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Wagner AJ, Ravi V, Riedel RF, Ganjoo K, Van Tine BA, Chugh R, Cranmer L, Gordon EM, Hornick JL, Du H, Ding L, Schmid AN, Navarro WH, Kwiatkowski DJ, Dickson MA. Phase II Trial of nab-Sirolimus in Patients With Advanced Malignant Perivascular Epithelioid Cell Tumors (AMPECT): Long-Term Efficacy and Safety Update. J Clin Oncol 2024; 42:1472-1476. [PMID: 38427923 PMCID: PMC11095855 DOI: 10.1200/jco.23.02266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/01/2023] [Accepted: 01/04/2024] [Indexed: 03/03/2024] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.nab-Sirolimus is approved in the United States for the treatment of metastatic or locally advanced malignant perivascular epithelioid cell tumor (PEComa) on the basis of the primary analysis results of the phase II Advanced Malignant Perivascular Epithelioid Cell Tumors (AMPECT) trial (ClinicalTrials.gov identifier: NCT02494570). Results from the primary analysis were previously published; however, the median duration of response (mDOR) had not been reached at that time. Here, 3 years after the primary analysis, we report final efficacy and safety data (data cutoff: April 29, 2022). At study completion, the confirmed overall response rate (by independent radiologist review using RECIST v1.1) was 38.7% (95% CI, 21.8 to 57.8), with an additional converted confirmed complete response (n = 2). Median progression-free survival remained the same at 10.6 months (95% CI, 5.5 to 41.2). The mDOR was reached at 39.7 months (95% CI, 6.5 to not reached [NR]), and the median overall survival at completion was 53.1 months (95% CI, 22.2 to NR). The most common treatment-related adverse events (TRAEs) were stomatitis (82.4%) and fatigue and rash (each 61.8%). No new or unexpected adverse events occurred, and no grade ≥4 TRAEs were reported. These results highlight the long-term clinical benefit of nab-sirolimus in patients with advanced malignant PEComa, with a DOR of >3 years.
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Affiliation(s)
- Andrew J. Wagner
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Lee Cranmer
- University of Washington/Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | - Heng Du
- Brigham and Women's Hospital, Boston, MA
| | - Li Ding
- Aadi Bioscience Inc, Pacific Palisades, CA
| | | | | | | | - Mark A. Dickson
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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2
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Gleason CE, Dickson MA, Klein (Dooley) ME, Antonescu CR, Gularte-Mérida R, Benitez M, Delgado JI, Kataru RP, Tan MWY, Bradic M, Adamson TE, Seier K, Richards AL, Palafox M, Chan E, D'Angelo SP, Gounder MM, Keohan ML, Kelly CM, Chi P, Movva S, Landa J, Crago AM, Donoghue MT, Qin LX, Serra V, Turkekul M, Barlas A, Firester DM, Manova-Todorova K, Mehrara BJ, Kovatcheva M, Tan NS, Singer S, Tap WD, Koff A. Therapy-Induced Senescence Contributes to the Efficacy of Abemaciclib in Patients with Dedifferentiated Liposarcoma. Clin Cancer Res 2024; 30:703-718. [PMID: 37695642 PMCID: PMC10870201 DOI: 10.1158/1078-0432.ccr-23-2378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE We conducted research on CDK4/6 inhibitors (CDK4/6i) simultaneously in the preclinical and clinical spaces to gain a deeper understanding of how senescence influences tumor growth in humans. PATIENTS AND METHODS We coordinated a first-in-kind phase II clinical trial of the CDK4/6i abemaciclib for patients with progressive dedifferentiated liposarcoma (DDLS) with cellular studies interrogating the molecular basis of geroconversion. RESULTS Thirty patients with progressing DDLS enrolled and were treated with 200 mg of abemaciclib twice daily. The median progression-free survival was 33 weeks at the time of the data lock, with 23 of 30 progression-free at 12 weeks (76.7%, two-sided 95% CI, 57.7%-90.1%). No new safety signals were identified. Concurrent preclinical work in liposarcoma cell lines identified ANGPTL4 as a necessary late regulator of geroconversion, the pathway from reversible cell-cycle exit to a stably arrested inflammation-provoking senescent cell. Using this insight, we were able to identify patients in which abemaciclib induced tumor cell senescence. Senescence correlated with increased leukocyte infiltration, primarily CD4-positive cells, within a month of therapy. However, those individuals with both senescence and increased TILs were also more likely to acquire resistance later in therapy. These suggest that combining senolytics with abemaciclib in a subset of patients may improve the duration of response. CONCLUSIONS Abemaciclib was well tolerated and showed promising activity in DDLS. The discovery of ANGPTL4 as a late regulator of geroconversion helped to define how CDK4/6i-induced cellular senescence modulates the immune tumor microenvironment and contributes to both positive and negative clinical outcomes. See related commentary by Weiss et al., p. 649.
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Affiliation(s)
- Caroline E. Gleason
- Louis V. Gerstner Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
- Program in Molecular Biology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Mark A. Dickson
- Departments of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Mary E. Klein (Dooley)
- Louis V. Gerstner Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
- Program in Molecular Biology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | | | - Rodrigo Gularte-Mérida
- Department of Surgery, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Marimar Benitez
- Louis V. Gerstner Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
- Program in Molecular Biology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Juliana I. Delgado
- Louis V. Gerstner Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
- Program in Molecular Biology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Raghu P. Kataru
- Department of Plastic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark Wei Yi Tan
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Martina Bradic
- The Marie Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Travis E. Adamson
- Departments of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Kenneth Seier
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allison L. Richards
- Departments of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Marta Palafox
- The Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Eric Chan
- The Molecular Cytology Core Facility, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sandra P. D'Angelo
- Departments of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Mrinal M. Gounder
- Departments of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Mary Louise Keohan
- Departments of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Ciara M. Kelly
- Departments of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Ping Chi
- Departments of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
- Human Oncology and Pathogenesis, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sujana Movva
- Departments of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Jonathan Landa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aimee M. Crago
- Department of Surgery, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Mark T.A. Donoghue
- The Marie Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Li-Xuan Qin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Violetta Serra
- The Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Mesruh Turkekul
- The Molecular Cytology Core Facility, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Afsar Barlas
- The Molecular Cytology Core Facility, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel M. Firester
- Department of Sensory Neuroscience, The Rockefeller University, New York, New York
| | - Katia Manova-Todorova
- The Molecular Cytology Core Facility, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Babak J. Mehrara
- Department of Plastic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marta Kovatcheva
- Program in Molecular Biology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Nguan Soon Tan
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - William D. Tap
- Departments of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Andrew Koff
- Program in Molecular Biology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
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Rosenbaum E, Seier K, Bradic M, Kelly C, Movva S, Nacev BA, Gounder MM, Keohan ML, Avutu V, Chi P, Thornton KA, Chan JE, Dickson MA, Donoghue MT, Tap WD, Qin LX, D'Angelo SP. Immune-related Adverse Events after Immune Checkpoint Blockade-based Therapy Are Associated with Improved Survival in Advanced Sarcomas. Cancer Res Commun 2023; 3:2118-2125. [PMID: 37787759 PMCID: PMC10583739 DOI: 10.1158/2767-9764.crc-22-0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/31/2022] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
The association between immune-related AEs (irAE) and outcome in patients with sarcoma is not known. We retrospectively reviewed a cohort of patients with advanced sarcoma treated with immune checkpoint blockade (ICB)-based therapy. Association of irAEs with survival was assessed using a Cox regression model that incorporated irAE occurrence as a time-dependent covariate. Tumor samples with available RNA sequencing data were stratified by presence of an irAE to identify patterns of differential gene expression. A total of 131 patients were included. Forty-two (32%) had at least one irAE of any grade and 16 (12%) had at least one grade ≥ 3 irAE. The most common irAEs were hypothyroidism (8.3%), arthralgias (5.3%), pneumonitis (4.6%), allergic reaction (3.8%), and elevated transaminases (3.8%). Median progression-free survival (PFS) and overall survival (OS) from the time of study entry were 11.4 [95% confidence interval (CI), 10.7-15.0) and 74.6 weeks (CI, 44.9-89.7), respectively. On Cox analysis adjusting for clinical covariates that were significant in the univariate setting, the HR for an irAE (HR, 0.662; CI, 0.421-1.041) approached, but did not reach statistical significance for PFS (P = 0.074). Patients had a significantly lower HR for OS (HR, 0.443; CI, 0.246-0.798; P = 0.007) compared with those without or before an irAE. Gene expression profiling on baseline tumor samples found that patients who had an irAE had higher numbers of tumor-infiltrating dendritic cells, CD8+ T cells, and regulatory T cells as well as upregulation of immune and inflammatory pathways. SIGNIFICANCE irAE after ICB therapy was associated with an improved OS; it also approached statistical significance for improved PFS. Patients who had an irAE were more likely to have an inflamed tumor microenvironment at baseline.
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Affiliation(s)
- Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Kenneth Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martina Bradic
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ciara Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sujana Movva
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Benjamin A. Nacev
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mrinal M. Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mary L. Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Viswatej Avutu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ping Chi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine A. Thornton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Jason E. Chan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mark A. Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mark T.A. Donoghue
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William D. Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Li-Xuan Qin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sandra P. D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
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4
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Attia S, Villalobos V, Hindi N, Wagner AJ, Chmielowski B, Oakley GJ, Peterson PM, Ceccarelli M, Jones RL, Dickson MA. Randomized Phase 2 Clinical Trial of Olaratumab in Combination with Gemcitabine and Docetaxel in Advanced Soft Tissue Sarcomas. Cancers (Basel) 2023; 15:4871. [PMID: 37835565 PMCID: PMC10572019 DOI: 10.3390/cancers15194871] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/23/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Gemcitabine plus docetaxel is an effective treatment regimen for advanced soft tissue sarcomas (STSs). However, the prognosis for patients remains poor, and thus there is an urgent medical need for novel and effective therapies to improve long-term outcomes. The aim of the ANNOUNCE 2 trial was to explore the addition of olaratumab (O) to gemcitabine (G) and docetaxel (D) for advanced STS. Adults with unresectable locally advanced/metastatic STS, ≤2 prior lines of systemic therapy, and ECOG PS 0-1 were eligible. In Phase 2, patients were randomized 1:1 from two cohorts (O-naïve and O-pretreated) to 21-day cycles of olaratumab (20 mg/kg Cycle 1 and 15 mg/kg other cycles, Days 1 and 8), gemcitabine (900 mg/m2, Days 1 and 8), and docetaxel (75 mg/m2, Day 8). The primary objective was overall survival (OS) in the O-naïve population (α level = 0.20). Secondary endpoints included OS (O-pretreated), other efficacy parameters, patient-reported outcomes, safety, pharmacokinetics, and immunogenicity. A total of 167 and 89 patients were enrolled in the O-naïve and O-pretreated cohorts, respectively. Baseline patient characteristics were well balanced. No statistically significant difference in OS was observed between the investigational vs. control arm for either cohort (O-naïve cohort: HR = 0.95 (95% CI: 0.64-1.40), p = 0.78, median OS, 16.8 vs. 18.0 months; O-pretreated cohort: HR = 0.67 (95% CI: 0.39-1.16), p = 0.15, median OS 19.8 vs. 17.3 months). Safety was manageable across treatment arms. There was no statistically significant difference in the primary endpoint of OS between the two arms in the O-naïve population, and therefore based on hierarchical evaluation no other outcomes in this study can be considered statistically significant. No new safety signals were observed.
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Affiliation(s)
| | - Victor Villalobos
- School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA
| | - Nadia Hindi
- Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
- Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain
- Hospital General de Villalba, 28400 Madrid, Spain
| | - Andrew J. Wagner
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Bartosz Chmielowski
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA 90024, USA;
| | | | | | | | - Robin L. Jones
- Institute of Cancer Research, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - Mark A. Dickson
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Weill Cornell Medical College, New York, NY 10065, USA
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5
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Lebow ES, Lobaugh SM, Zhang Z, Dickson MA, Rosenbaum E, D'Angelo SP, Nacev BA, Shepherd AF, Shaverdian N, Wolden S, Wu AJ, Gelblum DY, Simone CB, Gomez DR, Alektiar K, Tap WD, Rimner A. Stereotactic body radiation therapy for sarcoma pulmonary metastases. Radiother Oncol 2023; 187:109824. [PMID: 37532104 DOI: 10.1016/j.radonc.2023.109824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/20/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND/PURPOSE Stereotactic body radiation therapy (SBRT) is standard for patients with inoperable early-stage NSCLC. We hypothesized that SBRT for sarcoma pulmonary metastases would achieve high rates of local control with acceptable toxicity and that patients with oligometastatic disease may achieve prolonged survival following SBRT. MATERIALS/METHODS This retrospective review included consecutive patients at our institution treated with SBRT for sarcoma pulmonary metastases. Cumulative incidence of local failure (LF) was estimated using a competing risks framework. RESULTS We identified 66 patients treated to 95 pulmonary metastases with SBRT. The median follow-up from the time of SBRT was 36 months (95% CI 34 - 53 months). The cumulative incidence of LF at 12 and 24 months was 3.1% (95% CI 0.9 - 10.6%) and 7.4% (95% CI 4.0% - 13.9%), respectively. The 12- and 24-month overall survival was 74% (95% CI 64 - 86%) and 49% (38 - 63%), respectively. Oligometastatic disease, intrathoracic only disease, and performance status were associated with improved survival on univariable analysis. Three patients had grade 2 pneumonitis, and one patient had grade 2 esophagitis. No patients had ≥ grade 3+ toxicities. CONCLUSION To the best of our knowledge, this is the largest series of patients treated with SBRT for pulmonary sarcoma metastases. We observed that SBRT offers an effective alternative to surgical resection with excellent local control and low proportions of toxicity.
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Affiliation(s)
- Emily S Lebow
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Stephanie M Lobaugh
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.
| | - Zhigang Zhang
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Sandra P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Benjamin A Nacev
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Annemarie F Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Narek Shaverdian
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Suzanne Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Daphna Y Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Charles B Simone
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Kaled Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.
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6
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Kelly CM, Qin LX, Whiting KA, Richards AL, Avutu V, Chan JE, Chi P, Dickson MA, Gounder MM, Keohan ML, Movva S, Nacev BA, Rosenbaum E, Adamson T, Singer S, Bartlett EK, Crago AM, Yoon SS, Hwang S, Erinjeri JP, Antonescu CR, Tap WD, D’Angelo SP. A Phase II Study of Epacadostat and Pembrolizumab in Patients with Advanced Sarcoma. Clin Cancer Res 2023; 29:2043-2051. [PMID: 36971773 PMCID: PMC10752758 DOI: 10.1158/1078-0432.ccr-22-3911] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/15/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Epacadostat, an indole 2,3 dioxygenase 1 (IDO1) inhibitor, proposed to shift the tumor microenvironment toward an immune-stimulated state, showed early promise in melanoma but has not been studied in sarcoma. This study combined epacadostat with pembrolizumab, which has modest activity in select sarcoma subtypes. PATIENTS AND METHODS This phase II study enrolled patients with advanced sarcoma into five cohorts including (i) undifferentiated pleomorphic sarcoma (UPS)/myxofibrosarcoma, (ii) liposarcoma (LPS), (iii) leiomyosarcoma (LMS), (iv) vascular sarcoma, including angiosarcoma and epithelioid hemangioendothelioma (EHE), and (v) other subtypes. Patients received epacadostat 100 mg twice daily plus pembrolizumab at 200 mg/dose every 3 weeks. The primary endpoint was best objective response rate (ORR), defined as complete response (CR) and partial response (PR), at 24 weeks by RECIST v.1.1. RESULTS Thirty patients were enrolled [60% male; median age 54 years (range, 24-78)]. The best ORR at 24 weeks was 3.3% [PR, n = 1 (leiomyosarcoma); two-sided 95% CI, 0.1%-17.2%]. The median PFS was 7.6 weeks (two-sided 95% CI, 6.9-26.7). Treatment was well tolerated. Grade 3 treatment-related adverse events occurred in 23% (n = 7) of patients. In paired pre- and post-treatment tumor samples, no association was found between treatment and PD-L1 or IDO1 tumor expression or IDO-pathway-related gene expression by RNA sequencing. No significant changes in serum tryptophan or kynurenine levels were observed after baseline. CONCLUSIONS Combination epacadostat and pembrolizumab was well tolerated and showed limited antitumor activity in sarcoma. Correlative analyses suggested that inadequate IDO1 inhibition was achieved.
