Science of Institute, National University of Singapore, Singapore; Department of Pharmacology, National University of Singapore, Singapore.
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17
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Zhang M, Wang B, Chong QY, Pandey V, Guo Z, Chen RM, Wang L, Wang Y, Ma L, Kumar AP, Zhu T, Wu ZS, Yin Z, Basappa, Goh BC, Lobie PE. A novel small-molecule inhibitor of trefoil factor 3 (TFF3) potentiates MEK1/2 inhibition in lung adenocarcinoma. Oncogenesis 2019; 8:65. [PMID: 31685806 PMCID: PMC6828705 DOI: 10.1038/s41389-019-0173-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 02/08/2023] Open
Abstract
TFF3 has been identified as a novel biomarker to distinguish between lung adenocarcinoma (ADC) and lung squamous-cell carcinoma (SCC). Herein, we determined the oncogenic functions of TFF3 and demonstrated the potential of pharmacological inhibition of TFF3 in lung ADC using a novel small-molecule inhibitor of TFF3 dimerization (AMPC). Forced expression of TFF3 in lung ADC cells enhanced cell proliferation and survival, increased anchorage-independent growth, cancer stem cell behavior, growth in 3D Matrigel, and cell migration and invasion. In contrast, depleted expression of TFF3 suppressed these cellular functions. Mechanistically, TFF3 exerted its oncogenic function through upregulation of ARAF and hence enhanced downstream activation of MEK1/2 and ERK1/2. Pharmacological inhibition of TFF3 by AMPC, resulted in markedly decreased cell survival, proliferation, 3D growth and foci formation, and impaired tumor growth in a xenograft mouse model. Moreover, the combination of various MEK1/2 inhibitors with AMPC exhibited synergistic inhibitory effects on lung ADC cell growth. In conclusion, this study provides the first evidence that TFF3 is a potent promoter of lung ADC progression. Targeting TFF3 with a novel small-molecule inhibitor alone or in combination with conventional MEK1/2 inhibitors are potential strategies to improve the outcome of lung ADC.
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Affiliation(s)
- Mengyi Zhang
- College of Pharmacy, State Key Laboratory of Medicinal Chemical Biology, Nankai University, Tianjin, China.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Baocheng Wang
- Biomedical Translational Research Institute, Jinan University, Guangzhou, China.,Tsinghua Berkeley Shenzhen Institute (TBSI), Tsinghua University, Shenzhen, China
| | - Qing-Yun Chong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Vijay Pandey
- Tsinghua Berkeley Shenzhen Institute (TBSI), Tsinghua University, Shenzhen, China.,Shenzhen Bay Laboratory, Shenzhen, Guangzhou, China
| | - Zhirong Guo
- Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Ru-Mei Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Lingzhi Wang
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Yanxin Wang
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Lan Ma
- Tsinghua Berkeley Shenzhen Institute (TBSI), Tsinghua University, Shenzhen, China
| | - Alan P Kumar
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Cancer Program, Medical Science Cluster, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tao Zhu
- Department of Oncology of the First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230027, China
| | - Zheng-Sheng Wu
- Department of Pathology, Anhui Medical University, Hefei, Anhui, China
| | - Zhinan Yin
- Biomedical Translational Research Institute, Jinan University, Guangzhou, China
| | - Basappa
- Laboratory of Chemical Biology, Department of Studies in Organic Chemistry, University of Mysore, Manasagangotri, Mysore, 570006, Karnataka, India
| | - Boon-Cher Goh
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Haematology-Oncology, National University Health System, Singapore, Singapore
| | - Peter E Lobie
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore. .,Tsinghua Berkeley Shenzhen Institute (TBSI), Tsinghua University, Shenzhen, China. .,Shenzhen Bay Laboratory, Shenzhen, Guangzhou, China.
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18
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Lee M, Hirpara JL, Eu JQ, Sethi G, Wang L, Goh BC, Wong AL. Targeting STAT3 and oxidative phosphorylation in oncogene-addicted tumors. Redox Biol 2018; 25:101073. [PMID: 30594485 PMCID: PMC6859582 DOI: 10.1016/j.redox.2018.101073] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/08/2018] [Accepted: 12/07/2018] [Indexed: 02/07/2023] Open
Abstract
Drug resistance invariably limits the response of oncogene-addicted cancer cells to targeted therapy. The upregulation of signal transducer and activator of transcription 3 (STAT3) has been implicated as a mechanism of drug resistance in a range of oncogene-addicted cancers. However, the development of inhibitors against STAT3 has been fraught with challenges such as poor delivery or lack of specificity. Clinical experience with small molecule STAT3 inhibitors has seen efficacy signals, but this success has been tempered by drug limiting toxicities from off-target adverse events. It has emerged in recent years that, contrary to the Warburg theory, certain tumor types undergo metabolic reprogramming towards oxidative phosphorylation (OXPHOS) to satisfy their energy production. In particular, certain drug-resistant oncogene-addicted tumors have been found to rely on OXPHOS as a mechanism of survival. Multiple cellular signaling pathways converge on STAT3, hence the localization of STAT3 to the mitochondria may provide the link between oncogene-induced signaling pathways and cancer cell metabolism. In this article, we review the role of STAT3 and OXPHOS as targets of novel therapeutic strategies aimed at restoring drug sensitivity in treatment-resistant oncogene-addicted tumor types. Apart from drugs which have been re-purposed as OXPHOS inhibitors for-anti-cancer therapy (e.g., metformin and phenformin), several novel compounds in the drug-development pipeline have demonstrated promising pre-clinical and clinical activity. However, the clinical development of OXPHOS inhibitors remains in its infancy. The further identification of compounds with acceptable toxicity profiles, alongside the discovery of robust companion biomarkers of OXPHOS inhibition, would represent tangible early steps in transforming the therapeutic landscape of cancer cell metabolism. Metabolic reprogramming of cancer cells is one of the hallmarks of cancer. STAT3 and OXPHOS upregulation are resistance mechanisms in oncogene-addicted tumors. mSTAT3 has a role in the direct, non-transcriptional regulation of OXPHOS. Combining OXPHOS inhibitors with TKIs reverses resistance to targeted therapy.
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Affiliation(s)
- Matilda Lee
- Department of Haematology-Oncology, National University Health System, Singapore; Haematology-Oncology Research Group, National University Cancer Institute of Singapore, National University Health System, Singapore
| | | | | | - Gautam Sethi
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Health System, Singapore; Haematology-Oncology Research Group, National University Cancer Institute of Singapore, National University Health System, Singapore; Cancer Science Institute, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrea L Wong
- Department of Haematology-Oncology, National University Health System, Singapore; Haematology-Oncology Research Group, National University Cancer Institute of Singapore, National University Health System, Singapore; Cancer Science Institute, Singapore.
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19
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Syn NL, Wong ALA, Lee SC, Teoh HL, Yip JWL, Seet RC, Yeo WT, Kristanto W, Bee PC, Poon LM, Marban P, Wu TS, Winther MD, Brunham LR, Soong R, Tai BC, Goh BC. Genotype-guided versus traditional clinical dosing of warfarin in patients of Asian ancestry: a randomized controlled trial. BMC Med 2018; 16:104. [PMID: 29986700 PMCID: PMC6038204 DOI: 10.1186/s12916-018-1093-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Genotype-guided warfarin dosing has been shown in some randomized trials to improve anticoagulation outcomes in individuals of European ancestry, yet its utility in Asian patients remains unresolved. METHODS An open-label, non-inferiority, 1:1 randomized trial was conducted at three academic hospitals in South East Asia, involving 322 ethnically diverse patients newly indicated for warfarin (NCT00700895). Clinical follow-up was 90 days. The primary efficacy measure was the number of dose titrations within the first 2 weeks of therapy, with a mean non-inferiority margin of 0.5 over the first 14 days of therapy. RESULTS Among 322 randomized patients, 269 were evaluable for the primary endpoint. Compared with traditional dosing, the genotype-guided group required fewer dose titrations during the first 2 weeks (1.77 vs. 2.93, difference -1.16, 90% CI -1.48 to -0.84, P < 0.001 for both non-inferiority and superiority). The percentage of time within the therapeutic range over 3 months and median time to stable international normalized ratio (INR) did not differ between the genotype-guided and traditional dosing groups. The frequency of dose titrations (incidence rate ratio 0.76, 95% CI 0.67 to 0.86, P = 0.001), but not frequency of INR measurements, was lower at 1, 2, and 3 months in the genotype-guided group. The proportions of patients who experienced minor or major bleeding, recurrent venous thromboembolism, or out-of-range INR did not differ between both arms. For predicting maintenance doses, the pharmacogenetic algorithm achieved an R2 = 42.4% (P < 0.001) and mean percentage error of -7.4%. CONCLUSIONS Among Asian adults commencing warfarin therapy, a pharmacogenetic algorithm meets criteria for both non-inferiority and superiority in reducing dose titrations compared with a traditional dosing approach, and performs well in prediction of actual maintenance doses. These findings imply that clinicians may consider applying a pharmacogenetic algorithm to personalize initial warfarin dosages in Asian patients. TRIAL REGISTRATION ClinicalTrials.gov NCT00700895 . Registered on June 19, 2008.
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Affiliation(s)
- Nicholas L Syn
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Andrea Li-Ann Wong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Hock-Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - James Wei Luen Yip
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Raymond Cs Seet
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wee Tiong Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - William Kristanto
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ping-Chong Bee
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - L M Poon
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Patrick Marban
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Tuck Seng Wu
- Department of Pharmacy, National University Hospital, Singapore, Singapore
| | - Michael D Winther
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Liam R Brunham
- Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Richie Soong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Bee-Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore. .,Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore, 119228, Singapore.
