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Armstrong P, Hayden P, Jeffers M, Fitzpatrick L, Mcknight A, Armstrong J. Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma Treated with Radiation Therapy: A Case Report and Review of the Literature. Case Rep Oncol 2023; 16:1528-1535. [PMID: 38045431 PMCID: PMC10691828 DOI: 10.1159/000534802] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/09/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Mucosa-associated lymphoid tissue lymphoma (MALT lymphoma or MALToma) is a prevalent type of primary pulmonary lymphoma. Typically, the primary therapeutic approaches involve surgery or chemotherapy, although there have been instances of radiation therapy being employed. Case Report We present a case of pulmonary MALToma that exhibited progression despite rituximab therapy. Subsequently, the patient demonstrated a positive response to radiation therapy. Conclusion This case highlights the potential efficacy of radiation therapy as a treatment option for pulmonary MALToma, especially in cases where other conventional treatments like rituximab have proven ineffective. Further research and studies are warranted to better understand the role of radiation therapy in managing pulmonary MALToma and to determine optimal treatment strategies for patients with this condition.
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Affiliation(s)
- Paul Armstrong
- Medical Student, University College Dublin, Dublin, Ireland
| | - Patrick Hayden
- Consultant Haematologist, St. James Hospital, Dublin, Ireland
| | - Michael Jeffers
- Consultant Histopathologist, Beacon Hospital, Dublin, Ireland
| | | | | | - John Armstrong
- Consultant Radiation Oncologist, Beacon Hospital, Dublin, Ireland
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2
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Shi DD, Savani MR, Levitt MM, Wang AC, Endress JE, Bird CE, Buehler J, Stopka SA, Regan MS, Lin YF, Puliyappadamba VT, Gao W, Khanal J, Evans L, Lee JH, Guo L, Xiao Y, Xu M, Huang B, Jennings RB, Bonal DM, Martin-Sandoval MS, Dang T, Gattie LC, Cameron AB, Lee S, Asara JM, Kornblum HI, Mak TW, Looper RE, Nguyen QD, Signoretti S, Gradl S, Sutter A, Jeffers M, Janzer A, Lehrman MA, Zacharias LG, Mathews TP, Losman JA, Richardson TE, Cahill DP, DeBerardinis RJ, Ligon KL, Xu L, Ly P, Agar NYR, Abdullah KG, Harris IS, Kaelin WG, McBrayer SK. De novo pyrimidine synthesis is a targetable vulnerability in IDH mutant glioma. Cancer Cell 2022; 40:939-956.e16. [PMID: 35985343 PMCID: PMC9515386 DOI: 10.1016/j.ccell.2022.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 06/09/2022] [Accepted: 07/26/2022] [Indexed: 12/30/2022]
Abstract
Mutations affecting isocitrate dehydrogenase (IDH) enzymes are prevalent in glioma, leukemia, and other cancers. Although mutant IDH inhibitors are effective against leukemia, they seem to be less active in aggressive glioma, underscoring the need for alternative treatment strategies. Through a chemical synthetic lethality screen, we discovered that IDH1-mutant glioma cells are hypersensitive to drugs targeting enzymes in the de novo pyrimidine nucleotide synthesis pathway, including dihydroorotate dehydrogenase (DHODH). We developed a genetically engineered mouse model of mutant IDH1-driven astrocytoma and used it and multiple patient-derived models to show that the brain-penetrant DHODH inhibitor BAY 2402234 displays monotherapy efficacy against IDH-mutant gliomas. Mechanistically, this reflects an obligate dependence of glioma cells on the de novo pyrimidine synthesis pathway and mutant IDH's ability to sensitize to DNA damage upon nucleotide pool imbalance. Our work outlines a tumor-selective, biomarker-guided therapeutic strategy that is poised for clinical translation.
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Affiliation(s)
- Diana D Shi
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA 02215, USA; Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Milan R Savani
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Medical Scientist Training Program, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Michael M Levitt
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Adam C Wang
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Jennifer E Endress
- Ludwig Cancer Center, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Cylaina E Bird
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Joseph Buehler
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Sylwia A Stopka
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Michael S Regan
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Yu-Fen Lin
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Vinesh T Puliyappadamba
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Wenhua Gao
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Januka Khanal
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Laura Evans
- Bayer HealthCare Pharmaceuticals, Inc., Cambridge, MA 02142, USA
| | - Joyce H Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Lei Guo
- Quantitative Biomedical Research Center, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Yi Xiao
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Min Xu
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Bofu Huang
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Rebecca B Jennings
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Dennis M Bonal
- Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Boston, MA 02210, USA
| | - Misty S Martin-Sandoval
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Tammie Dang
- Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lauren C Gattie
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Amy B Cameron
- Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Boston, MA 02210, USA
| | - Sungwoo Lee
- New Drug Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu 41061, Republic of Korea
| | - John M Asara
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Harley I Kornblum
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA 90095, USA; Department of Psychiatry and Behavioral Sciences, and Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA 90024, USA
| | - Tak W Mak
- The Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, ON M5G 2M9, Canada; The Princess Margaret Cancer Centre and Ontario Cancer Institute, University Health Network, Toronto, ON M5G 1L7, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Ryan E Looper
- Department of Chemistry, University of Utah, Salt Lake City, UT 84112, USA
| | - Quang-De Nguyen
- Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Boston, MA 02210, USA
| | - Sabina Signoretti
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Stefan Gradl
- Bayer AG, Muellerstrasse 178, 13353 Berlin, Germany
| | | | - Michael Jeffers
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ 07981, USA
| | | | - Mark A Lehrman
- Department of Pharmacology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lauren G Zacharias
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Thomas P Mathews
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Julie-Aurore Losman
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Timothy E Richardson
- Department of Pathology, Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Daniel P Cahill
- Department of Neurosurgery, Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Ralph J DeBerardinis
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Keith L Ligon
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Department of Pathology, Children's Hospital Boston, Boston, MA 02115, USA
| | - Lin Xu
- Quantitative Biomedical Research Center, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Peter Ly
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Nathalie Y R Agar
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Cancer Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Kalil G Abdullah
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Hillman Comprehensive Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA
| | - Isaac S Harris
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - William G Kaelin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA; Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA.
| | - Samuel K McBrayer
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA.
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Yap T, Konstantinopoulos P, Grisham R, Gupta D, Wilkinson G, Cao A, Jeffers M, Sharma N. 494TiP Phase Ib study of elimusertib (ATRi; BAY 1895344) in combination with niraparib (PARPi) in patients with advanced solid tumors. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Liston K, Jeffers M, Hogan J, McHugh J. Protein-losing enteropathy in association with gastrointestinal IgM deposition in Waldenström macroglobulinaemia. Br J Haematol 2022; 198:801. [PMID: 35796502 DOI: 10.1111/bjh.18325] [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: 11/29/2022]
Affiliation(s)
- Katie Liston
- Department of Haematology, Adelaide and Meath Hospital, Dublin, Ireland
| | - Michael Jeffers
- Department of Haematology, Adelaide and Meath Hospital, Dublin, Ireland
| | - Jill Hogan
- Department of Haematology, Adelaide and Meath Hospital, Dublin, Ireland
| | - Johnny McHugh
- Department of Haematology, Adelaide and Meath Hospital, Dublin, Ireland
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Shi D, Wang A, Gao W, Khanal J, Levitt M, Jennings R, Signoretti S, Nguyen Q, Endress J, Xu M, Gradl S, Sutter A, Jeffers M, Janzer A, Cahill D, Abdullah K, Ligon K, Harris I, Kaelin W, McBrayer S. Identification of De Novo Pyrimidine Synthesis as a Targetable Vulnerability in a Novel IDH1 Mutant Engineered Astrocytoma Model. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kaulfuss S, Janzer A, Siemeister G, Borowicz R, Jaensch K, Gutberlet K, Schlenz R, Triller A, Eheim A, Jeffers M, Christian S. Abstract 2077: Activity of DHODH inhibitor BAY2402234 in subcutaneous and intracranial models of SCLC. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: BAY2402234 is a potent and specific orally administered inhibitor of dihydroorotate dehydrogenase (DHODH) which showed anti-tumor activity in preclinical models of AML and is under clinical evaluation in myeloid malignancies (NCT03404726). Small cell lung cancer (SCLC) is a highly metastatic malignancy (the brain being a frequent metastatic site), which carries a dismal clinical prognosis. Previous preclinical research indicated that SCLC was particularly sensitive to DHODH inhibition, and in the current investigation the activity of BAY2402234 in this tumor indication was evaluated.
Experimental Procedures: A variety of in vivo models derived from human SCLC samples were evaluated: (1) cell-line derived xenograft (CDX) subcutaneous models; (2) a CDX intracranial model; and (3) patient-derived xenograft (PDX) subcutaneous models. As is typical for SCLC, most of these models harbored mutations in both p53 and Rb1. BAY2402234 was administered orally either once daily or on an intermittent schedule (4 days on/3 days off). Standard-of-care (SoC) therapies were included in some experiments. Tumor tissue and plasma were collected for pharmacodynamic analyses.
Results: In subcutaneous CDX models, BAY2402234 exhibited robust anti-tumor activity, including tumor regressions in some models. Strong anti-tumor activity was also observed in various subcutaneous PDX models, including activity in a model resistant to SoC therapy. In an intracranial tumor model, BAY2402234 significantly enhanced survival compared to the vehicle-treated cohort. Both dosing schedules tested were well-tolerated and highly active. Pharmacodynamic analyses to quantify the level of target inhibition observed in the various models are ongoing.
Conclusions: The results of this investigation confirm and extend previous preclinical results and indicate that BAY2402234 may represent a novel treatment for SCLC, including patients with brain metastases.
RESTRICTED
Citation Format: Stefan Kaulfuss, Andreas Janzer, Gerhard Siemeister, Renan Borowicz, Katrin Jaensch, Katrin Gutberlet, Ricarda Schlenz, Andrea Triller, Ashley Eheim, Michael Jeffers, Sven Christian. Activity of DHODH inhibitor BAY2402234 in subcutaneous and intracranial models of SCLC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2077.
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Shi DD, Wang AC, Levitt MM, Endress JE, Xu M, Gao W, Khanal J, Bonal D, Kornblum HI, Nguyen QD, Gradl S, Sutter A, Jeffers M, Janzer A, Cahill DP, Ligon KL, Abdullah KG, Harris IS, Kaelin WG, McBrayer SK. DDRE-29. DE NOVO PYRIMIDINE SYNTHESIS IS A TARGETABLE VULNERABILITY IN IDH-MUTANT GLIOMA. Neurooncol Adv 2021. [PMCID: PMC7992238 DOI: 10.1093/noajnl/vdab024.051] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
70–90% of lower-grade gliomas and secondary glioblastomas harbor gain-of-function mutations in isocitrate dehydrogenase 1 (IDH1), causing overproduction of the oncometabolite (R)-2-hydroxyglutarate [(R)-2HG]. Although inhibitors of mutant IDH enzymes are effective in other cancers, including leukemia, they have shown guarded efficacy in preclinical and clinical brain tumor studies, thus underscoring the need to identify additional therapeutic targets in IDH mutant glioma. We sought to identify tumor-specific metabolic vulnerabilities induced by IDH1 mutations that could be exploited therapeutically. To uncover such vulnerabilities, we conducted a chemical synthetic lethality screen using isogenic IDH1 mutant and IDH1 wild-type (WT) glioma cell lines and a novel metabolic inhibitor screening platform. We discovered that IDH1 mutant cells are hypersensitive to drugs targeting enzymes in the de novo pyrimidine nucleotide synthesis pathway, including dihydroorotate dehydrogenase (DHODH). This vulnerability is specific because inhibitors of purine nucleotide metabolism did not score in our screen. We validated that the cytotoxicity of pyrimidine synthesis inhibitors is on-target and showed that IDH1 mutant patient-derived glioma stem-like cell lines are also hyperdependent on de novo pyrimidine nucleotide synthesis compared to IDH1 WT lines. To test pyrimidine synthesis dependence of IDH1 mutant gliomas in vivo, we used a brain-penetrent DHODH inhibitor currently undergoing evaluation in leukemia patients, BAY 2402234. We found that BAY 2402234 displays monotherapy activity against gliomas in an orthotopic xenograft model of IDH1 mutant glioma, with an effect size that compared favorably with radiotherapy. We also developed novel genetically engineered and allograft mouse models of mutant IDH1-driven anaplastic astrocytoma and showed that BAY 2402234 blocked growth of orthotopic astrocytoma allografts. Our findings bolster rationale to target DHODH in glioma, highlight BAY 2402234 as a clinical-stage drug that can be used to inhibit DHODH in brain tumors, and establish IDH1 mutations as predictive biomarkers of DHODH inhibitor efficacy.
