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Jamieson SM, Tsai P, Kondratyev MK, Budhani P, Liu A, Senzer NN, Chiorean EG, Jalal SI, Nemunaitis JJ, Kee D, Shome A, Wong WW, Li D, Poonawala-Lohani N, Kakadia PM, Knowlton NS, Lynch CR, Hong CR, Lee TW, Grénman RA, Caporiccio L, McKee TD, Zaidi M, Butt S, Macann AM, McIvor NP, Chaplin JM, Hicks KO, Bohlander SK, Wouters BG, Hart CP, Print CG, Wilson WR, Curran MA, Hunter FW. Evofosfamide for the treatment of human papillomavirus-negative head and neck squamous cell carcinoma. JCI Insight 2023; 8:169136. [PMID: 36810255 PMCID: PMC9990753 DOI: 10.1172/jci.insight.169136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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Jamieson SM, Tsai P, Kondratyev MK, Budhani P, Liu A, Senzer NN, Chiorean EG, Jalal SI, Nemunaitis JJ, Kee D, Shome A, Wong WW, Li D, Poonawala-Lohani N, Kakadia PM, Knowlton NS, Lynch CR, Hong CR, Lee TW, Grénman RA, Caporiccio L, McKee TD, Zaidi M, Butt S, Macann AM, McIvor NP, Chaplin JM, Hicks KO, Bohlander SK, Wouters BG, Hart CP, Print CG, Wilson WR, Curran MA, Hunter FW. Evofosfamide for the treatment of human papillomavirus-negative head and neck squamous cell carcinoma. JCI Insight 2018; 3:122204. [PMID: 30135316 PMCID: PMC6141174 DOI: 10.1172/jci.insight.122204] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/13/2018] [Indexed: 01/10/2023] Open
Abstract
Evofosfamide (TH-302) is a clinical-stage hypoxia-activated prodrug of a DNA-crosslinking nitrogen mustard that has potential utility for human papillomavirus (HPV) negative head and neck squamous cell carcinoma (HNSCC), in which tumor hypoxia limits treatment outcome. We report the preclinical efficacy, target engagement, preliminary predictive biomarkers and initial clinical activity of evofosfamide for HPV-negative HNSCC. Evofosfamide was assessed in 22 genomically characterized cell lines and 7 cell line-derived xenograft (CDX), patient-derived xenograft (PDX), orthotopic, and syngeneic tumor models. Biomarker analysis used RNA sequencing, whole-exome sequencing, and whole-genome CRISPR knockout screens. Five advanced/metastatic HNSCC patients received evofosfamide monotherapy (480 mg/m2 qw × 3 each month) in a phase 2 study. Evofosfamide was potent and highly selective for hypoxic HNSCC cells. Proliferative rate was a predominant evofosfamide sensitivity determinant and a proliferation metagene correlated with activity in CDX models. Evofosfamide showed efficacy as monotherapy and with radiotherapy in PDX models, augmented CTLA-4 blockade in syngeneic tumors, and reduced hypoxia in nodes disseminated from an orthotopic model. Of 5 advanced HNSCC patients treated with evofosfamide, 2 showed partial responses while 3 had stable disease. In conclusion, evofosfamide shows promising efficacy in aggressive HPV-negative HNSCC, with predictive biomarkers in development to support further clinical evaluation in this indication.
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Affiliation(s)
- Stephen Mf Jamieson
- Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand.,Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | - Peter Tsai
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Maria K Kondratyev
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Pratha Budhani
- Department of Immunology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Arthur Liu
- Department of Immunology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Neil N Senzer
- Mary Crowley Cancer Research Center, Dallas, Texas, USA
| | - E Gabriela Chiorean
- Indiana University Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, Indiana, USA.,Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - Shadia I Jalal
- Indiana University Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, Indiana, USA
| | - John J Nemunaitis
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA
| | - Dennis Kee
- LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Avik Shome
- Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand
| | - Way W Wong
- Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand
| | - Dan Li
- Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand
| | | | - Purvi M Kakadia
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Nicholas S Knowlton
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand.,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Courtney Rh Lynch
- Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand
| | - Cho R Hong
- Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand
| | - Tet Woo Lee
- Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
| | - Reidar A Grénman
- Department of Otolaryngology-Head and Neck Surgery, Turku University Hospital, Turku, Finland
| | - Laura Caporiccio
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Trevor D McKee
- STTARR Innovation Centre, University Health Network, Toronto, Ontario, Canada
| | - Mark Zaidi
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,STTARR Innovation Centre, University Health Network, Toronto, Ontario, Canada
| | - Sehrish Butt
- STTARR Innovation Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrew Mj Macann
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand
| | - Nicholas P McIvor
- Department of Otolaryngology-Head and Neck Surgery, Auckland City Hospital, Auckland, New Zealand
| | - John M Chaplin
- Department of Otolaryngology-Head and Neck Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Kevin O Hicks
- Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
| | - Stefan K Bohlander
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand.,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Bradly G Wouters
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Charles P Hart
- Threshold Pharmaceuticals, South San Francisco, California, USA
| | - Cristin G Print
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand.,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - William R Wilson
- Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
| | - Michael A Curran
- Department of Immunology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Francis W Hunter
- Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
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Anderson PM, Ghisoli M, Barve MA, Gill JB, Wexler LH, DeAngulo G, Neville K, Manning L, Wallraven G, Senzer NN, Birkhofer M, Nemunaitis JJ. A bi-shRNA furin and GMCSF engineered autologous tumor cell immunotherapy vs. gemcitabine + docetaxel for Ewing sarcoma and with cryoablation in Ewing family tumors. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps11079] [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
TPS11079 Background: Vigil, an immuno-stimulatory autologous cellular therapy, uses patient tumor cells transfected with a plasmid encoding genes for GM-CSF and furin (to down regulate TGFβ 1&2). A Phase I study in relapsed Ewing’s sarcoma. (N = 16) had one 9 month partial response and a two-year survival rate of 44% [1]. Rapid, durable systemic immune activation was seen in the majority of patients using an IFNƔ ELISPOT assay [2]. We seek to extend these early findings in a randomized Phase 2 study (NCT02511132). Methods: Following surgery (for Vigil manufacture), patients are randomized 1:1 to Vigil (1 x 107cells/ml by monthly intradermal injection), or to chemotherapy with gemcitabine 675mg/m2 IV D1 and D8 and docetaxel 75 mg/m2 IV D8 every 21 days. Key eligibility criteria include: Age > 2, histologically documented metastatic Ewing's, refractory or intolerant to ≥2 prior lines of chemotherapy, and availability of at least 4 doses of manufactured Vigil. Patients with bone only disease are ineligible. The primary objective is to compare the overall survival of patients treated with Vigil vs. chemotherapy. The sample size of 62 patients assumes a one-year survival rate of 25% in the chemotherapy group vs. 60% in the Vigil group, corresponding to a hazard ratio of 0.383 favoring Vigil. Results: As of January 2017, thirteen patients have been randomized at 10 centers in the U.S. The design allows for reduction in disease burden prior to surgery using modalities like SBRT and interventional radiology. Toxicity of Vigil has been low compared to chemotherapy. Time to disease progression is being assessed in patients who crossover to Vigil after progressing on chemotherapy. Systemic control of metastatic lesions using cryoablation is also being assessed in other patients (e.g. DSRCT liver metastases) using a separate IND. Conclusions: Although associated with systemic immune activation, additional means to reduce disease burden such as SBRT and cryoablation can possibly improve patient health and augment Vigil efficacy. References: 1.Ghisoli M, Barve M, et al. Mol Ther. 2016 Apr 25 2. Oh J, Barve M, et al. Gynecologic Oncology 2016; 143: 504–510. Clinical trial information: NCT02511132.
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Oh J, Barve MA, Tewari D, Chan JK, Grosen E, Rocconi RP, Stevens EE, DeMars LR, Ghamande SA, Coleman RL, Manning L, Wallraven G, Senzer NN, Birkhofer M, Nemunaitis JJ. Clinical trial in progress: A phase 3 study of maintenance bi-shRNA-furin/GM-CSF-expressing autologous tumor cell vaccine in women with stage IIIb-IV high-grade epithelial ovarian cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps5604] [Citation(s) in RCA: 2] [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
TPS5604 Background: Vigil is an immuno-stimulatory autologous cellular therapy, which uses patient tumor cells transfected with a plasmid encoding genes for GM-CSF and furin (to down regulate TGFβ 1&2). In Phase I, systemic immune activation was demonstrated in the majority of patients using an IFNƔ ELISPOT assay. A randomized Phase 2 assessment of Vigil maintenance therapy vs. observation in ovarian cancer demonstrated prolonged relapse free survival (RFS) (Oh J, Barve M, et al. Gynecologic Oncology, 2016; 143: 504–510.). Based on these observations, a Phase 3 study of maintenance Vigil therapy in patients with advanced ovarian cancer was initiated (NCT02346747). Methods: This is a multicenter, randomized, double-blind, placebo-controlled, Phase 3 study of maintenance Vigil in women with Stage IIIb,c or IV high-grade papillary serous/clear cell/ endometrioid ovarian, fallopian tube or primary peritoneal cancer. Patients will have a minimum of 4 and a maximum of 12 Vigil doses manufactured from tumor obtained at primary debulking surgery. Patients must achieve a complete clinical remission following primary surgery and chemotherapy before being randomized 1:1 to receive either monthly intradermal Vigil or placebo. Randomization is stratified by extent of surgical cytoreduction (complete/microscopic vs. macroscopic residual disease) and neoadjuvant vs. adjuvant chemotherapy. The primary objective is to compare RFS of subjects randomized to Vigil vs. placebo, and the key secondary objective is overall survival (OS). The sample size calculation of 222 patients assumes 24 months for accrual and 36 months of follow-up with a median RFS of 19 months from randomization, in the control group. This provides 90% power to detect a hazard ratio (HR) of 0.6 favoring Vigil at the 0.05 level of significance. To date, 61 patients have been randomized and an additional 55 patients are receiving chemotherapy in anticipation of randomization. Tumor tissue is being obtained from approximately 20 patients per month at multiple sites across the U.S. At their last meeting in January, 2017 the independent DSMB recommended that the study continue without change. Clinical trial information: NCT02346747.