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20
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Wong ALA, Sundar R, Wang TT, Ng TC, Zhang B, Tan SH, Soh TIP, Pang ASL, Tan CS, Ow SGW, Wang L, Mogro J, Ho J, Jeyasekharan AD, Huang Y, Thng CH, Chan CW, Hartman M, Iau P, Buhari SA, Goh BC, Lee SC. Phase Ib/II randomized, open-label study of doxorubicin and cyclophosphamide with or without low-dose, short-course sunitinib in the pre-operative treatment of breast cancer. Oncotarget 2018; 7:64089-64099. [PMID: 27577069 PMCID: PMC5325427 DOI: 10.18632/oncotarget.11596] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 08/08/2016] [Indexed: 01/05/2023] Open
Abstract
Background Prolonged anti-angiogenic therapy destroys tumor vasculature, whereas vascular-normalizing doses may enhance intra-tumoral drug delivery. We hypothesize that low-dose, short-course sunitinib normalizes vasculature, enhancing chemotherapy efficacy. Patients and Methods In phase Ib, treatment-naïve breast cancer patients received four cycles of pre-operative doxorubicin/cyclophosphamide, with sunitinib before each cycle. The optimal dose of sunitinib leading to tumor vessel normalization on immunohistochemistry was identified. In phase II, subjects were randomized to chemotherapy alone or chemotherapy plus sunitinib at the recommended phase II dose (RP2D). Primary endpoint was pathological complete response (pCR) rate. Tumor and functional imaging biomarkers were evaluated serially. Results In phase Ib (n=9), sunitinib 12.5 mg daily for 7 days before each chemotherapy was established as RP2D. In phase II, patients receiving chemotherapy plus sunitinib (n=24) had similar pCR rates (5.0% versus 4.3%, p=1.00), but a higher incidence of chemotherapy dose delays (33.3% versus 8.7%, p=0.04), compared to those receiving chemotherapy alone (n=25). The addition of sunitinib to chemotherapy significantly increased vascular normalization index (VNI) and decreased lymphatic vessel density (D2-40) on immunohistochemistry [VNI:25.50±27.94% versus 49.29±31.84%, p=0.034; D2-40:3.29±2.70 versus 1.29±1.54, p=0.014, baseline versus post-cycle 1], and improved perfusion on DCE-MRI (Ktrans:12.6±9.6 mL/100 g/min versus 16.3±10.7 mL/100 g/min, baseline versus post-cycle 1, p=0.015). Conversely, immunohistochemical and DCE-MRI parameters were not significantly altered by chemotherapy alone. Conclusion Low-dose, short-course sunitinib prior to anthracycline-based chemotherapy in breast cancer patients did not improve pCR and increased chemotherapy dose delays. However, the addition of sunitinib induced compelling pharmacodynamic evidence of vascular normalization. Further studies with alternative cytotoxic regimens should be explored.
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Affiliation(s)
- Andrea L A Wong
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore.,Cancer Science Institute, National University of Singapore, Singapore
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore
| | - Ting-Ting Wang
- Cancer Science Institute, National University of Singapore, Singapore
| | - Thian-C Ng
- Clinical Imaging Research Centre, National University of Singapore, Singapore
| | - Bo Zhang
- Clinical Imaging Research Centre, National University of Singapore, Singapore
| | - Sing-Huang Tan
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore
| | - Thomas I P Soh
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore
| | - Angela S L Pang
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore
| | - Chee-Seng Tan
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore
| | - Samuel G W Ow
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore
| | - Lingzhi Wang
- Cancer Science Institute, National University of Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Jannet Mogro
- Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore
| | - Jingshan Ho
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore
| | - Anand D Jeyasekharan
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore.,Cancer Science Institute, National University of Singapore, Singapore
| | - Yiqing Huang
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore
| | - Choon-Hua Thng
- Department of Diagnostic Imaging, National Cancer Centre, Singapore
| | - Ching-Wan Chan
- Department of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Mikael Hartman
- Department of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Philip Iau
- Department of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Shaik A Buhari
- Department of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore.,Cancer Science Institute, National University of Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore.,Cancer Science Institute, National University of Singapore, Singapore
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21
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Ma BBY, Lim WT, Goh BC, Hui EP, Lo KW, Pettinger A, Foster NR, Riess JW, Agulnik M, Chang AYC, Chopra A, Kish JA, Chung CH, Adkins DR, Cullen KJ, Gitlitz BJ, Lim DW, To KF, Chan KCA, Lo YMD, King AD, Erlichman C, Yin J, Costello BA, Chan ATC. Antitumor Activity of Nivolumab in Recurrent and Metastatic Nasopharyngeal Carcinoma: An International, Multicenter Study of the Mayo Clinic Phase 2 Consortium (NCI-9742). J Clin Oncol 2018; 36:1412-1418. [PMID: 29584545 DOI: 10.1200/jco.2017.77.0388] [Citation(s) in RCA: 288] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose This multinational study evaluated the antitumor activity of nivolumab in nasopharyngeal carcinoma (NPC). Tumor and plasma-based biomarkers were investigated in an exploratory analysis. Patients and Methods Patients with multiply pretreated recurrent or metastatic NPC were treated with nivolumab until disease progression. The primary end point was objective response rate (ORR) and secondary end points included survival and toxicity. The expression of programmed death-ligand 1 (PD-L1) and human leukocyte antigens A and B in archived tumors and plasma clearance of Epstein-Barr virus DNA were correlated with ORR and survival. Results A total of 44 patients were evaluated and the overall ORR was 20.5% (complete response, n = 1; partial response, n = 8). Nine patients received nivolumab for > 12 months (20%). The 1-year overall survival rate was 59% (95% CI, 44.3% to 78.5%) and 1-year progression-free survival (PFS) rate was 19.3% (95% CI, 10.1% to 37.2%). There was no statistical correlation between ORR and the biomarkers; however, a descriptive analysis showed that the proportion of patients who responded was higher among those with PD-L1 positive tumors (> 1% expression) than those with PD-L1-negative tumors. The loss of expression of one or both human leukocyte antigen class 1 proteins was associated with better PFS than when both proteins were expressed (1-year PFS, 30.9% v 5.6%; log-rank P = .01). There was no association between survival and PD-L1 expression or plasma Epstein-Barr virus DNA clearance. There was no unexpected toxicity to nivolumab. Conclusion Nivolumab has promising activity in NPC and the 1-year overall survival rate compares favorably with historic data in similar populations. Additional evaluation in a randomized setting is warranted. The biomarker results were hypothesis generating and validation in larger cohorts is needed.
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Affiliation(s)
- Brigette B Y Ma
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Wan-Teck Lim
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Boon-Cher Goh
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Edwin P Hui
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Kwok-Wai Lo
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Adam Pettinger
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Nathan R Foster
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Jonathan W Riess
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Mark Agulnik
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Alex Y C Chang
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Akhil Chopra
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Julie A Kish
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Christine H Chung
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Douglas R Adkins
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Kevin J Cullen
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Barbara J Gitlitz
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Dean W Lim
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Ka-Fai To
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - K C Allen Chan
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Y M Dennis Lo
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Ann D King
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Charles Erlichman
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Jun Yin
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Brian A Costello
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Anthony T C Chan
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
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Tan CS, Kumarakulasinghe NB, Huang YQ, Ang YLE, Choo JRE, Goh BC, Soo RA. Third generation EGFR TKIs: current data and future directions. Mol Cancer 2018; 17:29. [PMID: 29455654 PMCID: PMC5817792 DOI: 10.1186/s12943-018-0778-0] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/01/2018] [Indexed: 12/16/2022] Open
Abstract
Acquired T790 M mutation is the commonest cause of resistance for advanced non-small cell lung cancer (NSCLC) epidermal growth factor receptor (EGFR) mutant patients who had progressed after first line EGFR TKI (tyrosine kinase inhibitor). Several third generation EGFR TKIs which are EGFR mutant selective and wild-type (WT) sparing were developed to treat these patients with T790 M acquired resistant mutation. Osimertinib is one of the third generation EGFR TKIs and is currently the most advanced in clinical development. Unfortunately, despite good initial response, patients who was treated with third generation EGFR TKI would develop acquired resistance and several mechanisms had been identified and the commonest being C797S mutation at exon 20. Several novel treatment options were being developed for patients who had progressed on third generation EGFR TKI but they are still in the early phase of development. Osimertinib under FLAURA study had been shown to have better progression-free survival over first generation EGFR TKI in the first line setting and likely will become the new standard of care.
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Affiliation(s)
- Chee-Seng Tan
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228, Singapore
| | - Nesaretnam Barr Kumarakulasinghe
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228, Singapore
| | - Yi-Qing Huang
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228, Singapore
| | - Yvonne Li En Ang
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228, Singapore
| | - Joan Rou-En Choo
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228, Singapore
| | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Ross A Soo
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore, 119228, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore. .,School of Surgery, The University of Western Australia, Perth, Australia.
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Tai WM, Yong WP, Lim C, Low LS, Tham CK, Koh TS, Ng QS, Wang WW, Wang LZ, Hartono S, Thng CH, Huynh H, Lim KT, Toh HC, Goh BC, Choo SP. A phase Ib study of selumetinib (AZD6244, ARRY-142886) in combination with sorafenib in advanced hepatocellular carcinoma (HCC). Ann Oncol 2018; 29:526. [PMID: 28368515 DOI: 10.1093/annonc/mdx060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Heong V, Syn NL, Lee XW, Sapari NS, Koh XQ, Adam Isa ZF, Sy Lim J, Lim D, Pang B, Thian YL, Ng LK, Wong AL, Soo RA, Yong WP, Chee CE, Lee SC, Goh BC, Soong R, Tan DSP. Value of a molecular screening program to support clinical trial enrollment in Asian cancer patients: The Integrated Molecular Analysis of Cancer (IMAC) Study. Int J Cancer 2017; 142:1890-1900. [PMID: 28994108 DOI: 10.1002/ijc.31091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/15/2017] [Accepted: 09/27/2017] [Indexed: 02/01/2023]
Abstract
The value of precision oncology initiatives in Asian contexts remains unresolved. Here, we review the institutional implementation of prospective molecular screening to facilitate accrual of patients into biomarker-driven clinical trials, and to explore the mutational landscape of advanced tumors occurring in a prospective cohort of Asian patients (n = 396) with diverse cancer types. Next-generation sequencing (NGS) and routine clinicopathological assays, such as immunohistochemistry, copy number analysis and in situ hybridization tests, were performed on tumor samples. Actionable biomarker results were used to identify eligibility for early-phase, biomarker-driven clinical trials. Overall, NGS was successful in 365 of 396 patients (92%), achieving a mean depth of 1,943× and coverage uniformity of 96%. The median turnaround time from sample receipt to return of genomic results was 26.0 days (IQR, 19.0-39.0 days). Reportable mutations were found in 300 of 365 patients (82%). Ninety-one percent of patients at study enrollment indicated consent to receive incidental findings and willingness to undergo genetic counseling if required. The most commonly mutated oncogenes included KRAS (19%), PIK3CA (16%), EGFR (5%), BRAF (3%) and KIT (3%); while the most frequently mutated tumor suppressor genes included TP53 (40%), SMARCB1 (12%), APC (8%), PTEN (6%) and SMAD4 (5%). Among 23 patients enrolled in genotype-matched trials, median progression-free survival was 2.9 months (IQR, 1.5-4.0 months). Nine of 20 evaluable patients (45%; 95% CI, 23.1-68.5%) derived clinical benefit, including 3 partial responses and 6 with stable disease lasting ≥ 8 weeks.
