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Fracasso PM, Fisher GA, Goodner SA, Beumer JH, Egorin MJ, Fears CL, Wildi JD, Jones GJ, Pearce TE, Sikic BI. A Phase I Trial of the ABCB1 Inhibitor, Oral Valspodar, in Combination With Paclitaxel in Patients With Advanced Solid Tumors. Am J Clin Oncol 2023; 46:353-359. [PMID: 37264515 PMCID: PMC10524540 DOI: 10.1097/coc.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Multidrug resistance mediated by P-glycoprotein is a potential obstacle to cancer treatment. This phase 1 trial determined the safety of paclitaxel with valspodar, a P-glycoprotein inhibitor, in patients with advanced solid tumors. METHODS Patients were treated with single-agent paclitaxel Q3W 175 mg/m 2 (or 135 mg/m 2 if heavily pretreated) as a 3-hour infusion. If their disease was stable (SD) or progressive (PD), paclitaxel at 30% (52.5 mg/m 2 ), 40% (70 mg/m 2 ), or 50% (87.5 mg/m 2 ) of 175 mg/m 2 (full dose) was administered with valspodar 5 mg/kg orally 4 times daily for 12 doses. Pharmacokinetic sampling (PK) for paclitaxel and valspodar was performed during single-agent and combination therapy. RESULTS Sixteen patients had SD/PD after one cycle of paclitaxel and then received paclitaxel at 30% (n=3), 40% (n=3), and 50% (n=10) with valspodar. Hematologic adverse events (AEs) including myelosuppression at paclitaxel 40% were comparable to those of full-dose paclitaxel. Non-hematologic AEs consisted of reversible hepatic (hyperbilirubinemia and transaminitis) and neurologic AEs (ataxia and paresthesias). Eleven patients experienced SD with a median of 12.7 weeks (range, 5.4 to 36.0), 4 patients progressed, and 1 was inevaluable. Reduced dose paclitaxel with valspodar resulted in lower plasma peak concentrations of paclitaxel; otherwise, concentrations were similar to single-agent paclitaxel. CONCLUSION Paclitaxel at 70 mg/m 2 was administered safely with valspodar. Limited efficacy in hematologic and solid tumors resulted in discontinuation of its clinical development and other transporter inhibitors. Recently, the development of ATP-binding cassette transporter inhibitors has been reconsidered to mitigate resistance to antibody-drug conjugates.
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Affiliation(s)
- Paula M. Fracasso
- Division of Oncology, Department of Medicine, Washington University School of Medicine and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - George A. Fisher
- Department of Medicine (Oncology), Stanford University, Stanford, CA, USA
| | - Sherry A. Goodner
- Division of Oncology, Department of Medicine, Washington University School of Medicine and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Jan H. Beumer
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Merrill J Egorin
- Deceased, Departments of Medicine and Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Carole L. Fears
- Division of Oncology, Department of Medicine, Washington University School of Medicine and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Jonathan D. Wildi
- Division of Oncology, Department of Medicine, Washington University School of Medicine and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Gary J. Jones
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Branimir I. Sikic
- Department of Medicine (Oncology), Stanford University, Stanford, CA, USA
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2
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He K, Hong DS, Ke D, Kebriaei P, Wang T, Danesi H, Bertolet G, Leuschner C, Puebla-Osorio N, Voss TA, Lin Q, Norry E, Fracasso PM, Welsh JW. Durable control of metastases in an HLA-A2+ patient with refractory melanoma after low-dose radiotherapy in combination with MAGE-A4 T cell therapy: a case report. Melanoma Res 2023; 33:332-337. [PMID: 37325860 PMCID: PMC10309102 DOI: 10.1097/cmr.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/22/2022] [Indexed: 06/17/2023]
Abstract
There is no currently approved adoptive cellular therapy for solid tumors. Pre-clinical and clinical studies have demonstrated that low-dose radiotherapy (LDRT) can enhance intratumoral T cell infiltration and efficacy. This case report describes a 71-year-old female patient with rectal mucosal melanoma that had developed metastases to liver, lung, mediastinum, axillary nodes, and brain. After systemic therapies had failed, she enrolled in the radiation sub-study of our phase-I clinical trial exploring the safety and efficacy of afamitresgene autoleucel (afami-cel), genetically engineered T cells with a T cell receptor (TCR) targeting the MAGE-A4 tumor antigen in patients with advanced malignancies (NCT03132922). Prior to the infusion of afami-cel, she received concurrent lymphodepleting chemotherapy and LDRT at 5.6 Gy/4 fractions to the liver. Time to partial response was 10 weeks, and duration of overall response was 18.4 weeks. Although the patient progressed at 28 weeks, the disease was well controlled after high-dose radiotherapy to liver metastases and checkpoint inhibitors. As of the last follow-up, she remains alive over two years after LDRT and afami-cel therapy. This report suggests that afami-cel in combination with LDRT safely enhanced clinical benefit. This provides evidence for further exploring the benefit of LDRT in TCR-T cell therapy.
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Affiliation(s)
- Kewen He
- Department of Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
- Department of Radiation Oncology
| | | | - Danxia Ke
- Department of Investigational Cancer Therapeutics
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | | | | | - Quan Lin
- Adaptimmune, Philadelphia, Pennsylvania, USA
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3
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Hong DS, Van Tine BA, Biswas S, McAlpine C, Johnson ML, Olszanski AJ, Clarke JM, Araujo D, Blumenschein GR, Kebriaei P, Lin Q, Tipping AJ, Sanderson JP, Wang R, Trivedi T, Annareddy T, Bai J, Rafail S, Sun A, Fernandes L, Navenot JM, Bushman FD, Everett JK, Karadeniz D, Broad R, Isabelle M, Naidoo R, Bath N, Betts G, Wolchinsky Z, Batrakou DG, Van Winkle E, Elefant E, Ghobadi A, Cashen A, Grand'Maison A, McCarthy P, Fracasso PM, Norry E, Williams D, Druta M, Liebner DA, Odunsi K, Butler MO. Autologous T cell therapy for MAGE-A4 + solid cancers in HLA-A*02 + patients: a phase 1 trial. Nat Med 2023; 29:104-114. [PMID: 36624315 PMCID: PMC9873554 DOI: 10.1038/s41591-022-02128-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 11/09/2022] [Indexed: 01/11/2023]
Abstract
Affinity-optimized T cell receptors can enhance the potency of adoptive T cell therapy. Afamitresgene autoleucel (afami-cel) is a human leukocyte antigen-restricted autologous T cell therapy targeting melanoma-associated antigen A4 (MAGE-A4), a cancer/testis antigen expressed at varying levels in multiple solid tumors. We conducted a multicenter, dose-escalation, phase 1 trial in patients with relapsed/refractory metastatic solid tumors expressing MAGE-A4, including synovial sarcoma (SS), ovarian cancer and head and neck cancer ( NCT03132922 ). The primary endpoint was safety, and the secondary efficacy endpoints included overall response rate (ORR) and duration of response. All patients (N = 38, nine tumor types) experienced Grade ≥3 hematologic toxicities; 55% of patients (90% Grade ≤2) experienced cytokine release syndrome. ORR (all partial response) was 24% (9/38), 7/16 (44%) for SS and 2/22 (9%) for all other cancers. Median duration of response was 25.6 weeks (95% confidence interval (CI): 12.286, not reached) and 28.1 weeks (95% CI: 12.286, not reached) overall and for SS, respectively. Exploratory analyses showed that afami-cel infiltrates tumors, has an interferon-γ-driven mechanism of action and triggers adaptive immune responses. In addition, afami-cel has an acceptable benefit-risk profile, with early and durable responses, especially in patients with metastatic SS. Although the small trial size limits conclusions that can be drawn, the results warrant further testing in larger studies.
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Affiliation(s)
- David S Hong
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Brian A Van Tine
- Section of Medical Oncology, Division of Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Melissa L Johnson
- Sarah Cannon Cancer Institute, Tennessee Oncology/One Oncology, Nashville, TN, USA
| | - Anthony J Olszanski
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Dejka Araujo
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - George R Blumenschein
- Department of Thoracic-Head and Neck Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Quan Lin
- Adaptimmue, Philadelphia, PA, USA
| | | | | | | | | | | | - Jane Bai
- Adaptimmue, Philadelphia, PA, USA
| | | | - Amy Sun
- Adaptimmue, Philadelphia, PA, USA
| | | | | | - Frederic D Bushman
- Department of Microbiology, University of Pennsylvania, Philadelphia, PA, USA
| | - John K Everett
- Department of Microbiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Derin Karadeniz
- Department of Microbiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | | | | | - Armin Ghobadi
- Section of Medical Oncology, Division of Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Amanda Cashen
- Section of Medical Oncology, Division of Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Anne Grand'Maison
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Philip McCarthy
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | | | | | - Mihaela Druta
- Sarcoma Medical Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - David A Liebner
- Department of Internal Medicine, Division of Medical Oncology, and Department of Biomedical Informatics, Division of Computational Biology and Bioinformatics, Ohio State University, Columbus, OH, USA
| | - Kunle Odunsi
- University of Chicago Medicine Comprehensive Cancer Center, Chicago, IL, USA
| | - Marcus O Butler
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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4
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Fracasso PM, Goodner SA, Wildi JD, Naughton MJ, Linette GP, Govindan R, Tan BR, Blum KA, Jones GJ, Pearce TE, Levitt DJ, Clamon GH. A Phase I Study of Apolizumab, an Anti-HLA-DR ß-chain Monoclonal Antibody, in Patients With Solid Tumor Malignancies. Am J Clin Oncol 2022; 45:294-297. [PMID: 35700081 PMCID: PMC9219582 DOI: 10.1097/coc.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human leukocyte antigen (HLA)-DR, a member of the major histocompatibility complex class II antigen family, is a target for antibody-based therapeutics. Apolizumab (Hu1D10, Remitogen), a humanized IgG1 monoclonal anti-HLA-DR ß-chain antibody targets the antigen, 1D10, expressed on a wide variety of hematologic and solid tumor malignancies. In this Phase 1 trial, the maximum tolerated dose and dose-limiting toxicity of weekly apolizumab in patients with advanced solid tumor malignancies were determined. PATIENTS AND METHODS Eligible patients with refractory solid tumors were initially screened for ID10 Ag on their tumor. Patients whose tumors expressed 1D10 were administered apolizumab 0.5, 1.0, 1.5, or 3.0 mg/kg intravenously over 90 minutes weekly for 4 consecutive weeks, followed by a 4-week break, and assessment of response. Patients whose disease had not progressed were offered additional treatment. RESULTS Tumors from 75 patients were screened for 1D10 Ag of which 17 patients were positive and underwent treatment. The first 3 dose levels were well-tolerated. Dose-limiting toxicities of grade 3 infusion-related hypersensitivity reactions and grade 3 headache and hypertension occurred in 2 patients, respectively, at apolizumab 3.0 mg/kg. Four patients, 1 each with breast carcinoma, melanoma, renal cell carcinoma, and sarcoma had stable disease for a median of 15 weeks (range: 12 to 19 wk). CONCLUSION Apolizumab can be administered safely at a maximum tolerated dose of 1.5 mg/kg for 4 consecutive weeks. Adverse events and limited clinical data in both hematologic and solid tumor malignancies resulted in discontinuation of clinical development of apolizumab. HLA-DR remains an interesting immunotherapeutic target.