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Nemunaitis JJ, Barve MA, Melnyk A, Wallraven G, Manning L, Senzer NN. Long-term follow-up of DNA engineered bi-shRNA furin GMCSF plasmid/autologous tumor induced immune response in patients with advanced solid tumors (phase I trial). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.7_suppl.110] [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
110 Background: Previously we described safety and evidence of activity to VigilÒ (FANGÒ) and identified relationship of survival advantage to ELISPOT “+” Vigil treated patients (Senzer N et al. Long Term Follow Up: Phase I Trial of “bi-shRNA furin/GMCSF DNA/Autologous Tumor Cell” Immunotherapy (FANG) in Advanced Cancer. J Vaccines Vaccine 2013; 4: 209. doi: 10.4172/2157-7560.1000209). We have updated survival and long-term ELISPOT assessment of this same group of patients. Methods: A non-randomized phase 1 trial of patient treated with Vigil immunotherapy (n=39) compared to a similar matched comparator (MC) group not treated with Vigil (n=35). Results: Trial results suggest survival benefit without evidence of Vigil related toxicity (no ≥ grade 3). γ-IFN ELISPOT served as a biomarker for response and shows correlation with survival. 22/30 evaluable Vigil-treated patients showed ELISPOT conversion (73%) from negative to positive (threshold of ≥10 spots from baseline) during treatment. Durable evidence of γIFN-secreting circulating cytotoxic T cells was observed (up to 30months from treatment start), suggesting induction of memory T effector cells. Survival correlation demonstrated significant benefit of ELISPOT “+” Vigil treated patients (median OS of 784 days, 26.1 months) compared to ELISPOT “-“ patients (median OS of 353 days, 11.77 moths), and supports immune-related survival benefit compared to MC (median OS of 122 days, 4 months), (Table). Conclusions: Vigil immunotherapy induces a significant immune response. Detailed analysis of the immune effector population phenotype is underway to determine optimal correlation with survival. Clinical trial information: NCT01061840. [Table: see text]
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Kaufman HL, Amatruda T, Reid T, Gonzalez R, Glaspy J, Whitman E, Harrington K, Nemunaitis J, Zloza A, Wolf M, Senzer NN. Systemic versus local responses in melanoma patients treated with talimogene laherparepvec from a multi-institutional phase II study. J Immunother Cancer 2016; 4:12. [PMID: 26981242 PMCID: PMC4791835 DOI: 10.1186/s40425-016-0116-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/04/2016] [Indexed: 11/19/2022] Open
Abstract
Background We previously reported that talimogene laherparepvec, an oncolytic herpes virus encoding granulocyte-macrophage colony-stimulating factor (GM-CSF), resulted in an objective response rate of 26 % in patients with advanced melanoma in a phase II clinical trial. The response of individual lesions, however, was not reported. Since talimogene laherparepvec is thought to mediate anti-tumor activity through both direct tumor cytolysis and induction of systemic tumor-specific immunity, we sought to determine the independent response rate in virus-injected and non-injected lesions. Methods Fifty patients with stage IIIC or IV melanoma were treated with talimogene laherparepvec in a multi-institutional single-arm open-label phase II clinical trial. In this study patients were treated until a complete response was achieved, all accessible tumors disappeared, clinically significant disease progression, or unacceptable toxicity. This report is a post hoc analysis of the systemic effects of talimogene laherparepvec in injected lesions and two types of uninjected lesions—non-visceral lesions and visceral lesions. Results Eleven of 23 patients (47.8 %) had a ≥ 30 % reduction in the total burden of uninjected non-visceral lesions, and 2 of 12 patients (16.7 %) had a ≥ 30 % reduction in the total burden of visceral lesions. Among 128 evaluable lesions directly injected with talimogene laherparepvec, 86 (67.2 %) decreased in size by ≥ 30 % and 59 (46.1 %) completely resolved. Of 146 uninjected non-visceral lesions, 60 (41.1 %) decreased in size by ≥ 30 %, the majority of which (44 [30.1 %]) completely resolved. Of 32 visceral lesions, 4 (12.5 %) decreased in size by ≥ 30 %, and 3 (9.4 %) completely resolved. The median time to lesion response was shortest for lesions that were directly injected (18.4 weeks), followed by uninjected non-visceral lesions (23.1 weeks) and visceral lesions (51.3 weeks), consistent with initiation of a delayed regional and systemic anti-tumor immune response to talimogene laherparepvec. Conclusions These results support a regional and systemic effect of talimogene laherparepvec immunotherapy in patients with advanced melanoma.
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Affiliation(s)
- Howard L Kaufman
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, Room 2004, New Brunswick, NJ 08901 USA
| | | | - Tony Reid
- University of California San Diego Medical Center, La Jolla, CA USA
| | - Rene Gonzalez
- University of Colorado Cancer Center, Aurora, CO USA
| | - John Glaspy
- UCLA Jonsson Comprehesive Cancer Center, Los Angeles, CA USA
| | - Eric Whitman
- Carol G. Simon Cancer Center, Morristown, NJ USA
| | - Kevin Harrington
- The Institute of Cancer Research/Royal Marsden NIHR Biomedical Research Centre, London, UK
| | | | - Andrew Zloza
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, Room 2004, New Brunswick, NJ 08901 USA
| | | | - Neil N Senzer
- Mary Crowley Cancer Research Centers, Dallas, TX USA
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Ghisoli M, Barve MA, Schneider R, Mennel RG, Lenarsky C, Wallraven G, Kumar P, Nemunaitis D, Roth A, Senzer NN, Fletcher FA, Nemunaitis JJ. Pilot trial of vigil immunotherapy in Ewing’s sarcoma. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.10522] [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
Affiliation(s)
| | | | | | | | | | | | | | | | - Alyssa Roth
- Mary Crowley Cancer Research Centers, Dallas, TX
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Mita AC, Senzer NN, Vemulapalli S, Sarantopoulos J, Mahalingam D, Mita MM, Hart J, Gallegos NS, Anderson G, Charles J, Kosuba A, Rogers JM, Nemunaitis JJ. Abstract A113: ATI-1123, a novel human albumin-stabilized docetaxel liposomal formulation: Final results of a phase I study in patients with advanced solid malignancies. Drug Deliv 2014. [DOI: 10.1158/1535-7163.targ-11-a113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Senzer NN, Matsuno K, Yamagata N, Fujisawa T, Wasserman E, Sutherland W, Sharma S, Phan A. Abstract C36: MBP‐426, a novel liposome‐encapsulated oxaliplatin, in combination with 5‐FU/leucovorin (LV): Phase I results of a Phase I/II study in gastro‐esophageal adenocarcinoma, with pharmacokinetics. Clin Trials 2014. [DOI: 10.1158/1535-7163.targ-09-c36] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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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Kaufman HL, Andtbacka RHI, Collichio FA, Amatruda T, Senzer NN, Chesney J, Delman KA, Spitler LE, Puzanov I, Ye Y, Li A, Gansert JL, Coffin R, Ross MI. Primary overall survival (OS) from OPTiM, a randomized phase III trial of talimogene laherparepvec (T-VEC) versus subcutaneous (SC) granulocyte-macrophage colony-stimulating factor (GM-CSF) for the treatment (tx) of unresected stage IIIB/C and IV melanoma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9008a] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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
Affiliation(s)
| | | | - Frances A. Collichio
- The University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC
| | | | | | | | | | | | - Igor Puzanov
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, School of Medicine, Nashville, TN
| | - Yining Ye
- Department of Biostatistics and Epidemiology, Amgen Inc., South San Francisco, CA
| | - Ai Li
- Department of Biostatistics and Epidemiology, Amgen Inc., Thousand Oaks, CA
| | | | | | - Merrick I. Ross
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Nemunaitis JJ, Senzer NN, Barve MA, Oh J, Kumar P, Rao D, Pappen BO, Wallraven G, Fletcher FA. Survival effect of bi-shRNA furin/GMCSF DNA-based immunotherapy (FANG) in 123 advanced cancer patients to α-interferon-ELISPTOT response. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.3077] [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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Ferris RL, Gross ND, Nemunaitis JJ, Andtbacka RHI, Argiris A, Ohr J, Vetto JT, Senzer NN, Bedell C, Ungerleider RS, Tanaka M, Nishiyama Y. Phase I trial of intratumoral therapy using HF10, an oncolytic HSV-1, demonstrates safety in HSV+/HSV- patients with refractory and superficial cancers. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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)
| | | | | | | | - Athanassios Argiris
- The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - James Ohr
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA
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Goyal L, Supko JG, Berlin J, Blaszkowsky LS, Carpenter A, Heuman DM, Hilderbrand SL, Stuart KE, Cotler S, Senzer NN, Chan E, Berg CL, Clark JW, Hezel AF, Ryan DP, Zhu AX. Phase 1 study of N(1),N(11)‑diethylnorspermine (DENSPM) in patients with advanced hepatocellular carcinoma. Cancer Chemother Pharmacol 2014; 72:1305-14. [PMID: 24121453 DOI: 10.1007/s00280-013-2293-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/06/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE N(1),N(11)-diethylnorspermine (DENSPM), a synthetic analog of the naturally occurring polyamine spermine, can induce polyamine depletion and inhibit tumor cell growth. The objectives of this phase I study were to assess the safety, maximum-tolerated dose (MTD), pharmacokinetics, and preliminary antitumor activity of DENSPM in advanced HCC. METHODS Patients with measurable advanced HCC, Child-Pugh A or B cirrhosis, CLIP score ≤3, and Karnofsky score ≥60 % were eligible. DENSPM was given as a short intravenous infusion on days 1, 3, 5, 8, 10, and 12 of each 28-day cycle. The starting dose of 30 mg/m(2) was escalated at a fixed increment of 15 mg/m(2) until the MTD was identified. The plasma pharmacokinetics of DENSPM for the first and last doses given in cycle 1 was characterized. RESULTS Thirty-eight patients (male 79 %; median age 61 years; Child-Pugh A 84 %; ≥1 prior systemic therapy 45 %) were enrolled and treated. The most common adverse events (AEs) ≥grade 1 were fatigue (53 %), nausea (34 %), diarrhea (32 %), vomiting (32 %), anemia (29 %), and elevated AST (29 %). The most common grade 3-4 AEs were fatigue/asthenia (13 %), elevated AST (13 %), hyperbilirubinemia (11 %), renal failure (8 %), and hyperglycemia (8 %). The MTD was 75 mg/m(2). There were no objective responses, although 7/38 (18 %) patients achieved stable disease for ≥16 weeks. The overall mean (±SD) total body clearance for the initial dose, 66.3 ± 35.9 L/h/m(2) (n = 16), was comparable to the clearance in patients with normal to near normal hepatic function. Drug levels in plasma decayed rapidly immediately after the infusion but remained above 10 nM for several days after dosing at the MTD. CONCLUSIONS N(1),N(11)-diethylnorspermine treatment at the MTD of 75 mg/m(2), given intravenously every other weekday for two consecutive weeks of each 28-day cycle, was relatively well tolerated in patients with advanced HCC including those with mild-to-moderate liver dysfunction. This administration schedule provided prolonged systemic exposure to potentially effective concentrations of the drug. Stable disease was seen in 18 % of patients receiving DENSPM treatment. Further evaluation of DENSPM monotherapy for advanced HCC does not appear to be justified because of insufficient evidence of clinical benefit in the patients evaluated in this study.