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Affiliation(s)
- Ciara M. Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Weill Cornell Medical College
| | - Li-Xuan Qin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Karissa A. Whiting
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Allison L. Richards
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center
| | - Viswatej Avutu
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Weill Cornell Medical College
| | - Jason E. Chan
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Weill Cornell Medical College
| | - Ping Chi
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Weill Cornell Medical College
| | - Mark A. Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Weill Cornell Medical College
| | - Mrinal M. Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Weill Cornell Medical College
| | - Mary Louise Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Weill Cornell Medical College
| | - Sujana Movva
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Weill Cornell Medical College
| | - Benjamin A. Nacev
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Weill Cornell Medical College
| | - Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Weill Cornell Medical College
| | - Travis Adamson
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Sam Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center
| | | | - Aimee M. Crago
- Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Sam S. Yoon
- Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center
| | | | | | - William D. Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Weill Cornell Medical College
| | - Sandra P. D’Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Department of Medicine, Weill Cornell Medical College
- Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center
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7
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Linos K, Dermawan JK, Bale T, Rosenblum MK, Singer S, Tap W, Dickson MA, Hornick JL, Antonescu CR. Expanding the Molecular Diversity of CIC-Rearranged Sarcomas With Novel and Very Rare Partners. Mod Pathol 2023; 36:100103. [PMID: 36788092 PMCID: PMC10324473 DOI: 10.1016/j.modpat.2023.100103] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
Capicua transcriptional repressor (CIC)-rearranged sarcoma represents a distinct pathologic entity and constitutes the second most prevalent category of undifferentiated round cell sarcomas (URCSs) after Ewing sarcoma. The 2 most common translocations are t(4;19) and t(10;19), resulting in CIC fusions with either DUX4 and DUX4L paralog, respectively; however, other rare variant fusions have also been reported. In this study, we expand the molecular spectrum of CIC-gene partners, reporting on 5 cases of URCSs showing CIC fusions with AXL, CITED1, SYK, and LEUTX by targeted RNA or DNA sequencing. There were 4 female patients and 1 male patient with a wide age range (12-70 years; median, 36 years). Four cases occurred in the deep soft tissues (lower extremity, 3; neck, 1) and 1 case in the central nervous system (midbrain/thalamus). All cases showed similar histologic findings within the spectrum of URCSs. Immunohistochemistry, showed variable positivity for ETV4 in 4 of the 4 cases and positive results for ERG in 3 of the 4 cases and for WT1 in 1 of the 4 cases. CD31 showed positivity in 2 of the 3 cases, including one coexpressing ERG. Unsupervised clustering of methylation profiles by T-distributed stochastic neighborhood embedding performed in 4 cases showed that all clustered tightly together and along the CIC sarcoma methylation class. RNA-sequencing data showed consistent upregulation of ETV1 and ETV4 mRNA in all cases examined, at similar levels to CIC::DUX4 URCSs. Our study expands the molecular diversity of CIC-rearranged URCSs to include novel and rare partners, providing morphologic, immunohistochemical, gene expression, and methylation evidence supporting their classification within the family of tumors harboring the more common DUX4/DUX4L partner genes.
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Affiliation(s)
- Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Josephine K Dermawan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tejus Bale
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc K Rosenblum
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William Tap
- Department of Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark A Dickson
- Department of Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jason L Hornick
- Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cristina R Antonescu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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8
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Gu L, Lin E, Liu S, Yang N, Kurtansky N, Neumann N, Stoll J, Lezcano C, Pulitzer M, Noor S, Markova A, Rossi A, Dickson MA, Deng L. Efficacy of immunotherapy with combination of cryotherapy and topical imiquimod for treatment of Kaposi sarcoma. J Med Virol 2023; 95:e28396. [PMID: 36504005 PMCID: PMC10461380 DOI: 10.1002/jmv.28396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Multiple treatment modalities for Kaposi sarcoma (KS) have been reported, including chemotherapy, radiation therapy, surgical excision, electrochemotherapy, and cryotherapy. Common topical treatments include timolol, imiquimod, and alitretinoin. We searched our institutional database for patients with ICD-9 or 10 codes for KS seen by a dermatologist with experience in KS management from July 1, 2004 to January 1, 2022. We screened patient charts to include patients who received combination therapy of cryotherapy followed by topical imiquimod three times a week for 2 months (n = 9). Patients were followed in the clinic every 3 months. Time to resolution was assessed by photographic evidence of resolution as determined by a dermatologist and corroborated with clinical documentation in patient charts. Median age (IQR) at KS diagnosis was 58 (27.5) years. All patients were male (n = 9, 100%). Majority were white (n = 7, 78%) and non-Hispanic (n = 8, 89%). Five (56%) had classic KS, one (11%) had HIV-associated KS, and three (33%) were HIV-negative men who have sex with men. Median time to resolution was 30.5 weeks, with a median of two treatments. In our study, 93% (n = 42/45) of lesions and 89% (n = 8/9) of patients experienced complete resolution during a median (range) duration of follow-up of 58 (13-209) weeks. Side effects were limited to pain during cryotherapy, occasional blister formation after cryotherapy, and mild inflammation due to imiquimod. No infections were observed. Combination therapy of cryotherapy and topical imiquimod may be an efficacious and comparatively low-risk treatment for limited, cutaneous KS.
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Affiliation(s)
- Lilly Gu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10065
| | - Erica Lin
- Warren Alpert Medical School of Brown University, Providence, RI 02903
| | - Shuaitong Liu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ning Yang
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Nicholas Kurtansky
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Neil Neumann
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Joseph Stoll
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10065
| | - Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sarah Noor
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Anthony Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mark A. Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Liang Deng
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10065
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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9
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Gounder MM, Razak AA, Somaiah N, Chawla S, Martin-Broto J, Grignani G, Schuetze SM, Vincenzi B, Wagner AJ, Chmielowski B, Jones RL, Riedel RF, Stacchiotti S, Loggers ET, Ganjoo KN, Le Cesne A, Italiano A, Garcia del Muro X, Burgess M, Piperno-Neumann S, Ryan C, Mulcahy MF, Forscher C, Penel N, Okuno S, Elias A, Hartner L, Philip T, Alcindor T, Kasper B, Reichardt P, Lapeire L, Blay JY, Chevreau C, Valverde Morales CM, Schwartz GK, Chen JL, Deshpande H, Davis EJ, Nicholas G, Gröschel S, Hatcher H, Duffaud F, Herráez AC, Beveridge RD, Badalamenti G, Eriksson M, Meyer C, von Mehren M, Van Tine BA, Götze K, Mazzeo F, Yakobson A, Zick A, Lee A, Gonzalez AE, Napolitano A, Dickson MA, Michel D, Meng C, Li L, Liu J, Ben-Shahar O, Van Domelen DR, Walker CJ, Chang H, Landesman Y, Shah JJ, Shacham S, Kauffman MG, Attia S. Selinexor in Advanced, Metastatic Dedifferentiated Liposarcoma: A Multinational, Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Oncol 2022; 40:2479-2490. [PMID: 35394800 PMCID: PMC9467680 DOI: 10.1200/jco.21.01829] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/23/2021] [Accepted: 02/08/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Antitumor activity in preclinical models and a phase I study of patients with dedifferentiated liposarcoma (DD-LPS) was observed with selinexor. We evaluated the clinical benefit of selinexor in patients with previously treated DD-LPS whose sarcoma progressed on approved agents. METHODS SEAL was a phase II-III, multicenter, randomized, double-blind, placebo-controlled study. Patients age 12 years or older with advanced DD-LPS who had received two-five lines of therapy were randomly assigned (2:1) to selinexor (60 mg) or placebo twice weekly in 6-week cycles (crossover permitted). The primary end point was progression-free survival (PFS). Patients who received at least one dose of study treatment were included for safety analysis (ClinicalTrials.gov identifier: NCT02606461). RESULTS Two hundred eighty-five patients were enrolled (selinexor, n = 188; placebo, n = 97). PFS was significantly longer with selinexor versus placebo: hazard ratio (HR) 0.70 (95% CI, 0.52 to 0.95; one-sided P = .011; medians 2.8 v 2.1 months), as was time to next treatment: HR 0.50 (95% CI, 0.37 to 0.66; one-sided P < .0001; medians 5.8 v 3.2 months). With crossover, no difference was observed in overall survival. The most common treatment-emergent adverse events of any grade versus grade 3 or 4 with selinexor were nausea (151 [80.7%] v 11 [5.9]), decreased appetite (113 [60.4%] v 14 [7.5%]), and fatigue (96 [51.3%] v 12 [6.4%]). Four (2.1%) and three (3.1%) patients died in the selinexor and placebo arms, respectively. Exploratory RNA sequencing analysis identified that the absence of CALB1 expression was associated with longer PFS with selinexor compared with placebo (median 6.9 v 2.2 months; HR, 0.19; P = .001). CONCLUSION Patients with advanced, refractory DD-LPS showed improved PFS and time to next treatment with selinexor compared with placebo. Supportive care and dose reductions mitigated side effects of selinexor. Prospective validation of CALB1 expression as a predictive biomarker for selinexor in DD-LPS is warranted.
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Affiliation(s)
- Mrinal M. Gounder
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | - Neeta Somaiah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO—IRCCS, Candiolo, Torino, Italy
| | | | - Bruno Vincenzi
- Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | | | | | - Robin L. Jones
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | | | | | | | | | | | - Melissa Burgess
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA
| | | | | | - Mary F. Mulcahy
- The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - Nicolas Penel
- Centre Oscar Lambret and Lille University, Lille, France
| | | | | | - Lee Hartner
- University of Pennsylvania, Philadelphia, PA
| | - Tony Philip
- Northwell Health Physician Partners, New Hyde Park, NY
| | | | - Bernd Kasper
- Mannheim University Medical Center, Mannheim, Germany
| | | | | | | | | | | | | | | | | | | | | | - Stefan Gröschel
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Heidelberg, Germany
| | - Helen Hatcher
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Florence Duffaud
- La Timone University Hospital Center and Aix-Marseille University, Marseille, France
| | | | | | - Giuseppe Badalamenti
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | | | | | | | | | - Katharina Götze
- Klinik und Poliklinik für Innere Medizin III, Hämatologie und Onkologie Klinikum rechts der Isar der TU Muenchen, Marburg, Germany
| | | | | | - Aviad Zick
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; The Oncology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Alexander Lee
- The Christie NHS Foundation, Manchester, United Kingdom
| | - Anna Estival Gonzalez
- Catalan Institute of Oncology (ICO) Germans Trias I Pujol University Hospital, B-ARGO, Barcelona, Spain
| | | | - Mark A. Dickson
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | | | - Hua Chang
- Karyopharm Therapeutics Inc, Newton, MA
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10
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D'Angelo SP, Richards AL, Conley AP, Woo HJ, Dickson MA, Gounder M, Kelly C, Keohan ML, Movva S, Thornton K, Rosenbaum E, Chi P, Nacev B, Chan JE, Slotkin EK, Kiesler H, Adamson T, Ling L, Rao P, Patel S, Livingston JA, Singer S, Agaram NP, Antonescu CR, Koff A, Erinjeri JP, Hwang S, Qin LX, Donoghue MTA, Tap WD. Pilot study of bempegaldesleukin in combination with nivolumab in patients with metastatic sarcoma. Nat Commun 2022; 13:3477. [PMID: 35710741 PMCID: PMC9203519 DOI: 10.1038/s41467-022-30874-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/23/2022] [Indexed: 12/15/2022] Open
Abstract
PD-1 blockade (nivolumab) efficacy remains modest for metastatic sarcoma. In this paper, we present an open-label, non-randomized, non-comparative pilot study of bempegaldesleukin, a CD122-preferential interleukin-2 pathway agonist, with nivolumab in refractory sarcoma at Memorial Sloan Kettering/MD Anderson Cancer Centers (NCT03282344). We report on the primary outcome of objective response rate (ORR) and secondary endpoints of toxicity, clinical benefit, progression-free survival, overall survival, and durations of response/treatment. In 84 patients in 9 histotype cohorts, all patients experienced ≥1 adverse event and treatment-related adverse event; 1 death was possibly treatment-related. ORR was highest in angiosarcoma (3/8) and undifferentiated pleomorphic sarcoma (2/10), meeting predefined endpoints. Results of our exploratory investigation of predictive biomarkers show: CD8 + T cell infiltrates and PD-1 expression correlate with improved ORR; upregulation of immune-related pathways correlate with improved efficacy; Hedgehog pathway expression correlate with resistance. Exploration of this combination in selected sarcomas, and of Hedgehog signaling as a predictive biomarker, warrants further study in larger cohorts.
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Affiliation(s)
- Sandra P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA.
- Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
| | - Allison L Richards
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Anthony P Conley
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hyung Jun Woo
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Mrinal Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Ciara Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Mary Louise Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Sujana Movva
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Katherine Thornton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Ping Chi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Benjamin Nacev
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
- Laboratory of Chromatin Biology and Epigenetics, The Rockefeller University, New York City, NY, USA
| | - Jason E Chan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Emily K Slotkin
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Hannah Kiesler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Travis Adamson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Lilan Ling
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Pavitra Rao
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Shreyaskumar Patel
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jonathan A Livingston
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Narasimhan P Agaram
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Andrew Koff
- Program in Molecular Biology, Memorial Sloan Kettering Cancer, New York City, NY, USA
| | - Joseph P Erinjeri
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Li-Xuan Qin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Mark T A Donoghue
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
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11
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Nacev BA, Sanchez-Vega F, Smith SA, Antonescu CR, Rosenbaum E, Shi H, Tang C, Socci ND, Rana S, Gularte-Mérida R, Zehir A, Gounder MM, Bowler TG, Luthra A, Jadeja B, Okada A, Strong JA, Stoller J, Chan JE, Chi P, D'Angelo SP, Dickson MA, Kelly CM, Keohan ML, Movva S, Thornton K, Meyers PA, Wexler LH, Slotkin EK, Glade Bender JL, Shukla NN, Hensley ML, Healey JH, La Quaglia MP, Alektiar KM, Crago AM, Yoon SS, Untch BR, Chiang S, Agaram NP, Hameed MR, Berger MF, Solit DB, Schultz N, Ladanyi M, Singer S, Tap WD. Clinical sequencing of soft tissue and bone sarcomas delineates diverse genomic landscapes and potential therapeutic targets. Nat Commun 2022; 13:3405. [PMID: 35705560 PMCID: PMC9200818 DOI: 10.1038/s41467-022-30453-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/02/2022] [Indexed: 02/02/2023] Open
Abstract
The genetic, biologic, and clinical heterogeneity of sarcomas poses a challenge for the identification of therapeutic targets, clinical research, and advancing patient care. Because there are > 100 sarcoma subtypes, in-depth genetic studies have focused on one or a few subtypes. Herein, we report a comparative genetic analysis of 2,138 sarcomas representing 45 pathological entities. This cohort is prospectively analyzed using targeted sequencing to characterize subtype-specific somatic alterations in targetable pathways, rates of whole genome doubling, mutational signatures, and subtype-agnostic genomic clusters. The most common alterations are in cell cycle control and TP53, receptor tyrosine kinases/PI3K/RAS, and epigenetic regulators. Subtype-specific associations include TERT amplification in intimal sarcoma and SWI/SNF alterations in uterine adenosarcoma. Tumor mutational burden, while low compared to other cancers, varies between and within subtypes. This resource will improve sarcoma models, motivate studies of subtype-specific alterations, and inform investigations of genetic factors and their correlations with treatment response.
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Affiliation(s)
- Benjamin A Nacev
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA
- The Laboratory of Chromatin Biology and Epigenetics, The Rockefeller University, New York, 10065, NY, USA
| | - Francisco Sanchez-Vega
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Shaleigh A Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Hongyu Shi
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Cerise Tang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Physiology, Biophysics and Systems Biology Graduate Program, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Nicholas D Socci
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Bioinformatics Core, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Satshil Rana
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | | | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Mrinal M Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Timothy G Bowler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Anisha Luthra
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Bhumika Jadeja
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Azusa Okada
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Jonathan A Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Jake Stoller
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Jason E Chan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Ping Chi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Sandra P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Ciara M Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Mary Louise Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Sujana Movva
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Katherine Thornton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Paul A Meyers
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Leonard H Wexler
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Emily K Slotkin
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Julia L Glade Bender
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Neerav N Shukla
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Martee L Hensley
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA
| | - John H Healey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Michael P La Quaglia
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Surgery, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Aimee M Crago
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Surgery, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Sam S Yoon
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Surgery, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Brian R Untch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Surgery, Weill Cornell Medical College, New York, 10065, NY, USA
| | - Sarah Chiang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Narasimhan P Agaram
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Meera R Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Michael F Berger
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - David B Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Nikolaus Schultz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA.
- Department of Surgery, Weill Cornell Medical College, New York, 10065, NY, USA.
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, 10065, NY, USA.
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12
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Gounder MM, Agaram NP, Trabucco SE, Robinson V, Ferraro RA, Millis SZ, Krishnan A, Lee J, Attia S, Abida W, Drilon A, Chi P, Angelo SPD, Dickson MA, Keohan ML, Kelly CM, Agulnik M, Chawla SP, Choy E, Chugh R, Meyer CF, Myer PA, Moore JL, Okimoto RA, Pollock RE, Ravi V, Singh AS, Somaiah N, Wagner AJ, Healey JH, Frampton GM, Venstrom JM, Ross JS, Ladanyi M, Singer S, Brennan MF, Schwartz GK, Lazar AJ, Thomas DM, Maki RG, Tap WD, Ali SM, Jin DX. Clinical genomic profiling in the management of patients with soft tissue and bone sarcoma. Nat Commun 2022; 13:3406. [PMID: 35705558 PMCID: PMC9200814 DOI: 10.1038/s41467-022-30496-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/04/2022] [Indexed: 02/07/2023] Open
Abstract
There are more than 70 distinct sarcomas, and this diversity complicates the development of precision-based therapeutics for these cancers. Prospective comprehensive genomic profiling could overcome this challenge by providing insight into sarcomas' molecular drivers. Through targeted panel sequencing of 7494 sarcomas representing 44 histologies, we identify highly recurrent and type-specific alterations that aid in diagnosis and treatment decisions. Sequencing could lead to refinement or reassignment of 10.5% of diagnoses. Nearly one-third of patients (31.7%) harbor potentially actionable alterations, including a significant proportion (2.6%) with kinase gene rearrangements; 3.9% have a tumor mutational burden ≥10 mut/Mb. We describe low frequencies of microsatellite instability (<0.3%) and a high degree of genome-wide loss of heterozygosity (15%) across sarcomas, which are not readily explained by homologous recombination deficiency (observed in 2.5% of cases). In a clinically annotated subset of 118 patients, we validate actionable genetic events as therapeutic targets. Collectively, our findings reveal the genetic landscape of human sarcomas, which may inform future development of therapeutics and improve clinical outcomes for patients with these rare cancers.