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Affiliation(s)
- Paula M. Fracasso
- Department of Medicine, Washington University School of Medicine and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO 63110
| | - Sherry A. Goodner
- Department of Medicine, Washington University School of Medicine and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO 63110
| | - Jonathan D. Wildi
- Department of Medicine, Washington University School of Medicine and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO 63110
| | - Michael J. Naughton
- Department of Medicine, Washington University School of Medicine and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO 63110
| | - Gerald P. Linette
- Department of Medicine, Washington University School of Medicine and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO 63110
| | - Ramaswamy Govindan
- Department of Medicine, Washington University School of Medicine and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO 63110
| | - Benjamin R. Tan
- Department of Medicine, Washington University School of Medicine and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO 63110
| | - Kristie A. Blum
- Department of Medicine, Washington University School of Medicine and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO 63110
| | - Gary J. Jones
- PDL BioPharma, Inc., 34801 Campus Drive, Freemont, CA 94555
| | | | | | - Gerald H. Clamon
- Department of Internal Medicine, University of Iowa Hospital and Clinics, Iowa City, IA 52242
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5
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Fracasso PM, Duska LR, Thaker PH, Gao F, Zoberi I, Dehdashti F, Siegel BA, Uliel L, Menias CO, Rehm PK, Goodner SA, Creekmore AN, Lothamer HL, Rader JS. An Exploratory Study of Neoadjuvant Cetuximab Followed by Cetuximab and Chemoradiotherapy in Women With Newly Diagnosed Locally Advanced Cervical Cancer. Am J Clin Oncol 2022; 45:286-293. [PMID: 35696702 PMCID: PMC9233135 DOI: 10.1097/coc.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study explored the feasibility of cetuximab with chemoradiation in women with cervical carcinoma and evaluated fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) to assess early response to cetuximab (NCT00292955). PATIENTS AND METHODS Eligible patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IVB invasive carcinoma of the uterine cervix were treated on 1 of 3 dose levels (DL). DL1 consisted of neoadjuvant cetuximab, then concurrent radiotherapy with cetuximab 250 mg/m2/cisplatin 40 mg/m2, followed by weekly cetuximab. DL2 consisted of radiotherapy with cetuximab 200 mg/m2 and cisplatin 30 mg/m2. DL3 consisted of radiotherapy with cetuximab 250 mg/m2 and cisplatin 30 mg/m2. Patients underwent 18F-FDG-PET/CT before treatment, after neoadjuvant cetuximab, and at the end of treatment. RESULTS Of the 21 patients enrolled, 9, 3, and 9 were treated in DL1, DL2, and DL3, respectively. DL1 required dose reductions due to gastrointestinal toxicities. DL2 and 3 were tolerated with 1 dose-limiting toxicity (grade 4 renal failure) at DL3. Following 3 weekly treatments of neoadjuvant cetuximab in DL1, 7 patients had maximum standardized uptake value changes on 18F-FDG-PET/CT consistent with response to cetuximab. Of the 12 patients with locally advanced disease, eleven evaluable patients had no evidence of disease on 18F-FDG-PET/CT at treatment end. Five-year progression-free survival and overall survival rates for all patients were 57.5% and 58.5%, respectively. CONCLUSIONS Cetuximab with cisplatin 30 mg/m2 and radiotherapy was tolerated. 18F-FDG-PET/CT demonstrated early evidence of response to neoadjuvant cetuximab. With advances in precision oncology and the recent approval of pembrolizumab in metastatic cervical cancer, dual-target inhibition with an epidermal growth factor receptor inhibitor may be a promising treatment in the future.
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Affiliation(s)
- Paula M. Fracasso
- UVA Cancer Center, University of Virginia, Charlottesville,
VA, 22908
- Department of Medicine, University of Virginia,
Charlottesville, VA 22908
| | - Linda R. Duska
- UVA Cancer Center, University of Virginia, Charlottesville,
VA, 22908
- Department of Obstetrics and Gynecology, University of
Virginia, Charlottesville, VA 22908
| | - Premal H. Thaker
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Obstetrics and Gynecology, Washington
University School of Medicine, St. Louis, MO, 63110
| | - Feng Gao
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Surgery and the Division of Public Health
Sciences, Washington University School of Medicine, St. Louis, MO, 63110
| | - Imran Zoberi
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Radiation Oncology, Washington University
School of Medicine, St. Louis, MO, 63110
| | - Farrokh Dehdashti
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Division of Nuclear Medicine, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Barry A. Siegel
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Division of Nuclear Medicine, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Livnat Uliel
- Division of Nuclear Medicine, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Christine O. Menias
- Division of Diagnostic Radiology, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Patrice K. Rehm
- Division of Nuclear Medicine, University of Virginia,
Charlottesville, VA 22908
| | - Sherry A. Goodner
- UVA Cancer Center, University of Virginia, Charlottesville,
VA, 22908
| | - Allison N. Creekmore
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
| | - Heather L. Lothamer
- Department of Obstetrics and Gynecology, University of
Virginia, Charlottesville, VA 22908
| | - Janet S. Rader
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and
Washington University School of Medicine, St. Louis, MO 63110
- Department of Obstetrics and Gynecology, Washington
University School of Medicine, St. Louis, MO, 63110
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Hong DS, Butler MO, Pachynski RK, Sullivan R, Kebriaei P, Boross-Harmer S, Ghobadi A, Frigault MJ, Dumbrava EE, Sauer A, Brophy F, Navenot JM, Fayngerts S, Wolchinsky Z, Broad R, Batrakou DG, Wang R, Solis LM, Duose DY, Sanderson JP, Gerry AB, Marks D, Bai J, Norry E, Fracasso PM. Phase 1 Clinical Trial Evaluating the Safety and Anti-Tumor Activity of ADP-A2M10 SPEAR T-Cells in Patients With MAGE-A10+ Head and Neck, Melanoma, or Urothelial Tumors. Front Oncol 2022; 12:818679. [PMID: 35372008 PMCID: PMC8972123 DOI: 10.3389/fonc.2022.818679] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/18/2022] [Indexed: 02/02/2023] Open
Abstract
Background ADP-A2M10 specific peptide enhanced affinity receptor (SPEAR) T-cells are genetically engineered autologous T-cells that express a high-affinity melanoma-associated antigen (MAGE)-A10-specific T-cell receptor (TCR) targeting MAGE-A10-positive tumors in the context of human leukocyte antigen (HLA)-A*02. ADP-0022-004 is a phase 1, dose-escalation trial to evaluate the safety and anti-tumor activity of ADP-A2M10 in three malignancies (https://clinicaltrials.gov: NCT02989064). Methods Eligible patients were HLA-A*02 positive with advanced head and neck squamous cell carcinoma (HNSCC), melanoma, or urothelial carcinoma (UC) expressing MAGE-A10. Patients underwent apheresis; T-cells were isolated, transduced with a lentiviral vector containing the MAGE-A10 TCR, and expanded. Patients underwent lymphodepletion with fludarabine and cyclophosphamide prior to receiving ADP-A2M10. ADP-A2M10 was administered in two dose groups receiving 0.1×109 and >1.2 to 6×109 transduced cells, respectively, and an expansion group receiving 1.2 to 15×109 transduced cells. Results Ten patients (eight male and two female) with HNSCC (four), melanoma (three), and UC (three) were treated. Three patients were treated in each of the two dose groups, and four patients were treated in the expansion group. The most frequently reported adverse events grade ≥3 were leukopenia (10), lymphopenia (10), neutropenia (10), anemia (nine), and thrombocytopenia (five). Two patients reported cytokine release syndrome (one each with grade 1 and grade 3), with resolution. Best response included stable disease in four patients, progressive disease in five patients, and not evaluable in one patient. ADP-A2M10 cells were detectable in peripheral blood from patients in each dose group and the expansion group and in tumor tissues from patients in the higher dose group and the expansion group. Peak persistence was greater in patients from the higher dose group and the expansion group compared with the lower dose group. Conclusions ADP-A2M10 has shown an acceptable safety profile with no evidence of toxicity related to off-target binding or alloreactivity in these malignancies. Persistence of ADP-A2M10 in the peripheral blood and trafficking of ADP-A2M10 into the tumor was demonstrated. Because MAGE-A10 expression frequently overlaps with MAGE-A4 expression in tumors and responses were observed in the MAGE-A4 trial (NCT03132922), this clinical program closed, and trials with SPEAR T-cells targeting the MAGE-A4 antigen are ongoing.