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Andtbacka RHI, Collichio FA, Amatruda T, Senzer NN, Chesney J, Delman KA, Spitler LE, Puzanov I, Doleman S, Ye Y, Vanderwalde AM, Coffin R, Kaufman H. OPTiM: A randomized phase III trial of talimogene laherparepvec (T-VEC) versus subcutaneous (SC) granulocyte-macrophage colony-stimulating factor (GM-CSF) for the treatment (tx) of unresected stage IIIB/C and IV melanoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.18_suppl.lba9008] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [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
LBA9008 Background: T-VEC is an oncolytic immunotherapy (OI) derived from herpes simplex virus type-1 designed to selectively replicate within tumors and to produce GM-CSF to enhance systemic antitumor immune responses. OPTiM is a randomized, phase III trial of T-VEC or GM-CSF in patients (pts) with unresected melanoma with regional or distant metastases. We report the primary results of the first phase III study of OI. Methods: Key criteria: age ≥18 yrs; ECOG ≤1; unresectable melanoma stage IIIB/C or IV; injectable cutaneous, SC, or nodal lesions; LDH ≤1.5X upper limit of normal; ≤3 visceral lesions (excluding lung), none >3 cm. Pts were randomized 2:1 to intralesional T-VEC (initially ≤ 4 mL x106 pfu/mL then after 3 wks, ≤ 4 mL x108 pfu/mL Q2W) or SC GM-CSF (125 µg/m2qd x 14 days q28d). The primary endpoint was durable response rate (DRR): partial or complete response (CR) continuously for ≥6 mos starting within 12 mos. Responses were per modified WHO by blinded central review. A planned interim analysis of overall survival (OS; key secondary endpoint) was performed. Results: 436 pts are in the ITT set: 295 (68%) T-VEC, 141 (32%) GM-CSF. 57% were men; median age was 63 yrs. Stage distribution was: IIIB/C 30%, IVM1a 27%, IVM1b 21%, IVM1c 22%. Objective response rate with T-VEC was 26% (95% CI: 21%, 32%) with 11% CR, and with GM-CSF was 6% (95% CI: 2%, 10%) with 1% CR. DRR for T-VEC was 16% (95% CI: 12%, 21%) and 2% for GM-CSF (95% CI: 0%, 5%), p<0.0001. DRR by stage (T-VEC, GM-CSF) was IIIB/C (33%, 0%), M1a (16%, 2%), M1b (3%, 4%), and M1c (8%, 3%). Interim OS showed a trend in favor of T-VEC; HR 0.79 (95% CI: 0.61, 1.02). Most common adverse events (AEs) with T-VEC were fatigue, chills, and pyrexia. Serious AEs occurred in 26% of T-VEC and 13% of GM-CSF pts. No ≥ grade 3 AE occurred in ≥ 3% of pts in either arm. Conclusions: T-VEC demonstrated both a statistically significant improvement in DRR over GM-CSF in pts with unresectable stage IIIB-IV melanoma and a tolerable safety profile; an interim analysis showed a trend toward improved OS. T-VEC represents a novel potential tx option for melanoma with regional or distant metastases. Clinical trial information: NCT00769704.
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Affiliation(s)
| | - Frances A. Collichio
- The University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC
| | | | | | | | | | | | - Igor Puzanov
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Yining Ye
- Department of Biostatistics and Epidemiology, Amgen Inc., South San Francisco, CA
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15
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Andtbacka RHI, Collichio FA, Amatruda T, Senzer NN, Chesney J, Delman KA, Spitler LE, Puzanov I, Doleman S, Ye Y, Vanderwalde AM, Coffin R, Kaufman H. OPTiM: A randomized phase III trial of talimogene laherparepvec (T-VEC) versus subcutaneous (SC) granulocyte-macrophage colony-stimulating factor (GM-CSF) for the treatment (tx) of unresected stage IIIB/C and IV melanoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.lba9008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA9008 The full, final text of this abstract will be available at abstract.asco.org at 7:30 AM (EDT) on Saturday, June, 1, 2013, and in the Annual Meeting Proceedings online supplement to the June 20, 2013, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Saturday edition of ASCO Daily News.
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Affiliation(s)
| | - Frances A. Collichio
- The University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC
| | | | | | | | | | | | - Igor Puzanov
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Yining Ye
- Department of Biostatistics and Epidemiology, Amgen Inc., South San Francisco, CA
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16
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Senzer NN, LoRusso P, Martin LP, Schilder RJ, Amaravadi RK, Papadopoulos KP, Segota ZE, Weng DE, Graham M, Adjei AA. Phase II clinical activity and tolerability of the SMAC-mimetic birinapant (TL32711) plus irinotecan in irinotecan-relapsed/refractory metastatic colorectal cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.3621] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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
3621 Background: Birinapant (B) is a SMAC-mimetic that inhibits IAPs and has potent preclinical anti-tumor synergy combined with TNFa-inducing chemotherapies [i.e irinotecan (I)]. B and I combination is well-tolerated and has encouraging activity in a phase 1 study. This study tested B+I with an ascending dose strategy (ADS) of B to mitigate Bell’s palsy (BP) risk, an unusual and reversible side effect of SMAC mimetics. Methods: I at 350mg/m2 IV q3weeks was administered with B weekly (2 of 3 weeks). The dose of B was titrated incrementally during Cycle 1: C1D1 at 5.6mg/m2 and C1D8 at 11mg/m2 for ADS. For Cycle 2 (C2) and ongoing treatment, the B dose was 22mg/m2 or 35mg/m2, which were the MTD and DLT (BP) dose levels when combined with I from the Ph 1 study. Safety and clinical activity for KRAS mutant (KRAS-MT) and wild-type (KRAS-WT) were assessed in 3 cohorts: (1) at 22mg/m2 for CRC KRAS MT; (2) 22mg/m2 for CRC KRAS WT; (3) 35mg/m2 for CRC KRAS MT. Results: 51 patients (pts) with CRC had a median number of 4 prior regimens with 47 refractory/relapsed to irinotecan (92%). Tolerability was comparable to I alone. There were 2 PRs (4%), 27 SD (>2 cycles; 53%, median 4.7 mo), 17 PD (33%), and 5 non- evaluable pts (9%) for an overall clinical benefit (CR+PR+SD) rate of 57%. Median progression-free survival (PFS) was 2.1 months, and 6 mo PFS was 20%. KRAS MT CRC with prior I had a median PFS of 2.9 mo and 6 mo PFS of 25% (n=20). KRAS WT CRC with prior I had a median PFS of 1.4 mo and 6 mo PFS of 17% (n=18). The ADS seemed to reduce BP risk. No BP events occurred among 40 pts (22mg/m2 with ADS), compared to 1 of 7 pts (22mg/m2 without ADS). In the 35mg/m2 cohort, 1 BP event occurred among 12 pts (with ADS), compared to 3 of 6 (35mg/m2 without ADS). Conclusions: B + I demonstrated clinical benefit in pts refractory/relapsed to irinotecan, with greatest benefit in KRAS MT CRC. The ADS may provide a mitigation strategy for BP risk. Prior studies with I retreatment have showed no benefit in KRAS MT CRC. Comparable CRC pts with best supportive care have 6 mo PFS of 2%. Clinical activity supports the hypothesis for therapeutic synergy of B + I, with I as a TNFa-inducing agent. Further study of this combination is warranted. Clinical trial information: NCT01188499.