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Affiliation(s)
- Valerie Heong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Nicholas L Syn
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Xiao Wen Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Nur Sabrina Sapari
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Xue Qing Koh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Zul Fazreen Adam Isa
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Joey Sy Lim
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Diana Lim
- Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, Singapore.,Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Brendan Pang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, Singapore.,Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Yee Liang Thian
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore
| | - Lai Kuan Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Andrea L Wong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Ross Andrew Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Cheng Ean Chee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Richie Soong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - David S P Tan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore
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25
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Abaza YM, Kadia TM, Jabbour EJ, Konopleva MY, Borthakur G, Ferrajoli A, Estrov Z, Wierda WG, Alfonso A, Chong TH, Chuah C, Koh LP, Goh BC, Chang JE, Durkes DE, Foudray MC, Kantarjian HM, Dong XQ, Garcia-Manero G. Phase 1 dose escalation multicenter trial of pracinostat alone and in combination with azacitidine in patients with advanced hematologic malignancies. Cancer 2017; 123:4851-4859. [PMID: 28841236 DOI: 10.1002/cncr.30949] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/04/2017] [Accepted: 07/17/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pracinostat is a potent histone deacetylase inhibitor with antitumor activity in both solid tumor and acute myeloid leukemia (AML) cell lines. Pracinostat is reported to have modest clinical activity in patients with advanced solid tumors. Given the higher preclinical sensitivity of hematologic malignancies to pracinostat, the authors conducted a phase 1 study to assess the safety, maximum tolerated dose, recommended phase 2 dose, efficacy, pharmacokinetics, and pharmacodynamics of pracinostat in patients with advanced hematological malignancies. METHODS Pracinostat was administered orally 3 times a week for 3 weeks on a 28-day cycle. Patients were assigned to 7 dose levels using a 3 + 3 dose escalation design. RESULTS A total of 44 patients were enrolled, 25 of whom had AML and 14 of whom had myelodysplastic syndrome. The maximum tolerated dose was 120 mg and the recommended phase 2 dose was 60 mg. Two patients with AML achieved a response: 1 complete remission (CR) and 1 complete cytogenetic response. Despite a dose-dependent increase in the plasma concentration of pracinostat, a similar increase in histone acetylation was not observed. As an extension, 10 additional patients with myelodysplastic syndrome were enrolled to assess the safety and efficacy of pracinostat in combination with azacitidine. Six patients achieved a CR and 3 achieved a CR without platelet recovery with no added toxicity. CONCLUSIONS The results of the current study demonstrate that pracinostat is safe, with modest single-agent activity in patients with hematological malignancies. Cancer 2017;123:4851-9. © 2017 American Cancer Society.
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Affiliation(s)
- Yasmin M Abaza
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marina Y Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zeev Estrov
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William G Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ana Alfonso
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Toh Han Chong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Charles Chuah
- Cancer and Stem Cell Biology Program, Duke-National University of Singapore Graduate Medical School Singapore, Singapore General Hospital, Singapore
| | - Liang-Piu Koh
- Department of Hematology and Oncology, National University Cancer Institute, National University Hospital, Singapore
| | - Boon-Cher Goh
- Department of Hematology and Oncology, National University Cancer Institute, National University Hospital, Singapore
| | - Julie E Chang
- Division of Hematology and Oncology, University of Wisconsin Paul B. Carbone Comprehensive Cancer Center, Madison, Wisconsin
| | | | - Maria Cielo Foudray
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiao Qin Dong
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
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26
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Wong AL, Hirpara JL, Pervaiz S, Eu JQ, Sethi G, Goh BC. Do STAT3 inhibitors have potential in the future for cancer therapy? Expert Opin Investig Drugs 2017; 26:883-887. [DOI: 10.1080/13543784.2017.1351941] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Andrea L.A. Wong
- Department of Haematology-Oncology, National University Health System, Singapore
- Haematology-Oncology Research Group, National University Cancer Institute of Singapore, National University Health System, Singapore
- Cancer Science Institute, Singapore
| | | | - Shazib Pervaiz
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore
| | | | - Gautam Sethi
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Health System, Singapore
- Haematology-Oncology Research Group, National University Cancer Institute of Singapore, National University Health System, Singapore
- Cancer Science Institute, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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27
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Syn NL, Wang L, Chow EKH, Lim CT, Goh BC. Exosomes in Cancer Nanomedicine and Immunotherapy: Prospects and Challenges. Trends Biotechnol 2017; 35:665-676. [PMID: 28365132 DOI: 10.1016/j.tibtech.2017.03.004] [Citation(s) in RCA: 277] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 12/13/2022]
Abstract
Exosomes (versatile, cell-derived nanovesicles naturally endowed with exquisite target-homing specificity and the ability to surmount in vivo biological barriers) hold substantial promise for developing exciting approaches in drug delivery and cancer immunotherapy. Specifically, bioengineered exosomes are being successfully deployed to deliver potent tumoricidal drugs (siRNAs and chemotherapeutic compounds) preferentially to cancer cells, while a new generation of exosome-based therapeutic cancer vaccines has produced enticing results in early-phase clinical trials. Here, we review the state-of-the-art technologies and protocols, and discuss the prospects and challenges for the clinical development of this emerging class of therapeutics.
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Affiliation(s)
- Nicholas L Syn
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Lingzhi Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore.
| | - Edward Kai-Hua Chow
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Chwee Teck Lim
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore; Mechanobiology Institute, National University of Singapore, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore; Department of Mechanical Engineering, National University of Singapore, Singapore
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Hematology-Oncology, National University Cancer Institute, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore; Developmental Therapeutics Unit, National University Cancer Institute, Singapore
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28
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Wang T, Seah S, Loh X, Chan CW, Hartman M, Goh BC, Lee SC. Simvastatin-induced breast cancer cell death and deactivation of PI3K/Akt and MAPK/ERK signalling are reversed by metabolic products of the mevalonate pathway. Oncotarget 2016; 7:2532-44. [PMID: 26565813 PMCID: PMC4823053 DOI: 10.18632/oncotarget.6304] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 10/14/2015] [Indexed: 02/07/2023] Open
Abstract
Statins purportedly exert anti-tumoral effects on breast cancer. However, the biologic mechanisms for these actions are not fully elucidated. The aims of this study were 1) to explore the effects of simvastatin on apoptosis, proliferation as well as PI3K/Akt/mTOR and MAPK/ERK pathway in a window-of-opportunity breast cancer trial; 2) to further confirm findings from the clinical trial by functional studies; 3) to explore the regulatory role of mevalonate pathway on the anti-tumoral effects of simvastatin. In clinical samples, simvastatin led to increase in cleaved caspase-3 (p = 0.002) and decreased trend for Ki67 (p = 0.245). Simvastatin markedly suppressed PI3K/Akt/mTOR signalling by activating PTEN (p = 0.005) and by dephosphorylating Akt (p = 0.002) and S6RP (p = 0.033); it also inhibited MAPK/ERK pathway by dephosphorylating c-Raf (p = 0.018) and ERK1/2 (p = 0.002). In ER-positive (MCF-7, T47D) and ER-negative (MDA-MB-231, BT-549) breast cancer cells, simvastatin treatment consistently induced apoptosis and inhibited proliferation by deregulating caspase cascades and cell cycle proteins in a dose dependent manner. Concordantly, simvastatin strongly suppressed PI3K/Akt/mTOR pathway by enhancing PTEN expression and by further sequentially dephosphorylating downstream cascades including Akt, mTOR, p70S6K, S6RP and 4E-BP1. Furthermore, simvastatin significantly inhibited MAPK/ERK pathway by dephosphorylating sequential cascades such as c-Raf, MEK1/2 and ERK1/2. These simvastatin anti-tumoral effects were reversed by metabolic products of the mevalonate pathway, including mevalonate, farnesyl pyrophosphate and geranylgeranyl pyrophosphate. These findings shed light on the biological and potential anti-tumoral effects of simvastatin in breast cancer.
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Affiliation(s)
- Tingting Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Serena Seah
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Xinyi Loh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Ching-Wan Chan
- Department of Surgery, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Mikael Hartman
- Department of Surgery, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Haematology and Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Soo-Chin Lee
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Haematology and Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
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29
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Syn N, Lee SC, Goh BC, Yong WP. Capecitabine pharmacogenetics: historical milestones and progress toward clinical implementation. Pharmacogenomics 2016; 17:1607-1610. [DOI: 10.2217/pgs-2016-0133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nicholas Syn
- Department of Haematology-Oncology, National University Cancer Institute, Singapore 119228
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore 119228
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599
| | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore 119228
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600
| | - Wei-Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore 119228
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599
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30
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Tai WM, Yong WP, Lim C, Low LS, Tham CK, Koh TS, Ng QS, Wang WW, Wang LZ, Hartano S, Thng CH, Huynh H, Lim KT, Toh HC, Goh BC, Choo SP. A phase Ib study of selumetinib (AZD6244, ARRY-142886) in combination with sorafenib in advanced hepatocellular carcinoma (HCC). Ann Oncol 2016; 27:2210-2215. [PMID: 27681866 DOI: 10.1093/annonc/mdw415] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Treatment with sorafenib, although associated with inhibition of tumour growth and angiogenesis in in vivo studies, leads to up-regulation of pERK. The addition of MEK inhibition could potentially abrogate this effect and potentiate anti-tumour activity. This phase I study investigated the maximum tolerated dose (MTD), safety, tolerability, pharmacokinetics (PK) and biomarker correlates of selumetinib combined with sorafenib in patients with advanced hepatocellular carcinoma (HCC). METHODS Patients with Child-Pugh (CP) score ≤7 were treated with 400 mg twice daily of sorafenib with escalating doses of selumetinib in a 3 + 3 study design. The dose-limiting toxicity (DLT) evaluation period was 28 days. PK of selumetinib was determined. Angiogenic effect was evaluated with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). RESULTS Twenty-seven patients of Asian ethnicity were enrolled. The MTD was selumetinib 75 mg daily with sorafenib 400 mg twice daily. DLT included grade 3 transaminitis, diarrhoea and fatigue. Most common treatment-related adverse events at MTD (all grades) were diarrhoea (85%), rash (59%), hypertension (44%), fatigue (30%), anorexia (22%) and hand-foot syndrome (22%). Four patients (15%) had PR and 13 (48%) had SD. PR or SD was observed for ≥6 months in seven patients. The median overall survival was 14.4 months. Selumetinib exposures in combination with sorafenib were comparable to other monotherapy studies. A reduction in permeability-surface area product noted in DCE-MRI with treatment correlated with worse survival outcomes. CONCLUSION The MTD of selumetinib was 75 mg daily when combined with sorafenib 400 mg twice a day in CP ≤7 HCC. Acceptable adverse events and encouraging anti-tumour activity warrant further evaluation. DCE-MRI findings deserve prospective evaluation. CLINICALTRIALSGOV IDENTIFIER NCT01029418.