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Affiliation(s)
- Mrinal M Gounder
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Weill Cornell Medical College, New York, NY, USA.
| | | | | | | | - Richard A Ferraro
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | - Anita Krishnan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica Lee
- Foundation Medicine, Inc., Cambridge, MA, USA
| | | | - Wassim Abida
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Alexander Drilon
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Ping Chi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Sandra P D' Angelo
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Mark A Dickson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Mary Lou Keohan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Ciara M Kelly
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | - Sant P Chawla
- Sarcoma Center of Santa Monica, Santa Monica, CA, USA
| | - Edwin Choy
- Massachusetts General Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Christian F Meyer
- Johns Hopkins Sidney Kimmel Comprehensive Center, Baltimore, MD, USA
| | - Parvathi A Myer
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Ross A Okimoto
- University of California at San Francisco, San Francisco, CA, USA
| | | | - Vinod Ravi
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arun S Singh
- University of California at Los Angeles, Los Angeles, CA, USA
| | - Neeta Somaiah
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Wagner
- Harvard Medical School, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - John H Healey
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Jeffrey S Ross
- Foundation Medicine, Inc., Cambridge, MA, USA
- Albany Medical College, Albany, NY, USA
| | - Marc Ladanyi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samuel Singer
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Murray F Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Gary K Schwartz
- Herbert Irving Cancer Center, Columbia University, New York, NY, USA
| | | | - David M Thomas
- Garvan Institute of Medical Research, Darlinghurst,, NSW, Australia
| | - Robert G Maki
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - William D Tap
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Siraj M Ali
- Foundation Medicine, Inc., Cambridge, MA, USA
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13
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Chi P, Qin LX, Camacho N, Kelly CM, D'Angelo SP, Dickson MA, Gounder MM, Keohan ML, Movva S, Nacev BA, Rosenbaum E, Thornton KA, Crago AM, Francis JH, Martindale M, Phelan HT, Biniakewitz MD, Lee CJ, Singer S, Hwang S, Berger MF, Chen Y, Antonescu CR, Tap WD. Phase Ib Trial of the Combination of Imatinib and Binimetinib in Patients with Advanced Gastrointestinal Stromal Tumors. Clin Cancer Res 2022; 28:1507-1517. [PMID: 35110417 PMCID: PMC9012681 DOI: 10.1158/1078-0432.ccr-21-3909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/06/2022] [Accepted: 01/31/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE This phase Ib trial was designed to evaluate the safety and early efficacy signal of the combination of imatinib and binimetinib in patients with imatinib-resistant advanced gastrointestinal stromal tumors (GISTs). PATIENTS AND METHODS This trial used a standard 3 + 3 design to determine the recommended phase II dose (RP2D). Additional patients were enrolled on an expansion cohort at the RP2D enriching for succinate dehydrogenase (SDH)-deficient GISTs to explore potential efficacy. RESULTS The trial enrolled nine patients in the dose-escalation cohort and 14 in the dose-expansion cohort including six with SDH-deficient GISTs. Imatinib 400 mg daily with binimetinib 45 mg twice daily was established as the RP2D. Dose-limiting toxicity (DLT) was asymptomatic grade 4 creatinine phosphokinase (CPK) elevation. The most common non-DLT grade 3/4 toxicity was asymptomatic CPK elevation (69.6%). Other common ≥grade 2 toxicities included peripheral edema (17.4%), acneiform rash (21.7%), anemia (30.4%), hypophosphatemia (39.1%), and aspartate aminotransferase (AST) increase (17.4%). Two serious adverse events occurred (grade 2 dropped head syndrome and grade 3 central retinal vein occlusion). No unexpected toxicities were observed. Limited clinical activity was observed in KIT-mutant GIST. For SDH-deficient GISTs, one of five had confirmed RECIST1.1 partial response (PR). The median progression-free survival (mPFS) in patients with SDH-deficient GIST was 45.1 months [95% confidence interval (CI), 15.8-not estimable (NE)]; the median overall survival (mOS) was not reached (95% CI, 31.6 months-NE). One patient with a refractory metastatic SDH-deficient GIST had an exceptional pathologic response and durable clinical benefit. CONCLUSIONS The combination of imatinib and binimetinib is safe with manageable toxicity and has encouraging activity in SDH-deficient but not imatinib-refractory KIT/PDGFRA-mutant GISTs. The observed clinical benefits provide a motivation for a larger trial of the combination strategy in SDH-deficient GISTs.
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Affiliation(s)
- Ping Chi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Li-Xuan Qin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Niedzica Camacho
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ciara M. Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sandra P. D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mark A. Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mrinal M. Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mary L. Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sujana Movva
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Benjamin A. Nacev
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Katherine A. Thornton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Aimee M. Crago
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | - Jasmine H. Francis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York
| | - Moriah Martindale
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Haley T. Phelan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Cindy J. Lee
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael F. Berger
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yu Chen
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | | | - William D. Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
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14
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Rosenbaum E, Antonescu CR, Smith S, Bradic M, Kashani D, Richards AL, Donoghue M, Kelly CM, Nacev B, Chan JE, Chi P, Dickson MA, Keohan ML, Gounder MM, Movva S, Avutu V, Thornton K, Zehir A, Bowman AS, Singer S, Tap W, D'Angelo S. Clinical, genomic, and transcriptomic correlates of response to immune checkpoint blockade-based therapy in a cohort of patients with angiosarcoma treated at a single center. J Immunother Cancer 2022; 10:jitc-2021-004149. [PMID: 35365586 PMCID: PMC8977792 DOI: 10.1136/jitc-2021-004149] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Accepted: 03/12/2022] [Indexed: 12/15/2022] Open
Abstract
Background Angiosarcoma is a histologically and molecularly heterogeneous vascular neoplasm with aggressive clinical behavior. Emerging data suggests that immune checkpoint blockade (ICB) is efficacious against some angiosarcomas, particularly cutaneous angiosarcoma of the head and neck (CHN). Methods Patients with histologically confirmed angiosarcoma treated with ICB-based therapy at a comprehensive cancer center were retrospectively identified. Clinical characteristics and the results of targeted exome sequencing, transcriptome sequencing, and immunohistochemistry analyses were examined for correlation with clinical benefit. Durable clinical benefit was defined as a progression-free survival (PFS) of ≥16 weeks. Results For the 35 patients included in the analyses, median PFS and median overall survival (OS) from the time of first ICB-based treatment were 11.9 (95% CI 7.4 to 31.9) and 42.5 (95% CI 19.6 to 114.2) weeks, respectively. Thirteen patients (37%) had PFS ≥16 weeks. Clinical factors associated with longer PFS and longer OS in multivariate analyses were ICB plus other therapy regimens, CHN disease, and white race. Three of 10 patients with CHN angiosarcoma evaluable for tumor mutational burden (TMB) had a TMB ≥10. Five of six patients with CHN angiosarcoma evaluable for mutational signature analysis had a dominant mutational signature associated with ultraviolet (UV) light. No individual gene or genomic pathway was significantly associated with PFS or OS; neither were TMB or UV signature status. Analyses of whole transcriptomes from nine patient tumor samples found upregulation of angiogenesis, inflammatory response, and KRAS signaling pathways, among others, in patients with PFS ≥16 weeks, as well as higher levels of cytotoxic T cells, dendritic cells, and natural killer cells. Patients with PFS <16 weeks had higher numbers of cancer-associated fibroblasts. Immunohistochemistry findings for 12 patients with baseline samples available suggest that neither PD-L1 expression nor presence of tumor-infiltrating lymphocytes at baseline appears necessary for a response to ICB-based therapy. Conclusions ICB-based therapy benefits only a subset of angiosarcoma patients. Patients with CHN angiosarcoma are more likely to have PFS ≥16 weeks, a dominant UV mutational signature, and higher TMB than angiosarcomas arising from other primary sites. However, clinical benefit was seen in other angiosarcomas also and was not restricted to tumors with a high TMB, a dominant UV signature, PD-L1 expression, or presence of tumor infiltrating lymphocytes at baseline.
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Affiliation(s)
- Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA .,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Shaleigh Smith
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martina Bradic
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel Kashani
- Department of Medicine, SUNY Downstate Medical Center, New York City, New York, USA
| | - Allison L Richards
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark Donoghue
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ciara M Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Benjamin Nacev
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Jason E Chan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Ping Chi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Mary L Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Mrinal M Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Sujana Movva
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Viswatej Avutu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Katherine Thornton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Anita S Bowman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - William Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Sandra D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York City, New York, USA
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15
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Chi P, Qin LX, Nguyen B, Kelly CM, D'Angelo SP, Dickson MA, Gounder MM, Keohan ML, Movva S, Nacev BA, Rosenbaum E, Thornton KA, Crago AM, Yoon S, Ulaner G, Yeh R, Martindale M, Phelan HT, Biniakewitz MD, Warda S, Lee CJ, Berger MF, Schultz ND, Singer S, Hwang S, Chen Y, Antonescu CR, Tap WD. Phase II Trial of Imatinib Plus Binimetinib in Patients With Treatment-Naive Advanced Gastrointestinal Stromal Tumor. J Clin Oncol 2022; 40:997-1008. [PMID: 35041493 PMCID: PMC8937014 DOI: 10.1200/jco.21.02029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/30/2021] [Accepted: 12/14/2021] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Dual targeting of the gastrointestinal stromal tumor (GIST) lineage-specific master regulators, ETV1 and KIT, by MEK and KIT inhibitors were synergistic preclinically and may enhance clinical efficacy. This trial was designed to test the efficacy and safety of imatinib plus binimetinib in first-line treatment of GIST. METHODS In this trial (NCT01991379), treatment-naive adult patients with confirmed advanced GISTs received imatinib (400 mg once daily) plus binimetinib (30 mg twice daily), 28-day cycles. The primary end point was RECIST1.1 best objective response rate (ORR; complete response plus partial response [PR]). The study was designed to detect a 20% improvement in the ORR over imatinib alone (unacceptable rate of 45%; acceptable rate of 65%), using an exact binomial test, one-sided type I error of 0.08 and type II error of 0.1, and a planned sample size of 44 patients. Confirmed PR or complete response in > 24 patients are considered positive. Secondary end points included Choi and European Organisation for Research and Treatment of Cancer Response Rate, progression-free survival (PFS), overall survival (OS), pathologic responses, and toxicity. RESULTS Between September 15, 2014, and November 15, 2020, 29 of 42 evaluable patients with advanced GIST had confirmed RECIST1.1 PR. The best ORR was 69.0% (two-sided 95% CI, 52.9 to 82.4). Thirty-nine of 41 (95.1%) had Choi PR approximately 8 weeks. Median PFS was 29.9 months (95% CI, 24.2 to not estimable); median OS was not reached (95% CI, 50.4 to not estimable). Five of eight patients with locally advanced disease underwent surgery after treatment and achieved significant pathologic response (≥ 90% treatment effect). There were no unexpected toxicities. Grade 3 and 4 toxicity included asymptomatic creatinine phosphokinase elevation (79.1%), hypophosphatemia (14.0%), neutrophil decrease (9.3%), maculopapular rash (7.0%), and anemia (7.0%). CONCLUSION The study met the primary end point. The combination of imatinib and binimetinib is effective with manageable toxicity and warrants further evaluation in direct comparison with imatinib in frontline treatment of GIST.
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Affiliation(s)
- Ping Chi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Li-Xuan Qin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bastien Nguyen
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
- Marie-José and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ciara M. Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Sandra P. D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Mark A. Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Mrinal M. Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Mary L. Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Sujana Movva
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Benjamin A. Nacev
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Katherine A. Thornton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Aimee M. Crago
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Sam Yoon
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Gary Ulaner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA
| | - Randy Yeh
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA
| | - Moriah Martindale
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Haley T. Phelan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Sarah Warda
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Cindy J. Lee
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael F. Berger
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
- Marie-José and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nikolaus D. Schultz
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
- Marie-José and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yu Chen
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - William D. Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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16
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Gounder MM, Rosenbaum E, Wu N, Dickson MA, Sheikh TN, D'Angelo SP, Chi P, Keohan ML, Erinjeri JP, Antonescu CR, Agaram N, Hameed MR, Martindale M, Lefkowitz RA, Crago AM, Singer S, Tap WD, Takebe N, Qin LX, Schwartz GK. A Phase Ib/II Randomized Study of RO4929097, a Gamma Secretase or Notch Inhibitor with or without Vismodegib, a Hedgehog Inhibitor, in Advanced Sarcoma. Clin Cancer Res 2022; 28:1586-1594. [PMID: 35110418 DOI: 10.1158/1078-0432.ccr-21-3874] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/17/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Because the Hedgehog and Notch pathways are often overexpressed in mesenchymal malignancies, we evaluated the efficacy of concurrent inhibition of Notch and Hedgehog signaling using the gamma secretase inhibitor (GSI) RO4929097 and the smoothened antagonist vismodegib in unresectable or metastatic sarcoma. PATIENTS AND METHODS In this investigator-initiated trial, phase 1b employed standard 3+3 dose-escalation in which patients first received vismodegib once daily for 21 days, followed by the combination of RO4929097 concurrently with vismodegib in 21-day cycles. In phase II, patients were randomized to RO4929097 alone or in combination with vismodegib. RESULTS Nine patients were treated in phase Ib with no dose-limiting toxicities. RO4929097 at 15 mg daily in combination with 150 mg daily of vismodegib was declared the recommended phase 2 dose. Most adverse events (AEs) were grade {less than or equal to} 2. In phase II (closed early due to discontinuation of RO4929097 evaluation), 34 patients were randomized to RO4929097 alone and 33 to RO4929097 plus vismodegib. RO4929097 did not interfere with the steady-state concentration of vismodegib, while vismodegib reduced the plasma concentration of RO492909. No patients had an objective response. Neither progression-free nor overall survival differed significantly between treatment arms. Paired tumor biopsies from a subset of patients demonstrated inhibition of cleaved Notch. CONCLUSIONS The combination of RO4929097 plus vismodegib was generally well tolerated. Although accrual to this study was not completed, vismodegib did not meaningfully enhance the clinical efficacy of RO4929097 in an unplanned analysis. GSIs and GSIs plus vismodegib can inhibit intratumoral Notch and downstream pAkt signaling.
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Affiliation(s)
- Mrinal M Gounder
- Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College
| | | | | | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Tahir N Sheikh
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center
| | - Sandra P D'Angelo
- Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College
| | - Ping Chi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center
| | | | | | | | | | - Meera R Hameed
- Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College
| | | | | | - Aimee M Crago
- Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center
| | | | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College
| | - Naoko Takebe
- Early Clinical Trials Development Program, DCTD, NCI/NIH
| | - Li-Xuan Qin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
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17
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Klemen ND, Hwang S, Bradic M, Rosenbaum E, Dickson MA, Gounder MM, Kelly CM, Keohan ML, Movva S, Thornton KA, Chi P, Nacev BA, Chan JE, Bartlett EK, Richards AL, Singer S, Donoghue MTA, Tap WD, D'Angelo SP. Long term follow-up and patterns of response, progression and hyperprogression in patients after PD-1 blockade in advanced sarcoma. Clin Cancer Res 2021; 28:939-947. [PMID: 34965948 DOI: 10.1158/1078-0432.ccr-21-3445] [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: 09/23/2021] [Revised: 11/23/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE PD-1 blockade can mediate objective responses in advanced sarcomas, but their durability has not been established and it is unclear if hyperprogressive disease (HPD) occurs in sarcomas treated with PD-1 inhibitors. METHODS We pooled patients who were treated prospectively with nivolumab or pembrolizumab as monotherapy or with bempegaldesleukin, epacadostat, ipilimumab or Talimogene laherparepvec. We did a new independent assessment for HPD and analyzed clinical, pathologic and genomic data from baseline tumor biopsies. Our primary endpoint was the incidence of HPD; secondary endpoints were clinical or genomic correlates of response or HPD. RESULTS We treated 134 patients with advanced sarcoma from 2015 - 2019. Twenty-one patients (16%) had a complete or partial response (CR/PR), and 30% of responses were durable for over 2 years. Forty-eight (36%) patients had stable disease (SD), 45 (34%) had progressive disease without HPD (PD) and 15 (11%) had HPD. Five patients (4%) were not evaluable for HPD. The sarcoma subtypes, sites of metastasis, clinical course, and genomic alterations in patients with PD and HPD were similar, except HPD tumors were smaller at baseline. CONCLUSIONS In patients with advanced sarcoma, PD-1 blockade can mediate durable responses. HPD occurs in sarcoma at an incidence that is similar to what has been reported in other solid tumors, but patients with HPD were clinically and biologically similar to those who had PD. Further research is required to establish whether HPD is a biologically distinct phenomenon and whether a theoretical risk of HPD should influence patient management.
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Affiliation(s)
| | | | - Martina Bradic
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center
| | | | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Mrinal M Gounder
- Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College
| | | | | | | | | | - Ping Chi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center
| | | | - Jason E Chan
- Medicine, Memorial Sloan Kettering Cancer Center
| | | | - Allison L Richards
- Marie-Josee and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center
| | | | - Mark T A Donoghue
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College
| | - Sandra P D'Angelo
- Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College
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18
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Wagner AJ, Ravi V, Riedel RF, Ganjoo K, Van Tine BA, Chugh R, Cranmer L, Gordon EM, Hornick JL, Du H, Grigorian B, Schmid AN, Hou S, Harris K, Kwiatkowski DJ, Desai NP, Dickson MA. nab-Sirolimus for Patients With Malignant Perivascular Epithelioid Cell Tumors. J Clin Oncol 2021; 39:3660-3670. [PMID: 34637337 PMCID: PMC8601264 DOI: 10.1200/jco.21.01728] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/12/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Malignant perivascular epithelioid cell tumor (PEComa) is a rare aggressive sarcoma, with no approved treatment. To our knowledge, this phase II, single-arm, registration trial is the first prospective clinical trial in this disease, investigating the safety and efficacy of the mammalian target of rapamycin inhibitor nab-sirolimus (AMPECT, NCT02494570). PATIENTS AND METHODS Patients with malignant PEComa were treated with nab-sirolimus 100 mg/m2 intravenously once weekly for 2 weeks in 3-week cycles. The primary end point was objective response rate evaluated by independent radiology review. Key secondary end points included duration of response, progression-free survival, and safety. A key exploratory end point was tumor biomarker analysis. RESULTS Thirty-four patients were treated (safety evaluable), and 31 were evaluable for efficacy. The overall response rate was 39% (12 of 31; 95% CI, 22 to 58) with one complete and 11 partial responses, 52% (16 of 31) of patients had stable disease, and 10% (3 of 31) had progressive disease. Responses were of rapid onset (67% by week 6) and durable. Median duration of response was not reached after a median follow-up for response of 2.5 years, with 7 of 12 responders with treatment ongoing (range, 5.6-47.2+ months). Twenty-five of 31 patients had tumor mutation profiling: 8 of 9 (89%) patients with a TSC2 mutation achieved a confirmed response versus 2 of 16 (13%) without TSC2 mutation (P < .001). The median progression-free survival was 10.6 months (95% CI, 5.5 months to not reached), and the median overall survival was 40.8 months (95% CI, 22.2 months to not reached). Most treatment-related adverse events were grade 1 or 2 and were manageable for long-term treatment. No grade ≥ 4 treatment-related events occurred. CONCLUSION nab-Sirolimus is active in patients with malignant PEComa. The response rate, durability of response, disease control rate, and safety profile support that nab-sirolimus represents an important new treatment option for this disease.