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Affiliation(s)
- Diana D Shi
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Harvard Radiation Oncology Program, Boston, MA, USA
| | - Adam C Wang
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Michael M Levitt
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer E Endress
- Ludwig Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Min Xu
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Wenhua Gao
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Januka Khanal
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Dennis Bonal
- Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Harley I Kornblum
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Behavioral Sciences, and Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Quang-De Nguyen
- Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | - Daniel P Cahill
- Department of Neurosurgery, Translational Neuro-Oncology Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith L Ligon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kalil G Abdullah
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Isaac S Harris
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - William G Kaelin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Samuel K McBrayer
- Children’s Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Wick A, Bähr O, Schuler M, Rohrberg K, Chawla SP, Janku F, Schiff D, Heinemann V, Narita Y, Lenz HJ, Ikeda M, Ando Y, Wick W, Steinbach JP, Burger MC, Wenger K, Lassen U, Sankhala KK, Roggia C, Genvresse I, Munhoz C, Rentzsch C, Reschke S, Langer S, Wagner M, Kaulfuss S, Cai C, Lagkadinou E, Jeffers M, Peña C, Tabatabai G. Phase I Assessment of Safety and Therapeutic Activity of BAY1436032 in Patients with IDH1-Mutant Solid Tumors. Clin Cancer Res 2021; 27:2723-2733. [PMID: 33622704 DOI: 10.1158/1078-0432.ccr-20-4256] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/15/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE BAY1436032, an inhibitor of mutant isocitrate dehydrogenase 1 (mIDH1), was active against multiple IDH1-R132X solid tumors in preclinical models. This first-in-human study was designed to determine the safety and pharmacokinetics of BAY1436032, and to evaluate its potential pharmacodynamics and antitumor effects. PATIENTS AND METHODS The study comprised of dose escalation and dose expansion cohorts. BAY1436032 tablets were orally administered twice daily on a continuous basis in subjects with mIDH1 solid tumors. RESULTS In dose escalation, 29 subjects with various tumor types were administered BAY1436032 across five doses (150-1,500 mg twice daily). BAY1432032 exhibited a relatively short half-life. Most evaluable subjects experienced target inhibition as indicated by a median maximal reduction of plasma R-2-hydroxyglutarate levels of 76%. BAY1436032 was well tolerated and an MTD was not identified. A dose of 1,500 mg twice daily was selected for dose expansion, where 52 subjects were treated in cohorts representing four different tumor types [lower grade glioma (LGG), glioblastoma, intrahepatic cholangiocarcinoma, and a basket cohort of other tumor types]. The best clinical outcomes were in subjects with LGG (n = 35), with an objective response rate of 11% (one complete response and three partial responses) and stable disease in 43%. As of August 2020, four of these subjects were in treatment for >2 years and still ongoing. Objective responses were observed only in LGG. CONCLUSIONS BAY1436032 was well tolerated and showed evidence of target inhibition and durable objective responses in a small subset of subjects with LGG.
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Affiliation(s)
- Antje Wick
- Department of Neurology and Neurooncology Program of the National Center for Tumor Diseases, Heidelberg University Hospital & Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Oliver Bähr
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Martin Schuler
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen and German Cancer Consortium (DKTK), Partner site University Hospital Essen, Essen, Germany
| | - Kristoffer Rohrberg
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sant P Chawla
- Department of Medicine, Sarcoma Oncology Center, Santa Monica, California
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Center, Houston, Texas
| | - David Schiff
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Volker Heinemann
- Department of Medical Oncology and Hematology, LMU University Hospital Munich, Munich, Germany
| | - Yoshitaka Narita
- Department of Neurosurgery and Neurooncology, National Cancer Center Hospital, Tokyo, Japan
| | - Heinz-Josef Lenz
- Adult Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yuichi Ando
- Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan
| | - Wolfgang Wick
- Department of Neurology and Neurooncology Program of the National Center for Tumor Diseases, Heidelberg University Hospital & Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joachim P Steinbach
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Michael C Burger
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Katharina Wenger
- Dr. Senckenberg Institute of Neurooncology, Department of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Ulrik Lassen
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Cristiana Roggia
- Department of Neurology & Interdisciplinary Neurooncology, University Hospital of Tübingen, Hertie Institute for Clinical Brain Research, Center for Neuro-Oncology at Comprehensive Cancer Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | | | | | | | - Simon Langer
- Early Development Statistics - Oncology, Chrestos Concept GmbH & Co. KG, Essen, Germany
| | | | | | - Charles Cai
- Pharmaceuticals Division, Bayer HealthCare Pharmaceuticals, Inc., Whippany, New Jersey
| | | | - Michael Jeffers
- Pharmaceuticals Division, Bayer HealthCare Pharmaceuticals, Inc., Whippany, New Jersey
| | - Carol Peña
- Pharmaceuticals Division, Bayer HealthCare Pharmaceuticals, Inc., Whippany, New Jersey
| | - Ghazaleh Tabatabai
- Department of Neurology & Interdisciplinary Neurooncology, University Hospital of Tübingen, Hertie Institute for Clinical Brain Research, Center for Neuro-Oncology at Comprehensive Cancer Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
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Chaturvedi A, Gupta C, Gabdoulline R, Borchert NM, Goparaju R, Kaulfuss S, Görlich K, Schottmann R, Othman B, Welzenbach J, Panknin O, Wagner M, Geffers R, Ganser A, Thol F, Jeffers M, Haegebarth A, Heuser M. Synergistic activity of IDH1 inhibitor BAY1436032 with azacitidine in IDH1 mutant acute myeloid leukemia. Haematologica 2021; 106:565-573. [PMID: 32241846 PMCID: PMC7849562 DOI: 10.3324/haematol.2019.236992] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 09/09/2019] [Accepted: 03/26/2020] [Indexed: 11/09/2022] Open
Abstract
Mutant isocitrate dehydrogenase 1 (mIDH1) inhibitors have shown single-agent activity in relapsed/refractory acute myeloid leukemia (AML), even though most patients eventually relapse. We evaluated the efficacy and molecular mechanism of the combination treatment with azacitidine, which is currently the standard of care in older AML patients, and mIDH1 inhibitor BAY1436032. Both compounds were evaluated in vivo as single agents and in combination with sequential (azacitidine, followed by BAY1436032) or simultaneous application in two human IDH1 mutated AML xenograft models. Combination treatment significantly prolonged survival compared to single agent or control treatment (P<0.005). The sequential combination treatment depleted leukemia stem cells by 470-fold. Interestingly, the simultaneous combination treatment depleted leukemia stem cells by 33,150-fold compared to control mice. This strong synergy is mediated through inhibition of MAPK/ERK and Rb/E2F signaling. Our data strongly argues for the concurrent application of mIDH1 inhibitors and azacitidine and predicts improved outcome of this regimen in IDH1 mutated AML patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Robert Geffers
- Helmholtz Centre for Infection Research, Braunschweig, Germany
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10
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Dinneen K, Timlin DM, O'Hare K, Walker J, Castriciano G, Connolly Y, Grant C, Bacon L, Vandenberghe E, Dunne B, Jeffers M, Flavin R. Incidence of single hit Bcl-2 and Bcl-6 rearrangements in DLBCL: the Irish experience. J Clin Pathol 2020; 73:689-690. [DOI: 10.1136/jclinpath-2020-206725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 01/01/2023]
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11
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Wick W, Tabatabai G, Schuler M, Rorhberg K, Chawla S, Janku F, Schiff D, Heinemann V, Narita Y, Ando Y, Lenz H, Ikeda M, Genvresse I, Rentzsch C, Reschke S, Cyris C, Cai C, Jeffers M, Peña C, Bähr O. Safety, efficacy, PK and PD biomarker results of the first-in-human study of mutant isocitrate dehydrogenase 1 (mIDH1) inhibitor BAY 1436032 in patients (pts) with mIDH1 advanced solid tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz244.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Clarke L, Adduri RS, Smyth P, Quinn F, Jeffers M, Dunne B, O'Leary J, McKiernan S, Vandenberghe E, Pyne S, Bashyam MD, Sheils O, Flavin R. Potentially important miRNAs in enteropathy-associated T-cell lymphoma pathogenesis: A pilot study. Leuk Res Rep 2019; 10:52-54. [PMID: 30989051 PMCID: PMC6446659 DOI: 10.1016/j.lrr.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/16/2018] [Accepted: 10/07/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lindsey Clarke
- Department of Histopathology, St. James's Hospital, Dublin and TTMI, Trinity College Dublin, Ireland
| | - Raju Sr Adduri
- Laboratory of Molecular Oncology, Centre for DNA Fingerprinting and Diagnostics, Nampally, Hyderabad, India
| | - Paul Smyth
- Department of Histopathology, St. James's Hospital, Dublin and TTMI, Trinity College Dublin, Ireland
| | - Fiona Quinn
- Department of Cancer Molecular Diagnostics, St. James's Hospital, Dublin, Ireland
| | - Michael Jeffers
- Department of Histopathology, St. James's Hospital, Dublin and TTMI, Trinity College Dublin, Ireland
| | - Barbara Dunne
- Department of Histopathology, St. James's Hospital, Dublin and TTMI, Trinity College Dublin, Ireland
| | - John O'Leary
- Department of Histopathology, St. James's Hospital, Dublin and TTMI, Trinity College Dublin, Ireland
| | - Susan McKiernan
- Department of Gastroenterology, St. James's Hospital, Dublin, Ireland
| | - Elisabeth Vandenberghe
- Department of Cancer Molecular Diagnostics, St. James's Hospital, Dublin, Ireland.,Department of Haematology, St. James's Hospital, Dublin, Ireland
| | - Saumyadipta Pyne
- Public Health Dynamics Laboratory, and Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, PA, USA.,ICMR National Institute of Medical Statistics, New Delhi, India
| | - Murali Dharan Bashyam
- Laboratory of Molecular Oncology, Centre for DNA Fingerprinting and Diagnostics, Nampally, Hyderabad, India
| | - Orla Sheils
- Department of Histopathology, St. James's Hospital, Dublin and TTMI, Trinity College Dublin, Ireland
| | - Richard Flavin
- Department of Histopathology, St. James's Hospital, Dublin and TTMI, Trinity College Dublin, Ireland.,Department of Cancer Molecular Diagnostics, St. James's Hospital, Dublin, Ireland
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13
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Dinneen K, Ryan C, Grant C, Dunne B, Bacon L, Vandenberghe E, Jeffers M, Flavin R. Impact and importance of a centralised review panel for lymphoma diagnostics in the WHO era: a single-centre experience. J Clin Pathol 2019; 72:506-509. [PMID: 30910823 DOI: 10.1136/jclinpath-2018-205691] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 11/03/2022]
Abstract
Lymphoma diagnosis is complex, requiring a wide array of adjunctive tests to reach accurate diagnoses. We retrospectively examined the rates of concordance between referral and review lymphoma diagnoses on cases referred to St James's Hospital, Dublin for multidisciplinary team review between 2013 and 2016. Frequency and cost of adjunctive diagnostic tests performed were also analysed. The overall discordance rate was 7.8% (14/179), compared with rates of 6%-48% in the published literature. 13 discordant cases required a change in clinical management following review of the referred diagnosis. Of all referred cases, 33.5% (60/179) required extra analyses to reach a final diagnosis, costing the reference laboratory €35463.40. We conclude that establishment of centralised haematopathology diagnostic networks would help reduce the rate of revision made to lymphoma diagnoses by providing specialist haematopathologist input and access to ancillary testing.