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Affiliation(s)
| | | | | | | | - Ravi K. Amaravadi
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
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Amaravadi RK, Senzer NN, Martin LP, Schilder RJ, LoRusso P, Papadopoulos KP, Weng DE, Graham M, Adjei AA. A phase I study of birinapant (TL32711) combined with multiple chemotherapies evaluating tolerability and clinical activity for solid tumor patients. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2504] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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
2504 Background: Birinapant (B) is a SMAC-mimetic that inhibits IAPs with excellent tolerability, drug exposure, target suppression and apoptotic pathway activation in clinical studies. Preclinical studies demonstrate potent anti-tumor synergy when B is combined with TNFa-inducing chemotherapies (CT). Methods: Escalating doses of B were combined with CT in a 5-arm 3+3 phase 1 study for adults (pts) with relapsed/refractory solid tumors to determine maximum tolerated dose (MTD), pharmacokinetics (PK), and efficacy to identify indications for further studies. The arms included carboplatin/paclitaxel (CP), irinotecan (I), docetaxel (D), gemcitabine (G), and liposomal doxorubicin (LD). Results: 124 pts were treated with B at doses of 2.8 to 47 mg/m2. The MTD of B for each arm was CP (47 mg/m2); I (22 mg/m2); D (47 mg/m2). The proposed G regimen could not be administered in heavily pretreated pts and B could not be evaluated for dose escalation; this arm was discontinued and no dose-limiting toxicities (DLT) occurred. LD drug shortage prevented dose escalation for B > 35mg/m2 (MTD not reached). B did not limit CT administration for CP, I, D, LD, supporting tolerable combination of B with CT. B-associated toxicity of Bell’s palsy (Grade 2) was considered a DLT and noted at higher dose levels for I, D, and LD, but not CP. This unusual reversible toxicity occurred during cycle 1 in 7 pts. Six of these pts continued therapy without recurrence. PK studies demonstrated no effect of B on CT. Except for CP, CT did not change the PK of B. CP increased plasma PK for B, possibly due to OATP1B3 transporter effects, but without increased B toxicities. 11 pts had a partial response, 61 pts had stable disease (>2 cycles, median 4.6 mo) and 37 pts had progressive disease as their best response, with clinical benefit (CR+PR+SD) of 58%. Conclusions: B can be combined with excellent tolerability with multiple CT at standard dosing. B plus CT demonstrated clinical benefit in many tumor types. Notable clinical activity occurred with I + B in pts who had failed prior I. These results support planning for further clinical studies of the I + B, and support the hypothesis for TNFa-mediated I + B synergy. Clinical trial information: NCT01188499.
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Affiliation(s)
- Ravi K. Amaravadi
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
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18
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Gildener-Leapman N, Ferris RL, Ohr J, Argiris A, Nemunaitis JJ, Senzer NN, Bedell C, Gross ND, Vetto JT, Tanaka M, Nishiyama Y, Ungerleider RS. A phase I trial of intratumoral administration of HF10 in patients with refractory superficial cancer: Immune correlates of virus injection. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.3099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3099 Background: HF10 is a spontaneously occurring, oncolytic, mutant Herpes Simplex Virus type 1 (HSV-1). Several deletions/insertions in its genome render it nonpathogenic. HF10 has been tested in solid tumors accessible for injection. Methods: We report correlative studies from an open label, non-randomized, multicenter, single dose escalation phase I study in patients with refractory superficial cancer. The study was a “3 + 3” design with 4-dose cohorts at escalating doses of HF10 (1 x 105 TCID50/dose with incremental dose escalations up to 1 x 107 TCID50/dose), which has been completed. Body fluids (qPCR), peripheral blood (flow cytometry) and serum (30-plex cytokine assay) were examined for viral levels, quantitative immune cell variation, and cytokines, respectively. Results: Seventeen patients were enrolled and 15 treated (9 H/N; 4 melanoma; 1 colon; 1 sarcoma). Best response was stable disease in six patients and progressive disease in nine patients. Three of the 15 patients had an adverse event possibly related to the study therapy. These AEs were grade 1 hypotension (1) and flu-like symptoms (2): typical of treatment with oncolytic viruses. qPCR analysis transiently revealed virus in the saliva of two patients (day 2 and day 22); viral clearance was achieved after 1 and 7 days respectively. Comparing the two highest and two lowest dose HF10 cohorts, CD8+PD1+ cells were decreased with increasing HF10 dose (p=0.023). Increased monocyte population (CD14+CD11c+) appeared to correlate with increased HF10 dose (p=0.063). IL-8 increased in all samples (p=0.0078 Wilcoxon Signed rank test) post injection. Conclusions: Single dose intratumoral injection was well tolerated with mild-drug related AEs and rapid viral clearance. Six patients achieved stable disease during the study period. There appears to be a generalized IL-8 related inflammatory response coincident with increased peripheral blood monocytes after HF10 administration. Decreased CD8+PD1+ cells may indicate a shift towards a non-exhausted, functional CTL phenotype. These results justify the currently accruing study of multiple administrations of HF10 at the highest administered dose. Clinical trial information: NCT01017185.
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Affiliation(s)
| | | | - James Ohr
- University of Pittsburgh, Pittsburgh, PA
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Goyal L, Supko JG, Berlin J, Blaszkowsky LS, Carpenter A, Heuman DM, Stuart KE, Cotler S, Senzer NN, Berg CL, Clark JW, Hezel AF, Ryan DP, Zhu AX. A phase I study of DENSPM (N1, N11-diethylnorspermine) in patients with advanced hepatocellular carcinoma (HCC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.260] [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
260 Background: DENSPM, a synthetic analog of the naturally occurring polyamine spermine, offers a novel approach for treating HCC by inducing polyamine depletion and inhibiting cell growth. The objectives of this multicenter phase I study were to assess the safety, maximum-tolerated dose (MTD), pharmacokinetics (PKs), and preliminary antitumor activity of DENSPM in HCC. Methods: Forty-four patients with measurable advanced HCC, Child-Pugh A or B cirrhosis, CLIP score ≤ 3, and Karnofsky score ≥ 60% were enrolled in a dose escalation study of DENSPM given intravenously on days 1, 3, 5, 8, 10, and 12 of each 28-day cycle. The starting dose of 30 mg/m2 was escalated at a fixed increment of 15 mg/m2 until the MTD was identified. A sensitive LC-MS/MS assay with a 6.4 nM limit of quantitation was developed and validated to characterize the plasma PKs of DENSPM. Results: Thirty-eight patients (male 79%; median age 61years; Child A 84%; Asian 5%; ≥1 prior systemic therapy 45%) received at least one dose of DENSPM. The most common adverse events (AEs) were fatigue (53%), nausea (34%), diarrhea (32%), vomiting (32%), anemia (29%), and increased AST (29%). The most common grade 3/4 AEs were fatigue/asthenia (13%) and increased AST (13%), hyperbilirubinemia (11%), renal failure (8%) and hyperglycemia (8%). The MTD was 75 mg/m2and was not directly associated with major treatment-related safety concerns. DENSPM plasma levels decreased very rapidly during the initial 60 min post-infusion. The total body clearance, 66.7±35.8 L/h/m2 (mean±SD) for the initial dose was comparable to that in solid tumor patients with normal to near normal hepatic function. However, drug concentrations ≥10 nM persisted for several days after dosing and remained detectable in samples obtained before day 12 dosing in 11/16 (68.8%) patients. No responses were seen but 9/27 (33.3%) evaluable patients achieved stable disease. Conclusions: DENSPM toxicity was dose dependent, the 75 mg/m2 MTD was relatively well-tolerated, and the PK behavior was favorable. Nevertheless, the study was terminated early because of insufficient evidence of clinical benefit in HCC patients. Further evaluation of DENSPM as a monotherapy for HCC does not appear to be justified. Clinical trial information: NCT00081900.
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Affiliation(s)
- Lipika Goyal
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | | | | | | | - Douglas M. Heuman
- Division of Hepatology, Virginia Commonwealth University Medical Center, Richmond, VA
| | - Keith E. Stuart
- Lahey Clinic Medical Center, Tufts University School of Medicine, Burlington, MA
| | | | | | | | | | - Aram F. Hezel
- James P. Wilmot Cancer Center, University of Rochester, Rochester, NY
| | - David P. Ryan
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Andrew X. Zhu
- Massachusetts General Hospital Cancer Center, Boston, MA
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20
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Bendell JC, Ervin TJ, Senzer NN, Richards DA, Firdaus I, Lockhart AC, Cohn AL, Saleh MN, Gardner LR, Sportelli P, Eng C. Results of the X-PECT study: A phase III randomized double-blind, placebo-controlled study of perifosine plus capecitabine (P-CAP) versus placebo plus capecitabine (CAP) in patients (pts) with refractory metastatic colorectal cancer (mCRC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.18_suppl.lba3501] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [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
LBA3501 Background: Perifosine (P) is an oral, synthetic alkylphospholipid that inhibits or modifies signal transduction pathways including AKT, NFkB and JNK. A randomized phase II study examined P-CAP vs. CAP in pts with 2nd or 3rd line mCRC. This study showed improvement in mTTP (HR 0.254 [0.117, 0.555]) and mOS (HR 0.370 [0.180,0.763]). Based on these results, a randomized phase III study of P-CAP vs. CAP with a primary endpoint of overall survival (OS) in pts with refractory mCRC was initiated. Methods: The study was a prospective, randomized, double-blind, placebo-controlled randomized phase III trial. Eligible pts had mCRC which was refractory to all standard therapies. Pts randomized 1:1 to Arm A = P-CAP (P 50 mg PO QD + CAP 1000 mg/m2PO BID d1-14) or Arm B = CAP (placebo + CAP 1000 mg/m2 PO BID d 1-14). Cycles were 21 days. Baseline tumor block collection and a biomarker cohort of pts with pre- and on-treatment tumor and blood samples were performed. Results: Between 3/31/10 and 8/12/11, 468 pts were randomized, 234 pts were in each arm. Baseline demographics were balanced between the arms: age < 65y (A: 65%, B: 58.5%), male (A: 57.7%, B: 53.0%), ECOG PS 0 (A: 39.7%, B: 39.7%), K-ras mutant (A: 50.4%, B: 51.3%), and median number of prior therapies (A: 4, B: 4). As of 3/19/12, median follow up was 6.6 months. Median overall survival: Arm A = 6.4 mo, Arm B = 6.8 mo, HR 1.111 [0.905,1.365], p = 0.315. Median overall survival for K-ras WT pts: Arm A = 6.6 mo, Arm B = 6.8 mo, HR 1.020 [0.763,1.365], p = 0.894; K-ras mutant pts: Arm A = 5.4 mo, Arm B = 6.9 mo HR 1.192 [0.890,1.596], p = 0.238. Conclusions: Despite promising randomized phase II data, this phase III study shows no benefit in overall survival adding perifosine to capecitabine in the refractory colorectal cancer setting. Response rate, progression free survival, and safety data will be presented. Biomarker analysis is pending to see if subgroups of patients may have potential benefit.