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Affiliation(s)
- Andrew J. Wagner
- Dana-Farber Cancer Institute and Harvard Medical School, Boston MA
| | | | | | | | | | | | - Lee Cranmer
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Heng Du
- Brigham and Women's Hospital, Boston, MA
| | | | | | - Shihe Hou
- Aadi Bioscience Inc, Pacific Palisades, CA
| | | | | | | | - Mark A. Dickson
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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19
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Angeles CV, Velez A, Rios J, Laxa B, Shum D, Ruiz PD, Shen Y, Ostrovnaya I, Gularte-Mérida R, Nacev BA, Dickson MA, Djaballah H, Okada T, Singer S. A High-Content Screen for C/EBPα Expression Identifies Novel Therapeutic Agents in Dedifferentiated Liposarcoma. Clin Cancer Res 2021; 28:175-186. [PMID: 34667024 DOI: 10.1158/1078-0432.ccr-19-2486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 06/21/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Dedifferentiated liposarcoma (DDLS), one of the most common and aggressive sarcomas, infrequently responds to chemotherapy. DDLS survival and growth depend on underexpression of C/EBPα, a tumor suppressor and transcriptional regulator controlling adipogenesis. We sought to screen and prioritize candidate drugs that increase C/EBPα expression and may therefore serve as differentiation-based therapies for DDLS. EXPERIMENTAL DESIGN We screened known bioactive compounds for the ability to restore C/EBPα expression and inhibit proliferation selectively in two DDLS cell lines but not in normal adipose-derived stem cells (ASC). Selected hits' activity was validated, and the mechanism of the most potent, SN-38, was investigated. The in vivo efficacy of irinotecan, the prodrug of SN-38, was evaluated in DDLS xenograft models. RESULTS Of 3,119 compounds, screen criteria were met by 19. Validation experiments confirmed the DDLS selectivity of deguelin, emetine, and SN-38 and showed that they induce apoptosis in DDLS cells. SN-38 had the lowest IC50 (approximately 10 nmol/L), and its pro-apoptotic effects were countered by knockdown of CEBPA but not of TP53. Irinotecan significantly inhibited tumor growth at well-tolerated doses, induced nuclear expression of C/EBPα, and inhibited HIF1α expression in DDLS patient-derived and cancer cell line xenograft models. In contrast, doxorubicin, the most common treatment for nonresectable DDLS, reduced tumor growth by 30% to 50% at a dose that caused weight loss. CONCLUSIONS This high-content screen revealed potential treatments for DDLS. These include irinotecan, which induces apoptosis of DDLS cells in a C/EBPα-dependent, p53-independent manner, and should be clinically evaluated in patients with advanced DDLS.
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Affiliation(s)
- Christina V Angeles
- Sarcoma Biology Laboratory, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ana Velez
- Sarcoma Biology Laboratory, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jordan Rios
- Sarcoma Biology Laboratory, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bernadette Laxa
- Sarcoma Biology Laboratory, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Shum
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Penelope D Ruiz
- Sarcoma Biology Laboratory, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yawei Shen
- Sarcoma Biology Laboratory, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rodrigo Gularte-Mérida
- Sarcoma Biology Laboratory, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin A Nacev
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Hakim Djaballah
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tomoyo Okada
- Sarcoma Biology Laboratory, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Samuel Singer
- Sarcoma Biology Laboratory, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. .,Department of Surgery, Weill Cornell Medical College, New York, New York
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20
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Lee A, Kang JJ, Bernstein H, Marqueen KE, Neal B, Kelly CM, Dickson MA, Jillian Tsai C, Tap W, Singer S, Alektiar K, Lee NY. Proton radiotherapy for recurrent or metastatic sarcoma with palliative quad shot. Cancer Med 2021; 10:4221-4227. [PMID: 34085781 PMCID: PMC8267151 DOI: 10.1002/cam4.3646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 01/25/2023] Open
Abstract
Patients with previously treated, recurrent or metastatic sarcomas who have progressed on multiples lines of systemic therapy may have limited options for local control. We evaluated outcomes of palliative proton therapy with the quad shot regimen to unresectable disease for patients with recurrent and/or metastatic sarcoma. From 2014 to 2018, 28 patients with recurrent or metastatic sarcomas were treated to 40 total sites with palliative proton RT with quad shot (14.8 Gy/4 twice daily). Outcomes included toxicity, ability to receive further systemic therapy, and subjective palliative response. Univariate analysis was performed for local progression‐free survival (LPFS) and overall survival (OS). Of the 40 total sites, 25 (62.5%) received ≥3 cycles with median follow up of 12 months (IQR 4–19). The most common histologies were GIST (9; 22.5%) and leiomyosarcoma (7; 17.5%). A total of 27 (67.5%) sites were located in the abdomen or pelvis. Seventeen (42.5%) treatments involved concurrent systemic therapy and 13 (32.5%) patients received further systemic therapy following proton therapy. Overall subjective palliative response was 70%. Median LPFS was 11 months and 6‐month LPFS was 66.1%. On univariate analysis, receipt of four cycles of quad shot (HR 0.06, p = 0.02) and receipt of systemic therapy after completion of radiation therapy (HR 0.17, p = 0.02) were associated with improved LPFS. Three grade 3 acute toxicities were observed. The proton quad shot regimen serves as a feasible alternative for patients with previously treated, recurrent or metastatic sarcomas where overall treatment options may be limited.
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Affiliation(s)
- Anna Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jung J Kang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Havah Bernstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathryn E Marqueen
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian Neal
- ProCure Proton Therapy Center, Somerset, NJ, USA
| | - Ciara M Kelly
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Mark A Dickson
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Chiaojung Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Tap
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Samuel Singer
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Kaled Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Kelly CM, Antonescu CR, Bowler T, Munhoz R, Chi P, Dickson MA, Gounder MM, Keohan ML, Movva S, Dholakia R, Ahmad H, Biniakewitz M, Condy M, Phelan H, Callahan M, Wong P, Singer S, Ariyan C, Bartlett EK, Crago A, Yoon S, Hwang S, Erinjeri JP, Qin LX, Tap WD, D'Angelo SP. Objective Response Rate Among Patients With Locally Advanced or Metastatic Sarcoma Treated With Talimogene Laherparepvec in Combination With Pembrolizumab: A Phase 2 Clinical Trial. JAMA Oncol 2020; 6:402-408. [PMID: 31971541 DOI: 10.1001/jamaoncol.2019.6152] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Patients with advanced sarcoma have limited treatment options. Talimogene laherparepvec (T-VEC) has been shown to increase tumor-specific immune activation via augmenting antigen presentation and T-cell priming. Objective To examine whether T-VEC in combination with pembrolizumab is associated with increased tumor-infiltrating lymphocyte infiltration and programmed death-ligand 1 expression and thus with increased antitumor activity in patients with locally advanced or metastatic sarcoma. Design, Setting, and Participants This open-label, single-institution phase 2 interventional trial of T-VEC plus pembrolizumab enrolled 20 patients with locally advanced or metastatic sarcoma between March 16 and December 4, 2017, for whom at least 1 standard systemic therapy had failed. The median duration of therapy was 16 weeks (range, 7-67 weeks). Reported analyses include data through December 14, 2018. Intervention Patients received pembrolizumab (200-mg flat dose) intravenously and T-VEC (first dose, ≤4 mL × 106 plaque-forming units [PFU]/mL; second and subsequent doses, ≤4 mL × 108 PFU/mL) injected into palpable tumor site(s) on day 1 of each 21-day cycle. Main Outcomes and Measures The primary end point was objective response rate (ORR; complete response and partial response) at 24 weeks determined by Response Evaluation Criteria In Solid Tumors (RECIST), version 1.1, criteria. Secondary end points included best ORR by immune-related RECIST criteria, progression-free survival rate at 24 weeks, overall survival, and safety. Results All 20 patients (12 women [60%]; median age, 63.5 years [range, 24-90 years]) were evaluable for response. The study met its primary end point of evaluating the best ORR at 24 weeks determined by RECIST, version 1.1, criteria; the best ORR was 30% (95% CI, 12%-54%; n = 6). The ORR overall was 35% (95% CI, 15%-59%; n = 7). The incidence of grade 3 treatment-related adverse events was low (4 patients [20%]). There were no grade 4 treatment-related adverse events or treatment-related deaths. Conclusions and Relevance In this phase 2 clinical trial, treatment with T-VEC plus pembrolizumab was associated with antitumor activity in advanced sarcoma across a range of sarcoma histologic subtypes, with a manageable safety profile. This combination therapy met its predefined primary study end point; further evaluation of T-VEC in combination with pembrolizumab for patients with select sarcoma subtypes is planned. Trial Registration ClinicalTrials.gov identifier: NCT03069378.
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Affiliation(s)
- Ciara M Kelly
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York.,Department of Sarcoma Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Timothy Bowler
- Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rodrigo Munhoz
- Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ping Chi
- Weill Cornell Medical College, New York, New York.,Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark A Dickson
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Mrinal M Gounder
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Mary Louise Keohan
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Sujana Movva
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Reena Dholakia
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hamza Ahmad
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew Biniakewitz
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mercedes Condy
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Haley Phelan
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Margaret Callahan
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York.,Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Phillip Wong
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York.,Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, New York.,Immune Monitoring Facility, Ludwig Center for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sam Singer
- Weill Cornell Medical College, New York, New York.,Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charlotte Ariyan
- Weill Cornell Medical College, New York, New York.,Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Edmund K Bartlett
- Weill Cornell Medical College, New York, New York.,Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aimee Crago
- Weill Cornell Medical College, New York, New York.,Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sam Yoon
- Weill Cornell Medical College, New York, New York.,Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sinchun Hwang
- Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph P Erinjeri
- Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Li-Xuan Qin
- Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William D Tap
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Sandra P D'Angelo
- Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York.,Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, New York
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22
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McAndrew NP, Dickson MA, Clark AS, Troxel AB, O'Hara MH, Colameco C, Gallager M, Gramlich K, Zafman K, Vaughn D, Schwartz GK, O'Dwyer PJ, DeMichele A. Early treatment-related neutropenia predicts response to palbociclib. Br J Cancer 2020; 123:912-918. [PMID: 32641862 PMCID: PMC7492243 DOI: 10.1038/s41416-020-0967-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 07/11/2019] [Revised: 05/13/2020] [Accepted: 06/18/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Palbociclib is highly active in oestrogen-receptor positive (ER+) metastatic breast cancer, but neutropenia is dose limiting. The goal of this study was to determine whether early neutropenia is associated with disease response to single-agent palbociclib. METHODS Blood count and disease-response data were analysed from two Phase 2 clinical trials at different institutions using single-agent palbociclib: advanced solid tumours positive for retinoblastoma protein and advanced liposarcoma. The primary endpoint was PFS. The primary exposure variable was the nadir absolute neutrophil count (ANC) during the first two cycles of treatment. RESULTS One hundred and ninety-six patients (61 breast, 135 non-breast) were evaluated between the two trials. Development of any grade neutropenia was significantly associated with longer median PFS in both the breast cancer (HR 0.29, 95% CI 0.11-0.74, p = 0.010) and non-breast cancer (HR 0.57, 95% CI 0.38-0.85, p = 0.006) cohorts. Grade 3-4 neutropenia was significantly associated with prolonged PFS in the non-breast cohort (HR 0.57, 95% CI 0.38-0.85, p = 0.006) but not in the breast cohort (HR 0.87, 95% CI 0.51-1.47, p = 0.596). Multivariate analysis yielded similar results. CONCLUSIONS Treatment-related neutropenia in the first two cycles was significantly and independently associated with prolonged PFS, suggesting that neutropenia may be a useful pharmacodynamic marker to guide individualised palbociclib dosing. CLINICAL TRIALS REGISTRATION INFORMATION Basket Trial: NCT01037790; Sarcoma Trial: NCT01209598.
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Affiliation(s)
- Nicholas P McAndrew
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Amy S Clark
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea B Troxel
- Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Mark H O'Hara
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Maryann Gallager
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristi Gramlich
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly Zafman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - David Vaughn
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Gary K Schwartz
- Herbert Irving Cancer Center, Columbia University School of Medicine, New York, NY, USA
| | - Peter J O'Dwyer
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela DeMichele
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA. .,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
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23
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Li GZ, Okada T, Kim YM, Agaram NP, Sanchez-Vega F, Shen Y, Tsubokawa N, Rios J, Martin AS, Dickson MA, Qin LX, Socci ND, Singer S. Rb and p53-Deficient Myxofibrosarcoma and Undifferentiated Pleomorphic Sarcoma Require Skp2 for Survival. Cancer Res 2020; 80:2461-2471. [PMID: 32161142 DOI: 10.1158/0008-5472.can-19-1269] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/19/2019] [Accepted: 03/06/2020] [Indexed: 12/20/2022]
Abstract
Myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS) are highly genetically complex soft tissue sarcomas. Up to 50% of patients develop distant metastases, but current systemic therapies have limited efficacy. MFS and UPS have recently been shown to commonly harbor copy number alterations or mutations in the tumor suppressor genes RB1 and TP53. As these alterations have been shown to engender dependence on the oncogenic protein Skp2 for survival of transformed cells in mouse models, we sought to examine its function and potential as a therapeutic target in MFS/UPS. Comparative genomic hybridization and next-generation sequencing confirmed that a significant fraction of MFS and UPS patient samples (n = 94) harbor chromosomal deletions and/or loss-of-function mutations in RB1 and TP53 (88% carry alterations in at least one gene; 60% carry alterations in both). Tissue microarray analysis identified a correlation between absent Rb and p53 expression and positive expression of Skp2. Downregulation of Skp2 or treatment with the Skp2-specific inhibitor C1 revealed that Skp2 drives proliferation of patient-derived MFS/UPS cell lines deficient in both Rb and p53 by degrading p21 and p27. Inhibition of Skp2 using the neddylation-activating enzyme inhibitor pevonedistat decreased growth of Rb/p53-negative patient-derived cell lines and mouse xenografts. These results demonstrate that loss of both Rb and p53 renders MFS and UPS dependent on Skp2, which can be therapeutically exploited and could provide the basis for promising novel systemic therapies for MFS and UPS. SIGNIFICANCE: Loss of both Rb and p53 renders myxofibrosarcoma and undifferentiated pleomorphic sarcoma dependent on Skp2, which could provide the basis for promising novel systemic therapies.See related commentary by Lambert and Jones, p. 2437.
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Affiliation(s)
- George Z Li
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tomoyo Okada
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Young-Mi Kim
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Narasimhan P Agaram
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Yawei Shen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Norifumi Tsubokawa
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jordan Rios
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Axel S Martin
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Li-Xuan Qin
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Nicholas D Socci
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
- Department of Surgery, Weill Cornell Medical College, New York, New York
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24
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Navarrete-Dechent C, Mori S, Barker CA, Dickson MA, Nehal KS. Imatinib Treatment for Locally Advanced or Metastatic Dermatofibrosarcoma Protuberans: A Systematic Review. JAMA Dermatol 2020; 155:361-369. [PMID: 30601909 DOI: 10.1001/jamadermatol.2018.4940] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Dermatofibrosarcoma protuberans (DFSP) has the potential for local destruction and recurrence, although it carries a low risk of metastasis. Complete surgical resection with negative margins is considered the gold standard for treatment; however, there are cases that are unresectable owing to tumor extension or size or owing to risk of cosmetic and/or functional impairment. Imatinib treatment has been used for locally advanced or metastatic DFSP. Objective To evaluate the usefulness of imatinib for treating DFSP. Evidence Review We conducted a systematic review on the PubMed and Embase databases for articles published from September 2002 through October 2017 using the key words "dermatofibrosarcoma" or "dermatofibrosarcoma protuberans" AND "therapy" AND "imatinib." References within retrieved articles were also reviewed to identify additional studies. Studies of adults with histologically proven DFSP treated with imatinib as monotherapy or as an adjuvant or neoadjuvant therapy to surgery were included. Extracted data were analyzed using descriptive statistics. PRISMA guidelines were followed. All analysis took place October through December 2017. Findings Nine studies met inclusion criteria; 152 patients were included. The calculated mean patient age was 49.3 years (range, 20-73 years). Calculated mean tumor diameter was 9.9 cm (range, 1.2-49.0 cm). When COL1A1-PDGFβ protein translocation (collagen, type 1, alpha 1-platelet-derived growth factor β) was reported, it was present in 90.9% of patients (111 of 122). Complete response was seen in 5.2% of patients (8 of 152), partial response in 55.2% (84 of 152), stable disease in 27.6% (42 of 152), and progression in 9.2% (14 of 152). Four of the 152 patients (2.6%) were excluded from the analysis owing to unknown or unevaluable response. There were no differences in response rate using 400-mg or 800-mg daily doses (67.5% or 27 of 40 patients for 400-mg dose vs 67.1% or 49 of 73 patients for 800-mg dose complete or partial response; P > .99). Adverse events were present in at least 73.5% of cases (78 of 106); severe adverse events were present in 15.1% of cases (20 of 132). Conclusions and Relevance Imatinib is a useful directed therapy in patients with DFSP who are not surgical candidates owing to disease extension or significant cosmetic or functional impairment. There seems to be no difference between 400- or 800-mg daily doses.