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Affiliation(s)
- Kate Dinneen
- Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - Ciara Ryan
- Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - Cliona Grant
- Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - Barbara Dunne
- Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - Larry Bacon
- Department of Haematology, St James's Hospital, Dublin, Ireland
| | | | - Michael Jeffers
- Department of Histopathology, Tallaght University Hospital, Dublin, Ireland
| | - Richard Flavin
- Department of Histopathology, St James's Hospital, Dublin, Ireland
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14
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Timlin DM, O’Hare K, Walker J, Castriciano G, Connolly Y, Grant C, Bacon CL, Vandenberghe E, Dunne B, Jeffers M, Flavin R. FISH studies in DLBCL: correlations with cell of origin: the Irish experience. J Clin Pathol 2018; 71:947-948. [DOI: 10.1136/jclinpath-2018-205247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/12/2018] [Indexed: 11/04/2022]
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15
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Patnaik A, Appleman LJ, Tolcher AW, Papadopoulos KP, Beeram M, Rasco DW, Weiss GJ, Sachdev JC, Chadha M, Fulk M, Ejadi S, Mountz JM, Lotze MT, Toledo FGS, Chu E, Jeffers M, Peña C, Xia C, Reif S, Genvresse I, Ramanathan RK. First-in-human phase I study of copanlisib (BAY 80-6946), an intravenous pan-class I phosphatidylinositol 3-kinase inhibitor, in patients with advanced solid tumors and non-Hodgkin's lymphomas. Ann Oncol 2017; 27:1928-40. [PMID: 27672108 PMCID: PMC5035790 DOI: 10.1093/annonc/mdw282] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/06/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To evaluate the safety, tolerability, pharmacokinetics, and maximum tolerated dose (MTD) of copanlisib, a phosphatidylinositol 3-kinase inhibitor, in patients with advanced solid tumors or non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS Phase I dose-escalation study including patients with advanced solid tumors or NHL, and a cohort of patients with type 2 diabetes mellitus. Patients received three weekly intravenous infusions of copanlisib per 28-day cycle over the dose range 0.1-1.2 mg/kg. Plasma copanlisib levels were analyzed for pharmacokinetics. Biomarker analysis included PIK3CA, KRAS, BRAF, and PTEN mutational status and PTEN immunohistochemistry. Whole-body [(18)F]-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) was carried out at baseline and following the first dose to assess early pharmacodynamic effects. Plasma glucose and insulin levels were evaluated serially. RESULTS Fifty-seven patients received treatment. The MTD was 0.8 mg/kg copanlisib. The most frequent treatment-related adverse events were nausea and transient hyperglycemia. Copanlisib exposure was dose-proportional with no accumulation; peak exposure positively correlated with transient hyperglycemia post-infusion. Sixteen of 20 patients treated at the MTD had reduced (18)FDG-PET uptake; 7 (33%) had a reduction >25%. One patient achieved a complete response (CR; endometrial carcinoma exhibiting both PIK3CA and PTEN mutations and complete PTEN loss) and two had a partial response (PR; both metastatic breast cancer). Among the nine NHL patients, all six with follicular lymphoma (FL) responded (one CR and five PRs) and one patient with diffuse large B-cell lymphoma had a PR by investigator assessment; two patients with FL who achieved CR (per post hoc independent radiologic review) were on treatment >3 years. CONCLUSION Copanlisib, dosed intermittently on days 1, 8, and 15 of a 28-day cycle, was well tolerated and the MTD was determined to be 0.8 mg/kg. Copanlisib exhibited dose-proportional pharmacokinetics and promising anti-tumor activity, particularly in patients with NHL. CLINICALTRIALSGOV NCT00962611; https://clinicaltrials.gov/ct2/show/NCT00962611.
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Affiliation(s)
- A Patnaik
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | | | - A W Tolcher
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - K P Papadopoulos
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - M Beeram
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - D W Rasco
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - G J Weiss
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale Cancer Treatment Centers of America, Goodyear
| | - J C Sachdev
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | - M Chadha
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | - M Fulk
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | - S Ejadi
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | | | - M T Lotze
- University of Pittsburgh, Pittsburgh
| | | | - E Chu
- University of Pittsburgh, Pittsburgh
| | - M Jeffers
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, USA
| | - C Peña
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, USA
| | - C Xia
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, USA
| | - S Reif
- Bayer Pharma AG, Berlin, Germany
| | | | - R K Ramanathan
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
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16
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Kelly BS, Govender P, Jeffers M, Kinsella J, Gibney J, Sherlock M, Torreggiani WC. Risk Stratification in Multinodular Goiter: A Retrospective Review of Sonographic Features, Histopathological Results, and Cancer Risk. Can Assoc Radiol J 2017; 68:425-430. [DOI: 10.1016/j.carj.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/13/2017] [Accepted: 03/28/2017] [Indexed: 11/16/2022] Open
Abstract
Purpose In the management of thyroid nodules, although the potential for malignancy exists, there is also the potential for overtreatment of subclinical disease. Although the TI-RADS (Thyroid Imaging-Reporting and Data System) system outlines a risk stratification score based on suspicious ultrasound findings, it has not been universally accepted. Many TI-RADS 2 or 3 patients proceed to fine needle aspiration biopsy (FNAB), potentially unnecessarily. The aim of the study was to identify whether lesions within a multinodular goiter (MNG) without suspicious features can be followed with ultrasound rather than biopsied as is recommended for single nodules. Methods Pathology records were retrospectively analysed for proven MNGs over a 5-year period. A total of 293 cases were identified. FNAB, prebiopsy ultrasound images, and reports were identified for each case. Images were reviewed and assessed for sonographically suspicious criteria guided by TI-RADS. Logistic regression was applied to determine if any sonographic features were associated with neoplasia. Odds ratios with 95% confidence intervals were calculated. Results Of 293 samples, 14 (4.7%) were neoplastic. Having no suspicious features conferred an average risk of 0.0339 (95% confidence interval: 0.02831-0.04087) of neoplasia. Risk of neoplasm significantly increased by having 1 and >1 suspicious feature ( P < .001). Regarding cytological results, of 237 patients with Thy-2 cytology, 159 were followed up and 8 had a neoplasm. Conclusion Ultrasound can be used to estimate risk of neoplasia in MNG. In the absence of suspicious radiological findings, follow-up with ultrasound rather than FNAB may be appropriate in patients who have a low clinical suspicion for neoplasia.
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Affiliation(s)
- Brendan S. Kelly
- Department of Radiology, Adelaide Meath Incorporating the National Children's Hospital, Tallaght, Ireland
| | - Pradeep Govender
- Department of Radiology, Adelaide Meath Incorporating the National Children's Hospital, Tallaght, Ireland
| | - Michael Jeffers
- Department of Pathology, Adelaide Meath Incorporating the National Children's Hospital, Tallaght, Ireland
| | - John Kinsella
- Department of Otolaryngology, Adelaide Meath Incorporating the National Children's Hospital Tallaght, Ireland
| | - James Gibney
- Department of Endocrinology, Adelaide Meath Incorporating the National Children's Hospital, Tallaght, Ireland
| | - Mark Sherlock
- Department of Endocrinology, Adelaide Meath Incorporating the National Children's Hospital, Tallaght, Ireland
| | - William C. Torreggiani
- Department of Radiology, Adelaide Meath Incorporating the National Children's Hospital, Tallaght, Ireland
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17
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Flynn A, Kiely C, Tobin AM, Jeffers M, Connolly M. Enlarging plaques and nodules on the face and legs. Clin Exp Dermatol 2017; 42:354-356. [PMID: 28111786 DOI: 10.1111/ced.13032] [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] [Accepted: 04/12/2016] [Indexed: 11/26/2022]
Affiliation(s)
- A Flynn
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - C Kiely
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - A M Tobin
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - M Jeffers
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - M Connolly
- Dermatology Department, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
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18
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Zhu AX, Kang YK, Rosmorduc O, Evans TRJ, Santoro A, Ross P, Gane E, Vogel A, Jeffers M, Meinhardt G, Peña CEA. Biomarker Analyses of Clinical Outcomes in Patients with Advanced Hepatocellular Carcinoma Treated with Sorafenib with or without Erlotinib in the SEARCH Trial. Clin Cancer Res 2016; 22:4870-4879. [PMID: 27220960 DOI: 10.1158/1078-0432.ccr-15-2883] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 11/25/2015] [Accepted: 05/10/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE Sorafenib is the current standard therapy for advanced hepatocellular carcinoma, but validated biomarkers predicting clinical outcomes are lacking. This study aimed to identify biomarkers predicting prognosis and/or response to sorafenib, with or without erlotinib, in hepatocellular carcinoma patients from the phase III SEARCH trial. EXPERIMENTAL DESIGN A total of 720 patients were randomized to receive oral sorafenib 400 mg twice daily plus erlotinib 150 mg once daily or placebo. Fifteen growth factors relevant to the treatment regimen and/or to hepatocellular carcinoma were measured in baseline plasma samples. RESULTS Baseline plasma biomarkers were measured in 494 (69%) patients (sorafenib plus erlotinib, n = 243; sorafenib plus placebo, n = 251). Treatment arm-independent analyses showed that elevated hepatocyte growth factor [HGF; HR, 1.687 (high vs. low expression); endpoint multiplicity adjusted (e-adj) P = 0.0001] and elevated plasma VEGFA (HR, 1.386; e-adj P = 0.0377) were significantly associated with poor overall survival (OS) in multivariate analyses, and low plasma KIT [HR, 0.75 (high vs. low); P = 0.0233; e-adj P = 0.2793] tended to correlate with poorer OS. High plasma VEGFC independently correlated with longer TTP (HR, 0.633; e-adj P = 0.0010) and trended toward associating with improved disease control rate (univariate: OR, 2.047; P = 0.030; e-adj P = 0.420). In 67% of evaluable patients (339/494), a multimarker signature of HGF, VEGFA, KIT, EPGN, and VEGFC correlated with improved median OS in multivariate analysis (HR, 0.150; P < 0.00001). No biomarker predicted efficacy from erlotinib. CONCLUSIONS Baseline plasma HGF, VEGFA, KIT, and VEGFC correlated with clinical outcomes in hepatocellular carcinoma patients treated with sorafenib with or without erlotinib. These biomarkers plus EPGN constituted a multimarker signature for improved OS. Clin Cancer Res; 22(19); 4870-9. ©2016 AACR.
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Affiliation(s)
- Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Olivier Rosmorduc
- Department of Hepatology, Hôpital de la Pitié-Salpétrière, Sorbonne Universités, Paris, France
| | - T R Jeffry Evans
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | | | - Paul Ross
- King's College Hospital, London, United Kingdom
| | - Edward Gane
- New Zealand Liver Transplant Unit, University of Auckland, Auckland, New Zealand
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany
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19
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Rudolph M, Anzeneder T, Schulz A, Beckmann G, Byrne AT, Jeffers M, Pena C, Politz O, Köchert K, Vonk R, Reischl J. AKT1 (E17K) mutation profiling in breast cancer: prevalence, concurrent oncogenic alterations, and blood-based detection. BMC Cancer 2016; 16:622. [PMID: 27515171 PMCID: PMC4982009 DOI: 10.1186/s12885-016-2626-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 07/26/2016] [Indexed: 12/30/2022] Open
Abstract
Background The single hotspot mutation AKT1 [G49A:E17K] has been described in several cancers, with the highest incidence observed in breast cancer. However, its precise role in disease etiology remains unknown. Methods We analyzed more than 600 breast cancer tumor samples and circulating tumor DNA for AKT1E17K and alterations in other cancer-associated genes using Beads, Emulsions, Amplification, and Magnetics digital polymerase chain reaction technology and targeted exome sequencing. Results Overall AKT1E17K mutation prevalence was 6.3 % and not correlated with age or menopausal stage. AKT1E17K mutation frequency tended to be lower in patients with grade 3 disease (1.9 %) compared with those with grade 1 (11.1 %) or grade 2 (6 %) disease. In two cohorts of patients with advanced metastatic disease, 98.0 % (n = 50) and 97.1 % (n = 35) concordance was obtained between tissue and blood samples for the AKT1E17K mutation, and mutation capture rates of 66.7 % (2/3) and 85.7 % (6/7) in blood versus tissue samples were observed. Although AKT1-mutant tumor specimens were often found to harbor concurrent alterations in other driver genes, a subset of specimens harboring AKT1E17K as the only known driver alteration was also identified. Initial follow-up survival data suggest that AKT1E17K could be associated with increased mortality. These findings warrant additional long-term follow-up. Conclusions The data suggest that AKT1E17K is the most likely disease driver in certain breast cancer patients. Blood-based mutation detection is achievable in advanced-stage disease. These findings underpin the need for a further enhanced-precision medicine paradigm in the treatment of breast cancer. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2626-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marion Rudolph
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany.
| | | | - Anke Schulz
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | - Georg Beckmann
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | - Annette T Byrne
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.,At the time of manuscript preparation, the author was on a Science Foundation Ireland-funded industry secondment, Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | | | - Carol Pena
- Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - Oliver Politz
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | - Karl Köchert
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | - Richardus Vonk
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | - Joachim Reischl
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany.,AstraZeneca R&D, Personalized Healthcare and Biomarkers, Gothenburg, Sweden
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20
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McGovern B, Quinn F, Andrews C, Jeffers M, Bacon CL, Bird B, Crotty G, Vandenberghe E, Flavin R. NOTCH1 mutation in type II Hodgkin transformation of chronic lymphocytic leukemia. Leuk Lymphoma 2016; 58:732-735. [DOI: 10.1080/10428194.2016.1211278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Brianan McGovern
- Department of Histopathology, St. James’s Hospital, Dublin, Ireland
| | - Fiona Quinn
- Department of Cancer Molecular Diagnostics, St. James’s Hospital, Dublin, Ireland
| | - Clare Andrews
- Department of Haematology, St. James’s Hospital, Dublin, Ireland
| | - Michael Jeffers
- Department of Histopathology, St. James’s Hospital, Dublin, Ireland
| | - Christopher L. Bacon
- Department of Cancer Molecular Diagnostics, St. James’s Hospital, Dublin, Ireland
- Department of Haematology, St. James’s Hospital, Dublin, Ireland
| | - Brian Bird
- Department of Medical Oncology, Bons Secours Hospital, Cork, Ireland
| | - Gerard Crotty
- Department of Haematology, Midland Regional Hospital, Tullamore, Ireland
| | - Elisabeth Vandenberghe
- Department of Cancer Molecular Diagnostics, St. James’s Hospital, Dublin, Ireland
- Department of Haematology, St. James’s Hospital, Dublin, Ireland
| | - Richard Flavin
- Department of Histopathology, St. James’s Hospital, Dublin, Ireland
- Department of Cancer Molecular Diagnostics, St. James’s Hospital, Dublin, Ireland
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21
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Murphy AJ, O'Neill P, O'Brien F, Enright H, Jeffers M, Thornhill JA, Loftus BM. Anaplastic Large Cell Lymphoma: A Unique Presentation with Urinary Bladder Involvement. Int J Surg Pathol 2016; 13:369-73. [PMID: 16273198 DOI: 10.1177/106689690501300414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anaplastic large cell lymphoma (ALCL) is a T-cell lymphoma composed of large pleomorphic CD30-positive cells. While systemic ALCL frequently involves extranodal sites, involvement of the urinary bladder is extremely rare. We report a case of systemic ALCL presenting with bladder involvement. A 28-year-old man presented with hematuria, dysuria, and lower abdominal pain. Imaging revealed pelvic lymphadenopathy and a thickened bladder wall. Bladder biopsies showed diffuse infiltration of the lamina propria by large pleomorphic cells, with preservation of the overlying urothelium. Immunohistochemistry demonstrated cell membrane and Golgi region staining for CD30 and epithelial membrane antigen. This is the first documented instance of systemic ALCL presenting with bladder symptoms.