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Affiliation(s)
| | - Thomas J. Ervin
- Sarah Cannon Research Institute/Florida Cancer Specialists, Englewood, FL
| | | | | | - Irfan Firdaus
- Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH
| | | | | | | | | | | | - Cathy Eng
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Fetterly GJ, Liu B, Senzer NN, Amaravadi RK, Schilder RJ, Martin LP, LoRusso P, Papadopoulos KP, Adjei AA, Zagst PD, McKinlay MA, Weng DE, Graham M. Clinical pharmacokinetics of the Smac-mimetic birinapant (TL32711) as a single agent and in combination with multiple chemotherapy regimens. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3029] [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
3029 Background: Birinapant is a novel small molecule Smac-mimetic that targets members of the inhibitor of apoptosis proteins (cIAP1, cIAP2 and XIAP) involved in the blockade of apoptosis. A population PK model was developed to characterize the interpatient variability in birinapant PK and to evaluate the effect of multiple combination regimens on birinapant disposition and safety. Methods: Birinapant was administered alone or in combination to 114 patients (55M/59F; 89% Caucasian) with advanced malignancies. Birinapant was administrated by a 30 min IV infusion QW alone (30 pats), or approx. 30 min. after chemotherapy with irinotecan (19 pats), docetaxel (20 pats), gemcitabine (17 pats), liposomal doxorubicin (13 pats), or paclitaxel/carboplatin (15 pats). Birinapant dose levels ranged from 0.18 to 35 mg/m2. Population PK modeling was performed to investigate the effect of the following patient covariates: [BW (38.5-127.5 kg), age (27.5-86.0 yrs), CrCL (36.4-219.2 ml/min), ALT (6-121 IU/L), and TBIL (0.1-1.7 mg/dL)]. Results: A 3-compartment PK model described the time course of birinapant disposition with predicted values for T1/2, CL, and Vd of 40 h, 21 L/h and 10.2 L, respectively. Birinapant displayed linear PK across the dose range with no significant accumulation in plasma following weekly dosing. Goodness of fit plots supported the model fit, with residual variability of 23%. The PK of birinapant remained unchanged when combined with irinotecan, docetaxel, gemcitabine and liposomal doxorubicin. Concomitant administration with paclitaxel/carboplatin resulted in a 2-fold increase in birinapant AUC possibly due to reduced OATP1B3 mediated tissue uptake. Conclusions: These data show that birinapant possesses an excellent PK profile with dose proportional kinetics, a long terminal half-life for target coverage, low/moderate interpatient variability in CL and no significant accumulation following weekly dosing. Importantly, the PK of birinapant remained unchanged when combined with multiple chemotherapy regimens and the increased exposure with paclitaxel/carboplatin was not associated with any change in birinapant tolerability.
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Affiliation(s)
| | - Biao Liu
- Roswell Park Cancer Institute, Buffalo, NY
| | | | - Ravi K. Amaravadi
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
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Camacho LH, Senzer NN, Harb WA, Barrett JA, Korth CC, Astl D, Jac J, Youssoufian H. A phase I study of oral darinaparsin in patients (pts) with advanced solid tumors (AST). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e13040] [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
e13040 Background: Darinaparsin [Zinapar, ZIO-101(S-dimethylarsino-glutathione)], is a novel organic arsenic compound with in vitro and in vivo anticancer activity in tumor cell lines resistant to arsenic trioxide. An oral formulation is now available. Methods: This study used a 3+3 escalating design, dosing orally for 21 days followed by 7 days off (28 day cycle). Pts with AST refractory to standard therapy, ECOG performance score (PS) ≤ 2 and adequate organ function were treated. Study objectives were safety profile evaluation, pharmacokinetics (PK) and preliminary activity of oral darinaparsin. CTCAE v. 4.0 and RECIST 1.1 were used. Results: A total of 10 pts (8 males, 2 females), with ECOG PS 0=2, 1=8, mean age of 71 years (range: 60-81), median of prior therapies 3 (range: 1-4) were treated. A median of 2 cycles of darinaparsin was administered (range: 1-6). Dose limiting toxicities (DLT) were confusion (n=1; 400 mg), cognitive disturbance (n=1; 400 mg) and encephalopathic syndrome (n=1; 300 mg), reversible with drug discontinuation. The highest tolerable dose was 300 mg per day. Most frequent AEs were: hypokalemia, nausea (40% each), fatigue (30%), anemia, diarrhea, hypophosphatemia, pneumonia, vomiting (20% each). Most frequent grade ≥3 AEs were: hypokalemia, hypophosphatemia (20% each). Best overall response was stable disease (at 2 cycles), observed in 5 pts: adenocarcinoma of colon (2 pts), chordoma, adenocarcinoma of small bowel and carcinoma of tongue. PK analysis of 400 mg cohort (n=4) and 300 mg cohort (n=6) resulted in Tmax at 9 hr post treatment and Cmax slightly greater than dose proportional (p<0.05). Steady-state trough levels were achieved on or before Day 5. Approximately 40 % greater Cmax was observed on D15 compared to D1 for the 300 mg cohort (p<0.05) while unchanged at 400 mg. DLTs were observed when duration of exposure was more than 7 days and serum trough levels were 800 ng/ml or above. Conclusions: Oral darinaparsin is well tolerated at the dosage of 300 mg per day for 21days in a 28 day cycle in pts with AST. Preliminary evidence of clinical activity and a predictable PK profile justify further evaluation of darinaparsin in selected indications.
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Jimeno A, Senzer NN, Rudin CM, Ma WW, Halmos B, Schnadig ID, Levy B, Hausman DF, Peterson S, Walker LN. PX-866 and docetaxel in patients with advanced solid tumors. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3024] [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
3024 Background: PX-866, an irreversible pan-isoform inhibitor of Class 1 PI-3K has additive to synergistic effects when combined with docetaxel in xenograft models of NSCLC and SCCHN. A phase I/II study of PX-866 and docetaxel was initiated to further evaluate this combination. Enrollment in phase I is complete, and the randomized, controlled phase II portion is now enrolling patients with either NSCLC or SCCHN. Phase I safety and pharmacokinetics were previously described; the recommended phase II dose of PX-866 was 8 mg daily, the same as the single agent MTD (Jimeno A, et al. AACR-NCI-EORTC, 2011). Updated phase I antitumor and biomarker results are presented here. Methods: Phase 1 consisted of dose escalation of PX-866 at 4, 6, or 8 mg po qd in combination with docetaxel 75 mg/m2 IV once every 21 days (d). Patients had advanced solid tumors for which docetaxel was compendia listed. Tumor restaging was performed every 2 cycles. Archived tumor biopsies were collected for assessment of potential biomarkers of response, including PIK3CA and KRAS mutations and PTEN expression. Results: 43 pts were enrolled: NSCLC (n=6), prostate (n=5), ovarian (n=5), SCCHN (n=3), and pancreatic (n=3) were the most common tumor types. Median time on study (TOS) was 81 d (5-361), with 9 pts still on study. 16 pts received ≥ 6 cycles (6-17), including 3 pts with NSCLC, and 4 pts with ovarian cancer. Biomarker data are available for 20 evaluable pts. Median days on study by mutational status was: PIK3CA/KRAS WT (n=13): 91 d (28-286); PIK3CA-MUT (n=5): 183 d (64-342); KRAS-MUT (n=3): 141 d (125-361); and PIK3CA/KRAS-MUT (n=2): 96 d (86-105). A trend toward longer TOS was observed in pts with PIK3CA-MUT vs PIK3CA/KRAS-WT (p=0.14). Assessment of PTEN is ongoing. Best response in 32 evaluable pts was 2 PR (6%), 22 SD (69%), and 8 PD (25%). The PRs were in NSCLC and ovarian cancer (both PIK3CA/KRAS WT). 8 other pts had ≥15% tumor shrinkage, including NSCLC (n=2). Conclusions: PX-866 with docetaxel was associated with a disease control rate of 75%, with 50% of evaluable pts demonstrating SD or better for ≥ 6 cycles. Based on available data, a trend for a longer TOS was seen with PIK3CA-MUT pts. This relationship will be further evaluated in phase II.
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Affiliation(s)
- Antonio Jimeno
- Division of Medical Oncology, University of Colorado Denver, Aurora, CO
| | | | - Charles M. Rudin
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Wen Wee Ma
- Roswell Park Cancer Institute, Buffalo, NY
| | | | | | - Benjamin Levy
- Continuum Cancer Centers of New York, Beth Israel Hospital, New York, NY
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Bendell JC, Ervin TJ, Senzer NN, Richards DA, Firdaus I, Lockhart AC, Cohn AL, Saleh MN, Gardner LR, Sportelli P, Eng C. Results of the X-PECT study: A phase III randomized double-blind placebo-controlled study of perifosine plus capecitabine (P-CAP) versus placebo plus capecitabine (CAP) in patients (pts) with refractory metastatic colorectal cancer (mCRC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.lba3501] [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
LBA3501 The full, final text of this abstract will be available at abstract.asco.org at 12:01 AM (EDT) on Sunday, June 3, 2012, and in the Annual Meeting Proceedings online supplement to the June 20, 2012, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Sunday edition of ASCO Daily News.