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Affiliation(s)
- David S. Hong
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: David S. Hong,
| | - Marcus O. Butler
- Princess Margaret Hospital Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Russell K. Pachynski
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Ryan Sullivan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Partow Kebriaei
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sarah Boross-Harmer
- Princess Margaret Hospital Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Armin Ghobadi
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Matthew J. Frigault
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ecaterina E. Dumbrava
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Amy Sauer
- Adaptimmune LLC, Philadelphia, PA, United States
| | | | | | | | | | - Robyn Broad
- Adaptimmune Limited, Abingdon, United Kingdom
| | | | - Ruoxi Wang
- Adaptimmune Limited, Abingdon, United Kingdom
| | - Luisa M. Solis
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dzifa Yawa Duose
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | | | - Diane Marks
- Adaptimmune LLC, Philadelphia, PA, United States
| | - Jane Bai
- Adaptimmune LLC, Philadelphia, PA, United States
| | - Elliot Norry
- Adaptimmune LLC, Philadelphia, PA, United States
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7
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Blumenschein GR, Devarakonda S, Johnson M, Moreno V, Gainor J, Edelman MJ, Heymach JV, Govindan R, Bachier C, Doger de Spéville B, Frigault MJ, Olszanski AJ, Lam VK, Hyland N, Navenot JM, Fayngerts S, Wolchinsky Z, Broad R, Batrakou D, Pentony MM, Sanderson JP, Gerry A, Marks D, Bai J, Holdich T, Norry E, Fracasso PM. Phase I clinical trial evaluating the safety and efficacy of ADP-A2M10 SPEAR T cells in patients with MAGE-A10 + advanced non-small cell lung cancer. J Immunother Cancer 2022; 10:jitc-2021-003581. [PMID: 35086946 PMCID: PMC8796260 DOI: 10.1136/jitc-2021-003581] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Background ADP-A2M10 specific peptide enhanced affinity receptor (SPEAR) T cells (ADP-A2M10) are genetically engineered autologous T cells that express a high-affinity melanoma-associated antigen A10 (MAGE-A10)-specific T-cell receptor (TCR) targeting MAGE-A10+ tumors in the context of human leukocyte antigen (HLA)-A*02. ADP-0022-003 was a phase I dose-escalation trial that aimed to evaluate the safety and antitumor activity of ADP-A2M10 in non-small cell lung cancer (NSCLC) (NCT02592577). Methods Eligible patients were HLA-A*02 positive with advanced NSCLC expressing MAGE-A10. Patients underwent apheresis; T cells were isolated, transduced with a lentiviral vector containing the TCR targeting MAGE-A10, and expanded. Patients underwent lymphodepletion with varying doses/schedules of fludarabine and cyclophosphamide prior to receiving ADP-A2M10. ADP-A2M10 were administered at 0.08–0.12×109 (dose group 1), 0.5–1.2×109 (dose group 2), and 1.2–15×109 (dose group 3/expansion) transduced cells. Results Eleven patients (male, n=6; female, n=5) with NSCLC (adenocarcinoma, n=8; squamous cell carcinoma, n=3) were treated. Five, three, and three patients received cells in dose group 1, dose group 2, and dose group 3/expansion, respectively. The most frequently reported grade ≥3 adverse events were lymphopenia (n=11), leukopenia (n=10), neutropenia (n=8), anemia (n=6), thrombocytopenia (n=5), and hyponatremia (n=5). Three patients presented with cytokine release syndrome (grades 1, 2, and 4, respectively). One patient received the highest dose of lymphodepletion (fludarabine 30 mg/m2 on days –5 to –2 and cyclophosphamide 1800 mg/m2 on days −5 to −4) prior to a second infusion of ADP-A2M10 and had a partial response, subsequently complicated by aplastic anemia and death. Responses included: partial response (after second infusion; one patient), stable disease (four patients), clinical or radiographic progressive disease (five patients), and not evaluable (one patient). ADP-A2M10 were detectable in peripheral blood and in tumor tissue. Peak persistence was higher in patients who received higher doses of ADP-A2M10. Conclusions ADP-A2M10 demonstrated an acceptable safety profile and no evidence of toxicity related to off-target binding or alloreactivity. There was persistence of ADP-A2M10 in peripheral blood as well as ADP-A2M10 trafficking into the tumor. Given the discovery that MAGE-A10 and MAGE-A4 expression frequently overlap, this clinical program closed as trials with SPEAR T cells targeting MAGE-A4 are ongoing.
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Affiliation(s)
- George R Blumenschein
- Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Melissa Johnson
- Lung Cancer Research and Drug Development, Sarah Cannon Research Institute at Tennessee Oncology, Nashville, Tennessee, USA
| | - Victor Moreno
- START Madrid-FJD, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Justin Gainor
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Martin J Edelman
- Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - John V Heymach
- Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ramaswamy Govindan
- Medical Oncology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Carlos Bachier
- Hematology, Sarah Cannon Center for Blood Cancer at TriStar Centennial, Nashville, Tennessee, USA
| | | | - Matthew J Frigault
- Bone Marrow Transplant & Cellular Therapy, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony J Olszanski
- Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Vincent K Lam
- Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | - Robyn Broad
- Adaptimmune, Milton Park, Abingdon, Oxfordshire, UK
| | | | | | | | - Andrew Gerry
- Adaptimmune, Milton Park, Abingdon, Oxfordshire, UK
| | - Diane Marks
- Adaptimmune, Philadelphia, Pennsylvania, USA
| | - Jane Bai
- Adaptimmune, Philadelphia, Pennsylvania, USA
| | - Tom Holdich
- Adaptimmune, Milton Park, Abingdon, Oxfordshire, UK
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Amin M, Gao F, Terrero G, Picus J, Wang-Gillam A, Suresh R, Ma C, Tan B, Baggstrom M, Naughton MJ, Trull L, Belanger S, Fracasso PM, Lockhart AC. Phase I Study of Docetaxel and Temsirolimus in Refractory Solid Tumors. Am J Clin Oncol 2021; 44:443-448. [PMID: 34310349 DOI: 10.1097/coc.0000000000000852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/25/2022]
Abstract
INTRODUCTION The mammalian target of rapamycin (mTOR) is a downstream mediator in the phosphatidylinositol 3-kinase/Akt signaling pathway, and plays a central role in cell proliferation, growth, differentiation, migration, and survival. Temsirolimus (CCI-779), a selective inhibitor of the mTOR, is an ester analog of rapamycin (sirolimus) with improved aqueous solubility and pharmacokinetic (PK) properties. Preclinical studies have confirmed additive and synergistic antitumor activity in cancer cell lines (breast, prostate cancer) with combinations of taxanes and mTOR inhibitors. We conducted a phase I open-label, dose-escalation study to determine the maximal tolerated dose (MTD) of docetaxel in combination with temsirolimus in patients with refractory solid tumors. PATIENTS AND METHODS Eligible patients had a diagnosis of a refractory solid malignancy, measurable disease, and adequate organ function. Patients were sequentially enrolled in 4 dose level intravenous combinations of docetaxel and temsirolimus. Temsirolimus was administered weekly with docetaxel administered every 3 weeks. Laboratory data for tumor markers and radiologic imaging were conducted prestudy and then after every 2 cycles of the treatment. Radiologic response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Blood samples for PK and pharmacodynamic analysis were planned to be drawn at MTD. Apart from the traditional 3+3 design, we also implemented Bayesian Optimal Interval design which uses isotonic regression method to select MTD. We proceeded with isotonic regression analysis by using 20% dose-limiting toxicity (DLT) rate as target. RESULTS Twenty-six patients were treated in this study in 4 cohorts and dose levels. Fourteen males and 12 females were enrolled with a median age of 50 years (range of 27 to 72 y) and median Eastern Cooperative Oncology Group performance score of 1. Tumor histologies included pancreas (6), colon (5), rectum (3), gallbladder (2), non-small cell lung (2), endometrium (1), neuroendocrine (1), esophagus (1), stomach (1), pharynx (1), small intestine (1), and duodenum (1). Stable disease was observed in 2/4 (50%), 3/7 (43%), 4/10 (40%), and 3/5 (60%) patients in cohorts 1, 2, 3, and 4, respectively. Dose escalation in cohorts 2, 3, and 4 was complicated by DLTs such as grade 4 neutropenia and grade 3 diarrhea and an inability for patients to tolerate treatments during and beyond cycle 1 without dose reductions. Therefore, we could not determine an MTD or recommended phase II dose using the traditional 3+3 study analysis. Blood samples for PK and pharmacodynamic analysis were not collected since MTD was not determined. By using 20% DLT rate closest to the target, isotonic regression analysis showed identical estimated DLT rates in dose -1 (docetaxel 50 mg/m2 and temsirolimus 15 mg/m2) and dose level 1 (docetaxel 60mg/m2 and temsirolimus 15 mg/m2). CONCLUSIONS Dose escalation of docetaxel and temsirolimus was limited by severe myelosuppressive toxicity in this phase I study. Most of the DLTs occurred after cycle 1 of therapy hence, we were unable to determine MTD or collect blood samples for PK and pharmacodynamic analysis. Our trial did not meet its objectives due to significant DLTs with this chemotherapy combination. Although our novel use of Bayesian Optimal Interval design using isotonic regression method to select MTD showed identical estimated DLT rates in dose levels 1 and -1, clinically our patients were not able to complete 2 cycles of this regimen without dose reductions due to myelosuppressive toxicity in either of these dose levels, and hence, escaped clinical validity. This combination regimen should not be studied further at the dose levels and schedules tested in our study.
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Affiliation(s)
- Manik Amin
- Division of Oncology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Feng Gao
- Division of Public Health Sciences, Washington University School of Medicine, Saint Louis, MO
| | - Gretel Terrero
- Division of Hematology/Oncology, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC
| | - Joel Picus
- Division of Oncology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | | - Rama Suresh
- Division of Oncology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Cynthia Ma
- Division of Oncology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Benjamin Tan
- Division of Oncology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Maria Baggstrom
- Division of Oncology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Michael J Naughton
- Division of Medical Oncology, Saint Francis Healthcare, Cape Girardeau, MO
| | - Lauren Trull
- Prelude Therapeutics Incorporated, Wilmington, DE
| | - Stephanie Belanger
- Clinical Research Operations at UNC Chapel Hill-Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Paula M Fracasso
- Department of Medicine and the UVA Cancer Center, University of Virginia, Charlottesville, VA
| | - Albert Craig Lockhart
- Division of Hematology/Oncology, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC
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9
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Gillen J, Miller A, Bell-McGuinn KM, Schilder RJ, Walker JL, Mathews CA, Duska LR, Guntupalli SR, O'Cearbhaill R, Hays J, Hagemann AR, Gray HJ, Gordon SW, Armstrong DK, Chen A, Fracasso PM, Aghajanian C, Moore KN. Post hoc analyses of GOG 9923: Does BRCA status affect toxicities?: An NRG oncology study. Gynecol Oncol 2021; 161:512-515. [PMID: 33610319 DOI: 10.1016/j.ygyno.2021.01.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/25/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate how women with epithelial ovarian cancer (EOC), dichotomized by BRCA status, tolerate intravenous (IV) or intraperitoneal (IP) chemotherapy given with veliparib and bevacizumab (bev) on a GOG phase I study (GOG 9923, NCT00989651). METHODS This is an unplanned, post hoc analysis of an IRB approved, multi-institutional, prospective study (GOG 9923). Clinical characteristics and toxicity data based on BRCA status were evaluated and descriptive statistics were used to summarize baseline patient characteristics and toxicities. The Kaplan Meier method was used to generate survival estimates. RESULTS Four hundred twenty-four patients were evaluable. Patients were treated with IV carboplatin, paclitaxel, and bev every 21 days (regimen 1), weekly IV paclitaxel with carboplatin and bev (regimen 2) or IV paclitaxel and bev with IP cisplatin (regimen 3). Bev was continued as maintenance in all arms. Within each of these regimens, veliparib was given either twice daily for the entirety of each cycle (continuous) or on days -2 to 5 (intermittent). Ten percent of patients treated on regimen 1, 12% on regimen 2, and 19.8% on regimen 3 had BRCA-associated tumors. Patients with BRCA-associated tumors, when compared to wild type, experienced similar rates of anemia, febrile neutropenia (, abdominal pain, colonic perforation, nausea, vomiting, and peripheral sensory neuropathy. Median progression free survival (PFS) was not significantly different between BRCA-associated and wild type cancers (HR 0.96, CI 0.65-1.42), though this study's primary aim was not to evaluate outcomes. CONCLUSIONS Germline BRCA mutations positively affect chemosensitivity in EOC, but whether differences in toxicities among BRCA-associated and BRCA wild type tumors existed was previously not reported. In this population with newly diagnosed ovarian cancer no differences in reported toxicity between the two groups was observed.