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Affiliation(s)
- Amanda J Murphy
- Department of Cellular Pathology, The Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
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22
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Maung SW, Desmond R, McHugh J, Ryan B, Neary P, Jeffers M, Enright H. A coincidence or a rare occurrence? A case of plasmablastic lymphoma of the small intestines following infliximab treatment for Crohn’s disease. Ann Hematol 2015; 95:149-150. [DOI: 10.1007/s00277-015-2497-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 01/27/2023]
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Jeffers M, Seidel H, Schwenke S, Reischl J, Rutstein M, Kappeler C, Kuss I, Teufel M. Abstract 929: Tumor genotyping in the phase III GRID study of regorafenib vs placebo in tyrosine kinase inhibitor (TKI)-refractory GIST: Detection of KIT mutations in circulating tumor DNA comparing digital PCR and massive parallel sequencing. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The GRID study demonstrated that regorafenib provides a significant improvement in progression-free survival (HR 0.27; p<0.0001) compared with placebo in patients with advanced gastrointestinal stromal tumors (GIST) following failure of at least imatinib and sunitinib. Mutations in KIT play an important role in GIST and identification of the specific KIT mutations that each GIST patient harbors could have important therapeutic implications. However, determining tumor genotype in TKI-refractory GIST has proven challenging due to intra and inter-tumoral genetic heterogeneity and the difficulty associated with obtaining fresh tumor biopsies. To overcome this limitation, tumor genotyping in GRID was performed using baseline plasma as a source of circulating tumor-derived DNA. We previously performed genotyping using BEAMing (a mutation-specific technology) and have now extended this analysis using Safe-SeqS (Kinde et al. 2011 PNAS 108:9530) a targeted NGS-based platform aiming to detect previously undetectable cKIT mutations.
Methods: 91 plasma samples from patients enrolled in the Ph 3 study (GRID) for which BEAMing data (Jeffers et al 2013 JCO 31:10503) were subjected to Safe-SeqS covering cKit Exon 8 to Exon 18.
Results: In 6 of 32 samples reported to be cKIT wildtype by BEAMing, mutations were identified by SafeSeqS. The detection of primary KIT exon 9 mutations showed a high degree of concordance among the two mutation-detection methods evaluated. Secondary / resistance hotspot mutations were also readily detected by both methods, although a greater number of such mutations were detected by Safe-SeqS than by BEAMing. The localization of the additional mutations detected by Safe-SeqS in known mutational hotspots supports their legitimacy. Safe-SeqS also detected KIT mutations for which BEAMing assays had not been developed, whereas in 17 samples a mutation for which a BEAMing assay was available was not detectable by Safe SeqS. In 58% (10/17) of samples, the mutant allele frequency found by BEAMing was close to the detection limit of this platform (<0.05). The cKITM541L mutation in Exon10 was found in 25% (23/91) of the samples.
Conclusion: Our data support the use of Safe-SeqS as a sensitive and specific “liquid biopsy” method for non-invasive tumor genotyping of patients with GIST, enabling the identification of known and novel tumor-associated mutations using circulating DNA. These results confirm and extend the genotypic heterogeneity that had previously been identified in GRID circulating DNA samples by BEAMing. The comprehensive tumor mutational profiles generated by Safe-SeqS will be used to evaluate potential correlations between tumor genotype and clinical outcome.
Citation Format: Michael Jeffers, Henrik Seidel, Susanne Schwenke, Joachim Reischl, Mark Rutstein, Christian Kappeler, Iris Kuss, Michael Teufel. Tumor genotyping in the phase III GRID study of regorafenib vs placebo in tyrosine kinase inhibitor (TKI)-refractory GIST: Detection of KIT mutations in circulating tumor DNA comparing digital PCR and massive parallel sequencing. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 929. doi:10.1158/1538-7445.AM2015-929
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Tabernero J, Lenz HJ, Siena S, Sobrero A, Falcone A, Ychou M, Humblet Y, Bouché O, Mineur L, Barone C, Adenis A, Yoshino T, Goldberg RM, Sargent DJ, Wagner A, Laurent D, Teufel M, Jeffers M, Grothey A, Van Cutsem E. Analysis of circulating DNA and protein biomarkers to predict the clinical activity of regorafenib and assess prognosis in patients with metastatic colorectal cancer: a retrospective, exploratory analysis of the CORRECT trial. Lancet Oncol 2015; 16:937-48. [PMID: 26184520 DOI: 10.1016/s1470-2045(15)00138-2] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tumour mutational status is an important determinant of the response of metastatic colorectal cancer to targeted treatments. However, the genotype of the tissue obtained at the time of diagnosis might not accurately represent tumour genotype after multiple lines of treatment. This retrospective exploratory analysis investigated the clinical activity of regorafenib in biomarker subgroups of the CORRECT study population defined by tumour mutational status or plasma protein levels. METHODS We used BEAMing technology to identify KRAS, PIK3CA, and BRAF mutations in DNA obtained from the plasma of 503 patients with metastatic colorectal cancer who enrolled in the CORRECT trial. We quantified total human genomic DNA isolated from plasma samples for 503 patients using a modified version of human long interspersed nuclear element-1 (LINE-1) quantitive real-time PCR. We also measured the concentration of 15 proteins of interest-angiopoietin 2, interleukin 6, interleukin 8, placental growth factor, soluble TIE-1, soluble VEGFR1, VEGF-A, VEGF-C, VEGF-D, VEGF-A isoform 121, bone morphogenetic protein 7, macrophage colony-stimulating factor, stromal cell-derived factor-1, tissue inhibitor of metalloproteinase 2, and von Willebrand factor-in plasma samples from 611 patients. We did correlative analyses of overall survival and progression-free survival in patient subgroups based on mutational status, circulating DNA concentration, and protein concentrations. The CORRECT trial was registered with ClinicalTrials.gov, number NCT01103323. FINDINGS Tumour-associated mutations were readily detected with BEAMing of plasma DNA, with KRAS mutations identified in 349 (69%) of 503 patients, PIK3CA mutations in 84 (17%) of 503 patients, and BRAF mutations in 17 (3%) of 502 patients. We did not do correlative analysis based on BRAF genotype because of the low mutational frequency detected for this gene. Some of the most prevalent individual hot-spot mutations we identified included: KRAS (KRAS G12D, 116 [28%] of 413 mutations; G12V, 72 [17%]; and G13D, 67 [16%]) and PIK3CA (PIK3CA E542K, 27 [30%] of 89 mutations; E545K, 37 [42%]; and H1047R, 12 [14%]). 41 (48%) of 86 patients who had received anti-EGFR therapy and whose archival tumour tissue DNA was KRAS wild-type in BEAMing analysis were identified as having KRAS mutations in BEAMing analysis of fresh plasma DNA. Correlative analyses suggest a clinical benefit favouring regorafenib across patient subgroups defined by KRAS and PIK3CA mutational status (progression-free survival with regorafenib vs placebo: hazard ratio [HR] 0·52, 95% CI 0·35-0·76 for KRAS wild-type; HR 0·51, 95% CI 0·40-0·65 for KRAS mutant [KRAS wild type vs mutant, pinteraction=0·74]; HR 0·50, 95% CI 0·40-0·63 for PIK3CA wild-type; HR 0·54, 95% CI 0·32-0·89 for PIK3CA mutant [PIK3CA wild-type vs mutant, pinteraction=0·85]) or circulating DNA concentration (progression-free survival with regorafenib vs placebo: HR 0·53, 95% CI 0·40-0·71, for low circulating DNA concentrations; HR 0·52, 95% CI 0·40-0·70, for high circulating DNA concentrations; low vs high circulating DNA, pinteraction=0·601). With the exception of von Willebrand factor, assessed with the median cutoff method, plasma protein concentrations were also not associated with regorafenib activity in terms of progression-free survival. In univariable analyses, the only plasma protein that was associated with overall survival was TIE-1, high concentrations of which were associated with longer overall survival compared with low TIE-1 concentrations. This association was not significant in multivariable analyses. INTERPRETATION BEAMing of circulating DNA could be a viable approach for non-invasive analysis of tumour genotype in real time and for the identification of potentially clinically relevant mutations that are not detected in archival tissue. Additionally, the results show that regorafenib seems to be consistently associated with a clinical benefit in a range of patient subgroups based on mutational status and protein biomarker concentrations. FUNDING Bayer HealthCare Pharmaceuticals.
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Affiliation(s)
- Josep Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Heinz-Josef Lenz
- University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Salvatore Siena
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy; Università di Milano, Milan, Italy
| | | | | | | | - Yves Humblet
- St-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Olivier Bouché
- Centre Hospitalier Universitaire Reims, Robert Debré Hospital, Reims, France
| | - Laurent Mineur
- Gastrointestinal and Liver Oncology Unit, Institut Sainte Catherine, Avignon, France
| | - Carlo Barone
- Catholic University of Sacred Heart, Rome, Italy
| | | | | | - Richard M Goldberg
- Ohio State University School of Medicine, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | | | | | | | | | | | | | - Eric Van Cutsem
- University Hospital Gasthuisberg/Leuven and KU Leuven, Leuven, Belgium
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Maguire A, Castriciano G, Walker J, Molloy K, Quinn F, Osman N, Vandenberghe E, Jeffers M, Gaffney E, Flavin R. Case Study: Diffuse Large B-Cell Lymphoma Arising in Ovarian Mature Cystic Teratoma. Int J Gynecol Pathol 2015; 34:459-64. [PMID: 25996637 DOI: 10.1097/pgp.0000000000000172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe an unexpected finding of diffuse large B-cell lymphoma associated with mature cystic teratoma of the ovary. A 68-yr-old woman with a complex left ovarian cystic mass on imaging underwent bilateral salpingo-oophorectomy, lymphadenectomy, appendicectomy, and omentectomy. Histopathologic examination revealed nodules of malignant non-Hodgkin lymphoma within the teratoma. A diagnosis of diffuse large B-cell lymphoma, germinal center cell subtype by Hans criteria was made after immunostaining and molecular studies. The patient was treated with R-CHOP chemotherapy and remains disease-free at 14-mo follow-up.