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Affiliation(s)
- Cristian Navarrete-Dechent
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shoko Mori
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark A Dickson
- Sarcoma Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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25
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Reid EG, Suazo A, Lensing SY, Dittmer DP, Ambinder RF, Maldarelli F, Gorelick RJ, Aboulafia D, Mitsuyasu R, Dickson MA, Wachsman W. Pilot Trial AMC-063: Safety and Efficacy of Bortezomib in AIDS-associated Kaposi Sarcoma. Clin Cancer Res 2019; 26:558-565. [PMID: 31624104 DOI: 10.1158/1078-0432.ccr-19-1044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/10/2019] [Accepted: 10/14/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE AIDS-related Kaposi sarcoma is often incompletely controlled, requiring serial therapies. Kaposi sarcoma herpesvirus (KSHV) induces transformation of endothelial cells, where it resides in a predominately latent state. We hypothesized proteasome inhibition would have direct antitumor activity, induce lytic activation of KSHV, and inhibit HIV infectivity, improving control of both Kaposi sarcoma and HIV. The primary objective was determining the MTD of bortezomib in AIDS-Kaposi sarcoma. Secondary objectives included estimating the impact of bortezomib on Kaposi sarcoma response, KSHV plasma DNA copy number (PDCN), and HIV viral loads (VL). PATIENTS AND METHODS A 3+3 dose escalation design was employed evaluating four dose levels of bortezomib (0.75, 1, 1.2, or 1.6 mg/m2) administered intravenously on days 1, 8, and 15 of 28-day cycles in patients with relapsed/refractory (r/r) AIDS-Kaposi sarcoma taking antiretroviral therapy. RESULTS Seventeen patients enrolled. No dose-limiting toxicities occurred and the MTD was not reached. The most common adverse events included diarrhea, fatigue and nausea. Among 15 evaluable patients, partial response (PR) occurred in nine (60%), with a PR rate of 83% in the 1.6 mg/m2 cohort; the remainder had stable disease (SD). Median time to response was 2.1 months. Median change in KSHV PDCN was significantly different between those with PR versus SD. During cycle 1, seven of 11 evaluable patients had decreases in HIV VL. CONCLUSIONS Bortezomib is well-tolerated and active in AIDS-Kaposi sarcoma. The 60% PR rate is notable given the dose-finding nature of the study in a r/r population. Changes in KSHV PDCN and HIV VL trended as hypothesized.
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Affiliation(s)
- Erin G Reid
- University of California, San Diego Moores Cancer Center, La Jolla, California.
| | - Adrienne Suazo
- University of California, San Diego Moores Cancer Center, La Jolla, California
| | - Shelly Y Lensing
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Dirk P Dittmer
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, North Carolina
| | | | - Frank Maldarelli
- HIV Dynamics and Replication Program, National Cancer Institute, Frederick, Maryland
| | - Robert J Gorelick
- AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - David Aboulafia
- Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, Washington
| | - Ronald Mitsuyasu
- Center for AIDS Research and Education, University of California, Los Angeles, Los Angeles, California
| | - Mark A Dickson
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
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26
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Rosenbaum E, Kelly C, D'Angelo SP, Dickson MA, Gounder M, Keohan ML, Movva S, Condy M, Adamson T, Mcfadyen CR, Antonescu CR, Hwang S, Singer S, Qin LX, Tap WD, Chi P. A Phase I Study of Binimetinib (MEK162) Combined with Pexidartinib (PLX3397) in Patients with Advanced Gastrointestinal Stromal Tumor. Oncologist 2019; 24:1309-e983. [PMID: 31213500 PMCID: PMC6795162 DOI: 10.1634/theoncologist.2019-0418] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022] Open
Abstract
Lessons Learned. The combination of pexidartinib and binimetinib was safe and tolerable and demonstrated encouraging signs of efficacy in two patients with advanced gastrointestinal stromal tumor (GIST) refractory to tyrosine kinase inhibitors (TKIs). Molecular profiling of GISTs at diagnosis and upon progression may provide insight into the mechanisms of response or resistance to targeted therapies. Additional trials are needed to further explore combined KIT and MEK inhibition in treatment‐naïve and TKI‐refractory patients with advanced GIST.
Background. Nearly all patients with advanced gastrointestinal stromal tumor (GIST) develop resistance to imatinib, and subsequent treatments have limited efficacy. Dual inhibition of KIT and MAPK pathways has synergistic antitumor activity in preclinical GIST models. Methods. This was an investigator‐initiated, phase I, dose escalation study of the MEK inhibitor binimetinib combined with pexidartinib, a potent inhibitor of CSF1R, KIT, and FLT3, in patients with advanced or metastatic GIST who progressed on imatinib. The primary endpoint was phase II dose determination; secondary endpoints included safety, tolerability, and efficacy. An expansion cohort to further evaluate safety and efficacy was planned. Results. Two patients were treated at dose level one (binimetinib 30 mg b.i.d. and pexidartinib 400 mg every morning and 200 mg every evening), after which the study was terminated by the manufacturer. No dose‐limiting toxicities (DLTs) were reported, and treatment was well tolerated. The only grade ≥3 treatment‐emergent adverse event (TEAE) was asymptomatic elevated creatine phosphokinase (CPK). Both patients had a best response of stable disease (SD) by RECIST. Progression‐free survival (PFS) and overall survival (OS) were 6.1 and 14.6 months, respectively, in one patient with five prior lines of therapy. The second patient with NF1‐mutant GIST had a 27% decrease in tumor burden by RECIST and remains on study after 19 months of treatment. Conclusion. Pexidartinib combined with binimetinib was tolerable, and meaningful clinical activity was observed in two imatinib‐refractory patients.
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Affiliation(s)
- Evan Rosenbaum
- Memorial Sloan Kettering Cancer Center, New York New York, USA
| | - Ciara Kelly
- Memorial Sloan Kettering Cancer Center, New York New York, USA
- Weill Cornell Medical College, New York New York, USA
| | - Sandra P D'Angelo
- Memorial Sloan Kettering Cancer Center, New York New York, USA
- Weill Cornell Medical College, New York New York, USA
| | - Mark A Dickson
- Memorial Sloan Kettering Cancer Center, New York New York, USA
- Weill Cornell Medical College, New York New York, USA
| | - Mrinal Gounder
- Memorial Sloan Kettering Cancer Center, New York New York, USA
- Weill Cornell Medical College, New York New York, USA
| | - Mary L Keohan
- Memorial Sloan Kettering Cancer Center, New York New York, USA
- Weill Cornell Medical College, New York New York, USA
| | - Sujana Movva
- Memorial Sloan Kettering Cancer Center, New York New York, USA
| | - Mercedes Condy
- Memorial Sloan Kettering Cancer Center, New York New York, USA
| | - Travis Adamson
- Memorial Sloan Kettering Cancer Center, New York New York, USA
| | | | | | - Sinchun Hwang
- Memorial Sloan Kettering Cancer Center, New York New York, USA
| | - Sam Singer
- Memorial Sloan Kettering Cancer Center, New York New York, USA
- Weill Cornell Medical College, New York New York, USA
| | - Li-Xuan Qin
- Memorial Sloan Kettering Cancer Center, New York New York, USA
| | - William D Tap
- Memorial Sloan Kettering Cancer Center, New York New York, USA
- Weill Cornell Medical College, New York New York, USA
| | - Ping Chi
- Memorial Sloan Kettering Cancer Center, New York New York, USA
- Weill Cornell Medical College, New York New York, USA
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27
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D'Adamo DR, Dickson MA, Keohan ML, Carvajal RD, Hensley ML, Hirst CM, Ezeoke MO, Ahn L, Qin LX, Antonescu CR, Lefkowitz RA, Maki RG, Schwartz GK, Tap WD. A Phase II Trial of Sorafenib and Dacarbazine for Leiomyosarcoma, Synovial Sarcoma, and Malignant Peripheral Nerve Sheath Tumors. Oncologist 2019; 24:857-863. [PMID: 30126857 PMCID: PMC6656505 DOI: 10.1634/theoncologist.2018-0160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/31/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sorafenib and dacarbazine have low single-agent response rates in metastatic sarcomas. As angiogenesis inhibitors can enhance the efficacy of chemotherapy, we investigated the combination of sorafenib and dacarbazine in select sarcoma subtypes. MATERIALS AND METHODS Patients with leiomyosarcoma (LMS), synovial sarcoma (SS), or malignant peripheral nerve sheath tumors (MPNST) with up to two previous lines of therapy and adequate hepatic, renal, and marrow function received 3-week cycles of sorafenib at 400 mg oral twice daily and dacarbazine 1,000 mg/m2 intravenously (later reduced to 850 mg/m2). Patients were evaluated for response every 6 weeks. The primary objective was to determine the disease control rate (DCR) of sorafenib plus dacarbazine in the selected sarcoma subtypes. RESULTS The study included 37 patients (19 female); median age was 55 years (range 26-87); and histologies included LMS (22), SS (11), and MPNST (4). The DCR was 46% (17/37). Median progression-free survival was 13.4 weeks. The RECIST response rate was 14% (5/37). The Choi response rate was 51% (19/37). Median overall survival was 13.2 months. Of the first 25 patients, 15 (60%) required dacarbazine dose reductions for hematologic toxicity, with one episode of grade 5 neutropenic fever. After reducing the starting dose of dacarbazine to 850 mg/m2, only 3 of the final 12 (25%) patients required dose reduction. CONCLUSION This phase II study met its primary endpoint with an 18-week DCR of 46%. The clinical activity of dacarbazine plus sorafenib in patients with these diagnoses is modest. IMPLICATIONS FOR PRACTICE Metastatic soft tissue sarcomas are a heterogeneous group of relatively rare malignancies. Most patients are treated with cytotoxic chemotherapy or targeted therapy in the form of tyrosine kinase inhibitors. Response rates are relatively low, and there is a need for better therapies. This clinical trial demonstrates that combining a cytotoxic therapy (dacarbazine) with an antiangiogenic small molecule (sorafenib) is feasible and associated with favorable disease-control rates; however, it also increases the potential for significant toxicity.
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Affiliation(s)
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Mary L Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | | | - Martee L Hensley
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Catherine M Hirst
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Marietta O Ezeoke
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Linda Ahn
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Li-Xuan Qin
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Robert A Lefkowitz
- Department of Radiology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | | | - Gary K Schwartz
- Department of Medicine, Columbia University, New York, New York, USA
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
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28
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Latham A, Srinivasan P, Kemel Y, Shia J, Bandlamudi C, Mandelker D, Middha S, Hechtman J, Zehir A, Dubard-Gault M, Tran C, Stewart C, Sheehan M, Penson A, DeLair D, Yaeger R, Vijai J, Mukherjee S, Galle J, Dickson MA, Janjigian Y, O'Reilly EM, Segal N, Saltz LB, Reidy-Lagunes D, Varghese AM, Bajorin D, Carlo MI, Cadoo K, Walsh MF, Weiser M, Aguilar JG, Klimstra DS, Diaz LA, Baselga J, Zhang L, Ladanyi M, Hyman DM, Solit DB, Robson ME, Taylor BS, Offit K, Berger MF, Stadler ZK. Microsatellite Instability Is Associated With the Presence of Lynch Syndrome Pan-Cancer. J Clin Oncol 2018; 37:286-295. [PMID: 30376427 DOI: 10.1200/jco.18.00283] [Citation(s) in RCA: 364] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Microsatellite instability (MSI) and/or mismatch repair deficiency (MMR-D) testing has traditionally been performed in patients with colorectal (CRC) and endometrial cancer (EC) to screen for Lynch syndrome (LS)-associated cancer predisposition. The recent success of immunotherapy in high-frequency MSI (MSI-H) and/or MMR-D tumors now supports testing for MSI in all advanced solid tumors. The extent to which LS accounts for MSI-H across heterogeneous tumor types is unknown. Here, we establish the prevalence of LS across solid tumors according to MSI status. METHODS MSI status was determined using targeted next-generation sequencing, with tumors classified as MSI-H, MSI-indeterminate, or microsatellite-stable. Matched germline DNA was analyzed for mutations in LS-associated mismatch repair genes ( MLH1, MSH2, MSH6, PMS2, EPCAM). In patients with LS with MSI-H/I tumors, immunohistochemical staining for MMR-D was assessed. RESULTS Among 15,045 unique patients (more than 50 cancer types), LS was identified in 16.3% (53 of 326), 1.9% (13 of 699), and 0.3% (37 of 14,020) of patients with MSI-H, MSI-indeterminate, and microsatellite-stable tumors, respectively ( P < .001). Among patients with LS with MSI-H/I tumors, 50% (33 of 66) had tumors other than CRC/EC, including urothelial, prostate, pancreas, adrenocortical, small bowel, sarcoma, mesothelioma, melanoma, gastric, and germ cell tumors. In these patients with non-CRC/EC tumors, 45% (15 of 33) did not meet LS genetic testing criteria on the basis of personal/family history. Immunohistochemical staining of LS-positive MSI-H/I tumors demonstrated MMR-D in 98.2% (56 of 57) of available cases. CONCLUSION MSI-H/MMR-D is predictive of LS across a much broader tumor spectrum than currently appreciated. Given implications for cancer surveillance and prevention measures in affected families, these data support germline genetic assessment for LS for patients with an MSI-H/MMR-D tumor, regardless of cancer type or family cancer history.
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Affiliation(s)
- Alicia Latham
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Yelena Kemel
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jinru Shia
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Sumit Middha
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ahmet Zehir
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | - Rona Yaeger
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Joseph Vijai
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jesse Galle
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark A Dickson
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Yelena Janjigian
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Eileen M O'Reilly
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Neil Segal
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Leonard B Saltz
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Diane Reidy-Lagunes
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Anna M Varghese
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Dean Bajorin
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Maria I Carlo
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Karen Cadoo
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Michael F Walsh
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Martin Weiser
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Julio Garcia Aguilar
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | | | - Luis A Diaz
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Jose Baselga
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Liying Zhang
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marc Ladanyi
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | - David M Hyman
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - David B Solit
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Mark E Robson
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | | | - Kenneth Offit
- 1 Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael F Berger
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
| | - Zsofia K Stadler
- 1 Memorial Sloan Kettering Cancer Center, New York, NY.,2 Weill Cornell Medical College, New York, NY
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29
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Geller S, Dickson MA, Busam KJ, Myskowski PL. Kaposi's Sarcoma After Autologous Stem-Cell Transplantation and Rituximab Treatment. J Oncol Pract 2018; 14:565-568. [PMID: 30044684 DOI: 10.1200/jop.18.00246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shamir Geller
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
| | - Mark A Dickson
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
| | - Klaus J Busam
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
| | - Patricia L Myskowski
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
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30
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Klein ME, Dickson MA, Antonescu C, Qin LX, Dooley SJ, Barlas A, Manova K, Schwartz GK, Crago AM, Singer S, Koff A, Tap WD. PDLIM7 and CDH18 regulate the turnover of MDM2 during CDK4/6 inhibitor therapy-induced senescence. Oncogene 2018; 37:5066-5078. [PMID: 29789718 PMCID: PMC6137027 DOI: 10.1038/s41388-018-0332-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 12/26/2017] [Revised: 04/05/2018] [Accepted: 05/01/2018] [Indexed: 12/16/2022]
Abstract
CDK4/6 inhibitors are being used to treat a variety of human malignancies. In well-differentiated and dedifferentiated liposarcoma their clinical promise is associated with their ability to downregulate the MDM2 protein. The downregulation of MDM2 following treatment with CDK4/6 inhibitors also induces many cultured tumor cell lines derived from different types of malignancies to progress from quiescence into senescence. Here we used cultured human cell lines and defined a role for PDLIM7 and CDH18, regulating MDM2 protein in CDK4/6 inhibitor-treated cells. Materials from our previous phase II trials with palbociclib were then used to demonstrate that expression of CDH18 protein was associated with response, measured as both progression-free survival and overall survival. This supports the hypothesis that the biologic transition from quiescence to senescence has clinical relevance for this class of drugs.