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Affiliation(s)
- W M Tai
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - W P Yong
- Department of Haematology-Oncology, National University Health System, Singapore
| | - C Lim
- Divisions of Clinical Trials and Epidemiological Sciences
| | - L S Low
- Divisions of Clinical Trials and Epidemiological Sciences
| | - C K Tham
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - T S Koh
- Oncologic Imaging, National Cancer Centre Singapore, Singapore
| | - Q S Ng
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - W W Wang
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - L Z Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - S Hartano
- SingHealth Duke-NUS Radiological Sciences Academic Clinical Program, Singapore
| | - C H Thng
- Oncologic Imaging, National Cancer Centre Singapore, Singapore
| | - H Huynh
- Laboratory of Molecular Endocrinology, Division of Molecular and Cellular Research, National Cancer Centre Singapore, Singapore
| | - K T Lim
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - H C Toh
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - B C Goh
- Department of Haematology-Oncology, National University Health System, Singapore
| | - S P Choo
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
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31
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Ong PS, Wang L, Chia DMH, Seah JYX, Kong LR, Thuya WL, Chinnathambi A, Lau JYA, Wong ALA, Yong WP, Yang D, Ho PCL, Sethi G, Goh BC. A novel combinatorial strategy using Seliciclib(®) and Belinostat(®) for eradication of non-small cell lung cancer via apoptosis induction and BID activation. Cancer Lett 2016; 381:49-57. [PMID: 27461583 DOI: 10.1016/j.canlet.2016.07.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/04/2016] [Accepted: 07/19/2016] [Indexed: 01/22/2023]
Abstract
With conventional anticancer agents for non-small cell lung cancer (NSCLC) reaching therapeutic ceiling, the novel combination using histone deacetylase inhibitor, PXD101 (Belinostat(®)), and CDK inhibitor, CYC202 (Seliciclib(®)), was investigated as an alternative anticancer strategy. At clinically achievable concentration of CYC202 (15 µM), combination therapy resulted in significant reduction in cell proliferation (IC50 = 3.67 ± 0.80 µM, p < 0.05) compared with PXD101 alone (IC50 = 6.56 ± 0.42 µM) in p53 wild-type A549 cells. Significant increase in apoptosis that occurred independently of cell cycle arrest was observed after concurrent treatment. This result was corroborated by greater formation of cleaved caspase-8, caspase-3 and PARP. Up-regulation of p53 and truncated BID protein levels was seen while Mcl-1 and XIAP protein levels were down-regulated upon combined treatment. Further analysis of apoptotic pathways revealed that caspase inhibitors, but not p53 silencing, significantly abrogated the cytotoxic enhancement. Moreover, the enhanced efficacy of this combination was additionally confirmed in p53 null H2444 cells, suggesting the potential of this combination for treatment of NSCLC that are not amenable to effects of conventional p53-inducing agents.
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Affiliation(s)
- Pei-Shi Ong
- Department of Pharmacy, National University of Singapore, Singapore
| | - Lingzhi Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Pharmacology, National University of Singapore, Singapore
| | | | | | - Li-Ren Kong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Win-Lwin Thuya
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Arunachalam Chinnathambi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Jie-Ying Amelia Lau
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Andrea Li-Ann Wong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Hematology & Oncology, National University Health System, Singapore
| | - Wei-Peng Yong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Hematology & Oncology, National University Health System, Singapore
| | - Daiwen Yang
- Department of Biological Science, National University of Singapore, Singapore
| | - Paul Chi-Lui Ho
- Department of Pharmacy, National University of Singapore, Singapore
| | - Gautam Sethi
- Department of Pharmacology, National University of Singapore, Singapore.
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Pharmacology, National University of Singapore, Singapore; Department of Hematology & Oncology, National University Health System, Singapore.
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32
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Soo RA, Syn N, Lee SC, Wang L, Lim XY, Loh M, Tan SH, Zee YK, Wong ALA, Chuah B, Chan D, Lim SE, Goh BC, Soong R, Yong WP. Pharmacogenetics-Guided Phase I Study of Capecitabine on an Intermittent Schedule in Patients with Advanced or Metastatic Solid Tumours. Sci Rep 2016; 6:27826. [PMID: 27296624 PMCID: PMC4906519 DOI: 10.1038/srep27826] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/25/2016] [Indexed: 11/23/2022] Open
Abstract
The FDA-approved starting dosage of capecitabine is 1,250 mg/m2, and market research indicates that U.S. physicians routinely prescribe 1,000 mg/m2. Retrospective analyses however report reduced toxicity and efficacy in a subset of patients with the 3R/3R genotype of the thymidylate synthase gene enhancer region (TSER). This study sought to develop TSER genotype-specific guidelines for capecitabine dosing. Capecitabine was dose-escalated in advanced and/or metastatic cancer patients with TSER 3R/3R (Group A; N = 18) or 2R/2R + 2R/3R (Group B; N = 5) from 1,250 to 1,625 mg/m2 b.i.d., every 2 weeks on/1 week off for up to 8 cycles. Parent and metabolites pharmacokinetics, adverse events, and tumour response were assessed. The maximum tolerated and recommended doses in 3R/3R patients are 1,625 mg/m2 and 1,500 mg/m2. At 1,500 mg/m2, one in nine 3R/3R patients experienced a dose-limiting toxicity. Dosing guidelines for 2R/2R + 2R/3R remain undetermined due to poor accrual. The results indicate that 3R/3R patients may be amenable to 1,500 mg/m2 b.i.d. on an intermittent schedule, and is the first to prospectively validate the utility of TSER pharmacogenetic-testing before capecitabine treatment.
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Affiliation(s)
- Ross Andrew Soo
- Department of Haematology-Oncology National University, Cancer Institute 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore.,Cancer Science Institute of Singapore National University of Singapore Centre for Translational Medicine, 14 Medical Drive, #12-01, 117599 Singapore
| | - Nicholas Syn
- Department of Haematology-Oncology National University, Cancer Institute 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore.,Cancer Science Institute of Singapore National University of Singapore Centre for Translational Medicine, 14 Medical Drive, #12-01, 117599 Singapore
| | - Soo-Chin Lee
- Department of Haematology-Oncology National University, Cancer Institute 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore.,Cancer Science Institute of Singapore National University of Singapore Centre for Translational Medicine, 14 Medical Drive, #12-01, 117599 Singapore
| | - Lingzhi Wang
- Department of Haematology-Oncology National University, Cancer Institute 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore.,Cancer Science Institute of Singapore National University of Singapore Centre for Translational Medicine, 14 Medical Drive, #12-01, 117599 Singapore.,Translational Laboratory in Genetic Medicine Agency for Science, Technology and Research (A*STAR), Singapore 8A Biomedical Grove Immunos Level 5, 138648 Singapore
| | - Xn-Yii Lim
- Cancer Science Institute of Singapore National University of Singapore Centre for Translational Medicine, 14 Medical Drive, #12-01, 117599 Singapore
| | - Marie Loh
- Cancer Science Institute of Singapore National University of Singapore Centre for Translational Medicine, 14 Medical Drive, #12-01, 117599 Singapore.,Translational Laboratory in Genetic Medicine Agency for Science, Technology and Research (A*STAR), Singapore 8A Biomedical Grove Immunos Level 5, 138648 Singapore
| | - Sing-Huang Tan
- Department of Haematology-Oncology National University, Cancer Institute 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore
| | - Ying-Kiat Zee
- Department of Haematology-Oncology National University, Cancer Institute 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore
| | - Andrea Li-Ann Wong
- Department of Haematology-Oncology National University, Cancer Institute 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore.,Cancer Science Institute of Singapore National University of Singapore Centre for Translational Medicine, 14 Medical Drive, #12-01, 117599 Singapore
| | - Benjamin Chuah
- Department of Haematology-Oncology National University, Cancer Institute 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore
| | - Daniel Chan
- Department of Haematology-Oncology National University, Cancer Institute 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore
| | - Siew-Eng Lim
- Department of Haematology-Oncology National University, Cancer Institute 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore
| | - Boon-Cher Goh
- Department of Haematology-Oncology National University, Cancer Institute 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore.,Cancer Science Institute of Singapore National University of Singapore Centre for Translational Medicine, 14 Medical Drive, #12-01, 117599 Singapore.,Department of Pharmacology Yong Loo Lin School of Medicine National University of Singapore, 21 Lower Kent Ridge Road, 119077 Singapore
| | - Richie Soong
- Cancer Science Institute of Singapore National University of Singapore Centre for Translational Medicine, 14 Medical Drive, #12-01, 117599 Singapore.,Department of Pathology National University Health System National University of Singapore, Lower Kent Ridge Road, 119077 Singapore
| | - Wei-Peng Yong
- Department of Haematology-Oncology National University, Cancer Institute 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore.,Cancer Science Institute of Singapore National University of Singapore Centre for Translational Medicine, 14 Medical Drive, #12-01, 117599 Singapore
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Syn NLX, Yong WP, Goh BC, Lee SC. Evolving landscape of tumor molecular profiling for personalized cancer therapy: a comprehensive review. Expert Opin Drug Metab Toxicol 2016; 12:911-22. [PMID: 27249175 DOI: 10.1080/17425255.2016.1196187] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Tumour molecular profiling has been at the crossroads of large-scale integrative genomic studies and major clinical trials over the past 5 years and has provided roadmaps for better disease stratification and therapeutic management. AREAS COVERED We review the landscape of precision oncology trials in Asia, Europe and the United States, and emerging insights gained from recently reported studies such as the SHIVA and CUSTOM trials. Changes in the molecular portraits of human cancers and the immune contexture of the tumor microenvironment during treatment may predict the course of tumor progression, including the development of treatment resistance. 'Liquid biopsy' approaches that harness circulating tumor cells, cell-free DNA and exosomes may provide a non-invasive means of monitoring the parent tumor in real-time. Several molecular signatures are being evaluated as biomarkers for emerging immunologic approaches, such as the mismatch-repair deficiency status and nonsynonymous mutation burden in anti-PD-1 immune checkpoint blockade. Finally, we review the current actionability and future clinical impact of multigene panel and next-generation sequencing (NGS)-based profiling. EXPERT OPINION In the future, molecular profiling may help to fulfill unmet needs for predictive biomarkers in novel immunotherapeutic approaches, while ongoing precision trials are laying the foundations for clinical uptake of NGS testing.
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Affiliation(s)
- Nicholas Li-Xun Syn
- a Department of Haematology-Oncology , National University Cancer Institute, National University Health System , Singapore , Singapore
| | - Wei-Peng Yong
- a Department of Haematology-Oncology , National University Cancer Institute, National University Health System , Singapore , Singapore
| | - Boon-Cher Goh
- a Department of Haematology-Oncology , National University Cancer Institute, National University Health System , Singapore , Singapore
| | - Soo-Chin Lee
- a Department of Haematology-Oncology , National University Cancer Institute, National University Health System , Singapore , Singapore
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Syn N, Wang L, Sethi G, Thiery JP, Goh BC. Exosome-Mediated Metastasis: From Epithelial-Mesenchymal Transition to Escape from Immunosurveillance. Trends Pharmacol Sci 2016; 37:606-617. [PMID: 27157716 DOI: 10.1016/j.tips.2016.04.006] [Citation(s) in RCA: 355] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/08/2016] [Accepted: 04/11/2016] [Indexed: 01/02/2023]
Abstract
Exosomes are extracellular signalosomes that facilitate eukaryotic intercellular communication under a wide range of normal physiological contexts. In malignancies, this regulatory circuit is co-opted to promote cancer cell survival and outgrowth. Tumour-derived exosomes (TDEs) carry a pro-EMT (epithelial-mesenchymal transition) programme including transforming growth factor beta (TGFβ), caveolin-1, hypoxia-inducible factor 1 alpha (HIF1α), and β-catenin that enhances the invasive and migratory capabilities of recipient cells, and contributes to stromal remodelling and premetastatic niche formation. The integrin expression patterns on TDEs appear to dictate their preferential uptake by organ-specific cells, implying a crucial role of this pathway in organotropic metastasis. Through the expression of immunomodulatory molecules such as CD39 and CD73, TDEs modify the immune contexture of the tumour microenvironment, which could have implications for immunotherapy. Hence, targeting TDE dysregulation pathways, such as the heparanase/syndecan-1 axis, could represent novel therapeutic strategies in the quest to conquer cancer.