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Affiliation(s)
- Aoife Maguire
- Department of Histopathology (A.M., G.C., J.W., M.J., E.G., R.F.), Cancer Molecular Diagnostics (K.M., F.Q.) Departments of Oncology (N.O.) Haematology and Cancer Molecular Diagnostics (E.V.), St. James's Hospital, Dublin, Ireland
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Pena CE, Jeffers M, Genvresse I, Appleman LJ, Ramanathan RK, Patnaik A. Biomarker analysis from a Phase I study of copanlisib with expansion cohorts in solid tumors with and without PIK3CA mutations and NHL. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.2548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
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Teufel M, Schwenke S, Seidel H, Beckmann G, Reischl J, Vonk R, Lenz HJ, Tabernero J, Siena S, Grothey A, Van Cutsem E, Jeffers M, Wilhelm S, Wagner A, Laurent D, Kobina S, Rutstein MD, Wirapati P, Guinney J, Tejpar S. Molecular subtypes and outcomes in regorafenib-treated patients with metastatic colorectal cancer (mCRC) enrolled in the CORRECT trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3558] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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)
| | | | | | | | | | | | | | | | - Salvatore Siena
- Niguarda Cancer Center, Ospedale Niguarda Ca’ Granda, Milan, Italy
| | | | | | | | | | | | - Dirk Laurent
- Bayer Healthcare Pharmaceuticals AG, Berlin, Germany
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Wong ALA, Lim JSJ, Sinha A, Gopinathan A, Lim R, Tan CS, Soh T, Venkatesh S, Titin C, Sapari NS, Lee SC, Yong WP, Tan DSP, Pang B, Wang TT, Zee YK, Soong R, Trnkova Z, Lathia C, Thiery JP, Wilhelm S, Jeffers M, Goh BC. Tumour pharmacodynamics and circulating cell free DNA in patients with refractory colorectal carcinoma treated with regorafenib. J Transl Med 2015; 13:57. [PMID: 25889309 PMCID: PMC4332724 DOI: 10.1186/s12967-015-0405-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/16/2015] [Indexed: 01/28/2023] Open
Abstract
Background Regorafenib, a multi-kinase inhibitor, is used in the treatment of patients with metastatic colorectal cancer refractory to standard therapy. However, this benefit was limited to 1.4 months improvement in overall survival, with more than half of patients experiencing grade 3 to 4 adverse events. We aim to elucidate the pharmacodynamic effects of regorafenib in metastatic colorectal cancer and discover potential biomarkers that may predict clinical benefit. Methods Patients with metastatic colorectal adenocarcinoma refractory to standard therapy with tumours amenable to biopsy were eligible for the study. Regorafenib was administered orally at 160 mg daily for 3 out of 4 weeks with tumour assessment every 2 cycles. Metabolic response was assessed by FDG PET-CT scans (pre-treatment and day 15); paired tumour biopsies (pre-treatment and day 21 post-treatment) were sampled for immunohistochemistry and proteomic profiling analyses. Plasma circulating cell free DNA was quantified serially before and after treatment. Results There were 2(6%) partial responses out of 35 patients, and 8(23%) patients had stable disease for more than 7 months. Adverse event profile was similar to reported data. Recurrent somatic mutations in K-RAS, PIK3CA and BRAF were detected in plasma circulating cell free DNA in 14 patients; some mutations were not found in archival tumour. Total plasma circulating cell free DNA inversely correlated with progression free survival (PFS), and presence of KRAS mutations associated with shorter PFS. Immunohistochemistry of pre- and post- treatment biopsies showed majority of patients had downregulation of phosphorylated-VEGFR2, podoplanin, phosphorylated-AKT, Ki-67 and upregulation of the MEK-ERK axis, phosphorylated-C-MET, phosphorylated-SRC, phosphorylated-STAT3 and phosphorylated-JUN. Proteomic analysis of fine needle tumour aspirates showed down-regulation of PI3K was associated with longer PFS. Conclusion Plasma circulating cell free DNA may yield potential predictive biomarkers of regorafenib treatment. Downregulation of the PI3K-AKT axis may be an important predictor of clinical benefit. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0405-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Li Ann Wong
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Joline Si Jing Lim
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Arvind Sinha
- Department of Diagnostic Imaging, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Anil Gopinathan
- Department of Diagnostic Imaging, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Robert Lim
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Chee-Seng Tan
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Thomas Soh
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Sudhakar Venkatesh
- Department of Diagnostic Imaging, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Christina Titin
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Nur Sabrina Sapari
- Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
| | - Wei-Peng Yong
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
| | - David Shao Ping Tan
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
| | - Brendan Pang
- Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore. .,Department of Pathology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Ting-Ting Wang
- Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
| | - Ying-Kiat Zee
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Richie Soong
- Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore. .,Department of Pathology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Zuzana Trnkova
- Bayer Healthcare Pharmaceuticals, 100 Bayer Boulevard, PO Box 915, Whippany, NJ, 07981-0915, USA.
| | - Chetan Lathia
- Bayer Healthcare Pharmaceuticals, 100 Bayer Boulevard, PO Box 915, Whippany, NJ, 07981-0915, USA.
| | - Jean-Paul Thiery
- Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
| | - Scott Wilhelm
- Bayer Healthcare Pharmaceuticals, 100 Bayer Boulevard, PO Box 915, Whippany, NJ, 07981-0915, USA.
| | - Michael Jeffers
- Bayer Healthcare Pharmaceuticals, 100 Bayer Boulevard, PO Box 915, Whippany, NJ, 07981-0915, USA.
| | - Boon-Cher Goh
- Department of Haematology-Oncology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Cancer Science Institute, Centre for Translational Medicine, 14 Medical Drive, #12-01, Singapore, 117599, Singapore.
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Lim HY, Heo J, Choi HJ, Lin CY, Yoon JH, Hsu C, Rau KM, Poon RT, Yeo W, Park JW, Tay MH, Hsieh WS, Kappeler C, Rajagopalan P, Krissel H, Jeffers M, Yen CJ, Tak WY. A Phase II Study of the Efficacy and Safety of the Combination Therapy of the MEK Inhibitor Refametinib (BAY 86-9766) Plus Sorafenib for Asian Patients with Unresectable Hepatocellular Carcinoma. Clin Cancer Res 2014; 20:5976-85. [DOI: 10.1158/1078-0432.ccr-13-3445] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zhu AX, Kang YK, Rosmorduc O, Evans TJ, Santoro A, Ross PJ, Gane E, Vogel A, Jeffers M, Meinhardt G, Pena CE. Biomarker analyses and association with clinical outcomes in patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib with or without erlotinib in the phase III SEARCH trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.4028] [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)
- Andrew X. Zhu
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Yoon-Koo Kang
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - T.R. Jeffry Evans
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom
| | | | - Paul J. Ross
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Edward Gane
- New Zealand Liver Transplant Unit, University of Auckland, Auckland, New Zealand
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Paschke R, Brose MS, Nutting C, Shong YK, Sherman SI, Smit JWA, Chung J, Molnar I, Jeffers M, Pena C, Schlumberger M. Association between tumor BRAF and RAS mutation status and clinical outcomes in patients with radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC) randomized to sorafenib or placebo: sub-analysis of the phase III DECISION trial. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Krahn T, Jeffers M, Von Hoff DD, Seetharam M, Liu X, Kim PS, Singh S. Capturing and molecular analysis of tumor cells isolated from ascites fluid to predict response to treatment. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e22110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22110 Background: As access to tumor tissue if often limited in clinical studies, we are exploring technologies to capture tumor cells from body fluids with the aim to use the profile of pathway activation to predict response to treatment in early clinical trials. Methods: Tumor cells were captured from ascites fluid collected from an ovarian cancer patient via immunomagnetic enrichment. Isolated tumor cells were characterized for panel of signal transduction proteins at base line and after the treatment with PI3K inhibitor and/or MEK inhibitor alone or in combination. Comprehensive functional pathway modulation was determined using multiplexed Collaborative Enzyme Enhanced Reactive-immunoassay (CEER) to evaluate the treatment efficacy. Results: Sufficient numbers of tumor cells were present in ascites fluid for immunomagnetic enrichment and for subsequent functional pathway analysis. Comprehensive pathway modulations (HER1, HER2, HER3, cMET, IGF1R, PDK1, PI3K, AKT, PRAS40, RPS6, ERK, MEK and RSK) were determined with tumor cells using CEER. Pathway modulation upon in vitro drug treatment revealed insufficient targets as well as downstream signal protein inhibition against single agent PI3Ki or MEKi treatment. When these cells were treated with both compounds however, a dramatic target/pathway inhibition was observed. Conclusions: Viable, stimulatable tumor cells can be isolated in high number from ascites fluid and routine pathway analysis can be achieved in clinical setting. As pathway redundancy is a common feature in most solid tumor, a comprehensive in vitro analysis of pathway against various targeted drugs using tumor cells isolated from easily obtainable biological fluid (ascites, plural fluid, etc.) may guide clinicians in selecting the most effective targeted drug combination. Significant differences can be detected between single and combination treatment. Further studies need to be done to validate these findings.
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Affiliation(s)
| | | | - Daniel D. Von Hoff
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale, AZ
| | - Mahesh Seetharam
- Arizona Oncology-Scottsdale Medical Oncology & Hematology, Scottsdale, AZ
| | - Xinjun Liu
- Prometheus Laboratories Inc., San Diego, CA
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Demetri GD, Jeffers M, Reichardt P, Kang YK, Blay JY, Rutkowski P, Gelderblom H, Hohenberger P, Leahy MG, von Mehren M, Joensuu H, Badalamenti G, Blackstein ME, Le Cesne A, Schoffski P, Maki RG, Xu JM, Nishida T, Kuss I, Casali PG. Mutational analysis of plasma DNA from patients (pts) in the phase III GRID study of regorafenib (REG) versus placebo (PL) in tyrosine kinase inhibitor (TKI)-refractory GIST: Correlating genotype with clinical outcomes. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.10503] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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
10503 Background: The phase III GRID study showed that REG provides a significant improvement in progression-free survival (PFS) compared with PL in pts with advanced gastrointestinal stromal tumors (GIST) following failure of at least imatinib (IM) and sunitinib (SU; HR 0.27, p<0.0001). Determining GIST genotype in TKI-refractory disease has proven challenging due to inter-tumoral heterogeneity and pt preference to avoid serial biopsies. To overcome this, we analysed circulating DNA in plasma as a source of tumor DNA and studied the correlation between mutational status and clinical outcome. Methods: DNA was isolated from both archival tumor tissue (n=102) and plasma at baseline (n=163) and analyzed for mutations via Sanger sequencing (tissue) or BEAMing (plasma). Results: Mutational frequencies for tumor tissue samples were: KIT, 66%; PDGFRA, 3%; KRAS, 1%; BRAF, 0%. For plasma, frequencies were: KIT, 58%; PDGFRA, 1%; KRAS, 1 out of 2 samples, BRAF, 0%. Detection of primary KIT mutations showed 84% concordance between tissue and plasma. Secondary KIT mutations were more commonly detected in plasma (47%) than in tissue (12%). Subgroup analysis based on mutational status showed an improved PFS in REG-treated pts vs PL in all subgroups by both central and local review of imaging studies. The presence of a secondary KIT mutation in plasma was associated with shorter PFS in pts receiving PL (HR 1.82, p=0.05). Pts with a KIT-exon 9 mutation received IM for a shorter period of time, and SU for a longer period of time, relative to other GIST genotypes. Pts with a PDGFRA mutation showed variable clinical responses, while 1/1 KRAS-mutant GIST did not respond well to IM, SU, or REG. Conclusions: KIT mutational status correlated to IM and SU treatment duration. While consistent with prior reports using tissue sampling, this validates the utility of plasma-based circulating DNA analysis of target oncogenes. Secondary KIT mutations appear to have a negative prognostic impact in GIST, while the clinical benefit of REG vs PL was not influenced by KIT mutational status. Clinical trial information: NCT01271712.
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Affiliation(s)
| | | | | | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Piotr Rutkowski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Hans Gelderblom
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Peter Hohenberger
- Department of Surgery, Mannheim University Medical Center, Mannheim, Germany
| | | | | | - Heikki Joensuu
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Giuseppe Badalamenti
- Department of Surgical and Oncological Sciences, University of Palermo, Palmero, Italy
| | | | | | - Patrick Schoffski
- Laboratory of Experimental Oncology and Department of General Medical Oncology, KU Leuven and University Hospitals, Leuven, Belgium
| | | | - Jian-Ming Xu
- Cancer Center, 307 Hospital, Academy of Military Medical Science, Beijing, China
| | | | - Iris Kuss
- Bayer HealthCare Pharmaceuticals, Berlin, Germany
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Lenz HJ, Van Cutsem E, Sobrero AF, Siena S, Falcone A, Ychou M, Humblet Y, Bouche O, Mineur L, Barone C, Adenis A, Tabernero J, Yoshino T, Goldberg RM, Sargent DJ, Cihon F, Wagner A, Laurent D, Jeffers M, Grothey A. Analysis of plasma protein biomarkers from the CORRECT phase III study of regorafenib for metastatic colorectal cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.3514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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
3514 Background: In the CORRECT phase III trial, the multikinase inhibitor regorafenib (REG) demonstrated significant improvement in overall survival (OS) and progression-free survival (PFS) vs placebo (Pla) in patients with metastatic colorectal cancer (mCRC) whose disease had progressed on other standard therapies. An exploratory biomarker subanalysis was conducted to identify protein biomarkers with potential predictive or prognostic value. Methods: Fifteen proteins of interest, many of which are involved in angiogenesis, were quantified by multiplex immunoassay or ELISA in baseline plasma samples collected at study entry from 80% (611/760) of patients. Potential predictive and prognostic effects were evaluated. Results: The biomarker subpopulation was representative of the overall study population in terms of OS and PFS. Using OS as the clinical endpoint, Tie-1 was the only protein whose level demonstrated significant correlation with efficacy (low protein group: REG/Pla, HR 0.87; high protein group, HR 0.56; interaction, p=0.035). Using PFS as the clinical endpoint, von Willebrand factor (VWF) was the only protein whose level demonstrated significant correlation with efficacy (low protein group: REG/Pla, HR 0.39; high protein group, HR 0.60; interaction, p=0.02). Following correction for multiple testing, neither Tie-1 nor VWF data retained statistical significance. Baseline levels of IL-8 and placental growth factor (PlGF) were found to have prognostic value for OS (IL-8: high/low protein levels, HR 3.48, p<0.001; PIGF: HR 1.81, p=0.002). IL-8 was also prognostic for PFS (high/low protein levels: HR 1.63, p<0.001). Conclusions: None of the plasma proteins examined showed significant predictive value for REG efficacy after multiple testing correction. The association between baseline levels of Tie-1/VWF and REG efficacy may be a hypothesis to be tested in further trials. Clinical trial information: NCT01103323.