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Affiliation(s)
- Jessica Gillen
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, United States of America.
| | - Austin Miller
- NRG Oncology SDMC, CTD Division, Roswell Park Cancer Institute, Buffalo, NY, United States of America.
| | - Katherine M Bell-McGuinn
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States of America.
| | - Russell J Schilder
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America.
| | - Joan L Walker
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, United States of America.
| | - Cara A Mathews
- Women and Infants Hospital of Rhode Island, Providence, RI, United States of America.
| | - Linda R Duska
- University of Virginia School of Medicine, Charlottesville, VA, United States of America.
| | | | - Roisin O'Cearbhaill
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States of America.
| | - John Hays
- The Ohio State University, Columbus, OH, United States of America.
| | | | - Heidi J Gray
- University of Washington, Seattle, WA, United States of America.
| | - Sarah W Gordon
- Virginia Commonwealth University, Richmond, VA, United States of America.
| | | | - Alice Chen
- Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, MD, United States of America.
| | - Paula M Fracasso
- University of Virginia School of Medicine, Charlottesville, VA, United States of America.
| | - Carol Aghajanian
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States of America.
| | - Kathleen N Moore
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, United States of America.
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10
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Huh WK, Brady WE, Fracasso PM, Dizon DS, Powell MA, Monk BJ, Leath CA, Landrum LM, Tanner EJ, Crane EK, Ueda S, McHale MT, Aghajanian C. Phase II study of axalimogene filolisbac (ADXS-HPV) for platinum-refractory cervical carcinoma: An NRG oncology/gynecologic oncology group study. Gynecol Oncol 2020; 158:562-569. [PMID: 32641240 DOI: 10.1016/j.ygyno.2020.06.493] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Women with persistent, recurrent, and/or metastatic cervical cancer have a poor prognosis. Even with the availability of cisplatin plus paclitaxel and bevacizumab, median overall survival (OS) is only 17.0 months, with median post-progression survival of approximately seven months. We studied the therapeutic vaccine, Axalimogene filolisbac (ADXS-HPV), in women who had progressed following at least one prior line of therapy (Gynecologic Oncology Group protocol 265/NCT01266460). METHODS Volunteers ≥18 years with advanced cervical cancer and GOG performance status score of 0 or 1 were eligible for participation in this 2-stage, phase II trial. In stage 1, women received up to three doses of ADXS-HPV (1 × 109 colony-forming units in 250 mL IV over 15 min every 28 days) and were monitored for tumor progression. In stage 2, women were treated until progression, intolerable adverse events (AEs), or voluntary withdrawal of consent. Co-primary endpoints were safety and proportion of volunteers surviving ≥12 months. An estimated, combined (stages 1 + 2) 12-month OS of 35% was calculated from historical GOG cohorts to declare ADXS-HPV sufficiently active in this platinum-pre-treated population. Secondary endpoints were OS and progression-free survival (PFS). RESULTS Among 50 evaluable volunteers, the 12-month OS was 38% (n = 19). Median OS was 6.1 months (95% CI: 4.3-12.1) and median PFS was 2.8 months (95% CI: 2.6-3.0). The most common treatment-related AEs were fatigue, chills, fever, nausea, and anemia. The majority of AEs were grade 1 or 2 and resolved spontaneously or with appropriate treatment. CONCLUSION At the dose and schedule studied, ADXS-HPV immunotherapy was tolerable and met the protocol-specified benchmark for activity required to warrant further investigation in volunteers with cervical carcinoma.
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Affiliation(s)
- Warner K Huh
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL 35249, United States of America.
| | - William E Brady
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park, Buffalo, NY 14263, United States of America
| | - Paula M Fracasso
- Department of Medicine, University of Virginia, UVA Cancer Center, Charlottesville, VA 22908, United States of America.
| | - Don S Dizon
- Division of Hematology-Oncology, Lifespan Cancer Institute, Rhode Island Hospital, Department of Medicine, Alpert Medical School of Brown University, Providence, RI 02903, United States of America
| | - Matthew A Powell
- Washington University School of Medicine, Saint Louis, MO 63110, United States of America.
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St. Joseph Hospital, Phoenix, AZ 85016, United States of America.
| | - Charles A Leath
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL 35249, United States of America.
| | - Lisa M Landrum
- Oklahoma University Health Science Center, OB/GYN, Oklahoma City, OK 73104, United States of America.
| | - Edward J Tanner
- Johns Hopkins Medical Institutions, Baltimore, MD 21287, United States of America.
| | - Erin K Crane
- Department of Gynecologic Oncology, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC 28203, United States of America.
| | - Stefanie Ueda
- University of California, San Francisco, OB/GYN & Reproductive Sciences, Division of Gyn Onc., San Francisco, CA 94115, United States of America.
| | - Michael T McHale
- Moores UCSD Cancer Center, La Jolla, CA 92093, United States of America.
| | - Carol Aghajanian
- Memorial Sloan-Kettering Cancer Center, Dept. of Medical Oncology, New York, NY 10021, United States of America.
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11
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Hong DS, Van Tine BA, Olszanski AJ, Johnson ML, Liebner DA, Trivedi T, Lin Q, Elefant E, Dryer-Minnerly R, Navenot JM, Williams D, Ramachandran IR, Fracasso PM, Norry E, Butler MO. Phase I dose escalation and expansion trial to assess the safety and efficacy of ADP-A2M4 SPEAR T cells in advanced solid tumors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.102] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
102 Background: MAGE-A4 is a cancer/testis antigen with expression in many solid tumors promoting cell growth by preventing cell cycle arrest and apoptosis. This study (NCT03132922) evaluated safety and efficacy of SPEAR T-cells directed against the MAGE-A4 peptide expressed in 9 tumor types. Methods: This Phase I dose-escalation, expansion trial evaluated patients (pt) who were HLA-A*02 positive with advanced cancers that expressed the MAGE-A4 protein. Autologous T-cells from eligible patients were isolated, transduced with a lentiviral vector containing the MAGE-A4c1032 TCR, and expanded. Prior to ADP-A2M4 infusion, pts received a lymphodepletion regimen of cyclophosphamide and fludarabine. Cohorts 1, 2, 3, and expansion were to receive transduced cell doses of up to: 0.12 × 109, 1.2 × 109, 6 × 109, and 10 x 109, respectively. Results: As of 23 October 2019, 9 pts were treated in dose escalation with no DLTs; 25 pts were treated in expansion. Median age was 56.5 yr (range: 31-78). All pts received prior chemotherapy. Most common ( > 30%) AEs ≥Grade 3 were lymphopenia, leukopenia, neutropenia, anemia, thrombocytopenia, and febrile neutropenia. Two pts had trial-related deaths (aplastic anemia and CVA) leading to modification of the lymphodepletion regimen and eligibility criteria. In Cohort 3/expansion (28 pts), Best Overall Response was PR (7), SD (11), PD (5), non-evaluable (5). All PRs, at the time of data cut-off, were in patients with synovial sarcoma. Transduced T-cells were detectable in all patients. Tumor infiltration of SPEAR T-cells was detectable in several cohort 3/expansion pts. Conclusions: The Phase I single agent ADP-A2M4 trial will complete enrollment shortly and updated data will be presented. ADP-A2M4 shows promising efficacy and a manageable safety profile at a dose range of 1.2 – 10 × 109. Clinical activity in various tumors has led to a separate on-going low dose radiation sub-study of this trial, a Phase II trial in sarcoma (SPEARHEAD-1, NCT04044768), and a Phase I trial (SURPASS, NCT04044859) with ADP-A2M4CD8, a next-generation SPEAR T-cell targeting MAGE-A4. Clinical trial information: NCT03132922.