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Affiliation(s)
| | - Thomas J. Ervin
- Sarah Cannon Research Institute/Florida Cancer Specialists, Englewood, FL
| | | | | | - Irfan Firdaus
- Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH
| | | | | | | | | | | | - Cathy Eng
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Chang KJ, Senzer NN, Binmoeller K, Goldsweig H, Coffin R. Phase I dose-escalation study of talimogene laherparepvec (T-VEC) for advanced pancreatic cancer (ca). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e14546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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
e14546 Background: T-VEC is an investigational, immune-enhanced oncolytic herpes simplex virus type I that selectively replicates in solid tumors. This was an open-label, dose-escalation study of T-VEC administered by endoscopic ultrasound (EUS)-guided fine needle injection (FNI) for advanced pancreatic ca. Methods: Eligibility criteria included ≥ 18 yrs old, ECOG 0-2, pathologically confirmed pancreatic ca with measurable disease (tumors ≥ 1 cm dia), and failure or unable to receive standard tx. T-VEC was administered at wks 6, 12, 18 to a single pancreatic tumor in 4 cohorts (C), 3 pts each enrolled sequentially (extended dosing allowed in pts thought to have benefit): C 1: 1 dose of 104 PFU/mL then 2 of 105 PFU/mL; C 2: 1 dose of 105 PFU/mL then 2 of 106 PFU/mL; C 3: 1 dose of 106 PFU/mL then 2 of 107 PFU/mL; C 4: 1 dose of 106 PFU/mL then 2 of 108 PFU/mL. 2 doses/pt were required for enrollment to the next C. A C could be expanded to 6 if 1 related DLT occurred. If 2 DLTs occurred, dose escalation was stopped. Endpoints were safety and activity as assessed by CT tumor dia changes from screening. Results: 17 pts were enrolled in C 1-3 given at least 1 dose of T-VEC; 65% were men; median age 54; 76% white, ECOG 0-1 82%. C 4 was not opened because of early study termination (not related to safety). 7/17 (41%) received all 3 planned doses and 8 (47%) had at least 1 post-dose CT scan. Only C 3 showed a median decrease in injected tumor dia with 2/4 pts achieving substantial tumor reductions (-36% and -33%). 3 pts (in C 1and C 3) showed decreases in the dia of ≥ 1 uninjected tumors (in liver, pancreas, kidney, and chest); 1 pt had disappearance of a nonmeasurable tumor in the liver. A dose trend was not observed for reductions of uninjected tumors. Most common AEs were ascites (47%), dehydration (41%), anemia, abdominal pain, constipation, and nausea (each 35%), and vomiting (29%). 2 pts (12%) had a grade 5 AE, both considered unrelated to T-VEC. Conclusions: EUS-guided FNI of T-VEC in advanced pancreatic ca, at initial doses of 104 to 106 PFU/mL followed by up to 107 PFU/mL, was feasible and tolerable. Evidence of biologic activity was observed. Future studies should be conducted in pts with less advanced disease, to allow sufficient time to receive multiple doses before PD.
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Senzer NN, Mendelson D, Weekes C, Rosen L, LoRusso P, Just R, Smith D, Ritchie E, DeLucia D, Quigley T, Dunbar J, Schmalbach T, Cortes J. Abstract B101: Safety, tolerability, and pharmacokinetics of IPI-493, an oral Hsp90 inhibitor, in patients with advanced cancers. Mol Cancer Ther 2011. [DOI: 10.1158/1535-7163.targ-11-b101] [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: Inhibition of the Hsp90 chaperone protein is associated with clinical activity in selected patients (pts). IPI-493, an oral Hsp90 inhibitor, was assessed in advanced solid and hematologic malignancies in two phase 1 studies. Study objectives included determination of the following: maximum tolerated dose (MTD), dose-limiting toxicities (DLTs), recommended phase 2 dose, safety/tolerability, pharmacokinetics (PK)/pharmacodynamics (PD), and clinical activity.
Methods: Pts with advanced cancers received oral IPI-493 for 21-day cycles in a routine 3+3, sequential dose escalation design with three unique schedules: three times weekly for 2 weeks + 1 week rest (TIW), twice weekly for 2 weeks + 1 week rest (BIW), and once weekly continuously (QW). PK and PD samples were obtained in Cycle 1 during Weeks 1 and 3. CT scans were performed at baseline and every 2 cycles thereafter.
Results: IPI-493 (TIW n=14, BIW n=21 and QW n=22) at doses from 50 to 250 mg was administered to 57 pts (53 with solid tumors, 4 with hematologic malignancies) with a median age of 58 years (range 21–86), ECOG score 0–1, and a median of 5 previous chemotherapy agents (range 1–16). The most common tumor types were colorectal cancer (10 pts) and gastrointestinal stromal tumor (6 pts). The median time on study was 65 days (range 15–544). Fourteen total DLTs were observed in 4 pts on the TIW (200 mg and 150 mg) schedule and 1 pt on the BIW (125 mg) schedule, which were primarily elevations in aspartate aminotransferase (AST), alanine aminotransferase, and alkaline phosphatase (ALP). No DLTs were observed on the QW schedule. DLTs of metabolic acidosis and acute renal failure were fatal in a single pt; all other DLTs were reversible. A maximum tolerated dose was not determined. The most common treatment-related adverse events were fatigue (35%), diarrhea (30%), elevated AST (28%), elevated ALP (25%), and nausea (21%). Maximal plasma concentrations occurred approximately 2–3 hours following single and repeat oral administration. Across all doses and schedules, the mean terminal elimination half life was approximately 14 hours, with no drug accumulation observed upon repeat dosing. Systemic exposure increased with dose across the 50–150 mg dose levels and demonstrated a plateau at 150 mg with no further increases in mean exposure at doses up to 250 mg.
Conclusions: IPI-493 tolerability was schedule dependent, with increasing toxicity identified on the TIW schedule. Development of IPI-493 is no longer being pursued due to the lack of increased exposure with increasing doses.
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 B101.
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Affiliation(s)
| | | | - Colin Weekes
- 1Mary Crowley Cancer Research Center, Dallas, TX
| | - Lee Rosen
- 1Mary Crowley Cancer Research Center, Dallas, TX
| | - Pat LoRusso
- 1Mary Crowley Cancer Research Center, Dallas, TX
| | - Richard Just
- 1Mary Crowley Cancer Research Center, Dallas, TX
| | - Doug Smith
- 1Mary Crowley Cancer Research Center, Dallas, TX
| | | | | | | | - Joi Dunbar
- 1Mary Crowley Cancer Research Center, Dallas, TX
| | | | - Jorge Cortes
- 1Mary Crowley Cancer Research Center, Dallas, TX
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Rudin CM, Poirier JT, Senzer NN, Stephenson J, Loesch D, Burroughs KD, Reddy PS, Hann CL, Hallenbeck PL. Phase I clinical study of Seneca Valley Virus (SVV-001), a replication-competent picornavirus, in advanced solid tumors with neuroendocrine features. Clin Cancer Res 2011; 17:888-95. [PMID: 21304001 DOI: 10.1158/1078-0432.ccr-10-1706] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Seneca Valley Virus (SVV-001) is a novel naturally occurring replication-competent picornavirus with potent and selective tropism for neuroendocrine cancer cell types, including small cell lung cancer. We conducted a first-in-human, first-in-class phase I clinical trial of this agent in patients with cancers with neuroendocrine features, including small cell lung cancer. EXPERIMENTAL DESIGN Clinical evaluation of single intravenous doses in patients with cancers with neuroendocrine features was performed across five log-increments from 10(7) to 10(11) vp/kg. Toxicity, viral titers and clearance, neutralizing antibody development, and tumor response were assessed. RESULTS A total of 30 patients were treated with SVV-001, including six with small cell carcinoma at the lowest dose of 10(7) vp/kg. SVV-001 was well tolerated, with no dose-limiting toxicities observed in any dose cohort. Viral clearance was documented in all subjects and correlated temporally with development of antiviral antibodies. Evidence of in vivo intratumoral viral replication was observed among patients with small cell carcinoma, with peak viral titers estimated to be >10(3)-fold higher than the administered dose. One patient with previously progressive chemorefractory small cell lung cancer remained progression-free for 10 months after SVV-001 administration, and is alive over 3 years after treatment. CONCLUSIONS Intravenous SVV-001 administration in patients is well tolerated at doses up to 10(11) vp/kg, with predictable viral clearance kinetics, intratumoral viral replication, and evidence of antitumor activity in patients with small cell lung cancer. Phase II clinical evaluation in small cell lung cancer is warranted, and has been initiated.
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Sequist LV, Gettinger S, Senzer NN, Martins RG, Jänne PA, Lilenbaum R, Gray JE, Iafrate AJ, Katayama R, Hafeez N, Sweeney J, Walker JR, Fritz C, Ross RW, Grayzel D, Engelman JA, Borger DR, Paez G, Natale R. Activity of IPI-504, a novel heat-shock protein 90 inhibitor, in patients with molecularly defined non-small-cell lung cancer. J Clin Oncol 2010; 28:4953-60. [PMID: 20940188 DOI: 10.1200/jco.2010.30.8338] [Citation(s) in RCA: 286] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE IPI-504 is a novel, water-soluble, potent inhibitor of heat-shock protein 90 (Hsp90). Its potential anticancer activity has been validated in preclinical in vitro and in vivo models. We studied the activity of IPI-504 after epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy in patients with advanced, molecularly defined non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with advanced NSCLC, prior treatment with EGFR TKIs, and tumor tissue available for molecular genotyping were enrolled in this prospective, nonrandomized, multicenter, phase II study of IPI-504 monotherapy. The primary outcome was objective response rate (ORR). Secondary aims included safety, progression-free survival (PFS), and analysis of activity by molecular subtypes. RESULTS Seventy-six patients were enrolled between December 2007 and May 2009 from 10 United States cancer centers. An ORR of 7% (five of 76) was observed in the overall study population, 10% (four of 40) in patients who were EGFR wild-type, and 4% (one of 28) in those with EGFR mutations. Although both EGFR groups were below the target ORR of 20%, among the three patients with an ALK gene rearrangement, two had partial responses and the third had prolonged stable disease (7.2 months, 24% reduction in tumor size). The most common adverse events included grades 1 and 2 fatigue, nausea, and diarrhea. Grade 3 or higher liver function abnormalities were observed in nine patients (11.8%). CONCLUSION IPI-504 has clinical activity in patients with NSCLC, particularly among patients with ALK rearrangements.