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Affiliation(s)
- Mary E Klein
- The Louis V. Gerstner Graduate School of Biomedical Science, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,The Programs in MolecularMemorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Mark A Dickson
- Departments of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Departments of Medicine, Weill Cornell Medical College, New York, NY, 10021, USA
| | - Cristina Antonescu
- Departments of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Li-Xuan Qin
- Departments of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Scott J Dooley
- Center for Advanced Retinal and Ocular Therapeutics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Afsar Barlas
- Developmental Biology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Katia Manova
- Developmental Biology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Gary K Schwartz
- Division of Hematology and Oncology, Columbia University Medical Center, Herbert Irving Pavilion 9th floor, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Aimee M Crago
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Departments of Surgery, Weill Cornell Medical College, New York, NY, 10021, USA
| | - Samuel Singer
- Departments of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Departments of Surgery, Weill Cornell Medical College, New York, NY, 10021, USA
| | - Andrew Koff
- The Louis V. Gerstner Graduate School of Biomedical Science, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. .,The Programs in MolecularMemorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - William D Tap
- Departments of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Departments of Medicine, Weill Cornell Medical College, New York, NY, 10021, USA
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Chung DJ, Carvajal RD, Postow MA, Sharma S, Pronschinske KB, Shyer JA, Singh-Kandah S, Dickson MA, D'Angelo SP, Wolchok JD, Young JW. Langerhans-type dendritic cells electroporated with TRP-2 mRNA stimulate cellular immunity against melanoma: Results of a phase I vaccine trial. Oncoimmunology 2017; 7:e1372081. [PMID: 29296525 DOI: 10.1080/2162402x.2017.1372081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/27/2022] Open
Abstract
Purpose: We conducted a phase I vaccine trial to determine safety, toxicity, and immunogenicity of autologous Langerhans-type dendritic cells (LCs), electroporated with murine tyrosinase-related peptide-2 (mTRP2) mRNA in patients with resected AJCC stage IIB, IIC, III, or IV (MIa) melanoma. Experimental Design: Nine patients received a priming immunization plus four boosters at three week intervals. Vaccines comprised 10 × 106 mRNA-electroporated LCs, based on absolute number of CD83+CD86brightHLA-DRbrightCD14neg LCs by flow cytometry. Initial vaccines used freshly generated LCs, whereas booster vaccines used viably thawed cells from the cryopreserved initial product. Post-vaccination assessments included evaluation of delayed-type hypersensitivity (DTH) reactions after booster vaccines and immune response assays at one and three months after the final vaccine. Results: All patients developed mild DTH reactions at injection sites after booster vaccines, but there were no toxicities exceeding grade 1 (CTCAE, v4.0). At one and three months post-vaccination, antigen-specific CD4 and CD8 T cells increased secretion of proinflammatory cytokines (IFN-γ, IL-2, and TNF-α), above pre-vaccine levels, and also upregulated the cytotoxicity marker CD107a. Next-generation deep sequencing of the TCR-V-β CDR3 documented fold-increases in clonality of 2.11 (range 0.85-3.22) for CD4 and 2.94 (range 0.98-9.57) for CD8 T cells at one month post-vaccines. Subset analyses showed overall lower fold-increases in clonality in three patients who relapsed (CD4: 1.83, CD8: 1.54) versus non-relapsed patients (CD4: 2.31, CD8: 3.99). Conclusions: TRP2 mRNA-electroporated LC vaccines are safe and immunogenic. Responses are antigen-specific in terms of cytokine secretion, cytolytic degranulation, and increased TCR clonality, which correlates with clinical outcomes.
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Affiliation(s)
- David J Chung
- Laboratory of Cellular Immunobiology, Memorial Sloan Kettering Cancer Center, New York, NY.,Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Memorial Sloan Kettering Cancer Center, New York, NY.,The Rockefeller University, New York, NY.,Weill Cornell Medical College, New York, NY, USA
| | - Richard D Carvajal
- Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Memorial Sloan Kettering Cancer Center, New York, NY.,Weill Cornell Medical College, New York, NY, USA
| | - Michael A Postow
- Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Memorial Sloan Kettering Cancer Center, New York, NY.,Weill Cornell Medical College, New York, NY, USA
| | - Sneh Sharma
- Laboratory of Cellular Immunobiology, Memorial Sloan Kettering Cancer Center, New York, NY.,Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine B Pronschinske
- Laboratory of Cellular Immunobiology, Memorial Sloan Kettering Cancer Center, New York, NY.,Memorial Sloan Kettering Cancer Center, New York, NY
| | - Justin A Shyer
- Laboratory of Cellular Immunobiology, Memorial Sloan Kettering Cancer Center, New York, NY.,Memorial Sloan Kettering Cancer Center, New York, NY
| | - Shahnaz Singh-Kandah
- Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark A Dickson
- Sarcoma Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Memorial Sloan Kettering Cancer Center, New York, NY.,Weill Cornell Medical College, New York, NY, USA
| | - Sandra P D'Angelo
- Sarcoma Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Memorial Sloan Kettering Cancer Center, New York, NY.,Weill Cornell Medical College, New York, NY, USA
| | - Jedd D Wolchok
- Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Memorial Sloan Kettering Cancer Center, New York, NY.,The Rockefeller University, New York, NY.,Weill Cornell Medical College, New York, NY, USA
| | - James W Young
- Laboratory of Cellular Immunobiology, Memorial Sloan Kettering Cancer Center, New York, NY.,Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Immunology Program, Sloan Kettering Institute for Cancer Research.,Memorial Sloan Kettering Cancer Center, New York, NY.,The Rockefeller University, New York, NY.,Weill Cornell Medical College, New York, NY, USA
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Kovatcheva M, Liao W, Klein ME, Robine N, Geiger H, Crago AM, Dickson MA, Tap WD, Singer S, Koff A. ATRX is a regulator of therapy induced senescence in human cells. Nat Commun 2017; 8:386. [PMID: 28855512 PMCID: PMC5577318 DOI: 10.1038/s41467-017-00540-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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: 05/09/2016] [Accepted: 07/07/2017] [Indexed: 01/24/2023] Open
Abstract
Senescence is a state of stable cell cycle exit with important implications for development and disease. Here, we demonstrate that the chromatin remodeling enzyme ATRX is required for therapy-induced senescence. ATRX accumulates in nuclear foci and is required for therapy-induced senescence in multiple types of transformed cells exposed to either DNA damaging agents or CDK4 inhibitors. Mobilization into foci depends on the ability of ATRX to interact with H3K9me3 histone and HP1. Foci form soon after cells exit the cell cycle, before other hallmarks of senescence appear. Eliminating ATRX in senescent cells destabilizes the senescence-associated heterochromatic foci. Additionally, ATRX binds to and suppresses expression from the HRAS locus; repression of HRAS is sufficient to promote the transition of quiescent cells into senescence and preventing repression blocks progression into senescence. Thus ATRX is a critical regulator of therapy-induced senescence and acts in multiple ways to drive cells into this state. Therapy induced senescence (TIS) is a growth suppressive program activated by cytostatic agents in some cancer cells. Here the authors show that the chromatin remodeling enzyme ATRX is a regulator of TIS and drives cells into this state via multiple mechanisms.
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Affiliation(s)
- Marta Kovatcheva
- The Louis V. Gerstner Graduate School of Biomedical Sciences, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, 10065, USA.,Program in Molecular Biology, Memorial Sloan Kettering Cancer Center, New York, 10065, USA
| | - Will Liao
- The New York Genome Center, New York, 10013, USA
| | - Mary E Klein
- The Louis V. Gerstner Graduate School of Biomedical Sciences, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, 10065, USA.,Program in Molecular Biology, Memorial Sloan Kettering Cancer Center, New York, 10065, USA
| | | | | | - Aimee M Crago
- Program in Molecular Biology, Memorial Sloan Kettering Cancer Center, New York, 10065, USA.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, USA
| | - Mark A Dickson
- Department of Medicine, Weill College of Medicine, Cornell University, New York, 10065, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, USA
| | - William D Tap
- Department of Medicine, Weill College of Medicine, Cornell University, New York, 10065, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, USA
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, 10065, USA
| | - Andrew Koff
- The Louis V. Gerstner Graduate School of Biomedical Sciences, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, 10065, USA. .,Program in Molecular Biology, Memorial Sloan Kettering Cancer Center, New York, 10065, USA.
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33
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Dickson MA, Schwartz GK, Keohan ML, D'Angelo SP, Gounder MM, Chi P, Antonescu CR, Landa J, Qin LX, Crago AM, Singer S, Koff A, Tap WD. Progression-Free Survival Among Patients With Well-Differentiated or Dedifferentiated Liposarcoma Treated With CDK4 Inhibitor Palbociclib: A Phase 2 Clinical Trial. JAMA Oncol 2017; 2:937-40. [PMID: 27124835 DOI: 10.1001/jamaoncol.2016.0264] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IMPORTANCE More than 90% of well-differentiated or dedifferentiated liposarcomas (WD/DDLS) have CDK4 amplification. The selective CDK4 and CDK6 inhibitor palbociclib inhibits growth and induces senescence in liposarcoma cell lines and xenografts. Our prior phase 2 study demonstrated that treatment with palbociclib (200 mg daily for 14 days every 21 days) resulted in clinical benefit in WD/DDLS but moderate hematologic toxic effects. It is important to understand whether palbociclib at a new dose and schedule-125 mg daily for 21 days every 28 days-results in clinical benefit and manageable toxic effects. OBJECTIVE To determine the progression-free survival (PFS) at 12 weeks of patients with WD/DDLS treated with palbociclib (PD0332991). DESIGN, SETTING, AND PARTICIPANTS In this phase 2, nonrandomized, open-label clinical trial conducted at the Memorial Sloan Kettering Cancer Center, 60 patients 18 years and older with advanced WD/DDLS and measurable disease by RECIST 1.1 were enrolled from December 2011 to January 2014 and followed to March 2015. Patients received oral palbociclib at 125 mg daily for 21 days in 28-day cycles. MAIN OUTCOMES AND MEASURES Primary end point was PFS. Secondary end points included response rate and toxic effects. RESULTS Overall, 30 patients were enrolled in the initial cohort and 30 more in an expansion cohort. Median (range) age was 61.5 (35-87) years; 31 patients (52%) were male; median (range) Eastern Cooperative Oncology Group score was 0 (0-1). Progression-free survival at 12 weeks was 57.2% (2-sided 95% CI, 42.4%-68.8%), and the median PFS was 17.9 weeks (2-sided 95% CI, 11.9-24.0 weeks). There was 1 complete response. Toxic effects were primarily hematologic and included neutropenia (grade 3, n = 20 [33%]; grade 4, n = 2 [3%]) but no neutropenic fever. CONCLUSIONS AND RELEVANCE In patients with advanced WD/DDLS, treatment with palbociclib was associated with a favorable PFS and occasional tumor response. This dose and schedule appears active and may have less toxic effects than 200 mg for 14 days. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01209598.
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Affiliation(s)
- Mark A Dickson
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York8Weill Cornell Medical College, New York, New York
| | | | - Mary Louise Keohan
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York8Weill Cornell Medical College, New York, New York
| | - Sandra P D'Angelo
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York8Weill Cornell Medical College, New York, New York
| | - Mrinal M Gounder
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York8Weill Cornell Medical College, New York, New York
| | - Ping Chi
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York8Weill Cornell Medical College, New York, New York
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jonathan Landa
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York8Weill Cornell Medical College, New York, New York
| | - Li-Xuan Qin
- Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Aimee M Crago
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York8Weill Cornell Medical College, New York, New York
| | - Samuel Singer
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York8Weill Cornell Medical College, New York, New York
| | - Andrew Koff
- Department of Cell Biology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - William D Tap
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York8Weill Cornell Medical College, New York, New York
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D'Angelo SP, Shoushtari AN, Keohan ML, Dickson MA, Gounder MM, Chi P, Loo JK, Gaffney L, Schneider L, Patel Z, Erinjeri JP, Bluth MJ, Sjoberg A, Streicher H, Takebe N, Qin LX, Antonescu C, DeMatteo RP, Carvajal RD, Tap WD. Combined KIT and CTLA-4 Blockade in Patients with Refractory GIST and Other Advanced Sarcomas: A Phase Ib Study of Dasatinib plus Ipilimumab. Clin Cancer Res 2017; 23:2972-2980. [PMID: 28007774 PMCID: PMC5486863 DOI: 10.1158/1078-0432.ccr-16-2349] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 12/20/2022]
Abstract
Purpose: A phase Ib study of dasatinib plus ipilimumab in patients with gastrointestinal stromal tumor (GIST) and other sarcomas was performed on the basis of preclinical data demonstrating that combined KIT and CTLA-4 blockade is synergistic.Experimental Design: A standard 3 + 3 design was used to evaluate the safety, efficacy, and immune correlates of treatment. Dose escalation cohorts received ipilimumab 10 or 3 mg/kg every 3 weeks, followed by maintenance every 12 weeks with escalating doses of dasatinib (70 mg daily, 100 mg daily, or 70 mg twice daily). Response was assessed by RECIST 1.1, Choi, and immune-related RECIST criteria (irRC).Results: A total of 28 patients (17 male) were enrolled. Histologic subtypes included GISTs (n = 20) and other sarcomas (n = 8.) Dasatinib 70 mg/day with ipilimumab 10 mg/kg or dasatinib 140 mg/day with ipilimumab 3 mg/kg can be safely administered. Dose-limiting toxicities included grade 3 gastric hemorrhage and anemia. No partial or complete responses were noted by RECIST or irRC. There were 7 of 13 partial responses in the GIST patients by Choi criteria, and 3 of 13 patients each had stable and progressive disease, respectively.Conclusions: Dasatinib and ipilimumab can be safely administered to GIST and sarcoma patients. However, dasatinib was not synergistic with ipilimumab, as there was limited clinical efficacy with the combination. This limited cohort provides prospective data that indoleamine-2,3-dioxygenase (IDO) suppression may potentially correlate with antitumor efficacy in GIST. Given the small cohort, it is only hypothesis generating and additional data would be required. In the era of more modern and effective checkpoint inhibitors, next steps could be consideration of tyrosine kinase inhibitors or IDO inhibitors in combination with anti-PD-1 therapy. Clin Cancer Res; 23(12); 2972-80. ©2016 AACR.
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Affiliation(s)
- Sandra P D'Angelo
- Department of Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
- Weill Cornell Medical College, New York, New York
| | - Alexander N Shoushtari
- Department of Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Mary Louise Keohan
- Department of Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Mark A Dickson
- Department of Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Mrinal M Gounder
- Department of Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Ping Chi
- Department of Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Jennifer K Loo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Leigh Gaffney
- Department of Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lee Schneider
- Department of Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zarine Patel
- Department of Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph Patrick Erinjeri
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark J Bluth
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ana Sjoberg
- Department of Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Howard Streicher
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Naoko Takebe
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Rockville, Maryland
| | - Li-Xuan Qin
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cristina Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ronald P DeMatteo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - William D Tap
- Department of Medicine, Sarcoma Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
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de Jonge M, de Weger VA, Dickson MA, Langenberg M, Le Cesne A, Wagner AJ, Hsu K, Zheng W, Macé S, Tuffal G, Thomas K, Schellens JHM. A phase I study of SAR405838, a novel human double minute 2 (HDM2) antagonist, in patients with solid tumours. Eur J Cancer 2017; 76:144-151. [PMID: 28324749 DOI: 10.1016/j.ejca.2017.02.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/05/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE In tumours with wild-type TP53, the tumour-suppressive function of p53 is frequently inhibited by HDM2. This phase I, dose-escalating study investigated the maximum tolerated dose (MTD), safety, pharmacokinetics and pharmacodynamics of SAR405838, an HDM2 inhibitor, in patients with advanced solid tumours (NCT01636479). METHODS In dose escalation, patients with any locally advanced/metastatic solid tumour with TP53 mutation prevalence below 40%, or documented as TP53 wild-type, were eligible. In the MTD expansion cohort, only patients with de-differentiated liposarcoma were included. Primary end-points were MTD and efficacy in the MTD expansion cohort. Secondary end-points included safety, pharmacokinetics and pharmacodynamics biomarkers. RESULTS Seventy-four patients were treated with SAR405838 (50-800 mg once daily [QD], 800-1800 mg weekly and 1800 mg twice weekly). Two patients treated with SAR405838 400 mg QD had thrombocytopaenia as a dose-limiting toxicity (DLT). The MTD for the QD schedule of SAR405838 was 300 mg QD. No DLTs were observed with the weekly schedule; one patient had a DLT of nausea with the 1800 mg twice-weekly dose. Treatment with SAR405838 was associated with increased plasma MIC-1, reflecting p53 pathway activation. In the de-differentiated liposarcoma MTD cohort, 89% of the patients had HDM2 amplification at baseline and no TP53 mutations were observed; best response was stable disease in 56% and progression-free rate at 3 months was 32%. CONCLUSION SAR405838 had an acceptable safety profile with limited activity in patients with advanced solid tumours. The MTD of SAR405838 was 300 mg QD; MTD was not reached with the weekly schedule.
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Affiliation(s)
- Maja de Jonge
- Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | | | - Mark A Dickson
- Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, USA.
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Dickson MA, Mahoney MR, Tap WD, D'Angelo SP, Keohan ML, Van Tine BA, Agulnik M, Horvath LE, Nair JS, Schwartz GK. Phase II study of MLN8237 (Alisertib) in advanced/metastatic sarcoma. Ann Oncol 2016; 27:1855-60. [PMID: 27502708 DOI: 10.1093/annonc/mdw281] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [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: 02/24/2016] [Accepted: 07/08/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Aurora kinase A (AURKA) is commonly overexpressed in sarcoma. The inhibition of AURKA by shRNA or by a specific AURKA inhibitor blocks in vitro proliferation of multiple sarcoma subtypes. MLN8237 (alisertib) is a novel oral adenosine triphosphate-competitive AURKA inhibitor. PATIENTS AND METHODS This Cancer Therapy Evaluation Program-sponsored phase II study of alisertib was conducted through the Alliance for Clinical Trials in Oncology (A091102). Patients were enrolled into histology-defined cohorts: (i) liposarcoma, (ii) leiomyosarcoma, (iii) undifferentiated sarcoma, (iv) malignant peripheral nerve sheath tumor, or (v) other. Treatment was alisertib 50 mg PO b.i.d. d1-d7 every 21 days. The primary end point was response rate; progression-free survival (PFS) was secondary. One response in the first 9 patients expanded enrollment in a cohort to 24 using a Simon two-stage design. RESULTS Seventy-two patients were enrolled at 24 sites [12 LPS, 10 LMS, 11 US, 10 malignant peripheral nerve sheath tumor (MPNST), 29 Other]. The median age was 55 years; 54% were male; 58%/38%/4% were ECOG PS 0/1/2. One PR expanded enrollment to the second stage in the other sarcoma cohort. The histology-specific cohorts ceased at the first stage. There were two confirmed PRs in the other cohort (both angiosarcoma) and one unconfirmed PR in dedifferentiated chondrosarcoma. Twelve-week PFS was 73% (LPS), 44% (LMS), 36% (US), 60% (MPNST), and 38% (Other). Grade 3-4 adverse events: oral mucositis (12%), anemia (14%), platelet count decreased (14%), leukopenia (22%), and neutropenia (42%). CONCLUSIONS Alisertib was well tolerated. Occasional responses, yet prolonged stable disease, were observed. Although failing to meet the primary RR end point, PFS was promising. TRIAL REGISTRATION ID NCT01653028.