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Affiliation(s)
| | - Brian A. Van Tine
- Division of Medical Oncology, Washington University School of Medicine, Saint Louis, MO
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12
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Mayadev JS, Enserro D, Lin YG, Da Silva DM, Lankes HA, Aghajanian C, Ghamande S, Moore KN, Kennedy VA, Fracasso PM, Schilder RJ. Sequential Ipilimumab After Chemoradiotherapy in Curative-Intent Treatment of Patients With Node-Positive Cervical Cancer. JAMA Oncol 2020; 6:92-99. [PMID: 31774464 DOI: 10.1001/jamaoncol.2019.3857] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Despite standard chemoradiotherapy (CRT), most women with lymph node (LN)-positive cervical cancer experience disease recurrence. Immunotherapy is being investigated in the up-front treatment setting. Objectives To assess the safety of sequential immunotherapy after CRT and to investigate human papillomavirus (HPV) genotype and HLA allele status on survival and programmed cell death 1 (PD-1) expression before and after CRT and sequential immunotherapy. Design, Setting, and Participants This prospective phase 1 trial conducted in 29 Gynecology Oncology Cooperative Group member institutions enrolled participants from December 18, 2012, to August 31, 2016, with a 14.8-month median follow-up and translational end points. Thirty-four women with International Federation of Gynecology and Obstetrics stage IB2 to IVA cervical cancer with positive pelvic LNs, para-aortic LNs, or both were enrolled; 13 did not receive ipilimumab and were excluded from the analysis. Data were analyzed from January 21 to April 4, 2018. Interventions Treatment consisted of 6 weekly doses of cisplatin, 40 mg/m2, concurrent with radiotherapy. After completion of chemotherapy, sequential ipilimumab was given every 21 days for 4 doses. Two dosage levels of ipilimumab, 3 mg/kg and 10 mg/kg, were studied to identify the maximum tolerated dose. Main Outcomes and Measures The primary end point was safety, and the secondary end points were overall survival and progression-free survival. Exploratory end points included HPV genotype, HLA allele status, and PD-1 expression measured in peripheral blood. Results The median age of the 32 participants included in the intent-to-treat analysis was 50 (range, 26-61) years, and 22 patients (69%) were white. Of the 21 patients who received ipilimumab, all had positive pelvic LN, and 6 (29%) had positive para-aortic LNs. All patients completed CRT, and of the 21 patients who received at least 2 cycles of ipilimumab, 18 (86%) completed 4 cycles of ipilimumab, and 3 (14%) completed 2 cycles. The maximum tolerated dose was 10 mg/kg. Two of the 21 patients (9.5%) who received ipilimumab had self-limiting grade 3 toxic effects (lipase increase; dermatitis). The 12-month overall survival was 90%, and progression-free survival was 81%. Human papillomavirus genotype and HLA subtype were not associated with progression-free survival or overall survival. T cells expressing PD-1 increased after CRT, and levels were sustained with ipilimumab. Conclusions and Relevance This study's findings suggest that the use of immunotherapy after CRT for curative-intent treatment of patients with cervical cancer is tolerable and effective. The results indicated that PD-1 was upregulated after CRT and sustained with sequential ipilimumab therapy. These immune findings may help guide future therapies to harness the activated T-cell phenotype in patients with node-positive cervical cancer.
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Affiliation(s)
- Jyoti S Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, Medical Center, La Jolla
| | - Danielle Enserro
- NRG Oncology, Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Yvonne G Lin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles
| | - Diane M Da Silva
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles
| | - Heather A Lankes
- Biopathology Center, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Carol Aghajanian
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sharad Ghamande
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Augusta University Medical Center, Augusta, Georgia
| | - Kathleen N Moore
- Department of Obstetrics and Gynecology, Oklahoma University Health Science Center, Oklahoma City
| | - Vanessa A Kennedy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Davis Comprehensive Cancer Center, Sacramento
| | - Paula M Fracasso
- Department of Medicine, UVA Cancer Center, University of Virginia, Charlottesville
| | - Russell J Schilder
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
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13
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Moore KN, Miller A, Bell-McGuinn KM, Schilder RJ, Walker JL, O'Cearbhaill RE, Guntupalli SR, Armstrong DK, Hagemann AR, Gray HJ, Duska LR, Mathews CA, Chen A, O'Malley D, Gordon S, Fracasso PM, Aghajanian C. A phase I study of intravenous or intraperitoneal platinum based chemotherapy in combination with veliparib and bevacizumab in newly diagnosed ovarian, primary peritoneal and fallopian tube cancer. Gynecol Oncol 2020; 156:13-22. [PMID: 31708167 PMCID: PMC7048389 DOI: 10.1016/j.ygyno.2019.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Improvements in disease free survival for epithelial ovarian, peritoneal or fallopian tube cancer (EOC) will only come with improved primary therapy. Incorporation of poly-ADP-ribose inhibitors (PARPi) in the frontline setting may represent one strategy. This study sought to determine the maximum tolerated and feasible doses of the PARPi veliparib in combination with chemotherapy for EOC. METHODS A phase I, 3 + 3 dose escalation evaluated dose-limiting toxicities (DLTs) in cycles 1-2. Once <2/6 patients experienced a DLT, that dose level expanded to evaluate feasibility over 4 cycles. This study opened 10/2009 and closed 8/2016. Eligible patients had untreated, stage II-IV EOC. Veliparib was added either continuous (day 1-21) or intermittent (day - 2 to 5) during 6 cycles of chemotherapy. Three chemotherapy backbones were evaluated (2 intravenous (q3week and weekly) and 1 intraperitoneal (IP)) all inclusive of bevacizumab with and as maintenance to 22 cycles. FINDINGS Dose evaluations for 424 treated patients were available. Regimen 1 (q3 week), continuous (Reg1c) the maximum tolerated dose (MTD) was 250 mg veliparib BID and feasible dose was 150 mg BID. For regimen 1, intermittent (Reg1i) the MTD and feasible dose were 400 and 250 mg BID. For Reg2c (weekly paclitaxel) the MTD and feasible dose were 150 mg BID. For Reg2i the MTD and feasible dose were 250 and 150 mg BID. For Reg3c (IP) the MTD and feasible dose were 150 mg BID and for Reg3i (IP), the MTD and feasible dose were 400 mg and 300 mg BID. INTERPRETATION The feasible dose for Reg1c, 2c, 2i and 3c was 150 mg po BID. For Reg1i and 3i the dose was pushed to 250 and 300 mg po BID respectively. There is no apparent difference in efficacy between continuous and intermittent dosing indicating that the higher doses achieved in intermittent dosing may not be needed. (NCT00989651). FUNDING National Cancer Institute.
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Affiliation(s)
- Kathleen N Moore
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA.
| | - Austin Miller
- NRG Oncology Statistics & Data Management Center, Roswell Park Cancer Institute.
| | | | - Russell J Schilder
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Joan L Walker
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - Roisin E O'Cearbhaill
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA.
| | | | | | | | | | - Linda R Duska
- University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Cara A Mathews
- Women and Infants Hospital of Rhode Island, Providence, RI, USA.
| | - Alice Chen
- Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, MD, USA.
| | | | - Sarah Gordon
- Virginia Commonwealth University, Richmond, VA, USA.
| | - Paula M Fracasso
- University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Carol Aghajanian
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA.
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14
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Westin SN, Sill MW, Coleman RL, Waggoner S, Moore KN, Mathews CA, Martin LP, Modesitt SC, Lee S, Ju Z, Mills GB, Schilder RJ, Fracasso PM, Birrer MJ, Aghajanian C. Safety lead-in of the MEK inhibitor trametinib in combination with GSK2141795, an AKT inhibitor, in patients with recurrent endometrial cancer: An NRG Oncology/GOG study. Gynecol Oncol 2019; 155:420-428. [PMID: 31623857 DOI: 10.1016/j.ygyno.2019.09.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to determine safety and efficacy of the AKT inhibitor, GSK2141795, combined with the MEK inhibitor, trametinib, in endometrial cancer. METHODS Patients with measurable recurrent endometrial cancer were eligible. One to two prior cytotoxic regimens were allowed; prior use of a MEK or PI3K pathway inhibitor was excluded. Initial trial design consisted of a KRAS mutation stratified randomized phase II with a safety lead-in evaluating the combination. For the safety lead in, the previously recommended phase 2 dose (RP2D; trametinib 1.5 mg, GSK2141795 50 mg) was chosen for Dose Level 1 (DL1). RESULTS Of 26 enrolled patients, 14 were treated on DL1 and 12 were treated on DL-1 (trametinib 1.5 mg, GSK2141795 25 mg). Most common histologies were endometrioid (58%) and serous (27%). Four of 25 (16%) patients were KRAS mutant. Dose limiting toxicities (DLTs) were assessed during cycle 1. DL1 had 8 DLTs (hypertension (n = 2), mucositis (2), rash (2), dehydration, stroke/acute kidney injury). DL1 was deemed non-tolerable so DL-1 was explored. DL-1 had no DLTs. Sixty-five percent of patients had ≥ grade 3 toxicity. There were no responses in DL1 (0%, 90%CI 0-15%) and 1 response in DL-1 (8.3%, 90%CI 0.4-33.9%). Proportion PFS at 6 months for DL1 is 14%, and 25% for DL-1. CONCLUSION The combination of trametinib and GSK2141795 had high levels of toxicity in endometrial cancer at the previously RP2D but was tolerable at a reduced dose. Due to insufficient preliminary efficacy at a tolerable dose, the Phase II study was not initiated.
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Affiliation(s)
- Shannon N Westin
- Department of Gynecologic Oncology, University of Texas M. D Anderson Cancer Center, USA.
| | - Michael W Sill
- NRG Oncology Statistics and Data Management Center Buffalo Office, Roswell Park Cancer Institute, USA.
| | - Robert L Coleman
- Department of Gynecologic Oncology, University of Texas M. D Anderson Cancer Center, USA.
| | - Steven Waggoner
- Department of Gynecologic Oncology, Case Western Reserve University, USA.
| | - Kathleen N Moore
- Department of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, USA.
| | - Cara A Mathews
- Department of Gynecologic Oncology, Women & Infants Hospital, USA.
| | - Lainie P Martin
- Department of Hematology/Oncology, Fox Chase Cancer Center, USA.
| | - Susan C Modesitt
- Director of Gynecologic Oncology Division, University of Virginia, USA.
| | - Sanghoon Lee
- Department of Medicine and the UVA Cancer Center, University of Virginia, USA.
| | - Zhenlin Ju
- Department of Bioinformatics and Computational Biology, University of Texas M. D Anderson Cancer Center, USA.
| | - Gordon B Mills
- Department of Medicine and the UVA Cancer Center, University of Virginia, USA.
| | - Russell J Schilder
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, USA.
| | - Paula M Fracasso
- Department of Systems Biology, University of Texas M.D Anderson Cancer Center, USA.
| | | | - Carol Aghajanian
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, USA.