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Affiliation(s)
- Lecia V Sequist
- Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA.
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Loesch D, Greco FA, Senzer NN, Burris HA, Hainsworth JD, Jones S, Vukelja SJ, Sandbach J, Holmes F, Sedlacek S, Pippen J, Lindquist D, McIntyre K, Blum JL, Modiano MR, Boehm KA, Zhan F, Asmar L, Robert N. Phase III multicenter trial of doxorubicin plus cyclophosphamide followed by paclitaxel compared with doxorubicin plus paclitaxel followed by weekly paclitaxel as adjuvant therapy for women with high-risk breast cancer. J Clin Oncol 2010; 28:2958-65. [PMID: 20479419 DOI: 10.1200/jco.2009.24.1000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study compared disease-free survival (DFS) obtained with two different regimens of adjuvant therapy in high-risk breast cancer. METHODS Women (who had performance status [PS] of 0 to 1) with operable, histologically confirmed, stage I to III adenocarcinoma of the breast were eligible. Patients had undergone primary surgery with no residual tumor. Treatments were as follows: arm 1 was doxorubicin 60 mg/m(2) plus cyclophosphamide 600 mg/m(2) every 3 weeks for four cycles followed by paclitaxel 175 mg/m(2) every 3 weeks for four cycles (ie, AC-P); and arm 2 was doxorubicin 50 mg/m(2) plus paclitaxel 200 mg/m(2) every 3 weeks for four cycles followed by paclitaxel 80 mg/m(2) weekly for 12 weeks. RESULTS Overall, 1,830 patients were enrolled and 1,801 were treated: arm 1 (n = 906; AC-->P) and arm 2 (n = 895; AP-WP). Overall, patients had a PS of 0 (88%), had estrogen receptor and progesterone receptor-positive disease (52%), had one to three positive nodes (46%), and were postmenopausal (57%); the median age was 52 years. Currently, 1,640 patients (90%) are alive. The 6-year DFS was 79% to 80% in both groups. Disease relapse was the cause of death for 83 patients in arm 1 and in 66 patients of arm 2. Overall 6-year survival rates were 82% and 87% in arms 1 and 2, respectively. Reasons for patients being taken off study treatment included toxicity (13% in arm 1 v 20% in arm 2), progressive disease or recurrence (7% v 5%), and consent withdrawn (9% v 8%), respectively. The most frequent toxicities were hematologic, including neutropenia and leukopenia followed by neuropathy, myalgia, nausea, fatigue, headache, arthralgia, and vomiting. CONCLUSION The results indicate that the AP-WP regimen is an equally effective and tolerable option for the adjuvant treatment of patients with high-risk breast cancer. The substitution of paclitaxel for cyclophosphamide results in comparable effectiveness of the regimen.
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Pirollo KF, Nemunaitis JJ, Senzer NN, Sleer L, Chang EH. Abstract LB-172: Transgene presence in patients’ tumors following tumor-targeted nanodelivery. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-lb-172] [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
Discussant: William F. Benedict, UT M. D. Anderson Center, Houston, TX.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr LB-172.
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Affiliation(s)
| | | | | | | | - Esther H. Chang
- 1Lombardi Comp. Cancer Center at Georgetown University, Washington, DC
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Senzer NN, Kaufman HL, Amatruda T, Nemunaitis M, Reid T, Daniels G, Gonzalez R, Glaspy J, Whitman E, Harrington K, Goldsweig H, Marshall T, Love C, Coffin R, Nemunaitis JJ. Phase II Clinical Trial of a Granulocyte-Macrophage Colony-Stimulating Factor–Encoding, Second-Generation Oncolytic Herpesvirus in Patients With Unresectable Metastatic Melanoma. J Clin Oncol 2009; 27:5763-71. [DOI: 10.1200/jco.2009.24.3675] [Citation(s) in RCA: 472] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PurposeTreatment options for metastatic melanoma are limited. We conducted this phase II trial to assess the efficacy of JS1/34.5-/47-/granulocyte-macrophage colony-stimulating factor (GM-CSF) in stages IIIc and IV disease.Patients and MethodsTreatment involved intratumoral injection of up to 4 mL of 106pfu/mL of JS1/34.5-/47-/GM-CSF followed 3 weeks later by up to 4 mL of 108pfu/mL every 2 weeks for up to 24 treatments. Clinical activity (by RECIST [Response Evaluation Criteria in Solid Tumors]), survival, and safety parameters were monitored.ResultsFifty patients (stages IIIc, n = 10; IVM1a, n = 16; IVM1b, n = 4; IVM1c, n = 20) received a median of six injection sets; 74% of patients had received one or more nonsurgical prior therapies for active disease, including dacarbazine/temozolomide or interleukin-2 (IL-2). Adverse effects were limited primarily to transient flu-like symptoms. The overall response rate by RECIST was 26% (complete response [CR], n = 8; partial response [PR], n = 5), and regression of both injected and distant (including visceral) lesions occurred. Ninety-two percent of the responses had been maintained for 7 to 31 months. Ten additional patients had stable disease (SD) for greater than 3 months, and two additional patients had surgical CR. On an extension protocol, two patients subsequently achieved CR by 24 months (one previously PR, one previously SD), and one achieved surgical CR (previously PR). Overall survival was 58% at 1 year and 52% at 24 months.ConclusionThe 26% response rate, with durability in both injected and uninjected lesions including visceral sites, together with the survival rates, are evidence of systemic effectiveness. This effectiveness, combined with a limited toxicity profile, warrants additional evaluation of JS1/34.5-/47-/GM-CSF in metastatic melanoma. A US Food and Drug Administration–approved phase III investigation is underway.
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Affiliation(s)
- Neil N. Senzer
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - Howard L. Kaufman
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - Thomas Amatruda
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - Mike Nemunaitis
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - Tony Reid
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - Gregory Daniels
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - Rene Gonzalez
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - John Glaspy
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - Eric Whitman
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - Kevin Harrington
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - Howard Goldsweig
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - Tracey Marshall
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - Colin Love
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - Robert Coffin
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
| | - John J. Nemunaitis
- From the Mary Crowley Cancer Research Centers; Texas Oncology Physicians Association; and Baylor Sammons Cancer Center, Dallas, TX; Columbia University, Department of Surgery, New York, NY; Hubert H. Humphrey Cancer Center, Robbinsdale, MN; University of Colorado, Aurora, CO; University of California, San Diego Cancer Center, La Jolla; and University of California, Los Angeles, Los Angeles, CA; Mountainside Hospital, Montclair, NJ; Royal Marsden Hospital, London, United Kingdom; and BioVex, Woburn, MA
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Eager RM, Cunningham CC, Senzer NN, Stephenson J, Anthony SP, O'Day SJ, Frenette G, Pavlick AC, Jones B, Uprichard M, Nemunaitis J. Phase II assessment of talabostat and cisplatin in second-line stage IV melanoma. BMC Cancer 2009; 9:263. [PMID: 19643020 PMCID: PMC2731782 DOI: 10.1186/1471-2407-9-263] [Citation(s) in RCA: 65] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Accepted: 07/30/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metastatic melanoma is an incurable disease with an average survival of less than one year. Talabostat is a novel dipeptidyl peptidase inhibitor with immunostimulatory properties. METHODS This phase II, open label, single arm study was conducted to evaluate the safety and efficacy of 75-100 mg/m2 cisplatin combined with 300-400 mcg talabostat bid for 6, 21-day cycles. The primary endpoint was overall response. The rate of complete responses, duration of overall objective response, progression-free survival (PFS), and overall survival were the secondary endpoints. RESULTS Six objective partial responses were recorded in the 74 patients (8.1%) in the intention-to-treat population. Five of these responses involved the 40 evaluable patients (12.5%). Thirty-one percent of patients reported SAEs to the combination of talabostat and cisplatin. CONCLUSION Acceptable tolerability was observed in the intention-to-treat population and antitumor activity was observed in 12.5% of evaluable patients, which is not greater than historical expectation with cisplatin alone.
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Nemunaitis J, Senzer NN. Emerging technologies for the genomic analysis of cancer. F1000 Biol Rep 2009; 1:35. [PMID: 20948650 PMCID: PMC2924702 DOI: 10.3410/b1-35] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer-cell survival, growth and metastatic potential are directed by dominant molecular signalling patterns, the components of which have been shown to be qualitatively different from their normal tissue counterparts. These signalling patterns can now be further distinguished by quantitative assessment, either at a single point in time or at intervals. This commentary will focus on the emergence of proteomic analysis which, in conjunction with the genomic expression data, is an evolving technology that one day will enable personalized therapeutic strategies that are differentially targeted against cancer.
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Affiliation(s)
- John Nemunaitis
- Mary Crowley Cancer Research Centers, 1700 Pacific Avenue, Suite 1100, Dallas, TX 75201, USA.
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Affiliation(s)
| | - Neil N. Senzer
- LEAD Therapeutics, Inc., San Bruno, CA
- Mary Crowley Cancer Research Centers, Dallas, TX
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Abstract
Chemo-inducible cancer gene therapy is a potential new treatment for solid tumors that may in part enhance the anti-tumor effects of chemotherapy while minimizing toxicity. This approach combines viral vectors expressing cytotoxic transgenes that can be transcriptionally activated by DNA-damaging agents. The development of chemo-inducible gene therapy has numerous implications for the treatment of both localized and metastatic disease in patients with solid tumors.