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Affiliation(s)
- M A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York Weill Cornell Medical College, New York
| | - M R Mahoney
- Biomedical Statistics & Informatics, Alliance Statistics and Data Center, Mayo Clinic, Rochester
| | - W D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York Weill Cornell Medical College, New York
| | - S P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York Weill Cornell Medical College, New York
| | - M L Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York Weill Cornell Medical College, New York
| | - B A Van Tine
- Department of Internal Medicine, Washington University School of Medicine, Saint Louis
| | - M Agulnik
- Department of Hematology and Oncology, Northwestern University, Chicago
| | - L E Horvath
- Department of Medicine, Alliance for Clinical Trials in Oncology, Chicago
| | - J S Nair
- Department of Medicine, Columbia University Medical Center, New York, USA
| | - G K Schwartz
- Department of Medicine, Columbia University Medical Center, New York, USA
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Abstract
There are 3 biologic groups of liposarcoma: well-differentiated and dedifferentiated liposarcoma, myxoid/round cell liposarcoma, and pleomorphic liposarcoma. In all 3 groups, complete surgical resection is central in treatment aimed at cure and is based on grade. Radiation can reduce risk of local recurrence in high-grade lesions or minimize surgical morbidity in the myxoid/round cell liposarcoma group. The groups differ in chemosensitivity, so adjuvant chemotherapy is selectively used in histologies with metastatic potential but not in the resistant subtype dedifferentiated liposarcoma. Improved understanding of the genetic aberrations that lead to liposarcoma initiation is allowing for the rapid development of targeted therapies for liposarcoma.
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Affiliation(s)
- Aimee M Crago
- Sarcoma Disease Management Team, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H1220, New York, NY 10065, USA; Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA.
| | - Mark A Dickson
- Sarcoma Disease Management Team, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Sarcoma Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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Gounder MM, Zer A, Tap WD, Salah S, Dickson MA, Gupta AA, Keohan ML, Loong HH, D'Angelo SP, Baker S, Condy M, Nyquist-Schultz K, Tanner L, Erinjeri JP, Jasmine FH, Friedlander S, Carlson R, Unger TJ, Saint-Martin JR, Rashal T, Ellis J, Kauffman M, Shacham S, Schwartz GK, Abdul Razak AR. Phase IB Study of Selinexor, a First-in-Class Inhibitor of Nuclear Export, in Patients With Advanced Refractory Bone or Soft Tissue Sarcoma. J Clin Oncol 2016; 34:3166-74. [PMID: 27458288 DOI: 10.1200/jco.2016.67.6346] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We evaluated the pharmacokinetics (PKs), pharmacodynamics, safety, and efficacy of selinexor, an oral selective inhibitor of nuclear export compound, in patients with advanced soft tissue or bone sarcoma with progressive disease. PATIENTS AND METHODS Fifty-four patients were treated with oral selinexor twice per week (on days 1 and 3) at one of three doses (30 mg/m(2), 50 mg/m(2), or flat dose of 60 mg) either continuously or on a schedule of 3 weeks on, 1 week off. PK analysis was performed under fasting and fed states (low v high fat content) and using various formulations of selinexor (tablet, capsule, or suspension). Tumor biopsies before and during treatment were evaluated for pharmacodynamic changes. RESULTS The most commonly reported drug-related adverse events (grade 1 or 2) were nausea, vomiting, anorexia, and fatigue, which were well managed with supportive care. Commonly reported grade 3 or 4 toxicities were fatigue, thrombocytopenia, anemia, lymphopenia, and leukopenia. Selinexor was significantly better tolerated when administered as a flat dose on an intermittent schedule. PK analysis of selinexor revealed a clinically insignificant increase (approximately 15% to 20%) in drug exposure when taken with food. Immunohistochemical analysis of paired tumor biopsies revealed increased nuclear accumulation of tumor suppressor proteins, decreased cell proliferation, increased apoptosis, and stromal deposition. Of the 52 patients evaluable for response, none experienced an objective response by RECIST (version 1.1); however, 17 (33%) showed durable (≥ 4 months) stable disease, including seven (47%) of 15 evaluable patients with dedifferentiated liposarcoma. CONCLUSION Selinexor was well tolerated at a 60-mg flat dose on a 3-weeks-on, 1-week-off schedule. There was no clinically meaningful impact of food on PKs. Preliminary evidence of anticancer activity in sarcoma was demonstrated.
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Affiliation(s)
- Mrinal M Gounder
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA.
| | - Alona Zer
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - William D Tap
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Samer Salah
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Mark A Dickson
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Abha A Gupta
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Mary Louise Keohan
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Herbert H Loong
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Sandra P D'Angelo
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Stephanie Baker
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Mercedes Condy
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Kjirsten Nyquist-Schultz
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Lanier Tanner
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Joseph P Erinjeri
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Francis H Jasmine
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Sharon Friedlander
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Robert Carlson
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Thaddeus J Unger
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Jean-Richard Saint-Martin
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Tami Rashal
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Joel Ellis
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Michael Kauffman
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Sharon Shacham
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Gary K Schwartz
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
| | - Albiruni Ryan Abdul Razak
- Mrinal M. Gounder, William D. Tap, Mark A. Dickson, Mary Louise Keohan, Sandra P. D'Angelo, Mercedes Condy, Lanier Tanner, Joseph P. Erinjeri, and Francis H. Jasmine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; Gary K. Schwartz, Columbia University Medical Center, New York, NY; Alona Zer, Samer Salah, Abha A. Gupta, Herbert H. Loong, Stephanie Baker, Kjirsten Nyquist-Schultz, and Albiruni Ryan Abdul Razak, Princess Margaret Cancer Center, Toronto, Ontario, Canada; and Sharon Friedlander, Robert Carlson, Thaddeus J. Unger, Jean-Richard Saint-Martin, Tami Rashal, Joel Ellis, Michael Kauffman, and Sharon Shacham, Karyopharm Therapeutics, Newton, MA
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Kovatcheva M, Liu DD, Dickson MA, Klein ME, O'Connor R, Wilder FO, Socci ND, Tap WD, Schwartz GK, Singer S, Crago AM, Koff A. MDM2 turnover and expression of ATRX determine the choice between quiescence and senescence in response to CDK4 inhibition. Oncotarget 2016; 6:8226-43. [PMID: 25803170 PMCID: PMC4480747 DOI: 10.18632/oncotarget.3364] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/15/2015] [Indexed: 12/19/2022] Open
Abstract
CDK4 inhibitors (CDK4i) earned Breakthrough Therapy Designation from the FDA last year and are entering phase III clinical trials in several cancers. However, not all tumors respond favorably to these drugs. CDK4 activity is critical for progression through G1 phase and into the mitotic cell cycle. Inhibiting this kinase induces Rb-positive cells to exit the cell cycle into either a quiescent or senescent state. In this report, using well-differentiated and dedifferentiated liposarcoma (WD/DDLS) cell lines, we show that the proteolytic turnover of MDM2 is required for CDK4i-induced senescence. Failure to reduce MDM2 does not prevent CDK4i-induced withdrawal from the cell cycle but the cells remain in a reversible quiescent state. Reducing MDM2 in these cells drives them into the more stable senescent state. CDK4i-induced senescence associated with loss of MDM2 is also observed in some breast cancer, lung cancer and glioma cell lines indicating that this is not limited to WD/DDLS cells in which MDM2 is overexpressed or in cells that contain wild type p53. MDM2 turnover depends on its E3 ligase activity and expression of ATRX. Interestingly, in seven patients the changes in MDM2 expression were correlated with outcome. These insights identify MDM2 and ATRX as new regulators controlling geroconversion, the process by which quiescent cells become senescent, and this insight may be exploited to improve the activity of CDK4i in cancer therapy.
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Affiliation(s)
- Marta Kovatcheva
- The Louis V. Gerstner Graduate School of Biomedical Sciences, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, USA.,Program in Molecular Biology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - David D Liu
- The Graduate Program in Biochemistry, Cellular and Molecular Biology, Weill College of Medicine, Cornell University, New York, USA.,Program in Molecular Biology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Mark A Dickson
- Department of Medicine, Weill College of Medicine, Cornell University, New York, USA.,Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Mary E Klein
- The Louis V. Gerstner Graduate School of Biomedical Sciences, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, USA.,Program in Molecular Biology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Rachael O'Connor
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Fatima O Wilder
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Nicholas D Socci
- Program in Computational Biology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - William D Tap
- Department of Medicine, Weill College of Medicine, Cornell University, New York, USA.,Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Gary K Schwartz
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA.,Current address: Columbia University, New York, USA
| | - Samuel Singer
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Aimee M Crago
- Program in Molecular Biology, Memorial Sloan-Kettering Cancer Center, New York, USA.,Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Andrew Koff
- The Louis V. Gerstner Graduate School of Biomedical Sciences, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, USA.,The Graduate Program in Biochemistry, Cellular and Molecular Biology, Weill College of Medicine, Cornell University, New York, USA.,Program in Molecular Biology, Memorial Sloan-Kettering Cancer Center, New York, USA
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Naidoo J, Schindler K, Querfeld C, Busam K, Cunningham J, Page DB, Postow MA, Weinstein A, Lucas AS, Ciccolini KT, Quigley EA, Lesokhin AM, Paik PK, Chaft JE, Segal NH, D'Angelo SP, Dickson MA, Wolchok JD, Lacouture ME. Autoimmune Bullous Skin Disorders with Immune Checkpoint Inhibitors Targeting PD-1 and PD-L1. Cancer Immunol Res 2016; 4:383-9. [PMID: 26928461 PMCID: PMC5241697 DOI: 10.1158/2326-6066.cir-15-0123] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 01/13/2016] [Indexed: 01/05/2023]
Abstract
Monoclonal antibodies (mAb) targeting immune checkpoint pathways such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed death 1 (PD-1) may confer durable disease control in several malignancies. In some patients, immune checkpoint mAbs cause cutaneous immune-related adverse events. Although the most commonly reported cutaneous toxicities are mild, a subset may persist despite therapy and can lead to severe or life-threatening toxicity. Autoimmune blistering disorders are not commonly associated with immune checkpoint mAb therapy. We report a case series of patients who developed bullous pemphigoid (BP), an autoimmune process classically attributed to pathologic autoantibody formation and complement deposition. Three patients were identified. Two patients developed BP while receiving the anti-PD-1 mAb nivolumab, and one while receiving the anti-PD-L1 mAb durvalumab. The clinicopathologic features of each patient and rash, and corresponding radiologic findings at the development of the rash and after its treatment, are described. Patients receiving an anti-PD-1/PD-L1 mAb may develop immune-related BP. This may be related to both T-cell- and B-cell-mediated responses. Referral to a dermatologist for accurate diagnosis and management is recommended. Cancer Immunol Res; 4(5); 383-9. ©2016 AACR.
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Affiliation(s)
- Jarushka Naidoo
- Department of Oncology, Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland.
| | - Katja Schindler
- Department of Dermatology and Dermato-oncology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Christiane Querfeld
- Department of Dermatology and Dermato-pathology, City of Hope Cancer Center and Beckman Research Institute, Duarte, California
| | - Klaus Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jane Cunningham
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David B Page
- Department of Medicine, Portland Providence Medical Center, Earl A. Chiles Research Institute, Portland, Oregon
| | - Michael A Postow
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Weill Cornell Medical College, New York, New York
| | - Alyona Weinstein
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anna Skripnik Lucas
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathryn T Ciccolini
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth A Quigley
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Weill Cornell Medical College, New York, New York. Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexander M Lesokhin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Weill Cornell Medical College, New York, New York
| | - Paul K Paik
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Weill Cornell Medical College, New York, New York
| | - Jamie E Chaft
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Weill Cornell Medical College, New York, New York
| | - Neil H Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Weill Cornell Medical College, New York, New York
| | - Sandra P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Weill Cornell Medical College, New York, New York
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Weill Cornell Medical College, New York, New York
| | - Jedd D Wolchok
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Weill Cornell Medical College, New York, New York. Ludwig Center for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mario E Lacouture
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Weill Cornell Medical College, New York, New York. Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
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Schwartz GK, Dickson MA, LoRusso PM, Sausville EA, Maekawa Y, Watanabe Y, Kashima N, Nakashima D, Akinaga S. Preclinical and first-in-human phase I studies of KW-2450, an oral tyrosine kinase inhibitor with insulin-like growth factor receptor-1/insulin receptor selectivity. Cancer Sci 2016; 107:499-506. [PMID: 26850678 PMCID: PMC4832855 DOI: 10.1111/cas.12906] [Citation(s) in RCA: 20] [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: 10/07/2015] [Revised: 01/18/2016] [Accepted: 01/26/2016] [Indexed: 01/07/2023] Open
Abstract
Numerous solid tumors overexpress or have excessively activated insulin-like growth factor receptor-1 (IGF-1R). We summarize preclinical studies and the first-in-human study of KW-2450, an oral tyrosine kinase inhibitor with IGF-1R and insulin receptor (IR) inhibitory activity. Preclinical activity of KW-2450 was evaluated in various in vitro and in vivo models. It was then evaluated in a phase I clinical trial in 13 patients with advanced solid tumors (NCT00921336). In vitro, KW-2450 inhibited human IGF-1R and IR kinases (IC50 7.39 and 5.64 nmol/L, respectively) and the growth of various human malignant cell lines. KW-2450 40 mg/kg showed modest growth inhibitory activity and inhibited IGF-1-induced signal transduction in the murine HT-29/GFP colon carcinoma xenograft model. The maximum tolerated dose of KW-2450 was 37.5 mg once daily continuously; dose-limiting toxicity occurred in two of six patients at 50 mg/day (both grade 3 hyperglycemia) and in one of seven patients at 37.5 mg/day (grade 3 rash). Four of 10 evaluable patients showed stable disease. Single-agent KW-2450 was associated with modest antitumor activity in heavily pretreated patients with solid tumors and is being further investigated in combination therapy with lapatinib/letrozole in patients with human epidermal growth factor receptor 2-postive metastatic breast cancer.
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Affiliation(s)
- Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA, USA
| | - Mark A Dickson
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA, USA.,Weill Cornell Medical College, New York, NY, USA, USA
| | | | | | - Yoshimi Maekawa
- Fuji Research Park, R&D Division, Kyowa Hakko Kirin Co., Ltd., Shizuoka, Japan
| | - Yasuo Watanabe
- Fuji Research Park, R&D Division, Kyowa Hakko Kirin Co., Ltd., Shizuoka, Japan
| | - Naomi Kashima
- Fuji Research Park, R&D Division, Kyowa Hakko Kirin Co., Ltd., Shizuoka, Japan
| | - Daisuke Nakashima
- Planning Department, Kyowa Hakko Kirin Pharma Inc., Princeton, NJ, USA
| | - Shiro Akinaga
- Tokyo Research Park, R&D Division, Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan
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Horvat TZ, Adel NG, Dang TO, Momtaz P, Postow MA, Callahan MK, Carvajal RD, Dickson MA, D'Angelo SP, Woo KM, Panageas KS, Wolchok JD, Chapman PB. Reply to A. Indini et al. J Clin Oncol 2016; 34:1018-9. [PMID: 26786917 DOI: 10.1200/jco.2015.65.7007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Troy Z Horvat
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nelly G Adel
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thu-Oanh Dang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Parisa Momtaz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael A Postow
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
| | - Margaret K Callahan
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
| | - Richard D Carvajal
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
| | - Mark A Dickson
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
| | - Sandra P D'Angelo
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
| | - Kaitlin M Woo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jedd D Wolchok
- Memorial Sloan Kettering Cancer Center; Ludwig Institute for Cancer Research; and Weill Cornell Medical College, New York, NY
| | - Paul B Chapman
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
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Jackson CC, Dickson MA, Sadjadi M, Gessain A, Abel L, Jouanguy E, Casanova J. Kaposi Sarcoma of Childhood: Inborn or Acquired Immunodeficiency to Oncogenic HHV-8. Pediatr Blood Cancer 2016; 63:392-7. [PMID: 26469702 PMCID: PMC4984265 DOI: 10.1002/pbc.25779] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/04/2015] [Accepted: 09/10/2015] [Indexed: 12/13/2022]
Abstract
Kaposi sarcoma (KS) is an endothelial malignancy caused by human herpes virus-8 (HHV-8) infection. The epidemic and iatrogenic forms of childhood KS result from a profound and acquired T cell deficiency. Recent studies have shown that classic KS of childhood can result from rare single-gene inborn errors of immunity, with mutations in WAS, IFNGR1, STIM1, and TNFRSF4. The pathogenesis of the endemic form of childhood KS has remained elusive. We review childhood KS pathogenesis and its relationship to inherited and acquired immunodeficiency to oncogenic HHV-8.