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Wang R, Gao C, Raymond M, Dito G, Kabbabe D, Shao X, Hilt E, Sun Y, Pak I, Gutierrez M, Melero I, Spreafico A, Carvajal RD, Ong M, Olszanski AJ, Milburn C, Thudium K, Yang Z, Feng Y, Fracasso PM, Korman AJ, Aanur P, Huang SMA, Quigley M. An Integrative Approach to Inform Optimal Administration of OX40 Agonist Antibodies in Patients with Advanced Solid Tumors. Clin Cancer Res 2019; 25:6709-6720. [PMID: 31573956 DOI: 10.1158/1078-0432.ccr-19-0526] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/29/2019] [Accepted: 08/09/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The success of checkpoint blockade has led to a significant increase in the development of a broad range of immunomodulatory molecules for the treatment of cancer, including agonists against T-cell costimulatory receptors, such as OX40. Unlike checkpoint blockade, where complete and sustained receptor saturation may be required for maximal activity, the optimal dosing regimen and receptor occupancy for agonist agents is less well understood and requires further study. EXPERIMENTAL DESIGN We integrated both preclinical and clinical biomarker data sets centered on dose, exposure, receptor occupancy, receptor engagement, and downstream pharmacodynamic changes to model the optimal dose and schedule for the OX40 agonist antibody BMS-986178 alone and in combination with checkpoint blockade. RESULTS Administration of the ligand-blocking anti-mouse surrogate antibody OX40.23 or BMS-986178 as monotherapy or in combination with checkpoint blockade led to increased peripheral CD4+ and CD8+ T-cell activation in tumor-bearing mice and patients with solid tumors, respectively. OX40 receptor occupancy between 20% and 50% both in vitro and in vivo was associated with maximal enhancement of T-cell effector function by anti-OX40 treatment, whereas a receptor occupancy > 40% led to a profound loss in OX40 receptor expression, with clear implications for availability for repeat dosing. CONCLUSIONS Our results highlight the value of an integrated translational approach applied during early clinical development to aggregate preclinical and clinical data in an effort to define the optimal dose and schedule for T-cell agonists in the clinic.
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Affiliation(s)
- Rui Wang
- Sanofi, Oncology Clinical Translational Medicine, Cambridge, Massachusetts
| | - Chan Gao
- Bristol-Myers Squibb, Discovery Oncology, Redwood City, California
| | - Megan Raymond
- Bristol-Myers Squibb, Discovery Oncology, Redwood City, California
| | | | | | - Xiao Shao
- Bristol-Myers Squibb, Princeton, New Jersey
| | - Ed Hilt
- Bristol-Myers Squibb, Princeton, New Jersey
| | | | - Irene Pak
- Bristol-Myers Squibb, Princeton, New Jersey
| | - Martin Gutierrez
- Divisions of Thoracic Oncology and Gastrointestinal Oncology, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Ignacio Melero
- Immunology and Immunotherapy Service, Center for Applied Medical Research, Clinica Universidad de Navarra, Pamplona, Spain
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Drug Development Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Richard D Carvajal
- Department of Medicine, Division of Hematology/Oncology, Columbia University Medical Center, New York, New York
| | - Michael Ong
- Department of Medicine, Division of Medical Oncology, University of Ottawa, Ottawa, Ontario, Canada
| | - Anthony J Olszanski
- Department of Hematology/Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania
| | | | | | - Zheng Yang
- Bristol-Myers Squibb, Princeton, New Jersey
| | - Yan Feng
- Bristol-Myers Squibb, Princeton, New Jersey
| | | | - Alan J Korman
- Bristol-Myers Squibb, Discovery Oncology, Redwood City, California
| | | | | | - Michael Quigley
- Bristol-Myers Squibb, Discovery Oncology, Redwood City, California.
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Armstrong DK, Moore KN, Miller A, Bell-McGuinn KM, Schilder RJ, Fracasso PM, Walker JL, Duska LR, Mathews CA, Chen AP, O'Malley DM, Gray HJ, O'Cearbhaill RE, Guntupalli SR, Hagemann AR, Aghajanian C. A phase I study of veliparib incorporated into front-line platinum based cheotherpy and bevacizumab in epithelial ovarian cancer (NCT00989651): A GOG/nrg trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5523] [Citation(s) in RCA: 5] [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
5523 Background: Veliparib, a poly-(ADP-ribose)-polymerase inhibitor, increases anti-tumor activity when combined with platinum chemotherapy and has monotherapy activity in BRCA deficient tumors. This study was done to determine the recommended phase II dose (RP2D) of veliparib in combination with front line treatment for epithelial ovarian cancer (EOC). Methods: Eligible patients had newly diagnosed, stage II-IV EOC. Six regimens were evaluated, 3 variations of chemo delivery with either continuous (D1-21) or intermittent (days-2-5) veliparib BID. Chemo included 1: IV q3week carboplatin (C) (AUC 6) and paclitaxel(T) (175mg/m2); 2, IV q3week C (AUC 6) and weekly T(80mg/m2); and 3, IV T (135mg/m2, day 1), IP cisplatin (75mg/m2, day 1 or 2) and IP T (60mg/m2, day 8). Bevacizumab 15mg/kg started cycle 2 and continued as monotherapy cycles 7-22. A 3+3 dose escalation design evaluated dose-limiting toxicities (DLTs) in cycles 1 and 2. Once < 2/6 patients experienced a DLT, that dose level was expanded to evaluate feasibility over 4 cycles. Results: The study accrued 424 treated patients. For regimen 1, continuous (Reg1c) the maximum tolerated dose (MTD) was 250mg veliparib BID but the feasible dose was found to be 150mg BID. For regimen 1, intermittent (Reg1i) the MTD and feasible dose were 400 and 250mg BID respectively. For Reg2c the MTD and feasible dose were the same at 150mg BID. For Reg2i the MTD and feasible dose were 250 and 150mg BID respectively. For Reg3c the MTD and feasible dose are both 150mg BID and for Reg3i, the MTD was 400mg BID and the feasible dose felt to be 300mg BID. Median PFS by residual disease and BRCA status is: (Positive residual disease) 14.6, 19.1 and 16.9 months for BRCA+, BRCAwt and BRCA ukn respectively. For no gross residual disease the PFS is NR, 34.2 and 24.5 months respectively. Conclusions: Given the difficulty with toxicity not defined as a DLT, the RP2D for all regimens is veliparib 150mg BID. This data informed the dose that moved into the phase III trial GOG 3005/Velia: NCT02470585. Velia also incorporated maintenance veliparib instead of maintenance bevacizumab among all high grade serous patients (BRCA+ and wt). These results will determine utilization of veliparib in this space. Clinical trial information: NCT00989651.
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Affiliation(s)
- Deborah Kay Armstrong
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Kathleen N. Moore
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK
| | - Austin Miller
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | | | - Joan L. Walker
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | - Alice P. Chen
- Developmental Therapeutics Clinic/Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Heidi J. Gray
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | | | - Andrea R. Hagemann
- Washington University School of Medicine in St. Louis and Siteman Cancer Center, St. Louis, MO
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Simonsen KL, Fracasso PM, Bernstein SH, Wind-Rotolo M, Gupta M, Comprelli A, Reilly TP, Cassidy J. The Fast Real-time Assessment of Combination Therapies in Immuno-ONcology (FRACTION) program: innovative, high-throughput clinical screening of immunotherapies. Eur J Cancer 2018; 103:259-266. [PMID: 30292142 DOI: 10.1016/j.ejca.2018.07.127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/06/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The unprecedented success of immuno-oncology (I-O) agents targeting the cytotoxic T lymphocyte-associated antigen 4 and programmed death-1/programmed death-ligand 1 pathways has stimulated the rapid development of other I-O agents against novel immune targets. Bristol-Myers Squibb has designed a novel phase II platform trial, the Fast Real-time Assessment of Combination Therapies in Immuno-ONcology (FRACTION) Program, to efficiently identify promising combinations for patients with specific malignancies. The concept and study design of the FRACTION Program-currently ongoing in patients with advanced non-small-cell lung cancer (FRACTION-Lung), gastric cancer (FRACTION-Gastric Cancer) and renal cell carcinoma (FRACTION-RCC)-are described. METHODS The FRACTION Program comprises open-label, phase II studies that use adaptive randomisation designs with rolling combination regimens. Master Protocols provide the overall study design framework, whereas Sub-Protocols introduced over time provide details on specific I-O combination therapies to which patients may be randomised. In a Master Protocol, patients are enrolled into different Study Tracks based on characteristics such as prior I-O therapy experience. Patients who progress may be rerandomised to other combination regimens from any ongoing Sub-Protocol. Primary objectives are to assess objective response rate, median duration of response and progression-free survival rate at 24 weeks; the secondary objective is to investigate safety and tolerability. Biomarker collection before and on treatment will facilitate identification of patient subsets who benefit most from each therapy. CONCLUSIONS The FRACTION Program allows for the evaluation of multiple I-O combinations through individual studies for specific tumours using an adaptive trial design and continuous enrolment.
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Affiliation(s)
- Katy L Simonsen
- Global Biometric Sciences - Oncology, Bristol-Myers Squibb, Princeton, NJ, USA.
| | | | | | | | - Manish Gupta
- Clinical Pharmacology and Pharmacometrics - Oncology, Bristol-Myers Squibb, Princeton, NJ, USA.
| | - Adriana Comprelli
- Oncology Clinical Operations Strategy, Bristol-Myers Squibb, Princeton, NJ, USA.
| | | | - Jim Cassidy
- Exploratory Clinical and Translational Research - Early Oncology Development, Bristol-Myers Squibb, Princeton, NJ, USA.
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Boardman CH, Brady WE, Dizon DS, Kunos CA, Moore KN, Zanotti KM, Matthews C, Cosin JA, Aghajanian C, Fracasso PM. A Phase I Evaluation of Extended Field Radiation Therapy With Concomitant Cisplatin Chemotherapy Followed by Paclitaxel and Carboplatin Chemotherapy in Women With Cervical Carcinoma Metastatic to the Para-aortic Lymph Nodes: An NRG Oncology/Gynecologic Oncology Group Study. Gynecol Oncol 2018; 151:202-207. [PMID: 30174176 DOI: 10.1016/j.ygyno.2018.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Chemo-radiation (chemoRT) has improved the overall survival for locally advanced cervical cancer (LACC) though women whose disease involves the para-aortic nodes (PAN) experience recurrence rates and worse survival outcomes compared to those without PAN involvement. This Phase I study determined if additional cycles of systemic chemotherapy could be safely added to extended field chemoRT in this population of patients. METHODS Women with LACC and documented positive PAN were eligible for treatment. All women were treated with extended field radiation and brachytherapy and concurrent cisplatin 40 mg/m2 weekly for six weeks. Four to six weeks after completion of chemoRT, patients were treated with four cycles of paclitaxel 135 mg/m2 and escalating doses of carboplatin (Dose Level (DL) 1 = AUC 4, DL2 = AUC 5). RESULTS Eleven women were entered on study and 9 were evaluable for dose limiting toxicities (DLT). Two women (1 in each of 2 DLs) did not complete chemoRT and so were not evaluable for DLT. Three women completed all 10 cycles at DL 1 with no DLTs. Six women were then treated at DL 2. For the 10 patients evaluable for response, the ORR was 60% (CR + PR). PFS and OS at 12 months were 60% and 90%, respectively. The predominant grade 3 or 4 acute toxicities were hematologic. There were no grade 5 events. CONCLUSION Extended field chemoRT followed by paclitaxel 135 mg/m2 and carboplatin AUC 5 is feasible in women with LACC and positive PAN.