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Affiliation(s)
- Heinz-Josef Lenz
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | - Alfredo Falcone
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Marc Ychou
- Centre Ressources pour Lésés Cérébraux Val d'Aurelle, Montpellier, France
| | - Yves Humblet
- Saint-Luc University Hospital, Brussels, Belgium
| | - Olivier Bouche
- Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Laurent Mineur
- Radiotherapy and Oncology GI and Liver Unit, Institut Sainte-Catherine, Avignon, France
| | | | | | | | | | | | | | - Frank Cihon
- Bayer HealthCare Pharmaceuticals, Montville, NJ
| | | | - Dirk Laurent
- Bayer HealthCare Pharmaceuticals, Berlin, Germany
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Wong ALA, Sinha A, Gopinathan A, Lim RS, Tan CS, Soh IPT, Venkatesh S, Titin C, Soong RCT, Pang B, Sapari NS, Wang TT, Zee YK, Chuah B, Jeffers M, Lathia C, Trnkova Z, Wilhelm S, Goh BC. Pharmacodynamic effects of regorafenib in metastatic colorectal carcinoma (mCRC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e14507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14507 Background: Regorafenib, an oral multikinase inhibitor of VEGFR2/3, PDGFRb, KIT, FGFR, RET, RAF and TIE2, is efficacious in refractory mCRC but its mechanism of action is unclear and predictive biomarkers are lacking. Methods: We assessed tumor and circulatory biomarkers in a phase 2 study of regorafenib in refractory mCRC patients. Regorafenib was administered orally at 160mg/d for 3 out of 4 weeks. Post cycle 2 response was assessed by RECIST 1.1. Subjects were scheduled for FDG PET-CT scans (pre + D15) and paired core needle tumor biopsies for IHC analysis (pre + D21) in cycle 1. Archival tumor mutations were evaluated using Sequenom MassARRAY OncoCarta Panel V1.0 assay. Results: 35 patients were treated; 49% received > 4 prior therapies and 43% had prior bevacizumab. Median PFS was 3.45 mths (95% CI: 3.40-3.49), ORR was 3% and disease control rate [DCR] (PR + SD at 8 wks) was 57%. Early PET responses (EORTC criteria) were seen in 49%, but did not predict for DCR (p=1.0). Fatigue, hand foot skin reaction (HFSR), voice change and diarrhea occurred in > 30% of subjects. Grade 3-5 toxicities occurred in 46%, the commonest being HFSR and rash (17% each). Median relative dose intensity was 92%; 43% required > 1 dose reduction, 60% required > 1 dose interruption. KRAS (29%), BRAF (9%), EGFR (9%), NRAS (6%) KIT (3%), PIK3CA (3%), PDGFRA (3%) and CDK (3%) mutations were detected in archival tumors. None predicted for ORR or DCR; PFS was identical in KRAS mutant vs wt patients (3.45 mths, p=0.39) and similar in BRAF mutant vs wt patients (3.48 vs 3.45 mths, p=0.10). The patient with the longest PFS (12.6 mths) had a BRAF mutation. Amongst the 10 paired tumor samples available, IHC markers upregulated in >50% cases were pMEK, pERK, pJun and pJNK, whilst those downregulated/ unchanged in >50% were pKIT, pVEGFR2, CD31 [vascular endothelial cells (ECs)] and podoplanin (lymphatic ECs). The greatest change was observed in podoplanin expression, corresponding to a 60% reduction in lymphatic vessel density. Conclusions: FDG-PET responses in cycle 1 did not predict for regorafenib clinical benefit in mCRC patients. Targeting lymphatic/vascular ECs in the tumor microenvironment may be a more significant antitumor mechanism of regorafenib than MAP kinase pathway inhibition. Clinical trial information: NCT01189903.
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Affiliation(s)
| | - Arvind Sinha
- National University Health System, Singapore, Singapore
| | | | | | - Chee Seng Tan
- National University Health System, Singapore, Singapore
| | | | | | | | | | - Brendan Pang
- National University Health System, Singapore, Singapore
| | | | | | - Ying Kiat Zee
- National University Health System, Singapore, Singapore
| | | | | | | | | | | | - Boon C. Goh
- National University Health System, Singapore, Singapore
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Demetri GD, Jeffers M, Reichardt P, Kang YK, Blay JY, Rutkowski P, Gelderblom H, Hohenberger P, Leahy M, von Mehren M, Joensuu H, Badalamenti G, Blackstein M, Le Cesne A, Schöffski P, Maki RG, Bauer S, Bui Nguyen B, Xu J, Nishida T, Chung J, Lathia CD, Kappeler C, Kuss I, Laurent D, Casali PG. Abstract LB-295: Detection of oncogenic kinase mutations in circulating plasma DNA and correlation with clinical benefit in the phase III GRID study of regorafenib vs placebo in TKI-refractory metastatic GIST. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-lb-295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: GRID is a phase III study for patients with advanced gastrointestinal stromal tumors (GIST) following failure of imatinib (I) and sunitinib (S) who were randomized to receive either the multikinase inhibitor regorafenib (R) or placebo (P). R demonstrated a highly significant improvement in progression-free survival compared with P (HR 0.27, p<0.0001). A preplanned retrospective biomarker analysis was conducted to assess GIST genotypes in GRID patients and to explore the possible impact of different driver oncogene mutations on clinical outcomes.
Methods: DNA was isolated from archival tumor tissue and analyzed for KIT mutations via Sanger sequencing. The expectation was that primary KIT mutations would be detectable in archival tissue but that secondary KIT mutations may be undetectable in tissues obtained before treatment with I or S. To overcome this potential limitation, plasma samples drawn at GRID study entry, post I and S failure, were used as a source of circulating DNA for evaluation of GIST oncogenic mutations (KIT, PDGFRA, BRAF) via BEAMing technology.
Results: KIT mutations were detected in 83 of 138 (60%) plasma samples and 64 of 99 (65%) tumor tissue samples analyzed. Primary KIT exon 11 and 9 mutations were identified in approximately 42% and 18% of the tissue samples, respectively. The frequency of the canonical exon 9 mutations was similar for plasma and tissue samples, showing consistency between mutation-detection technologies. With limitations of tumor-based assays, a lower incidence of secondary KIT resistance mutations was detected in patient-matched archival tumor tissue compared with plasma samples: resistance mutations were detected in 12% of tissue samples vs 48% of plasma samples. Most (76%) secondary KIT mutations detected in plasma DNA were located in the KIT activation loop encoding structural alterations known to mediate resistance to I and S. Nearly half of the plasma samples in which secondary KIT mutations were identified harbored multiple secondary mutations, consistent with the results of previous studies on fresh tumor biopsies taken following resistance to both I and S. R was clinically active compared with P in all KIT mutational subgroups evaluated (HR 0.27 in patients with KIT exon 9 mutations; HR 0.25 in patients with secondary KIT mutations identified via plasma DNA).
Conclusions: In GIST patients from the GRID trial, driver oncogenic mutations and secondary oncogenic mutations leading to I and S resistance are readily detectable via BEAMing of circulating DNA from plasma. BEAMing may provide a real-time assessment of tumor genotype in GIST and other cancers using blood-derived circulating DNA, that may be more comprehensive than tumor sampling. GIST patients with a wide spectrum of primary and secondary mutations in oncogenic kinases benefit from treatment with R.
Citation Format: George D. Demetri, Michael Jeffers, Peter Reichardt, Yoon-Koo Kang, Jean-Yves Blay, Piotr Rutkowski, Hans Gelderblom, Peter Hohenberger, Michael Leahy, Margaret von Mehren, Heikki Joensuu, Giuseppe Badalamenti, Martin Blackstein, Axel Le Cesne, Patrick Schöffski, Robert G Maki, Sebastian Bauer, Binh Bui Nguyen, Jianming Xu, Toshirou Nishida, John Chung, Chetan D. Lathia, Christian Kappeler, Iris Kuss, Dirk Laurent, Paolo G Casali. Detection of oncogenic kinase mutations in circulating plasma DNA and correlation with clinical benefit in the phase III GRID study of regorafenib vs placebo in TKI-refractory metastatic GIST. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-295. doi:10.1158/1538-7445.AM2013-LB-295
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Affiliation(s)
| | | | - Peter Reichardt
- 3Department of Hematology, Oncology and Palliative Medicine, HELIOS Klinikum, Bad Saarow, Germany
| | - Yoon-Koo Kang
- 4Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jean-Yves Blay
- 5Centre Leon Berard and University Claude Bernard, Leon, France
| | - Piotr Rutkowski
- 6Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sktodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Hans Gelderblom
- 7Department of Clinical Oncology, Leiden University Medical Centre, Leiden, Netherlands
| | - Peter Hohenberger
- 8Div. of Surgical Oncology & Thoracic Surgery Mannheim University Medical Center, Mannheim, Germany
| | - Michael Leahy
- 9The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Heikki Joensuu
- 11Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Martin Blackstein
- 13Medical Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Axel Le Cesne
- 14Department of Medicine, Gustave Roussy Institute, Paris, France
| | - Patrick Schöffski
- 15Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Robert G Maki
- 16Department of Medicine, Mount Sinai School of Medicine, New York, NY
| | - Sebastian Bauer
- 17Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | | | - Jianming Xu
- 19Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing, China
| | | | - John Chung
- 21Bayer Healthcare Pharmaceuticals, Wayne, NJ
| | | | | | | | | | - Paolo G Casali
- 24Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Jeffers M, Lathia CD, Wilhelm SM, Voliotis D, Laurent D, Pena CE. Abstract SY11-02: Detection of tumor-associated mutations in circulating DNA: clinical applications and experiences. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-sy11-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The detection of tumor-associated mutations is of paramount importance in the era of personalized medicine. Mutational testing is now a prerequisite for the use of some approved therapies (e.g., KRAS for cetuximab in colorectal cancer [CRC]; BRAF for vemurafenib in melanoma), and these clearly established correlations between tumor mutational status and drug response elevate the importance and urgency of evaluating such associations in clinical trials of investigational drugs.
While archival primary tumor tissue is often used for mutational evaluation, such material has inherent limitations, which may be overcome by recent technological developments enabling the detection of tumor-associated mutations using plasma-derived DNA. For example, when a tumor tissue specimen is unavailable, use of plasma DNA would allow mutational status to be ascertained without the need for an invasive procedure to obtain a new tumor sample. In addition, it is now apparent that most patients treated with targeted therapies will eventually develop drug resistance, often via the acquisition of new tumor-associated mutations; these mutations may vary not only between patients but also between metastases within an individual patient. As such, the mutational status of an archival primary tumor specimen may not be relevant to guide the selection of subsequent therapies, and obtaining fresh tumor tissue from each metastasis that arises following the development of drug resistance is impractical. In such instances, mutational analysis of DNA derived from a real-time plasma sample obtained after the onset of drug resistance may offer advantages in terms of both availability and biological relevance, since new mutations acquired in response to a particular targeted therapy may be detectable in plasma DNA. Finally, mutational analysis of plasma DNA may be useful in clinical trials to evaluate potential correlations between mutational status and clinical outcome. For such exploratory analyses, the collection of archival tumor specimens from a high proportion of enrolled patients can be logistically and ethically difficult to achieve, not to mention of questionable relevance given that acquired mutations would not be detectable in these specimens. Collection of fresh tumor tissue samples at study entry would provide biologically relevant material, but can be problematic and costly to obtain in large, global clinical trials. Thus, the utility of plasma DNA for real-time mutational analysis in the clinical-trial setting offers several distinct advantages.
Since DNA derived from both normal and tumor cells exists in the circulation, the detection of tumor-associated mutations in plasma DNA requires the ability to identify a relatively small number of mutant alleles among an excess of wild-type alleles. With the goal of identifying the most suitable technology for this purpose, we conducted a comparison of available methodologies and found that BEAMing technology (Beads, Emulsions, Amplification, and Magnetics) offered very sensitive detection of known tumor-associated mutations using plasma DNA, although this technique is not well suited for the discovery of previously unknown mutations. We have now used BEAMing to analyze more than 2,000 patient samples collected from oncology clinical trials, allowing us to evaluate a number of genes (e.g., KRAS, NRAS, HRAS, BRAF, PIK3CA, AKT1, EGFR, KIT, and PDGFRA) in different cancer types (e.g., CRC, gastrointestinal stromal tumors, hepatocellular carcinoma, non-small-cell lung cancer, and breast cancer). We have used BEAMing of plasma DNA both prospectively, to enroll patients into a phase I trial based on a molecular profile of interest, and retrospectively, to evaluate potential associations between mutational status and clinical outcome in phase II and III trials. In many of these trials, collection of both fresh plasma and archival tumor tissue from a subset of patients has enabled us to compare mutational status in patient-matched plasma and tumor samples. Our experiences with BEAMing of plasma DNA to determine tumor-associated mutational status will be discussed.