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Affiliation(s)
- Nicholas Syn
- Cancer Science Institute of Singapore, Centre for Translational Medicine, National University of Singapore, 14 Medical Drive, #12-01, Singapore 117599, Singapore; Department of Haematology-Oncology, National University Cancer Institute, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore 119228, Singapore
| | - Lingzhi Wang
- Cancer Science Institute of Singapore, Centre for Translational Medicine, National University of Singapore, 14 Medical Drive, #12-01, Singapore 117599, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore.
| | - Gautam Sethi
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore
| | - Jean-Paul Thiery
- Cancer Science Institute of Singapore, Centre for Translational Medicine, National University of Singapore, 14 Medical Drive, #12-01, Singapore 117599, Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117596, Singapore; UMR 7057 Matter and Complex Systems University Paris Denis Diderot, Paris, France; Comprehensive Cancer Center Institut Gustave Roussy, Villejuif, France
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore, Centre for Translational Medicine, National University of Singapore, 14 Medical Drive, #12-01, Singapore 117599, Singapore; Department of Haematology-Oncology, National University Cancer Institute, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore 119228, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore
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Syn NLX, Wang L, Wong ALA, Soe MY, Chuah B, Chan D, Tan SH, Soo RA, Lee SC, Goh BC, Yong WP. Dose modifications in Asian cancer patients with hepatic dysfunction receiving weekly docetaxel: A prospective pharmacokinetic and safety study. Cancer Sci 2016; 107:173-80. [PMID: 26663719 PMCID: PMC4768392 DOI: 10.1111/cas.12856] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/02/2015] [Accepted: 12/05/2015] [Indexed: 01/23/2023] Open
Abstract
Hepatic dysfunction may modify the safety profile and pharmacokinetics of docetaxel in cancer patients, but no validated guideline exists to guide dose modification necessitated by this uncommon comorbidity. We carried out the first prospective study of a personalized dosage regimen for cancer patients with liver dysfunction treated with docetaxel. Weekly dosages were stratified by hepatic dysfunction classification as such: Category 1, normal; Category 2, mild – alkaline phosphatase, aspartate aminotransferase, and/or alanine aminotransferase ≤5× upper limit of normal (ULN), and total bilirubin within normal range; and Category 3, moderate – any alkaline phosphatase, and aspartate aminotransferase or alanine aminotransferase ≤5–10× ULN, and/or total bilirubin ≤1–1.5× ULN. Category 1, 2 and 3 patients received starting dosages of 40, 30, and 20 mg/m2 docetaxel, respectively. Pharmacokinetics were evaluated on day 1 and 8 of the first treatment cycle, and entered into a multilevel model to delineate interindividual and interoccasion variability. Adverse event evaluation was carried out weekly for two treatment cycles. We found that docetaxel clearance was significantly different between patient categories (P < 0.001). Median clearance was 22.8, 16.4, and 11.3 L/h/m2 in Categories 1, 2, and 3, respectively, representing 28% and 50% reduced clearance in mild and moderate liver dysfunction patients, respectively. However, docetaxel exposure (area under the concentration–time curve) and docetaxel‐induced neutropenia (nadir and the maximum percentage decrease in neutrophil count) were not significantly different between categories. Median area under the concentration–time curve was 1.74, 1.83, and 1.77 mg·h/L in Categories 1, 2, and 3, respectively. The most common Grade 3/4 toxicity was neutropenia (30.0%). An unplanned comparison with the Child–Pugh and National Cancer Institute Organ Dysfunction Working Group grouping systems suggests that the proposed classification system appears to more effectively discriminate patients by docetaxel clearance and dose requirements. (ClinicalTrials.gov registration no. NCT00703378).
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Affiliation(s)
- Nicholas Li-Xun Syn
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
| | - Lingzhi Wang
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrea Li-Ann Wong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Mu-Yar Soe
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Benjamin Chuah
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Daniel Chan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Sing-Huang Tan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Ross Andrew Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
| | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei-Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,Cancer Science Institute, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
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Abstract
INTRODUCTION In the era of genomic medicine, it is increasingly recognized that ethnogeographic differences in drug pharmacology exist between Asian and other populations. This is particularly pertinent to oncology, where drugs forming the backbone of chemotherapy often have narrow therapeutic windows and are frequently dosed close to maximally tolerable levels. AREAS COVERED At the population level, ancestry is important because historical-biogeographical confluences have shaped population genetics and pharmacoethnicity in the Asian race through allelic differentiation and interethnic differences in inheritance patterns of linkage disequilibrium. At the individual level, cis- and trans-acting germline polymorphisms and somatic mutations in genes encoding drug-metabolizing enzymes and transporters act in a multifactorial manner to determine drug disposition phenotype and clinical response in Asian cancer patients. A growing body of evidence also finds that complex genetic interactions and regulation, including a multiplicity of gene control mechanisms, are increasingly implicated in genotype-phenotype correlates than has hitherto been appreciated--potentially serving as the mechanistic links between hits in non-coding regions of genome-wide association studies and drug toxicity. Together, these genetic factors contribute to the clinical heterogeneity of drug disposition in Asian cancer patients. EXPERT OPINION This topic has broad relevance for the optimization and individualization of anticancer strategies in Asians.
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Affiliation(s)
- Nicholas Li-Xun Syn
- a Department of Haematology-Oncology , National University Cancer Institute , Singapore 119228
| | - Wei-Peng Yong
- a Department of Haematology-Oncology , National University Cancer Institute , Singapore 119228.,b Cancer Science Institute of Singapore , National University of Singapore, Centre for Translational Medicine , Singapore 117599
| | - Soo-Chin Lee
- a Department of Haematology-Oncology , National University Cancer Institute , Singapore 119228.,b Cancer Science Institute of Singapore , National University of Singapore, Centre for Translational Medicine , Singapore 117599
| | - Boon-Cher Goh
- a Department of Haematology-Oncology , National University Cancer Institute , Singapore 119228.,b Cancer Science Institute of Singapore , National University of Singapore, Centre for Translational Medicine , Singapore 117599.,c Department of Pharmacology, Yong Loo Lin School of Medicine , National University of Singapore , Singapore 119077
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Toh DSL, Limenta LMG, Yee JY, Wang LZ, Goh BC, Murray M, Lee EJD. Effect of mushroom diet on pharmacokinetics of gabapentin in healthy Chinese subjects. Br J Clin Pharmacol 2015; 78:129-34. [PMID: 24168107 DOI: 10.1111/bcp.12273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022] Open
Abstract
AIMS This study evaluated the pharmacokinetics of gabapentin in Chinese subjects who received a diet rich in shiitake mushrooms. Shiitake mushrooms have been shown to contain high amount of ergothioneine. In vitro studies have shown that OCTN1-mediated secretion of gabapentin is trans-stimulated by ergothioneine. This study also investigated the concentrations of ergothioneine in plasma at baseline and following mushroom consumption. METHODS Ten healthy male subjects were recruited and received a diet containing no mushrooms (treatment A) or a high mushroom diet (treatment B; after at least a 7 day washout period) 1 day prior to administration of a single oral dose of gabapentin 600 mg. RESULTS Ingestion of shiitake mushrooms produced significant increases in plasma ergothioneine concentrations that were sustained for more than 48 h. A statistically significant but modest increase in the renal clearance (CLR ) of gabapentin occurred after intake of the mushroom diet (91.1 ± 25.1 vs. 76.9 ± 20.6 ml min(-1) , P = 0.031). No significant changes in AUC(0,tlast ) of gabapentin were observed (P = 0.726). Creatinine clearance did not correlate with CLR of gabapentin at baseline (treatment A). After ingestion of the mushroom diet, creatinine clearance accounted for 65.3% of the variance in CLR of gabapentin. CONCLUSIONS These data suggest that diet-drug pharmacokinetic interactions may occur during co-exposure to gabapentin and mushroom constituents. However, as it does not affect the AUC(0,tlast ) of gabapentin, it may not have clinically important consequences. Shiitake mushrooms can also be used as a source of ergothioneine for future clinical studies.
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Affiliation(s)
- Dorothy Su Lin Toh
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, 2006, Australia; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Wang LZ, Goh SH, Wong ALA, Thuya WL, Lau JYA, Wan SC, Lee SC, Ho PC, Goh BC. Validation of a rapid and sensitive LC-MS/MS method for determination of exemestane and its metabolites, 17β-hydroxyexemestane and 17β-hydroxyexemestane-17-O-β-D-glucuronide: application to human pharmacokinetics study. PLoS One 2015; 10:e0118553. [PMID: 25793887 PMCID: PMC4368747 DOI: 10.1371/journal.pone.0118553] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/20/2015] [Indexed: 11/24/2022] Open
Abstract
A novel, rapid and sensitive liquid chromatography-tandem mass spectrometric (LC-MS/MS) method was developed and validated for the evaluation of exemestane pharmacokinetics and its metabolites, 17β-dihydroexemestane (active metabolite) and 17β-dihydroexemestane-17-O-β-D-glucuronide (inactive metabolite) in human plasma. Their respective D3 isotopes were used as internal standards. Chromatographic separation of analytes was achieved using Thermo Fisher BDS Hypersil C18 analytic HPLC column (100 × 2.1 mm, 5 μm). The mobile phase was delivered at a rate of 0.5 mL/min by gradient elution with 0.1 % aqueous formic acid and acetonitrile. The column effluents were detected by API 4000 triple quadrupole mass spectrometer using electrospray ionisation (ESI) and monitored by multiple reaction monitoring (MRM) in positive mode. Mass transitions 297 > 121 m/z, 300 > 121 m/z, 299 > 135 m/z, 302 > 135 m/z, 475 > 281 m/z, and 478 > 284 m/z were monitored for exemestane, exemestane-d3, 17β-dihydroexemestane, 17β-dihydroexemestane-d3, 17β-dihydroexemestane-17-O-β-D-glucuronide, and 17β-dihydroexemestane-17-O-β-D-glucuronide-d3 respectively. The assay demonstrated linear ranges of 0.4 – 40.0 ng/mL, for exemestane; and 0.2 – 15.0 ng/mL, for 17β-dihydroexemestane and 17β-dihydroexemestane-17-O-β-D-glucuronide, with coefficient of determination (r2) of > 0.998. The precision (coefficient of variation) were ≤10.7%, 7.7% and 9.5% and the accuracies ranged from 88.8 to 103.1% for exemestane, 98.5 to 106.1% for 17β-dihydroexemestane and 92.0 to 103.2% for 17β-dihydroexemestane-17-O-β-D-glucuronide. The method was successfully applied to a pharmacokinetics/dynamics study in breast cancer patients receiving exemestane 25mg daily orally. For a representative patient, 20.7% of exemestane in plasma was converted into 17β-dihydroexemestane and 29.0% of 17β-dihydroexemestane was inactivated as 17β-dihydroexemestane-17-O-β-D-glucuronide 24 hours after ingestion of exemestane, suggesting that altered 17-dihydroexemestane glucuronidation may play an important role in determining effect of exemestane against breast cancer cells.