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Affiliation(s)
- Carolyn C. Jackson
- St. Giles Laboratory of Human Genetics of Infectious DiseasesRockefeller BranchThe Rockefeller UniversityNew York
- Department of PediatricsMemorial Sloan Kettering Cancer CenterNew York
| | - Mark A. Dickson
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew York
- Department of MedicineWeill Cornell Medical CollegeNew York
| | - Mahan Sadjadi
- St. Giles Laboratory of Human Genetics of Infectious DiseasesRockefeller BranchThe Rockefeller UniversityNew York
| | - Antoine Gessain
- Unit of Epidemiology and Physiopathology of Oncogenic VirusesInstitut PasteurParisFrance
| | - Laurent Abel
- St. Giles Laboratory of Human Genetics of Infectious DiseasesRockefeller BranchThe Rockefeller UniversityNew York
- Laboratory of Human Genetics of Infectious DiseasesNecker BranchINSERM U1163ParisFrance
- Paris Descartes UniversityImagine InstituteParisFrance
| | - Emmanuelle Jouanguy
- St. Giles Laboratory of Human Genetics of Infectious DiseasesRockefeller BranchThe Rockefeller UniversityNew York
- Laboratory of Human Genetics of Infectious DiseasesNecker BranchINSERM U1163ParisFrance
- Paris Descartes UniversityImagine InstituteParisFrance
| | - Jean‐Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious DiseasesRockefeller BranchThe Rockefeller UniversityNew York
- Laboratory of Human Genetics of Infectious DiseasesNecker BranchINSERM U1163ParisFrance
- Paris Descartes UniversityImagine InstituteParisFrance
- Howard Hughes Medical Institute
- Pediatric Hematology‐Immunology UnitNecker Hospital for Sick ChildrenParisFrance
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Munhoz RR, D'Angelo SP, Gounder MM, Keohan ML, Chi P, Carvajal RD, Singer S, Crago AM, Landa J, Healey JH, Qin LX, Hameed M, Ezeoke MO, Singh AS, Agulnik M, Chmielowski B, Luke JJ, Van Tine BA, Schwartz GK, Tap WD, Dickson MA. A Phase Ib/II Study of Gemcitabine and Docetaxel in Combination With Pazopanib for the Neoadjuvant Treatment of Soft Tissue Sarcomas. Oncologist 2015; 20:1245-6. [PMID: 26449382 DOI: 10.1634/theoncologist.2015-0245] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/19/2015] [Indexed: 11/17/2022] Open
Abstract
LESSONS LEARNED Our results highlight some of the challenges in the management of soft tissue sarcomas, which requires close cooperation between surgeons and medical oncologists and a careful selection of patients. The incidence of hepatotoxicity was a concerning finding and had been previously reported in patients treated with pazopanib.Although pharmacokinetic analysis was not part of this study, concomitant treatment with pazopanib has been recently reported to increase docetaxel exposure, which may explain the increased toxicity of combination regimens. It remains possible that lower doses of combined gemcitabine, docetaxel, and pazopanib may be tolerable. However, caution should be exercised in future trials investigating similar combinations. BACKGROUND For extremity soft tissue sarcomas (STS), surgical resection remains the standard of care, and the addition of chemotherapy is controversial. This was a phase Ib/II trial of neoadjuvant therapy for patients with STS. METHODS Patients with high grade, extremity STS of >8 cm and amenable to definitive resection were treated with up to four 21-day cycles of 900 mg/m(2) gemcitabine on days 1 and 8, 75 mg/m(2) docetaxel on day 8, and 400 mg of pazopanib daily (GDP), followed by surgery and, if indicated, radiation therapy. Primary and secondary endpoints (phase Ib portion) were the safety and rate of pathologic response. RESULTS The trial was discontinued because of slow accrual after inclusion of five patients (leiomyosarcoma: two; undifferentiated pleomorphic sarcoma: three). Two patients completed four treatment cycles: one underwent surgery and one had insufficient response and received additional therapies. Three patients discontinued treatment because of toxicity. Grade 3 adverse events included hypertension, fatigue, aspartate aminotransferase (AST) or alanine aminotransferase (ALT) elevation, hoarseness, and myelotoxicity. There were no complete or partial responses. One patient had ≥ 90% pathologic response. Among four patients who underwent resection, three remain free of disease, and one patient eventually relapsed. CONCLUSION GDP combination used in the neoadjuvant setting resulted in significant toxicity; despite pathologic responses, no objective responses occurred.
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Affiliation(s)
| | - Sandra P D'Angelo
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - Mrinal M Gounder
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - Mary L Keohan
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - Ping Chi
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | | | - Samuel Singer
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - Aimee M Crago
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - Jonathan Landa
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - John H Healey
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - Li-Xuan Qin
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - Meera Hameed
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | | | - Arun S Singh
- University of California at Los Angeles, Los Angeles, California, USA
| | | | | | | | | | | | - William D Tap
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
| | - Mark A Dickson
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA
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Gounder M, Desai V, Kuk D, Agaram N, Arcila M, Durham B, Keohan ML, Dickson MA, D'Angelo SP, Shukla N, Moskowitz C, Noy A, Maki RG, Herrera DA, Sanchez A, Krishnan A, Pourmoussa A, Qin LX, Tap WD. Impact of surgery, radiation and systemic therapy on the outcomes of patients with dendritic cell and histiocytic sarcomas. Eur J Cancer 2015; 51:2413-22. [PMID: 26298731 DOI: 10.1016/j.ejca.2015.06.109] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [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: 03/12/2015] [Revised: 05/13/2015] [Accepted: 06/17/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neoplasms of histiocytic and dendritic cell origin, including follicular dendritic cell sarcoma (FDCS), histiocytic sarcoma (HS) and interdigitating dendritic cell sarcoma (IDCS), are extremely rare, and data on their natural history and treatment outcomes are sparse. We evaluated the impact of surgery, radiation and systemic therapies on overall survival (OS). METHODS We conducted a retrospective chart review of patients with FDCS, IDCS and HS treated at Memorial Sloan Kettering Cancer Center between 1995 and 2014. RESULTS We identified 31, 15 and 7 patients with FDCS, HS and IDCS, respectively. Median age was 48.7, 42.3 and 58.8years for FDCS, HS and IDCS, respectively. Only a slight disparity in gender distribution existed for FDCS and HS; however, IDCS predominantly affected males (6:1). The most common sites of presentation were abdomen and pelvis (42%), extremities (33%) and head and neck (57%) for FDCS, HS and IDCS, respectively. At diagnosis, 74%, 40% and 86% of patients presented with localised disease in FDCS, HS and IDCS, respectively. Patients with localised disease had significantly improved OS than those with metastatic disease in FDCS (P=0.04) and IDCS (P=0.014) but not in HS (P=0.95). In FDCS and HS, adjuvant or neo-adjuvant therapy was not associated with improved OS compared with observation. In IDCS, surgery alone provided a 5-year overall survival rate of 71%. CONCLUSIONS Adjuvant or neo-adjuvant treatment in FDCS and HS did not affect OS. Patients with IDCS had an excellent outcome with surgery. In the metastatic setting, chemotherapy and small molecule inhibitors may provide benefit.
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Affiliation(s)
- Mrinal Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA.
| | - Ved Desai
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Deborah Kuk
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Narasimhan Agaram
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Maria Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Benjamin Durham
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Mary L Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Sandra P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Neerav Shukla
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Craig Moskowitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Robert G Maki
- Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, New York, NY, 10029, USA
| | - Diego Adrianzen Herrera
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Armando Sanchez
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Anita Krishnan
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Andrew Pourmoussa
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - Li-Xuan Qin
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY 10065, USA
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Horvat TZ, Adel NG, Dang TO, Momtaz P, Postow MA, Callahan MK, Carvajal RD, Dickson MA, D'Angelo SP, Woo KM, Panageas KS, Wolchok JD, Chapman PB. Immune-Related Adverse Events, Need for Systemic Immunosuppression, and Effects on Survival and Time to Treatment Failure in Patients With Melanoma Treated With Ipilimumab at Memorial Sloan Kettering Cancer Center. J Clin Oncol 2015; 33:3193-8. [PMID: 26282644 DOI: 10.1200/jco.2015.60.8448] [Citation(s) in RCA: 757] [Impact Index Per Article: 84.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Ipilimumab is a standard treatment for metastatic melanoma, but immune-related adverse events (irAEs) are common and can be severe. We reviewed our large, contemporary experience with ipilimumab treatment outside of clinical trials to determine the frequency of use of systemic corticosteroid or anti-tumor necrosis factor α (anti-TNFα) therapy and the effect of these therapies on overall survival (OS) and time to treatment failure (TTF). PATIENTS AND METHODS We reviewed retrospectively the medical records of patients with melanoma who had received treatment between April 2011 and July 2013 with ipilimumab at the standard dose of 3 mg/kg. We collected data on patient demographics, previous and subsequent treatments, number of ipilimumab doses, irAEs and how they were treated, and overall survival. RESULTS Of the 298 patients, 254 (85%) experienced an irAE of any grade. Fifty-six patients (19%) discontinued therapy because of an irAE, most commonly diarrhea. Overall, 103 patients (35%) required systemic corticosteroid treatment for an irAE; 29 (10%) also required anti-TNFα therapy. Defining TTF as either starting a new treatment or death, estimated median TTF was 5.7 months. Twelve percent of patients experienced long-term disease control without receiving additional antimelanoma therapy. OS and TTF were not affected by the occurrence of irAEs or the need for systemic corticosteroids. CONCLUSION IrAEs are common in patients treated with ipilimumab. In our experience, approximately one-third of ipilimumab-treated patients required systemic corticosteroids, and almost one-third of those required further immune suppression with anti-TNFα therapy. Practitioners and patients should be prepared to treat irAEs and should understand that such treatment does not affect OS or TTF.
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Affiliation(s)
- Troy Z Horvat
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY
| | - Nelly G Adel
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY
| | - Thu-Oanh Dang
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY
| | - Parisa Momtaz
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY
| | - Michael A Postow
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY
| | - Margaret K Callahan
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY
| | - Richard D Carvajal
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY
| | - Mark A Dickson
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY
| | - Sandra P D'Angelo
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY
| | - Kaitlin M Woo
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY
| | - Katherine S Panageas
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY
| | - Jedd D Wolchok
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY
| | - Paul B Chapman
- Troy Z. Horvat, Nelly G. Adel, Thu-Oanh Dang, Kaitlin M. Woo, Katherine S. Panageas, Parisa Momtaz, Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Memorial Sloan Kettering Cancer Center; Jedd D. Wolchok, Ludwig Institute for Cancer Research; and Michael A. Postow, Margaret K. Callahan, Richard D. Carvajal, Mark A. Dickson, Sandra P. D'Angelo, Jedd D. Wolchok, and Paul B. Chapman, Weill Cornell Medical College, New York, NY.
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47
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D'Angelo SP, Munhoz RR, Kuk D, Landa J, Hartley EW, Bonafede M, Dickson MA, Gounder M, Keohan ML, Crago AM, Antonescu CR, Tap WD. Outcomes of Systemic Therapy for Patients with Metastatic Angiosarcoma. Oncology 2015; 89:205-14. [PMID: 26043723 PMCID: PMC5587158 DOI: 10.1159/000381917] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/25/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Angiosarcomas (AS) are rare tumors of vascular origin with a variable behavior and overall poor prognosis. We sought to assess the outcomes of patients treated for metastatic disease. METHODS We performed a retrospective analysis of 119 patients treated for metastatic AS. Outcomes and efficacy measurements of the first and subsequent lines of treatment were analyzed. RESULTS Median age was 61 years, and the most frequent primary sites were chest wall/breast (31%), viscera (22%) and head/neck (20%). Seventy-three (61%) and 46 (39%) patients received ≥ 2 and ≥ 3 lines of therapy, respectively. The most commonly used agents included taxanes and anthracyclines. Median overall survival was 12.1 months. Median times to tumor progression were 3.5 months for first line, 3.7 months for second line and 2.7 months for third line. Among 48 patients evaluable per RECIST, the overall response rate to first line was 30% and <10% in subsequent lines. Doxorubicin, liposomal doxorubicin and taxanes resulted in similar response rates and survival, and there was no apparent benefit for combination chemotherapy. CONCLUSION Despite reasonable response rates in the first-line setting, benefit from systemic therapy is short-lived in metastatic AS, and outcomes are poor. Doxorubicin, liposomal doxorubicin and taxanes are reasonable and appropriate choices for monotherapy.
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Affiliation(s)
- Sandra P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, N.Y., USA
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Abstract
OPINION STATEMENT Sarcomas are rare malignant tumors that develop from mesenchymal tissue. Most sarcomas are idiopathic, however, a significant minority develops as a consequence of prior radiation exposure. Although the absolute risk of developing a radiation-associated sarcoma is small, these tumors represent significant clinical challenges. For recurrent, unresectable or metastatic disease, the standard treatment is systemic chemotherapy. Radiation-associated sarcomas tend to be undifferentiated sarcomas, angiosarcomas, or leiomyosarcomas, which are variably sensitive to chemotherapy. The best general approach is to treat each radiation-associated sarcoma as one would its sporadic histologic counterpart. There are limited data to guide the best treatment for radiation-associated sarcoma, therefore, the standard chemotherapy options are reasonable choices. These include doxorubicin, ifosfamide, gemcitabine, docetaxel, and pazopanib. Patients with radiation-associated sarcomas may have received prior anthracyclines to treat antecedent malignancies such as breast cancer or lymphoma. Thus, if additional doxorubicin cannot be used, liposomal doxorubicin is a reasonable substitute. More prospective research is needed on how radiation-associated sarcomas respond to systemic therapy. Future clinical trials of new agents in sarcoma should identify and include patients with radiation-associated sarcoma.
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Affiliation(s)
- Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, 300 E 66th St, New York, NY, 10065, USA,
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49
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D'Angelo SP, Shoushtari AN, Agaram NP, Kuk D, Qin LX, Carvajal RD, Dickson MA, Gounder M, Keohan ML, Schwartz GK, Tap WD. Prevalence of tumor-infiltrating lymphocytes and PD-L1 expression in the soft tissue sarcoma microenvironment. Hum Pathol 2014; 46:357-65. [PMID: 25540867 DOI: 10.1016/j.humpath.2014.11.001] [Citation(s) in RCA: 220] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/04/2014] [Accepted: 11/05/2014] [Indexed: 12/11/2022]
Abstract
The prognostic and predictive implications of programmed death-ligand 1 (PD-L1) is unknown in sarcoma. We sought to examine the immune milieu in sarcoma specimens. We evaluated PD-L1 expression by immunohistochemistry in sarcoma specimens and quantified tumor-infiltrating lymphocytes (TIL). We correlated expression with clinical parameters and outcomes. Fifty sarcoma patients treated at Memorial Sloan Kettering Cancer Center were selected. Using the DAKO PD-L1 immunohistochemistry assay and archival formalin-fixed paraffin-embedded tissue specimens; PD-L1 expression was examined. Macrophage and lymphocyte PD-L1 status was determined qualitatively. TIL was quantified. Associations between PD-L1 expression in tumor, macrophages and lymphocytes, TIL and clinical-pathological characteristics were performed. The median age was 46 years (range, 22-76), and 66% of patients were men. Tumor, lymphocyte and macrophage PD-L1 expression was noted in 12%, 30% and 58%, respectively, with the highest prevalence in gastrointestinal stromal tumors (29%). Lymphocyte and macrophage infiltration was present in 98% and 90%, respectively. There was no association between clinical features, overall survival and PD-L1 expression in tumor or immune infiltrates. Lymphocyte and macrophage infiltration is common in sarcoma, but PD-L1 tumor expression is uncommon in sarcoma with the highest frequency observed in gastrointestinal stromal tumors. There was no association between PD-L1 expression, TIL and clinicopathological features and overall survival; however, this is limited by the heterogenous patient sample and minimal death events in the studied cohort.
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Affiliation(s)
- Sandra P D'Angelo
- Sarcoma Service, Dept. of Medicine, Memorial Sloan Kettering Cancer Center, 10065 New York, New York; Weill Cornell Medical College, 10065 New York, New York.
| | - Alexander N Shoushtari
- Sarcoma Service, Dept. of Medicine, Memorial Sloan Kettering Cancer Center, 10065 New York, New York
| | - Narasimhan P Agaram
- Dept. of Pathology, Memorial Sloan Kettering Cancer Center, 10065 New York, New York
| | - Deborah Kuk
- Dept. of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, 10065 New York, New York
| | - Li-Xuan Qin
- Dept. of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, 10065 New York, New York
| | - Richard D Carvajal
- Weill Cornell Medical College, 10065 New York, New York; Melanoma and Immunotherapeutics Service, Dept. of Medicine, Memorial Sloan Kettering Cancer Center, 10065 New York, New York
| | - Mark A Dickson
- Sarcoma Service, Dept. of Medicine, Memorial Sloan Kettering Cancer Center, 10065 New York, New York; Weill Cornell Medical College, 10065 New York, New York
| | - Mrinal Gounder
- Sarcoma Service, Dept. of Medicine, Memorial Sloan Kettering Cancer Center, 10065 New York, New York; Weill Cornell Medical College, 10065 New York, New York
| | - Mary Louise Keohan
- Sarcoma Service, Dept. of Medicine, Memorial Sloan Kettering Cancer Center, 10065 New York, New York; Weill Cornell Medical College, 10065 New York, New York
| | - Gary K Schwartz
- Department of Medicine, Columbia University Medical Center, 10032 New York, New York
| | - William D Tap
- Sarcoma Service, Dept. of Medicine, Memorial Sloan Kettering Cancer Center, 10065 New York, New York; Weill Cornell Medical College, 10065 New York, New York
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50
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Abstract
Unrestrained growth is the hallmark of cancer, and disrupted cell-cycle regulation is, therefore, common. CDK4 is the key regulator of the G1-S transition. In complex with cyclin D, CDK4 phosphorylates retinoblastoma protein (Rb) and drives cell-cycle progression, a process inhibited by p16. The p16-CDK4-cyclin D-Rb is aberrant in the majority of cancers and is, thus, a logical target for anticancer therapy. Previous attempts to block CDK4 with nonselective cyclin-dependent kinase (CDK) inhibitors led to toxicity and little efficacy. However, the recent development of selective CDK4 inhibitors launched the first successful efforts to target the pathway for cancer therapy. Three oral selective CDK4 inhibitors have entered clinical trials: palbociclib (PD0332991), LEE011, and LY2835219. CDK4 inhibitors have in vitro activity against a broad range of cancers and in patients have shown antitumor activity in breast cancer, lymphoma, sarcoma, and other tumors. Major efforts are under way to develop biomarkers of response, understand potential mechanisms of resistance, and develop rational combinations of CDK4 inhibitors with chemotherapy and other targeted drugs.
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Affiliation(s)
- Mark A Dickson
- Author's Affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York
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