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Affiliation(s)
- Cecelia H Boardman
- VCU Health System, Gynecologic Oncology, HCA Henrico Doctors Hospital, Virginia Gynecologic Oncology, Richmond, VA 23229, USA.
| | - William E Brady
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute Buffalo, NY 14263, USA.
| | - Don S Dizon
- Massachusetts General Hospital Cancer Center, USA.
| | - Charles A Kunos
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD 20892, USA.
| | | | | | - Cara Matthews
- Women & Infants Hospital, Providence, RI 02905, USA.
| | | | | | - Paula M Fracasso
- Department of Medicine and the UVA Cancer Center, University of Virginia, Charlottesville, VA, USA.
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Thaker PH, Salani R, Brady WE, Lankes HA, Cohn DE, Mutch DG, Mannel RS, Bell-McGuinn KM, Di Silvestro PA, Jelovac D, Carter JS, Duan W, Resnick KE, Dizon DS, Aghajanian C, Fracasso PM. A phase I trial of paclitaxel, cisplatin, and veliparib in the treatment of persistent or recurrent carcinoma of the cervix: an NRG Oncology Study (NCT#01281852). Ann Oncol 2017; 28:505-511. [PMID: 27998970 DOI: 10.1093/annonc/mdw635] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Preclinical studies demonstrate poly(ADP-ribose) polymerase (PARP) inhibition augments apoptotic response and sensitizes cervical cancer cells to the effects of cisplatin. Given the use of cisplatin and paclitaxel as first-line treatment for persistent or recurrent cervical cancer, we aimed to estimate the maximum tolerated dose (MTD) of the PARP inhibitor veliparib when added to chemotherapy. Patients and methods Women with persistent or recurrent cervical carcinoma not amenable to curative therapy were enrolled. Patients had to have received concurrent chemotherapy and radiation as well as possible consolidation chemotherapy; have adequate organ function. The trial utilized a standard 3 + 3 phase I dose escalation with patients receiving paclitaxel 175 mg/m2 on day 1, cisplatin 50 mg/m2 on day 2, and escalating doses of veliparib ranging from 50 to 400 mg orally two times daily on days 1-7. Cycles occurred every 21 days until progression. Dose-limiting toxicities (DLTs) were assessed at first cycle. Fanconi anemia complementation group D2 (FANCD2) foci was evaluated in tissue specimens as a biomarker of response. Results Thirty-four patients received treatment. DLTs (n = 1) were a grade 4 dyspnea, a grade 3 neutropenia lasting ≥3 weeks, and febrile neutropenia. At 400 mg dose level (DL), one of the six patients had a DLT, so the MTD was not reached. Across DLs, the objective response rate (RR) for 29 patients with measurable disease was 34% [95% confidence interval (CI), 20%-53%]; at 400 mg DL, the RR was 60% (n = 3/5; 95% CI, 23%-88%). Median progression-free survival was 6.2 months (95% CI, 2.9-10.1), and overall survival was 14.5 months (95% CI, 8.2-19.4). FANCD2 foci was negative or heterogeneous in 31% of patients and present in 69%. Objective RR were not associated with FANCD2 foci (P = 0.53). Conclusions Combining veliparib with paclitaxel and cisplatin as first-line treatment for persistent or recurrent cervical cancer patients is safe and feasible. Clinical trial information NCT01281852.
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Affiliation(s)
- P H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Siteman Cancer Center, Washington University School of Medicine, St. Louis
| | - R Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University School of Medicine, Columbus, USA
| | - W E Brady
- NRG/Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, USA
| | - H A Lankes
- NRG/Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, USA
| | - D E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University School of Medicine, Columbus, USA
| | - D G Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Siteman Cancer Center, Washington University School of Medicine, St. Louis
| | - R S Mannel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, USA
| | - K M Bell-McGuinn
- Department of Medicine, Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - P A Di Silvestro
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, USA
| | - D Jelovac
- Division of Medical Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA
| | - J S Carter
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, USA
| | - W Duan
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - K E Resnick
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Cleveland, USA
| | - D S Dizon
- Division of Medical Gynecologic Oncology, Massachusetts General Hospital Cancer Center, Boston, USA
| | - C Aghajanian
- Department of Medicine, Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - P M Fracasso
- Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, USA
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Thaker PH, Brady WE, Lankes HA, Odunsi K, Bradley WH, Moore KN, Muller CY, Anwer K, Schilder RJ, Alvarez RD, Fracasso PM. A phase I trial of intraperitoneal GEN-1, an IL-12 plasmid formulated with PEG-PEI-cholesterol lipopolymer, administered with pegylated liposomal doxorubicin in patients with recurrent or persistent epithelial ovarian, fallopian tube or primary peritoneal cancers: An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2017; 147:283-290. [PMID: 28802766 DOI: 10.1016/j.ygyno.2017.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The study's purpose was to assess safety and efficacy of escalating doses of weekly GEN-1 with pegylated liposomal doxorubicin (PLD) in patients with recurrent or persistent epithelial ovarian, fallopian tube or primary peritoneal cancers (EOC). METHODS Patients had persistent or recurrent platinum-resistant EOC. The trial was a standard 3+3 phase I dose escalation design with patients receiving intravenous PLD 40mg/m2 (dose level 1 and 2) or 50mg/m2 (dose level 3) every 28days and intraperitoneal GEN-1 at 24mg/m2 (dose level 1) or 36mg/m2 (dose level 2 and 3) on days 1, 8, 15, and 22 of a 28day cycle. Cycles were repeated every 28days until disease progression. Patients were monitored for toxicity, clinical efficacy, and evidence of systemic and intraperitoneal immunologic effect. RESULTS Sixteen evaluable patients received a median of 4cycles (range 1-8). No dose limiting toxicities were found. The adverse side effects were 4 grade 3 anemia, 2 grade 3 abdominal pain, 7 grade 3 neutropenia, and 2 grade 4 neutropenia. A clinical benefit of 57.1% (PR=21.4%; SD=35.7%) was found in the 14 patients with measurable disease. The highest number of partial responses (28.6%) and stable disease (57.1%) were found at dose level 3. The maximum tolerated dose was not reached. Increases in IL-12, IFN-γ, and TNF-α levels were found in peritoneal fluid following GEN-1 treatment. CONCLUSIONS GEN-1 in combination with PLD has encouraging clinical benefit and biological activity in recurrent or persistent EOC and warrants further investigation with escalating doses of GEN-1.
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Affiliation(s)
- Premal H Thaker
- Division of Gynecologic Oncology, Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO, USA.
| | - William E Brady
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA.
| | - Heather A Lankes
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA.
| | - Kunle Odunsi
- Department of Gynecology, Roswell Park Cancer Institute, Buffalo, NY, USA.
| | - William H Bradley
- Division of Gynecologic Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Kathleen N Moore
- Division of Gynecologic Oncology, University of Oklahoma and Stephenson Cancer Center, Oklahoma City, OK, USA.
| | | | | | - Russell J Schilder
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Ronald D Alvarez
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Paula M Fracasso
- Department of Medicine and the UVA Cancer Center, University of Virginia, Charlottesville, VA, USA.
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Dillon PM, Petroni GR, Horton BJ, Moskaluk CA, Fracasso PM, Douvas MG, Varhegyi N, Zaja-Milatovic S, Thomas CY. A Phase II Study of Dovitinib in Patients with Recurrent or Metastatic Adenoid Cystic Carcinoma. Clin Cancer Res 2017; 23:4138-4145. [PMID: 28377480 PMCID: PMC5540767 DOI: 10.1158/1078-0432.ccr-16-2942] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/28/2016] [Accepted: 03/30/2017] [Indexed: 12/20/2022]
Abstract
Purpose: Genetic and preclinical studies have implicated FGFR signaling in the pathogenesis of adenoid cystic carcinoma (ACC). Dovitinib, a suppressor of FGFR activity, may be active in ACC.Experimental Design: In a two-stage phase II study, 35 patients with progressive ACC were treated with dovitinib 500 mg orally for 5 of 7 days continuously. The primary endpoints were objective response rate and change in tumor growth rate. Progression-free survival, overall survival, metabolic response, biomarker, and quality of life were secondary endpoints.Results: Of 34 evaluable patients, 2 (6%) had a partial response and 22 (65%) had stable disease >4 months. Median PFS was 8.2 months and OS was 20.6 months. The slope of the overall TGR fell from 1.95 to 0.63 on treatment (P < 0.001). Toxicity was moderate; 63% of patients developed grade 3-4 toxicity, 94% required dose modifications, and 21% stopped treatment early. An early metabolic response based on 18FDG-PET scans was seen in 3 of 15 patients but did not correlate with RECIST response. MYB gene translocation was observed and significantly correlated with overexpression of MYB but did not correlate with FGFR1 phosphorylation or clinical response to dovitinib.Conclusions: Dovitinib produced few objective responses in patients with ACC but did suppress the TGR with a PFS that compares favorably with those reported with other targeted agents. Future studies of more potent and selective FGFR inhibitors in biomarker-selected patients will be required to determine whether FGFR signaling is a valid therapeutic target in ACC. Clin Cancer Res; 23(15); 4138-45. ©2017 AACR.