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Affiliation(s)
- Ling-Zhi Wang
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore 117599, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore 117599, Singapore
- * E-mail: (LZW); (BCG)
| | - Sok-Hwei Goh
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore 117543, Singapore
| | - Andrea Li-Ann Wong
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore 117599, Singapore
- Department of Haematology & Oncology, National University Health System, Singapore 119074, Singapore
| | - Win-Lwin Thuya
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore 117599, Singapore
| | - Jie-Ying Amelia Lau
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore 117599, Singapore
| | - Seow-Ching Wan
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore 117599, Singapore
| | - Soo-Chin Lee
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore 117599, Singapore
- Department of Haematology & Oncology, National University Health System, Singapore 119074, Singapore
| | - Paul C. Ho
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore 117543, Singapore
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore 117599, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore 117599, Singapore
- Department of Haematology & Oncology, National University Health System, Singapore 119074, Singapore
- * E-mail: (LZW); (BCG)
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Tham LS, Wang LZ, Soo RA, Lee HS, Lee SC, Goh BC, Holford NHG. Erratum to: Does saturable formation of gemcitabine triphosphate occur in patients? Cancer Chemother Pharmacol 2015; 75:657. [DOI: 10.1007/s00280-015-2678-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wong ALA, Lim JSJ, Sinha A, Gopinathan A, Lim R, Tan CS, Soh T, Venkatesh S, Titin C, Sapari NS, Lee SC, Yong WP, Tan DSP, Pang B, Wang TT, Zee YK, Soong R, Trnkova Z, Lathia C, Thiery JP, Wilhelm S, Jeffers M, Goh BC. Tumour pharmacodynamics and circulating cell free DNA in patients with refractory colorectal carcinoma treated with regorafenib. J Transl Med 2015; 13:57. [PMID: 25889309 PMCID: PMC4332724 DOI: 10.1186/s12967-015-0405-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/16/2015] [Indexed: 01/28/2023] Open
Abstract
Background Regorafenib, a multi-kinase inhibitor, is used in the treatment of patients with metastatic colorectal cancer refractory to standard therapy. However, this benefit was limited to 1.4 months improvement in overall survival, with more than half of patients experiencing grade 3 to 4 adverse events. We aim to elucidate the pharmacodynamic effects of regorafenib in metastatic colorectal cancer and discover potential biomarkers that may predict clinical benefit. Methods Patients with metastatic colorectal adenocarcinoma refractory to standard therapy with tumours amenable to biopsy were eligible for the study. Regorafenib was administered orally at 160 mg daily for 3 out of 4 weeks with tumour assessment every 2 cycles. Metabolic response was assessed by FDG PET-CT scans (pre-treatment and day 15); paired tumour biopsies (pre-treatment and day 21 post-treatment) were sampled for immunohistochemistry and proteomic profiling analyses. Plasma circulating cell free DNA was quantified serially before and after treatment. Results There were 2(6%) partial responses out of 35 patients, and 8(23%) patients had stable disease for more than 7 months. Adverse event profile was similar to reported data. Recurrent somatic mutations in K-RAS, PIK3CA and BRAF were detected in plasma circulating cell free DNA in 14 patients; some mutations were not found in archival tumour. Total plasma circulating cell free DNA inversely correlated with progression free survival (PFS), and presence of KRAS mutations associated with shorter PFS. Immunohistochemistry of pre- and post- treatment biopsies showed majority of patients had downregulation of phosphorylated-VEGFR2, podoplanin, phosphorylated-AKT, Ki-67 and upregulation of the MEK-ERK axis, phosphorylated-C-MET, phosphorylated-SRC, phosphorylated-STAT3 and phosphorylated-JUN. Proteomic analysis of fine needle tumour aspirates showed down-regulation of PI3K was associated with longer PFS. Conclusion Plasma circulating cell free DNA may yield potential predictive biomarkers of regorafenib treatment. Downregulation of the PI3K-AKT axis may be an important predictor of clinical benefit. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0405-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Li Ann Wong
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Joline Si Jing Lim
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Arvind Sinha
- Department of Diagnostic Imaging, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Anil Gopinathan
- Department of Diagnostic Imaging, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Robert Lim
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Chee-Seng Tan
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Thomas Soh
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Sudhakar Venkatesh
- Department of Diagnostic Imaging, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Christina Titin
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Nur Sabrina Sapari
- Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
| | - Wei-Peng Yong
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
| | - David Shao Ping Tan
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
| | - Brendan Pang
- Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore. .,Department of Pathology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Ting-Ting Wang
- Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
| | - Ying-Kiat Zee
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Richie Soong
- Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore. .,Department of Pathology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Zuzana Trnkova
- Bayer Healthcare Pharmaceuticals, 100 Bayer Boulevard, PO Box 915, Whippany, NJ, 07981-0915, USA.
| | - Chetan Lathia
- Bayer Healthcare Pharmaceuticals, 100 Bayer Boulevard, PO Box 915, Whippany, NJ, 07981-0915, USA.
| | - Jean-Paul Thiery
- Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
| | - Scott Wilhelm
- Bayer Healthcare Pharmaceuticals, 100 Bayer Boulevard, PO Box 915, Whippany, NJ, 07981-0915, USA.
| | - Michael Jeffers
- Bayer Healthcare Pharmaceuticals, 100 Bayer Boulevard, PO Box 915, Whippany, NJ, 07981-0915, USA.
| | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
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Wong AL, Soo RA, Tan DS, Lee SC, Lim JS, Marban PC, Kong LR, Lee YJ, Wang LZ, Thuya WL, Soong R, Yee MQ, Chin TM, Cordero MT, Asuncion BR, Pang B, Pervaiz S, Hirpara JL, Sinha A, Xu WW, Yuasa M, Tsunoda T, Motoyama M, Yamauchi T, Goh BC. Phase I and biomarker study of OPB-51602, a novel signal transducer and activator of transcription (STAT) 3 inhibitor, in patients with refractory solid malignancies. Ann Oncol 2015; 26:998-1005. [PMID: 25609248 DOI: 10.1093/annonc/mdv026] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the maximum-tolerated dose (MTD), safety, pharmacokinetics, and pharmacodynamics of OPB-51602, an oral, direct signal transduction activator of transcription 3 (STAT3) inhibitor, in patients with refractory solid tumors. PATIENTS AND METHODS Three cohorts were studied: cohort A, a sequential dose escalation of OPB-51602 administered intermittently (days 1-14 every 21 days); cohort B, an expansion cohort evaluating the dose lower than the MTD; cohort C, evaluating continuous daily dosing. RESULTS Fifty-one patients were studied at 2, 4, and 5 mg per day dosing. The MTD was 5 mg; first-cycle dose-limiting toxicities (DLTs) were grade 3 hyponatremia in one patient, and grade 3 dehydration in another. Intermittent dosing of both 2 and 4 mg doses were tolerable, and the recommended phase II dose was 4 mg. Cohort B investigated 4 mg intermittently, whereas cohort C investigated 4 mg continuously. Common toxicities included fatigue, nausea/vomiting, diarrhea, anorexia, and early-onset peripheral neuropathy. Drug-induced pneumonitis occurred in two patients in cohort C. Continuous dosing was associated with a higher incidence of peripheral neuropathy and a lower mean relative dose intensity, compared with intermittent dosing. Steady-state pharmacokinetics was characterized by high oral clearance, mean elimination half-life ranging from 44 to 61 h, and a large terminal-phase volume of distribution. An active metabolite, OPB-51822, accumulated to a greater extent than OPB-51602. Flow cytometry of peripheral blood mononuclear cells demonstrated pSTAT3 (Tyr(705)) inhibition following exposure. Two patients achieved partial responses at 5 mg intermittently and 4 mg continuously; both had epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC) with prior EGFR tyrosine kinase inhibitor exposure. CONCLUSION OPB-51602 demonstrates promising antitumor activity, particularly in NSCLC. Its long half-life and poorer tolerability of continuous dosing, compared with intermittent dosing, suggest that less frequent dosing should be explored. CLINICALTRIALSGOV IDENTIFIER NCT01184807.
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Affiliation(s)
- A L Wong
- Department of Haematology-Oncology, National University Health System; Haematology Oncology Research Group, National University Cancer Institute of Singapore, National University Health System; Cancer Science Institute
| | - R A Soo
- Department of Haematology-Oncology, National University Health System; Haematology Oncology Research Group, National University Cancer Institute of Singapore, National University Health System; Cancer Science Institute
| | - D S Tan
- Department of Medical Oncology, National Cancer Centre
| | - S C Lee
- Department of Haematology-Oncology, National University Health System; Haematology Oncology Research Group, National University Cancer Institute of Singapore, National University Health System; Cancer Science Institute
| | - J S Lim
- Department of Haematology-Oncology, National University Health System; Haematology Oncology Research Group, National University Cancer Institute of Singapore, National University Health System
| | - P C Marban
- Haematology Oncology Research Group, National University Cancer Institute of Singapore, National University Health System
| | | | | | - L Z Wang
- Cancer Science Institute; Departments of Pharmacology
| | | | | | | | - T M Chin
- Department of Haematology-Oncology, National University Health System; Haematology Oncology Research Group, National University Cancer Institute of Singapore, National University Health System; Cancer Science Institute
| | - M T Cordero
- Haematology Oncology Research Group, National University Cancer Institute of Singapore, National University Health System
| | | | | | - S Pervaiz
- Physiology, Yong Loo Lin School of Medicine
| | | | - A Sinha
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - W W Xu
- Otsuka Beijing Research Institute, Beijing, China
| | - M Yuasa
- Otsuka Pharmaceutical Co., Ltd, Chiyoda-ku
| | - T Tsunoda
- Otsuka Pharmaceutical Co., Ltd, Chiyoda-ku
| | - M Motoyama
- Otsuka Pharmaceutical Co., Ltd, Chiyoda-ku
| | - T Yamauchi
- Fuji Memorial Research Institute, Otsuka Pharmaceutical Co. Ltd, Chiyoda-ku, Japan
| | - B C Goh
- Department of Haematology-Oncology, National University Health System; Haematology Oncology Research Group, National University Cancer Institute of Singapore, National University Health System; Cancer Science Institute; Departments of Pharmacology.