Citation Format: Michael Jeffers, Chetan D. Lathia, Scott M. Wilhelm, Dimitris Voliotis, Dirk Laurent, Carol E. Pena. Detection of tumor-associated mutations in circulating DNA: clinical applications and experiences. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr SY11-02. doi:10.1158/1538-7445.AM2013-SY11-02
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Weekes CD, Von Hoff DD, Adjei AA, Leffingwell DP, Eckhardt SG, Gore L, Lewis KD, Weiss GJ, Ramanathan RK, Dy GK, Ma WW, Sheedy B, Iverson C, Miner JN, Shen Z, Yeh LT, Dubowy RL, Jeffers M, Rajagopalan P, Clendeninn NJ. Multicenter phase I trial of the mitogen-activated protein kinase 1/2 inhibitor BAY 86-9766 in patients with advanced cancer. Clin Cancer Res 2013; 19:1232-43. [PMID: 23434733 DOI: 10.1158/1078-0432.ccr-12-3529] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the safety, pharmacokinetics, and pharmacodynamics of BAY 86-9766, a selective, potent, orally available, small-molecule allosteric inhibitor of mitogen-activated protein kinase 1/2 in patients with advanced solid tumors. EXPERIMENTAL DESIGN BAY 86-9766 was administered orally daily in 28-day courses, with doses escalated to establish the maximum-tolerated dose (MTD). An expanded cohort was evaluated at the MTD. Pharmacokinetic and pharmacodynamic parameters were assessed, with extracellular signal-regulated kinase (ERK) phosphorylation evaluated in paired biopsies from a subset of the expanded MTD cohort. Tumor specimens were evaluated for mutations in select genes. RESULTS Sixty-nine patients were enrolled, including 20 patients at the MTD. The MTD was 100 mg given once-daily or in two divided doses. BAY 86-9766 was well-tolerated. The most common treatment-related toxicities were acneiform rash and gastrointestinal toxicity. BAY 86-9766 was well-absorbed after oral administration (plasma half-life ~12 hours), and displayed dose proportional pharmacokinetics throughout the tested dose range. Continuous daily dosing resulted in moderate accumulation at most dose levels. BAY 86-9766 suppressed ERK phosphorylation in biopsied tissue and tetradecanoylphorbol acetate-stimulated peripheral blood leukocytes. Of 53 evaluable patients, one patient with colorectal cancer achieved a partial response and 11 patients had stable disease for 4 or more courses. An ocular melanoma specimen harbored a GNAQ-activating mutation and exhibited reduced ERK phosphorylation in response to therapy. CONCLUSION This phase I study showed that BAY 86-9766 was well-tolerated, with good oral absorption, dose proportional pharmacokinetics, target inhibition at the MTD, and some evidence of clinical benefit across a range of tumor types.
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Affiliation(s)
- Colin D Weekes
- University of Colorado Cancer Center, Aurora, Colorado 80045, USA
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Jeffers M, Van Cutsem E, Sobrero AF, Siena S, Falcone A, Ychou M, Humblet Y, Bouche O, Mineur L, Barone C, Adenis A, Tabernero J, Yoshino T, Lenz HJ, Goldberg RM, Sargent DJ, Cihon F, Wagner A, Laurent D, Grothey A. Mutational analysis of biomarker samples from the CORRECT study: Correlating mutation status with clinical response to regorafenib. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
381 Background: In the CORRECT Ph3 trial, regorafenib demonstrated significant improvement in OS and PFS vs. placebo in subjects with metastatic colorectal cancer (mCRC) who had progressed on standard therapies. An exploratory biomarker substudy was conducted on samples collected from subjects enrolled in CORRECT. Methods: DNA was isolated from archival tumor tissue and fresh baseline plasma samples that were available from 239 (31%) and 503 (66%) subjects enrolled in CORRECT, respectively. Mutations in KRAS, PIK3CA and BRAF were evaluated via BEAMing technology. Results: Mutations were readily detected in DNA isolated from both tumor and plasma samples: KRAS: 59/69%; PIK3CA: 12/17% and BRAF: 1.5/3.4%. The frequency of KRAS mutation detected in tumor samples via BEAMing (59%) was identical to the frequency determined from pre-existing “historical” KRAS mutation data that was available from 96% of the subjects enrolled in the study. Concordance among the mutations detected via BEAMing in tumor vs. plasma was 76% (KRAS), 88% (PIK3CA), and 97% (BRAF). A subset of CRC which was found to be KRAS-wildtype in DNA from archival tumor, but KRAS-mutant in DNA from fresh plasma was identified and may represent subjects whose KRAS mutational status had changed during prior therapy. Correlative subgroup analyses demonstrated that regorafenib mediated a trend for clinical benefit vs. placebo in both KRAS wildtype and mutant subgroups identified by plasma BEAMing (OS: KRAS WT, HR: 0.67, 95% CI: 0.41–1.08; KRAS mutant, HR: 0.81, 95% CI: 0.61–1.09; interaction p=0.561). Similar results were noted for PIK3CA WT/mutant subgroups (OS: WT, HR: 0.75, 95% CI: 0.57–0.99; mutant, HR: 0.84, 95% CI: 0.47–1.50; interaction p=0.723). BRAF was not analysed due to the small number of BRAF-mutant samples. Conclusions: The mutational analysis of DNA isolated from fresh plasma is feasible and robust using the BEAMing platform and may better represent the mutational status of the tumor(s) that a mCRC patient harbors at the time of enrollment than does the mutational analysis of archival primary tumor tissue. Regorafenib was associated with clinical benefit (vs. placebo) in all mutational subgroups evaluated. Clinical trial information: NCT01103323.
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Affiliation(s)
| | - Eric Van Cutsem
- Digestive Oncology Unit, Leuven Cancer Institute, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Salvatore Siena
- Department of Oncology, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Alfredo Falcone
- Dipartimento di Oncologia dei Trapianti e delle Nuove Tecnologie in Medicina, Università di Pisa, Pisa, Italy
| | | | - Yves Humblet
- Saint-Luc University Hospital, Brussels, Belgium
| | | | - Laurent Mineur
- Radiotherapy and Oncology GI and Liver Unit, Institut Sainte-Catherine, Avignon, France
| | - Carlo Barone
- Catholic University of Sacred Heart, Rome, Italy
| | | | | | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Heinz-Josef Lenz
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Richard M. Goldberg
- Division of Medical Oncology, Ohio State University School of Medicine, Columbus, OH
| | | | - Frank Cihon
- Bayer HealthCare Pharmaceuticals, Montville, NJ
| | | | - Dirk Laurent
- Bayer HealthCare Pharmaceuticals, Berlin, Germany
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Abstract
A 43-year-old lady was admitted to the intensive care unit with sepsis. She had a history of mixed connective tissue disease, Raynaud's syndrome and hypothyroidism. 2 days later, she developed a purpuric rash on her face and extremities with a livedoid background. Few days later, her distal fingers and toes became gangrenous which then had to be amputated. Laboratory investigations showed that she was coagulopathic and had multiple organ dysfunctions. Antiphospholipid antibodies were negative; however, protein C and antithrombin III levels were low. A skin biopsy showed fibrinoid necrosis in the vessel wall with microthrombi and red-cell extravasation. A diagnosis of purpura fulminans was made.
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Affiliation(s)
- Aizuri A Murad
- Dermatology Department, Adelaide and Meath Hospital, Dublin, Ireland
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Carcopino X, Maycock JA, Mancini J, Jeffers M, Farrar K, Martin M, Khalid S, Prendiville W. Image assessment of cervical dimensions after LLETZ: a prospective observational study. BJOG 2012; 120:472-8. [DOI: 10.1111/1471-0528.12105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - JA Maycock
- Department of Gynaecology; Colposcopy Clinic; The Adelaide and Meath Hospital; Tallaght; Dublin; Ireland
| | | | - M Jeffers
- Department of Pathology; The Adelaide and Meath Hospital; Tallaght; Dublin; Ireland
| | - K Farrar
- Department of Gynaecology; Colposcopy Clinic; The Adelaide and Meath Hospital; Tallaght; Dublin; Ireland
| | - M Martin
- Department of Gynaecology; Colposcopy Clinic; The Adelaide and Meath Hospital; Tallaght; Dublin; Ireland
| | - S Khalid
- Department of Gynaecology; Colposcopy Clinic; The Adelaide and Meath Hospital; Tallaght; Dublin; Ireland
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Coburn N, Kreso A, Nadler A, Hamilton T, Wei AC, Smith MJ, Hebbard P, McConnell YJ, Nessim C, Pathak KA, Quereshy FA, Dixon M, Mahar A, Paszat L, McLeod R, Law C, Swallow C, Helyer L, Seevaratnam R, Cardoso R, van Galen P, Davis T, Cao L, Baiazitov R, Du W, Sydorenko N, Moon YC, Szentgyorgyi E, Gallinger S, O’Brien CA, Dick JE, Cukier M, Singh S, Milot L, Law C, Leuger D, Kopachuk K, Dixon E, Sutherland F, Bathe O, Coburn NG, Devitt KS, Moulton CA, Cleary SP, Law C, Greig PD, Gallinger S, Heffron CC, Rothwell JR, Loftus BM, Jeffers M, Geraghty JG, Baxter N, Yun L, Rakovitch E, Wright F, Warner E, McCready D, Hodgson N, Quan ML, Mack LA, Temple WJ, Law C, McConnell Y, Sade S, McKinnon G, Wright F, Mazurat A, Lambert P, Klonisch TC, Nason RW, Poon JT, Law W. Canadian Society of Surgical Oncology Nineteenth Annual Scientific MeetingWhat provider volume is appropriate for gastric cancer resection? Results of a RAND/UCLA expert panelSelf-renewal as a therapeutic target in human colorectal cancerA novel hepatic parenchymal preserving technique in the management of neuroendocrine tumour liver metastases: a feasible approachInflammatory markers predict survival in liver metastases from colorectal cancerResection of multisite metastases from colorectal cancer: feasibility and interim results of a multicentre prospective phase II studyIs fine-needle aspiration cytology in symptomatic breast lesions still an important diagnostic modality?The effect of surgery on recurrence and survival of young women with breast cancerSurvival and selection criteria for cytoreductive surgery in patients with peritoneal carcinomatosis from colorectal cancer: results from a prospective Canadian cohortHow often do level 3 nodes bear melanoma metastases, and does it affect patient outcomes?Predicting outcomes of thyroid cancerLong-term outcomes of stenting as a bridge to surgery for acute left-sided malignant colonic obstruction. Can J Surg 2012. [DOI: 10.1503/cjs.012112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Strumberg D, Scheulen ME, Schultheis B, Richly H, Frost A, Büchert M, Christensen O, Jeffers M, Heinig R, Boix O, Mross K. Regorafenib (BAY 73-4506) in advanced colorectal cancer: a phase I study. Br J Cancer 2012; 106:1722-7. [PMID: 22568966 PMCID: PMC3364125 DOI: 10.1038/bjc.2012.153] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 02/29/2012] [Accepted: 03/22/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In a phase I dose-escalation study, regorafenib demonstrated tolerability and antitumour activity in solid tumour patients. The study was expanded to focus on patients with metastatic colorectal cancer (CRC). METHODS Patients received oral regorafenib 60-220 mg daily (160 mg daily in the extension cohort) in cycles of 21 days on, 7 days off treatment. Assessments included toxicity, response, pharmacokinetics and pharmacodynamics. RESULTS Thirty-eight patients with heavily pretreated CRC (median 4 prior lines of therapy, range 0-7) were enrolled in the dose-escalation and extension phases; 26 patients received regorafenib 160 mg daily. Median treatment duration was 53 days (range 7-280 days). The most common treatment-related toxicities included hand-foot skin reaction, fatigue, voice change and rash. Twenty-seven patients were evaluable for response: 1 achieved partial response and 19 had stable disease. Median progression-free survival was 107 days (95% CI, 66-161). At steady state, regorafenib and its active metabolites had similar systemic exposure. Pharmacodynamic assessment indicated decreased tumour perfusion in most patients. CONCLUSION Regorafenib showed tolerability and antitumour activity in patients with metastatic CRC. This expanded-cohort phase I study provided the foundation for further clinical trials of regorafenib in this patient population.