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Affiliation(s)
- James J Mezhir
- Department of Surgery, University of Chicago Hospitals, Chicago, Illinois 60637, USA
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Messersmith WA, Laheru DA, Senzer NN, Donehower RC, Grouleff P, Rogers T, Kelley SK, Ramies DA, Lum BL, Hidalgo M. Phase I trial of irinotecan, infusional 5-fluorouracil, and leucovorin (FOLFIRI) with erlotinib (OSI-774): early termination due to increased toxicities. Clin Cancer Res 2005; 10:6522-7. [PMID: 15475439 DOI: 10.1158/1078-0432.ccr-04-0746] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This phase I study was conducted to establish the dose-limiting toxicities and maximum-tolerated dose of erlotinib, an oral epidermal growth factor receptor tyrosine kinase inhibitor, in combination with FOLFIRI, a standard regimen of irinotecan, leucovorin, and infusional 5-fluorouracil (5-FU) in patients with advanced colorectal cancer. EXPERIMENTAL DESIGN The trial used a dose-escalation design beginning with 100 mg/day erlotinib continuously and dose-reduced FOLFIRI (150 mg/m2 i.v. day 1 irinotecan, 200 mg/m2 i.v. leucovorin, 320 mg/m2 i.v. bolus days 1 to 2 5-FU, and 480 mg/m2 i.v. 5-FU infusion over 22 hours, days 1 to 2) administered in 6-week cycles (three FOLFIRI treatments). Plasma sampling was performed for irinotecan, erlotinib, and 5-FU for pharmacokinetic analysis during cycle 1. RESULTS The study was halted after six patients at the lowest dose level due to unexpectedly severe toxicities, including disfiguring grade 2 rash (three patients), grade 3 diarrhea (three patients), and grade > or = 3 neutropenia (three patients). All patients required some dose interruption or reduction of either erlotinib or FOLFIRI, and only one patient completed two 6-week cycles of therapy. Five patients had stable disease after one cycle, and one patient had a partial response. No plasma pharmacokinetic interaction was observed that could explain the observed increased toxicity. CONCLUSIONS FOLFIRI combined with erlotinib causes excessive toxicity at reduced doses. These findings contrast with available data regarding the optimal safety profile of trials combining small molecule epidermal growth factor receptor inhibitors with other conventional chemotherapy and highlight the need to perform safety-oriented studies of such combinations.
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Affiliation(s)
- Wells A Messersmith
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
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Soulieres D, Senzer NN, Vokes EE, Hidalgo M, Agarwala SS, Siu LL. Multicenter phase II study of erlotinib, an oral epidermal growth factor receptor tyrosine kinase inhibitor, in patients with recurrent or metastatic squamous cell cancer of the head and neck. J Clin Oncol 2004; 22:77-85. [PMID: 14701768 DOI: 10.1200/jco.2004.06.075] [Citation(s) in RCA: 602] [Impact Index Per Article: 30.1] [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: 11/20/2022] Open
Abstract
PURPOSE To determine the efficacy and safety profiles of erlotinib in patients with advanced recurrent and/or metastatic squamous cell cancer of the head and neck (HNSCC). PATIENTS AND METHODS Patients with locally recurrent and/or metastatic HNSCC, regardless of their HER1/EGFR status, were treated with erlotinib at an initial dose of 150 mg daily. Dose reductions or escalations were allowed based on tolerability of erlotinib. RESULTS One-hundred fifteen patients were enrolled onto this study. Forty-seven percent of patients received erlotinib at 150 mg daily throughout the entire study, 6% had dose escalations, and 46% required dose reductions and/or interruptions. Five patients achieved partial responses on study, for an overall objective response rate of 4.3% (95% CI, 1.4% to 9.9%). Disease stabilization was maintained in 44 patients (38.3%) for a median duration of 16.1 weeks. The median progression-free survival was 9.6 weeks (95% CI, 8.1 to 12.1 weeks), and the median overall survival was 6.0 months (95% CI, 4.8 to 7.0 months). Subgroup analyses revealed a significant difference in overall survival favoring patients who developed at least grade 2 skin rashes versus those who did not (P =.045), whereas no difference was detected based on HER1/EGFR expression. Rash and diarrhea were the most common drug-related toxicities, encountered in 79% and 37% of patients, respectively, though the severity was mild to moderate in most cases. CONCLUSION Erlotinib was well tolerated in this heavily pretreated HNSCC population and produced prolonged disease stabilization; hence, further evaluation of its role in this tumor type is warranted.
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Epstein JB, Silverman S, Paggiarino DA, Crockett S, Schubert MM, Senzer NN, Lockhart PB, Gallagher MJ, Peterson DE, Leveque FG. Benzydamine HCl for prophylaxis of radiation-induced oral mucositis: results from a multicenter, randomized, double-blind, placebo-controlled clinical trial. Cancer 2001; 92:875-85. [PMID: 11550161 DOI: 10.1002/1097-0142(20010815)92:4<875::aid-cncr1396>3.0.co;2-1] [Citation(s) in RCA: 168] [Impact Index Per Article: 7.3] [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: 11/06/2022]
Abstract
BACKGROUND Benzydamine was evaluated in patients with head and neck carcinoma for treatment of radiation-induced oral mucositis, a frequent complication of radiation therapy (RT) for which there is no predictable therapy or preventive treatment currently available. METHODS The safety and efficacy of 0.15% benzydamine oral rinse in preventing or decreasing erythema, ulceration, and pain associated with oral mucositis during RT were evaluated in a randomized, placebo-controlled trial conducted in patients with head and neck carcinoma. Subjects were to rinse with 15 mL for 2 minutes, 4-8 times daily before and during RT, and for 2 weeks after completion of RT; study evaluations were conducted before RT and routinely thereafter up to 3 weeks after RT. RESULTS During conventional RT, regimens up to cumulative doses of 5000 centigrays (cGy) benzydamine (n = 69) significantly (P = 0.006) reduced erythema and ulceration by approximately 30% compared with the placebo (n = 76); greater than 33% of benzydamine subjects remained ulcer free compared with 18% of placebo subjects (P = 0.037), and benzydamine significantly delayed the use of systemic analgesics compared with placebo (P < 0.05). Benzydamine was not effective in subjects (n = 20) receiving accelerated RT doses (> or = 220 cGy/day). The incidence of adverse events between treatment groups was comparable without significant differences. Early discontinuation because of adverse events occurred in 6% of benzydamine subjects and 5% of placebo subjects, and there was 1 death (related to the primary diagnosis) in a placebo subject. CONCLUSIONS Benzydamine oral rinse was effective, safe, and well tolerated for prophylactic treatment of radiation-induced oral mucositis.
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Affiliation(s)
- J B Epstein
- British Columbia Cancer Agency, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, BC V5Z-4E6, Canada.
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Senzer NN. Prostate cancer: Multimodality approaches with docetaxel. Semin Oncol 2001. [DOI: 10.1053/sonc.2001.27199] [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: 11/11/2022]
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Abstract
The trend toward earlier diagnosis of prostate cancer and technological advances in radiotherapeutics (eg, imaging enhancement, planning optimization, refinement of calculation algorithms, and computerized delivery systems) have led to increased use of radiation therapy (RT) as primary treatment for presumed localized disease. However, monomodal local therapy fails to achieve consistently successful long-term disease control, especially in patients with intermediate- and high-grade risk factors. Local-regional factors, such as absolute and relative resistance mechanisms, epigenetic influences, and clonogenic heterogeneity, and probable micrometastatic disease require consideration, evaluation, and potentially the implementation of combined modality approaches. Patients receiving combined RT and androgen suppression (AS) in various sequences (AS --> AS + RT, AS + RT, AS --> AS + RT --> AS, and RT --> AS) have shown enhanced disease-free survival, increased pathologic local control related to the duration of AS treatment, and improved overall survival with prolonged AS. Furthermore, limited but provocative trials suggest that multimodality chemoradiotherapy may also enhance tumor control in patients with locally advanced disease with acceptable toxicity. Several new trials that will test the efficacy and safety of docetaxel combined with radiotherapy as well as biologic modifiers are described.
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Affiliation(s)
- N N Senzer
- Radiation Oncology Research, TOPA-Sammons Cancer Center, Dallas, TX 75246, USA
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Jones SE, Stringer CA, Dorr RT, Senzer NN. The Management of Cancer in the Pregnant Patient. Proc (Bayl Univ Med Cent) 1991. [DOI: 10.1080/08998280.1991.11929751] [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: 10/18/2022] Open
Affiliation(s)
| | - C. Allen Stringer
- Departments of Medicine and Pharmacology/Toxicology, University of Arizona College of Medicine, Tucson
| | - Robert T. Dorr
- Departments of Medicine and Pharmacology/Toxicology, University of Arizona College of Medicine, Tucson
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Affiliation(s)
- N N Senzer
- Department of Oncology, Baylor University Medical Center, Dallas, Texas 75246
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Senzer NN. Orthotopic Liver Transplantation for Bile Duct Cancer at Baylor University Medical Center. Proc (Bayl Univ Med Cent) 1990. [DOI: 10.1080/08998280.1990.11929732] [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: 10/18/2022] Open
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Mennel RG, Senzer NN, Lieberman ZH, Fulmer M. Head and Neck Cancer. Proc (Bayl Univ Med Cent) 1990. [DOI: 10.1080/08998280.1990.11929731] [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: 10/18/2022] Open
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Senzer NN. Hyperthermia: chemotherapeutic and biologic response modifications. Strahlenther Onkol 1989; 165:729-33. [PMID: 2683170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- N N Senzer
- Department of Radiation Oncology, Baylor University Medical Center, Dallas, Texas
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Senzer NN, Terrell W, Pratt CB. Evaluation of a chemotherapeutic regimen for primary liver cancer in children. Cancer Treat Rep 1978; 62:1403-4. [PMID: 210945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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