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Wang T, Seah S, Chan CW, Hartman M, Dar NNT, Iau P, Goh BC, Lee SC. Abstract 2630: Simvastatin induced apoptosis and suppressed proliferation of breast cancer through deactivating PI3K/Akt/mTOR pathway. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
PURPOSE: Statins, inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, purportedly exert anti-tumoral effects on breast cancer by increasing apoptosis and decreasing proliferation. However, the biologic mechanisms for these actions are not fully elucidated. The aim of this study was to explore the effects of simvastatin on apoptosis, proliferation and commonly abrogated PI3K/Akt/mTOR pathway in a window-of-opportunity breast cancer trial and breast cancer cell lines.
EXPERIMENTAL DESIGN: A total of 16 female patients with newly diagnosed primary breast cancer were recruited into a preoperative window-of-opportunity trial. Patients received simvastatin for 10-28 days at a dose of 20mg daily before definitive breast cancer surgery. Pre- and post-treatment tumor biopsies were obtained for immunohistochemistry staining for cleaved caspase 3, Ki67, Pten, phospho-Akt and phospho-S6 ribosomal protein, and the changes between paired pre- and post-treatment tumors compared. For in vitro functional studies, apoptosis and proliferation assays were performed on breast cancer cell lines MCF7 and MDA-MB-231 48 hours after treatment with simvastatin. Using Western blots, the effects of simvastatin on apoptosis protein caspase 3, cell cycle proteins of c-myc, cyclin D1, p21 and p27, and of PI3K/Akt/mTOR pathway through phosphorylation of Akt, mTOR, p70S6K, S6 ribosomal protein and 4EBP1, were assessed.
RESULTS: In the prospective clinical trial, simvastatin treatment led to significant increase in apoptosis in post-treatment tumors, as determined by positive cleaved caspase 3 (23.4±24.3 vs 8.9±7.4, p=0.002). Decreased trend for proliferation was also observed in post-treatment tumors (57.7±35.2 vs 74.6±59.9 for Ki67, p=0.245). Moreover, simvastatin treatment markedly suppressed PI3K/Akt/mTOR signalling pathway by activating Pten (66.1±65.2 vs 30.0±46.6, p=0.005) and by dephosphorylating Pten downstream effectors, Akt and S6 ribosomal protein (9.0±19.5 vs 93.0±87.4, p=0.002 for phospho-Akt; 63.7±51.6 vs 108.6±67.7, p=0.033 for phospho-S6 ribosomal protein). In MCF7 and MDA-MB-231 cells, simvastatin treatment similarly induced apoptosis and inhibited cell proliferation, with decrease in expression of c-myc and cyclin D1 and increase in cell cycle suppressor p21 and p27 at a dose dependent manner. Moreover, simvastatin treatment, at 20uM for MCF7 and 400nM for MDA-MB-231 cells, strongly suppressed sequential phosphorylation of PI3K/Akt/mTOR pathway cascades including Akt, mTOR, p70S6K, S6 ribosomal protein and 4EBP1.
CONCLUSION: The clinical trial and in vitro functional studies concordantly showed simvastatin to promote apoptosis, suppress proliferation and dephosphorylate sequential signalling cascades of PI3K/Akt/mTOR pathway of breast cancer. These findings shed light on the biological and potential anti-tumor effects of simvastatin in breast cancer.
Citation Format: Tingting Wang, Serena Seah, Ching-Wan Chan, Mikael Hartman, Nyein Nyein Thaw Dar, Philip Iau, Boon-Cher Goh, Soo-Chin Lee. Simvastatin induced apoptosis and suppressed proliferation of breast cancer through deactivating PI3K/Akt/mTOR pathway. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2630. doi:10.1158/1538-7445.AM2014-2630
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Affiliation(s)
- Tingting Wang
- 1Cancer Science Institute Singapore, Singapore, Singapore
| | - Serena Seah
- 1Cancer Science Institute Singapore, Singapore, Singapore
| | - Ching-Wan Chan
- 2Department of Surgery, National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Mikael Hartman
- 2Department of Surgery, National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Nyein Nyein Thaw Dar
- 3Department of Haematology and Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Philip Iau
- 2Department of Surgery, National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Boon-Cher Goh
- 3Department of Haematology and Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Soo-Chin Lee
- 3Department of Haematology and Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
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Voon PJ, Yap HL, Ma CYT, Lu F, Wong ALA, Sapari NS, Soong R, Soh TIP, Goh BC, Lee HS, Lee SC. Correlation of aldo-ketoreductase (AKR) 1C3 genetic variant with doxorubicin pharmacodynamics in Asian breast cancer patients. Br J Clin Pharmacol 2014; 75:1497-505. [PMID: 23116553 DOI: 10.1111/bcp.12021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 10/26/2012] [Indexed: 12/13/2022] Open
Abstract
AIMS Aldo-ketoreductases have been implicated in the metabolism of doxorubicin. We sought to assess the influence of AKR1C3 genetic variants on doxorubicin metabolism. METHODS We sequenced AKR1C3 exon 5 and genotyped seven functional single nucleotide polymorphisms in CBR3, ABCB1 and SLC22A16 involved in doxorubicin pharmacology in 151 Asian breast cancer patients treated with doxorubicin-containing chemotherapy, and correlated these genotypes with doxorubicin pharmacokinetics and pharmacodynamics. RESULTS Two previously reported AKR1C3 intronic variants, IVS4-212 C>G and IVS4+218 G>A, were detected. The AKR1C3 IVS4-212 GG genotype was associated with significantly lower cycle 1 day 15 leucocyte (mean leucocytes 2.49 ± 1.57 × 10(9) vs. 3.85 ± 3.42 × 10(9) l(-1) , P = 0.007) and neutrophil counts (mean neutrophils 0.70 ± 1.01 × 10(9) vs. 1.56 ± 2.80 × 10(9) l(-1) , P = 0.008) and significant improvement of progression-free survival [PFS, mean PFS 49.0 (95% confidence interval 42.2-55.8) vs. 31.0 (95% confidence interval 20.7-41.2) months, P = 0.017] and overall survival [OS; mean OS 64.4 (95% confidence interval 58.3-70.5) vs. 46.3 (95% confidence interval 35.1-57.5) months, P = 0.006] compared with those carrying at least one C allele. There was no significant association between AKR1C3 IVS4-212 C>G and doxorubicin pharmacokinetics. Of the other seven single nucleotide polymorphisms genotyped, CBR3 G11A correlated with doxorubicinol area under the concentration-time curve and OS, ABCB1 G2677T/A correlated with doxorubicin clearance and platelet toxicity, while ABCB1 IVS26+59 T>G correlated with OS. The AKR1C3 IVS4-212 C<G genotype remained significantly correlated with both PFS and OS on multivariate analysis with clinical prognosticators. CONCLUSIONS The AKR1C3 IVS4-212 GG genotype was associated with greater haematological toxicity and longer progression-free survival and overall survival after doxorubicin-based therapy, suggesting potential interaction of this variant with doxorubicin metabolism.
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Affiliation(s)
- Pei Jye Voon
- Department of Hematology-Oncology, National University Cancer Institute, National University Health System, Singapore
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Seng KY, Hee KH, Soon GH, Sapari NS, Soong R, Goh BC, Lee LSU. CYP3A5*3 and bilirubin predict midazolam population pharmacokinetics in Asian cancer patients. J Clin Pharmacol 2013; 54:215-24. [DOI: 10.1002/jcph.230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 11/05/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Kok-Yong Seng
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
- Defence Medical & Environmental Research Institute; DSO National Laboratories; Singapore Singapore
| | - Kim-Hor Hee
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Gaik Hong Soon
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Nur Sabrina Sapari
- Cancer Science Institute of Singapore; National University of Singapore; Singapore Singapore
| | - Richie Soong
- Cancer Science Institute of Singapore; National University of Singapore; Singapore Singapore
- Department of Pathology; National University Health System; Singapore Singapore
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore; National University of Singapore; Singapore Singapore
- National University Health System; Singapore Singapore
- Haematology Oncology Research Group; National University Cancer Institute of Singapore, National University Health System; Singapore Singapore
| | - Lawrence Soon-U Lee
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
- National University Health System; Singapore Singapore
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Tay K, Loh KS, Goh BC, Tham IW, Lim CM. Re-irradiation versus Chemo-reirradiation for Recurrent, Unresectable Head and Neck Cancer. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813495815a128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Both chemo-reirradiation and reirradiation alone have been shown to be feasible treatment options for recurrent, unresectable head and neck cancer in an irradiated field. However, no randomized controlled studies have been performed to compare their efficacy. Our goal was to compare the survival and toxicity rates among patients treated with chemo-reirradiation and reirradiation. Methods: A Pubmed search was performed using the search terms: re irradiation, previously irradiated, reirradiation, re-irradiation and head and neck neoplasms[Mesh]. Two observers identified the full manuscripts which fulfilled the inclusion criteria: recurrent or second primary head and neck cancer, prior irradiation, no surgery, and no targeted therapy. Median overall survival (OS), 1-year OS, and toxicity between reirradiation alone and chemo-reirradiation groups were compared using Mann-Whitney-U test. Results: Of 473 papers identified, 15 papers were included: 11 papers (n = 567) reported median OS, and 13 papers (n = 601) reported 1-year OS. Median age of the patients and radiation dosage delivered were similar between the groups. Average 1-year OS was 44.1% (n = 214) in the reirradiation group and 47.2% (n = 387) in the chemo-reirradiation group ( P = 0.42). Average median OS was 12 months in the reirradiation group (n = 162) and 10.6 months in the chemo-reirradiation group (n = 405) ( P = 0.32). Average incidence of Grade-3/4 Mucositis was 21.5% (n = 118) in the reirradiation group and 18.1% (n = 396) in the chemo-reirradiation group ( P =0.46). Chemotherapy-related-hematology toxicity was 24.2% (n = 353). Conclusions: This analysis involving more than 600 patients shows that, compared to reirradiation alone, chemo-reirradiation has no discernable difference in OS or local toxicity but poses additional hematological toxicity. Optimal treatment remains to be defined.