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Affiliation(s)
- D Strumberg
- Department of Hematology and Medical Oncology, University of Bochum, Marienhospital Herne, Hölkeskampring 40, D-44625 Herne, Germany.
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Lotze MT, Appleman LJ, Ramanathan RK, Tolcher AW, Beeram M, Papadopoulos KP, Rasco DW, Weiss GJ, Mountz JM, Toledo FG, Alvarez RJ, Oborski MJ, Rajagopalan P, Jeffers M, Roth D, Dubowy RL, Patnaik A. Phase I study of intravenous PI3K inhibitor BAY 80-6946: Activity in patients (pts) with advanced solid tumors and non-Hodgkin lymphoma treated in MTD expansion cohorts. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3019 Background: BAY 80-6946 (BAY) is a potent and highly selective reversible pan-Class I PI3K inhibitor, previously reported to be tolerated as a 1-hr infusion at a dose of 0.8 mg/kg on days 1, 8 and 15 every 28 days (MTD). Additional pts were treated in MTD expansion cohorts to assess safety, PK, biomarkers and clinical benefit in selected tumor types, as well as safety in Type 2 diabetics. Methods: To date, 23 nondiabetic pts with solid tumors and 5 with follicular lymphoma (FL) received BAY at the MTD, until disease progression or unacceptable toxicity. Tumor types were selected for high frequency of PIK3CA mutation, including breast cancer (BC; 16), endometrial (3), gastric (2), GU transitional cell (1) and ovarian clear cell (1). Partial enrichment for PIK3CA mutation was achieved by analysis of plasma DNA. 3 diabetic pts have been enrolled, at starting dose of 0.4 mg/kg. PK was done after the 1st and 3rd doses. FDG-PET/CT scans were done at baseline and 48 hrs after the 1st dose for pharmacodynamic assessment. Results: Safety and tolerability assessments confirmed MTD. There were no 1st cycle DLTs. Almost all nondiabetic pts had acute Grade 2/3 hyperglycemia (HG) following each dose; at least 10 of them received insulin for 1-3 days post dose. Hypertension (HTN) lasting < 24 hrs was common in pts with preexisting HTN, and manageable. 2 FL pts developed interstitial pneumonitis (IP) after cycles 2 and 3, both responsive to steroids. Diabetic pts tolerated 0.4 mg/kg. Tumor SUVmax consistently fell at 48 hrs. 3 of 4 FL pts had partial response (PR) after 2 cycles, with 2 confirmed PR pts on BAY for 10+ and 8+ mos. 2 BC pts showed PR , 1 confirmed. PIK3CA mutation (n=7) does not appear to correlate with response. Average T1/2 was 36 hrs. Observation of high Cmax in very obese pts led to recommended maximum dose of 65 mg. Conclusions: BAY induced PRs in pts with BC and FL. The acute toxicities of HG in most pts and HTN in some are manageable, and IP has been limited to 2 lymphoma pts and is responsive to steroids. The observed clinical activity of BAY, along with its acceptable safety profile, provide a rationale for the ongoing development of BAY in combination with cytotoxic and targeted agents.
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Affiliation(s)
| | | | | | | | | | | | - Drew Warren Rasco
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio, TX
| | - Glen J. Weiss
- Virginia G. Piper Cancer Center at Scottsdale Healthcare, Scottsdale, AZ
| | | | | | | | | | | | | | - Diane Roth
- Bayer HealthCare Pharmaceuticals, Montville, NJ
| | | | - Amita Patnaik
- South Texas Accelerated Research Therapeutics, LLC, San Antonio, TX
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Jeffers M, Dubowy RL, Lathia CD, Mallon R, Appleman LJ, Ramanathan RK, Patnaik A. Evaluation of the PI3K inhibitor BAY 80-6946 in hematologic malignancies. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e13576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13576 Background: BAY 80-6946 is a new investigational compound that potently inhibits all PI3K Class I isoforms. BAY 80-6946 is under phase 1 clinical evaluation and PRs have been observed in solid tumors (ST) and follicular lymphoma (FL). The present analysis was performed to gain mechanistic insights into the activity of this compound in FL and potentially other hematological malignancies. Methods: Preclinical: The growth-inhibitory activity of BAY 80-6946 on hematological cancer cell lines (n= 32) was determined by the CellTiterGlo assay. GS-1101 (formerly called CAL-101) and cisplatin (CP) were also tested. Clinical: Specimens from subjects enrolled in a BAY 80-6946 Phase 1 trial MTD expansion were used. Levels of various cytokines and chemokines were determined by ELISA or multiplex immunoassay in plasma samples (n= 27) obtained prior to and during BAY 80-6946 treatment of 6 subjects (3 FL + 3 ST). Proteins examined included CXCL13 (involved in B-cell homing) and BAFF (involved in B-cell survival). Tumor tissue was used to determine PTEN expression via IHC and the mutational status of PTEN via sequencing. PIK3CA mutational status was evaluated in tumor tissue and plasma via BEAMing. Results: Preclinical: BAY 80-6946 was more potent on B-cell lymphomas and other hematological cancer cell lines than GS-1101 or CP (median IC50 in μM: BAY 80-6946= 0.49; GS-1101= 37; CP= 2.9). Clinical: Plasma levels of CXCL13 decreased and BAFF increased following BAY 80-6946 administration in all subjects examined (CXCL13 mean change: -58%; p= 0.004; BAFF mean change: +67%; p= 0.042). PTEN expression was lower in FL compared to ST. No mutations in PTEN or PIK3CA were identified in FL. Mutations in PIK3CA were identified in some ST. Conclusions: These preclinical results indicate that the observed early clinical activity of BAY 80-6946 in FL may be due to a direct anti-proliferative effect on malignant B-cells. The plasma chemokine/cytokine results support the possibility that the modulation of factors involved in B-cell homing and survival may play a mechanistic role in mediating this activity. Overall these results support the continued clinical evaluation of BAY 80-6946 in FL and other hematological malignancies.
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Affiliation(s)
| | | | | | | | | | | | - Amita Patnaik
- South Texas Accelerated Research Therapeutics, LLC, San Antonio, TX
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Jeffers M, Dauffenbach LM, Pena C, Lathia C, Bhargava A, Kerfoot CA. Abstract 742: Comparison of commercially available phosphorylated ERK antibodies for immunohistochemical biomarker analysis. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Immunohistochemical (IHC) analysis of ERK phosphorylation is commonly performed on pre- and post-treatment cancer biopsies as part of pharmacodynamic biomarker assessments for targeted oncology therapeutics. The current study was performed to assess the specificity and sensitivity of four commercially-available pERK antibodies for IHC analysis, which included three monoclonal antibodies (clones 20G11, MAPK-YT, D13.14.4E) and one polyclonal antibody. To facilitate this analysis, the HEPG2 liver cancer cell line was grown in the presence or absence of inhibitors of the RAF/MEK/ERK pathway (U0126 or sorafenib). Cell lysates were prepared for analysis via Western blotting and formalin-fixed, paraffin-embedded cell pellets were prepared for analysis via IHC. All antibodies produced bands at 44 and 42 kDa, the expected molecular weights of ERK1/2, when used for Western analysis of untreated cells and demonstrated a reduction or ablation of these bands following treatment of cells with inhibitors of the RAF/MEK/ERK pathway. When examined via IHC, the monoclonals demonstrated nuclear and cytoplasmic staining in HEPG2 cells with increased sensitivity relative to the polyclonal antibody. The monoclonals also demonstrated greatly reduced staining in HEPG2 cells treated with inhibitors of the RAF/MEK/ERK pathway. These antibodies were further characterized for reactivity in human tumor specimens representing breast cancer, colon cancer, lung cancer, melanoma, and ovarian cancer. Melanoma tissues were stained with a red chromogen; all others were stained with DAB. Differences in the frequency of expression, percentage of expression, and protein localization were identified between the three monoclonals. In summary, this work has identified commercially-available antibodies that appear to be of suitable specificity and sensitivity for use in IHC assays.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 742. doi:1538-7445.AM2012-742
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Affiliation(s)
| | | | - Carol Pena
- 1Bayer HealthCare Pharmaceuticals Inc., Montville, NJ
| | - Chetan Lathia
- 1Bayer HealthCare Pharmaceuticals Inc., Montville, NJ
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Smith MJ, Heffron CC, Rothwell JR, Loftus BM, Jeffers M, Geraghty JG. Fine Needle Aspiration Cytology in Symptomatic Breast Lesions: Still an Important Diagnostic Modality? Breast J 2012; 18:103-10. [DOI: 10.1111/j.1524-4741.2012.01223.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Adjei AA, Richards DA, El-Khoueiry A, Becerra CH, Stephenson JJ, Leffingwell DP, Iverson C, Miner JN, Shen Z, Gunawan S, Wilson D, Manhard KJ, Dubowy RL, Jeffers M, Rajagopalan P, Franklin WA, Haney J, Lenhart P, Clendeninn NJ. Abstract A88: Safety, pharmacokinetic, and pharmacodynamic results of BAY 86–9766, an oral MEK inhibitor, in combination with sorafenib, an oral multikinase inhibitor, in advanced cancer patients. Mol Cancer Ther 2011. [DOI: 10.1158/1535-7163.targ-11-a88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Preclinical data revealed a synergistic interaction between sorafenib (Nexavar®) and BAY 86-9766 (RDEA119). Sorafenib is an oral, small molecule, multikinase inhibitor that is approved for the treatment of unresectable hepatocellular carcinoma (HCC) and advanced renal cell carcinoma. BAY 86-9766 is an investigational, oral, potent, non-ATP competitive, highly selective inhibitor of MEK1/2. In a Phase 1 single-agent trial of BAY 86-9766 in advanced cancer patients, the maximum tolerated dose (MTD) was 100 mg daily, given as 50 mg twice daily (bid) or 100 mg once daily, with rash being the most common treatment-related adverse event (AE) and significant inhibition of tumor phosphorylated ERK (pERK) observed. This Phase 1 trial was conducted to determine the MTD, safety, pharmacokinetics (PK), pharmacodynamics (PD), and preliminary efficacy of BAY 86-9766 in combination with sorafenib. Data from the dose escalation cohorts and MTD expansion cohort are reported here. An additional cohort of patients with advanced HCC is ongoing in the MTD expansion phase and is not described here.
Materials and Methods: Key eligibility criteria included advanced metastatic or locally recurrent solid tumors, ECOG performance status of 0–1, acceptable organ function, and life expectancy of at least 3 months. Patients initially received BAY 86-9766 alone for up to 3 days to determine PK and then began a 28-day course of combination treatment with BAY 86-9766 and sorafenib. Dose escalation proceeded with increasing doses of BAY 86-9766 from 5 mg to 50 mg bid and either 200 mg or 400 mg bid of sorafenib. At least 3 patients were treated at each of 6 dose escalation levels. Safety was assessed by AEs, clinical laboratory tests, vital signs, ECGs, ECHO/MUGA scans, and physical exams. If benefiting from treatment, patients continued with subsequent 28-day courses and response was assessed every 2 courses. Tumor mutational status and PD effect on pERK in tumor biopsies were evaluated.
Results: Forty-three patients have been enrolled (32 in dose escalation and 11 in MTD expansion). Tumor types included 23 colorectal, 6 melanoma, 4 pancreatic, 3 head & neck, 2 esophageal, 2 ovarian, and 1 each of NSCLC, prostate, and small bowel adenocarcinoma. The MTD was determined to be the full doses of both drugs, 50 mg bid for BAY 86-9766 and 400 mg bid for sorafenib. The most common AEs were diarrhea (81%), rash (63%), fatigue (61%), nausea (49%), and vomiting (37%). Following single and multiple doses, mean Cmax and AUC0–12 of BAY 86-9766 increased nearly proportionally with dose, ranging between 5 mg bid and 50 mg bid. Plasma exposures of sorafenib at 200 mg bid and 400 mg bid were generally within the range reported from other studies. There was 1 confirmed partial response in a patient with colorectal cancer and 24 patients achieved a best overall response of stable disease. Tumor mutational analysis as well as PD data on tumor pERK suppression will be presented.
Conclusions: BAY 86-9766 in combination with sorafenib was well tolerated with diarrhea and rash being the most common AEs. Based on the results of this study, a Phase 2 study with BAY 86-9766 in combination with sorafenib is underway in HCC.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2011 Nov 12-16; San Francisco, CA. Philadelphia (PA): AACR; Mol Cancer Ther 2011;10(11 Suppl):Abstract nr A88.
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Affiliation(s)
| | | | | | | | - Joe J. Stephenson
- 5Institute of Translational Oncology Research-US Oncology Research, The Woodlands, TX
| | | | | | | | | | | | | | | | | | | | | | | | - Jerry Haney
- 8University of Colorado Cancer Center, Aurora, CO
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Affiliation(s)
- Emmeline Nugent
- Department of Surgery, The Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin, Ireland.
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