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Tan TZ, Miow QH, Huang RYJ, Wong MK, Ye J, Lau JA, Wu MC, Bin Abdul Hadi LH, Soong R, Choolani M, Davidson B, Nesland JM, Wang LZ, Matsumura N, Mandai M, Konishi I, Goh BC, Chang JT, Thiery JP, Mori S. Functional genomics identifies five distinct molecular subtypes with clinical relevance and pathways for growth control in epithelial ovarian cancer. EMBO Mol Med 2013; 5:1051-66. [PMID: 23666744 PMCID: PMC3721473 DOI: 10.1002/emmm.201201823] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [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: 08/06/2012] [Revised: 04/03/2013] [Accepted: 04/09/2013] [Indexed: 01/06/2023] Open
Abstract
Epithelial ovarian cancer (EOC) is hallmarked by a high degree of heterogeneity. To address this heterogeneity, a classification scheme was developed based on gene expression patterns of 1538 tumours. Five, biologically distinct subgroups - Epi-A, Epi-B, Mes, Stem-A and Stem-B - exhibited significantly distinct clinicopathological characteristics, deregulated pathways and patient prognoses, and were validated using independent datasets. To identify subtype-specific molecular targets, ovarian cancer cell lines representing these molecular subtypes were screened against a genome-wide shRNA library. Focusing on the poor-prognosis Stem-A subtype, we found that two genes involved in tubulin processing, TUBGCP4 and NAT10, were essential for cell growth, an observation supported by a pathway analysis that also predicted involvement of microtubule-related processes. Furthermore, we observed that Stem-A cell lines were indeed more sensitive to inhibitors of tubulin polymerization, vincristine and vinorelbine, than the other subtypes. This subtyping offers new insights into the development of novel diagnostic and personalized treatment for EOC patients.
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Affiliation(s)
- Tuan Zea Tan
- Cancer Science Institute of Singapore, National University of SingaporeSingapore
| | - Qing Hao Miow
- Cancer Science Institute of Singapore, National University of SingaporeSingapore
- NUS Graduate School for Integrative Sciences and Engineering, National University of SingaporeSingapore
| | - Ruby Yun-Ju Huang
- Cancer Science Institute of Singapore, National University of SingaporeSingapore
- Department of Obstetrics and Gynecology, National University Health SystemSingapore
| | - Meng Kang Wong
- Cancer Science Institute of Singapore, National University of SingaporeSingapore
| | - Jieru Ye
- Cancer Science Institute of Singapore, National University of SingaporeSingapore
| | - Jieying Amelia Lau
- Cancer Science Institute of Singapore, National University of SingaporeSingapore
| | - Meng Chu Wu
- Cancer Science Institute of Singapore, National University of SingaporeSingapore
| | | | - Richie Soong
- Cancer Science Institute of Singapore, National University of SingaporeSingapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynecology, National University Health SystemSingapore
| | - Ben Davidson
- Division of Pathology, Norwegian Radium Hospital Oslo University HospitalOslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Clinical MedicineOslo, Norway
| | - Jahn M Nesland
- Division of Pathology, Norwegian Radium Hospital Oslo University HospitalOslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Clinical MedicineOslo, Norway
| | - Ling-Zhi Wang
- Cancer Science Institute of Singapore, National University of SingaporeSingapore
- Department of Pharmacology, National University of SingaporeSingapore
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kyoto UniversityKyoto, Japan
| | - Masaki Mandai
- Department of Obstetrics and Gynecology, Kyoto UniversityKyoto, Japan
| | - Ikuo Konishi
- Department of Obstetrics and Gynecology, Kyoto UniversityKyoto, Japan
| | - Boon-Cher Goh
- Cancer Science Institute of Singapore, National University of SingaporeSingapore
- Department of Pharmacology, National University of SingaporeSingapore
- Department of Hematology and Oncology, National University Health SystemSingapore
| | - Jeffrey T Chang
- Department of Integrative Biology and Pharmacology, University of Texas Health Science Center at HoustonTX, USA
| | - Jean Paul Thiery
- Cancer Science Institute of Singapore, National University of SingaporeSingapore
- Institute of Molecular and Cell Biology, A*STAR (Agency for ScienceTechnology and Research), Singapore
- Department of Biochemistry, National University of SingaporeSingapore
| | - Seiichi Mori
- Cancer Science Institute of Singapore, National University of SingaporeSingapore
- Department of Biochemistry, National University of SingaporeSingapore
- Division of Cancer Genomics, Cancer Institute of Japanese Foundation for Cancer Research3-8-31 Ariake, Koto-ku, Tokyo, Japan
- Present Address: Division of Cancer Genomics, Cancer Institute of Japanese Foundation for Cancer ResearchKoto-ku, Tokyo, Japan
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Tan TZ, Miow QH, Huang RYJ, Wong MK, Ye J, Lau JA, Wu MC, Bin Abdul Hadi LH, Soong R, Choolani M, Davidson B, Nesland JM, Wang LZ, Matsumura N, Mandai M, Konishi I, Goh BC, Chang JT, Thiery JP, Mori S. Functional genomics identifies five distinct molecular subtypes with clinical relevance and pathways for growth control in epithelial ovarian cancer. EMBO Mol Med 2013. [PMID: 23666744 DOI: 10.1002/emmm.201201823] [] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Epithelial ovarian cancer (EOC) is hallmarked by a high degree of heterogeneity. To address this heterogeneity, a classification scheme was developed based on gene expression patterns of 1538 tumours. Five, biologically distinct subgroups - Epi-A, Epi-B, Mes, Stem-A and Stem-B - exhibited significantly distinct clinicopathological characteristics, deregulated pathways and patient prognoses, and were validated using independent datasets. To identify subtype-specific molecular targets, ovarian cancer cell lines representing these molecular subtypes were screened against a genome-wide shRNA library. Focusing on the poor-prognosis Stem-A subtype, we found that two genes involved in tubulin processing, TUBGCP4 and NAT10, were essential for cell growth, an observation supported by a pathway analysis that also predicted involvement of microtubule-related processes. Furthermore, we observed that Stem-A cell lines were indeed more sensitive to inhibitors of tubulin polymerization, vincristine and vinorelbine, than the other subtypes. This subtyping offers new insights into the development of novel diagnostic and personalized treatment for EOC patients.
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Affiliation(s)
- Tuan Zea Tan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
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Wang LZ, Thuya WL, Toh DSL, Lie MGL, Lau JYA, Kong LR, Wan SC, Chua KN, Lee EJD, Goh BC. Quantification of L-ergothioneine in human plasma and erythrocytes by liquid chromatography-tandem mass spectrometry. J Mass Spectrom 2013; 48:406-412. [PMID: 23494799 DOI: 10.1002/jms.3150] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/24/2012] [Accepted: 11/27/2012] [Indexed: 06/01/2023]
Abstract
A sensitive analytical method has been developed and validated for the quantification of L-ergothioneine in human plasma and erythrocytes by liquid chromatography-tandem mass spectrometry. A commercially available isotope-labeled L-ergothioneine-d9 is used as the internal standard. A simple protein precipitation with acetonitrile is utilized for bio-sample preparation prior to analysis. Chromatographic separation of L-ergothioneine is conducted using gradient elution on Alltime C18 (150 mm × 2.1 mm, 5 µ). The run time is 6 min at a constant flow rate of 0.45 ml/min. The mass spectrometer is operated under a positive electrospray ionization condition with multiple reaction monitoring mode. The mass transitions of L-ergothioneine and L-ergothioneine-d9 are m/z 230 > 127 and m/z 239 > 127, respectively. Excellent linearity [coefficient of determination (r(2)) ≥ 0.9998] can be achieved for L-ergothioneine quantification at the ranges of 10 to 10,000 ng/ml, with the intra-day and inter-day precisions at 0.9-3.9% and 1.3-5.7%, respectively, and the accuracies for all quality control samples between 94.5 and 101.0%. This validated analytical method is suitable for pharmacokinetic monitoring of L-ergothioneine in human and erythrocytes. Based on the determination of bio-samples from five healthy subjects, the mean concentrations of L-ergothioneine in plasma and erythrocytes are 107.4 ± 20.5 ng/ml and 1285.0 ± 1363.0 ng/ml, respectively.
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Affiliation(s)
- Ling-Zhi Wang
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore, 117599, Singapore.
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Wang LZ, Ramírez J, Yeo W, Chan MYM, Thuya WL, Lau JYA, Wan SC, Wong ALA, Zee YK, Lim R, Lee SC, Ho PC, Lee HS, Chan A, Ansher S, Ratain MJ, Goh BC. Glucuronidation by UGT1A1 is the dominant pathway of the metabolic disposition of belinostat in liver cancer patients. PLoS One 2013; 8:e54522. [PMID: 23382909 PMCID: PMC3559838 DOI: 10.1371/journal.pone.0054522] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 12/12/2012] [Indexed: 01/25/2023] Open
Abstract
Belinostat is a hydroxamate class HDAC inhibitor that has demonstrated activity in peripheral T-cell lymphoma and is undergoing clinical trials for non-hematologic malignancies. We studied the pharmacokinetics of belinostat in hepatocellular carcinoma patients to determine the main pathway of metabolism of belinostat. The pharmacokinetics of belinostat in liver cancer patients were characterized by rapid plasma clearance of belinostat with extensive metabolism with more than 4-fold greater relative systemic exposure of major metabolite, belinostat glucuronide than that of belinostat. There was significant interindividual variability of belinostat glucuronidation. The major pathway of metabolism involves UGT1A1-mediated glucuronidation and a good correlation has been identified between belinostat glucuronide formation and glucuronidation of known UGT1A1 substrates. In addition, liver microsomes harboring UGT1A1*28 alleles have lower glucuronidation activity for belinostat compared to those with wildtype UGT1A1. The main metabolic pathway of belinostat is through glucuronidation mediated primarily by UGT1A1, a highly polymorphic enzyme. The clinical significance of this finding remains to be determined.
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Affiliation(s)
- Ling-Zhi Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
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Zee YK, Goh BC, Lee SC. Pharmacologic modulation strategies to reduce dose requirements of anticancer therapy while preserving clinical efficacy. Future Oncol 2012; 8:731-49. [PMID: 22764771 DOI: 10.2217/fon.12.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Drug interactions may be exploited to overcome pharmacokinetic issues in order to improve the therapeutic index of a drug, with clinical goals of reducing the dose of the active drug while preserving efficacy or reducing toxicity. This strategy has been used in infectious disease and transplant medicine, and, more recently, in oncology. Pharmacologic modulation strategies range from coadministration of either a drug that inhibits a metabolizing enzyme that would inactivate the drug of interest, a drug that induces an enzyme that activates the drug of interest or a drug that inhibits transporters that affect the uptake or elimination of the drug of interest. This review will discuss pharmacologic modulation strategies that have been tested clinically in order to increase systemic drug exposure. Important examples include ketoconazole inhibition of hepatic CYP3A4 in order to increase systemic exposure to docetaxel, irinotecan and etoposide, and cyclosporine inhibition of intestinal ATP-binding cassette transporters in order to decrease the toxicity of irinotecan and increase the bioavailability of oral docetaxel, paclitaxel and topotecan.
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Affiliation(s)
- Ying-Kiat Zee
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore
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