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Affiliation(s)
- Patrick M Dillon
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia.
| | - Gina R Petroni
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
| | - Bethany J Horton
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
| | | | - Paula M Fracasso
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
| | - Michael G Douvas
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
| | - Nikole Varhegyi
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
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22
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Mayadev J, Brady WE, Lin YG, Da Silva DM, Lankes HA, Fracasso PM, Ghamande SA, Moore KN, Pham HQ, Wilkinson KJ, Kennedy VA, Aghajanian C, Koh WJ, Monk BJ, Schilder RJ. A phase I study of sequential ipilimumab in the definitive treatment of node positive cervical cancer: GOG 9929. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5526] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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
5526 Background: The outcome of lymph node positive (LN) cervical cancer (CC) with chemoradiation (CRT) is dismal, especially with involved para-aortic nodes (PAN). The anti-CTLA-4 immune checkpoint inhibitor ipilimumab (ipi) holds promise. We report the safety, tolerability, and efficacy in this GOG phase I study examining sequential ipi after CRT for CC. Methods: Patients (pts) with LN CC were treated with 6 weekly doses of cisplatin (40 mg/m2) and extended field radiation (RT). 2-6 weeks after RT, if there was no progression of disease, sequential ipi was given at the following dose levels: dose level 1: 3mg/kg, level 2: 10mg/kg, and an expansion cohort of 10mg/kg. The primary endpoints (endpts) were the maximum tolerated dose (MTD), and dose-limiting toxicities (DLT) of adjuvant ipi. Secondary endpt included the 1-yr disease free survival (DFS). Translational endpts included the effect of CRT on enumeration and subsets of T-cells, and CTLA4, PD-1 and ICOS expression. Results: 34 pts were enrolled, and 19 pts are evaluable for the endpts: 14 pts went off study to reasons unrelated to the study drug, 1 pt continues in her DLT evaluable period. Of the evaluable pts, all had pelvic LN, with 25% PAN. All pts completed CRT, 90% had 4 cycles of ipi, and the other 10% had 2 cycles of ipi. The ipi MTD was 10 mg/kg. There were 3 pts (16%) with acute grade 3 toxicity (lipase, ↓ANC, rash) which self-resolved. Most of the acute toxicities were grade 1-2 GI distress, rash, endocrinopathies. There were no minor or major RT quality deviations. With a median follow up of 12 months, there were no major late toxicities reported, with a 1-year DFS of 74%. There was no difference in CD4+- and CD8+- T cell levels nor CTLA-4 expression with sequential ipi. CRT itself increased ICOS and PD-1 expression. Conclusions: This study is the first to describe the safety of immunotherapy sequencing with definitive CRT in CC. Our data suggests that immunotherapy is tolerable and shows possible activity in this population with a historical dismal prognosis with standard therapy. CRT increased ICOS and PD-1 expression which was sustained with ipi, illustrative of immune modulation targets for future clinical trials and radioimmunotherapy combinations. Clinical trial information: NCT01711515.
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Affiliation(s)
| | | | - Yvonne Gail Lin
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | - Diane M Da Silva
- Department of Molecular Microbiology and Immunology, University of Southern California, Los Angeles, CA
| | | | | | | | | | - Huyen Q. Pham
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | | | | | - Carol Aghajanian
- Memorial Sloan-Kettering Cancer Center and Weil Cornell Medical College, New York, NY
| | | | - Bradley J. Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St. Joseph's Hospital, Phoenix, AZ
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23
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Aanur P, Gutierrez M, Kelly RJ, Ajani JA, Ku GY, Denlinger CS, George TJ, Wind-Rotolo M, Guan X, Gupta M, Reilly TP, Fracasso PM. FRACTION (Fast Real-time Assessment of Combination Therapies in Immuno-Oncology)-gastric cancer (GC): A randomized, open-label, adaptive, phase 2 study of nivolumab in combination with other immuno-oncology (IO) agents in patients with advanced GC. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps4137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4137 Background: Nivolumab, a fully human IgG4 mAb that targets programmed death-1, alone and in combination with ipilimumab, a fully human IgG1 mAb that targets cytotoxic T-lymphocyte antigen 4, has demonstrated encouraging clinical activity in patients with advanced GC. These data support the rationale that nivolumab in combination with other IO agents or targeted therapies may improve treatment outcomes in patients with advanced GC. Given the rapid development of novel IO agents, traditional studies cannot efficiently evaluate all possible IO-IO and IO-targeted therapy combinations. FRACTION is an innovative clinical trial program with a rolling, adaptive platform design that allows for the addition of new combination regimens, as well as withdrawal of ineffective regimens. Here we describe the study concept, key design components, and the first IO treatment combinations of FRACTION-GC, a phase 2, randomized, open-label, adaptive study in advanced GC (NCT02935634). Methods: Patients with advanced GC or gastroesophageal junction (GEJ) cancer will be enrolled based on prior IO treatment and randomized to receive nivolumab plus BMS-986016 (fully human IgG4 mAb that targets lymphocyte activation gene 3) or nivolumab plus ipilimumab. Enrollment is continuous and may offer patients consecutive treatment options based on their treatment exposure and response. The primary endpoints are objective response rate, duration of response, and progression-free survival rate at 24 weeks. The secondary endpoint is safety. Comprehensive biomarker analyses will also be performed. New treatment combinations will be added over time to explore their potential benefits and to provide a continuous flow of treatment options for patients whose cancer progresses on existing treatments. In this way, FRACTION-GC is envisioned to accelerate the development of the next generation of IO combinations for patients with metastatic GC and GEJ cancer. Clinical trial information: NCT02935634.
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Affiliation(s)
| | - Martin Gutierrez
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Ronan Joseph Kelly
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Jaffer A. Ajani
- The University of Texas MD Anderson Cancer Center, Houston, TX
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24
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Monk BJ, Facciabene A, Brady WE, Aghajanian CA, Fracasso PM, Walker JL, Lankes HA, Manjarrez KL, Danet-Desnoyers GÄH, Bell-McGuinn KM, McCourt CK, Malykhin A, Hershberg RM, Coukos G. Integrative Development of a TLR8 Agonist for Ovarian Cancer Chemoimmunotherapy. Clin Cancer Res 2016; 23:1955-1966. [PMID: 27702821 DOI: 10.1158/1078-0432.ccr-16-1453] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/19/2016] [Accepted: 09/08/2016] [Indexed: 01/04/2023]
Abstract
Purpose: Immunotherapy is an emerging paradigm for the treatment of cancer, but the potential efficacy of many drugs cannot be sufficiently tested in the mouse. We sought to develop a rational combination of motolimod-a novel Toll-like receptor 8 (TLR8) agonist that stimulates robust innate immune responses in humans but diminished responses in mice-with pegylated liposomal doxorubicin (PLD), a chemotherapeutic that induces immunogenic cell death.Experimental Design: We followed an integrative pharmacologic approach including healthy human volunteers, non-human primates, NSG-HIS ("humanized immune system") mice reconstituted with human CD34+ cells, and patients with cancer to test the effects of motolimod and to assess the combination of motolimod with PLD for the treatment of ovarian cancer.Results: The pharmacodynamic effects of motolimod monotherapy in NSG-HIS mice closely mimicked those in non-human primates and healthy human subjects, whereas the effects of the motolimod/PLD combination in tumor-bearing NSG-HIS mice closely mimicked those in patients with ovarian cancer treated in a phase Ib trial (NCT01294293). The NSG-HIS mouse helped elucidate the mechanism of action of the combination and revealed a positive interaction between the two drugs in vivo The combination produced no dose-limiting toxicities in patients with ovarian cancer. Two subjects (15%) had complete responses and 7 subjects (53%) had disease stabilization. A phase II study was consequently initiated.Conclusions: These results are the first to demonstrate the value of pharmacologic approaches integrating the NSG-HIS mouse, non-human primates, and patients with cancer for the development of novel immunomodulatory anticancer agents with human specificity. Clin Cancer Res; 23(8); 1955-66. ©2016 AACR.
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Affiliation(s)
- Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine-Phoenix, Creighton University School of Medicine at St. Joseph's Hospital, Phoenix, Arizona.
| | | | - William E Brady
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, New York
| | | | | | - Joan L Walker
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Heather A Lankes
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, New York
| | | | | | | | | | | | | | - George Coukos
- University of Pennsylvania, Philadelphia, Pennsylvania
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25
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Duska LR, Lothamer H, Faust W, Petroni GR, Fracasso PM, Parsons S. A phase 0 pharmacodynamic study of dasatinib in women with newly diagnosed endometrial cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e23207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Linda R. Duska
- University of Virginia Health System, Charlottesville, VA
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26
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Dillon PM, Petroni GR, Moskaluk C, Fracasso PM, Douvas MG, Perez JR, Varhegyi N, Zaja-Milatovic S, Thomas CY. A phase II study of dovitinib in patients with recurrent or metastatic adenoid cystic carcinoma (ACC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e17092] [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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27
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Dizon DS, Brady WE, Lankes HA, Jandial DA, Howell SB, Schilder RJ, Beumer JH, Christner SM, Strychor S, Powell MA, Hagemann AR, Moore KN, Walker JL, DiSilvestro P, Fracasso PM. Results of a phase I pharmacokinetic study of intraperitoneal bortezomib (B) and carboplatin (C) in patients with persistent or recurrent ovarian cancer (OC): An NRG/Gynecologic Oncology Group study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Matthew A. Powell
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Andrea R. Hagemann
- Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO
| | | | | | - Paul DiSilvestro
- Women and Infants Hospital/The Warren Alpert Medical School of Brown University, Providence, RI
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28
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Bell-McGuinn KM, Brady WE, Schilder RJ, Fracasso PM, Moore KN, Walker JL, Duska LR, Mathews CA, Chen A, Shepherd SP, Giranda VL, Aghajanian C. A phase I study of continuous veliparib in combination with IV carboplatin/paclitaxel or IV/IP paclitaxel/cisplatin and bevacizumab in newly diagnosed patients with previously untreated epithelial ovarian, fallopian tube, or primary peritoneal cancer: An NRG Oncology/Gynecologic Oncology Group study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Linda R. Duska
- University of Virginia Health System, Charlottesville, VA
| | | | - Alice Chen
- Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, MD
| | | | | | - Carol Aghajanian
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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29
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McMeekin DS, Sill MW, Walker JL, Moore KN, Waggoner SE, Thaker PH, Rizack T, Hoffman JS, Fracasso PM. A phase I study of IV doxorubicin plus intraperitoneal (IP) paclitaxel and IV or IP cisplatin in endometrial cancer patients at high risk for peritoneal failure (GOG 9920): an NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2015; 138:36-40. [PMID: 25958319 DOI: 10.1016/j.ygyno.2015.04.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/29/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the maximum tolerated dose (MTD) of a modified paclitaxel/doxorubicin/cisplatin (TAP) regimen which incorporated intraperitoneal (IP) paclitaxel or IP paclitaxel/cisplatin in advanced endometrial cancer. METHODS Patients (pts) with FIGO (1998) Stage IIIA/IIIC with positive cytologic washings/ascites, adnexa, or serosa or Stage IV (intraperitoneal disease spread), histologically confirmed endometrial cancer were eligible. The study was designed as a phase I, 3+3 dose escalation study evaluating 5 dose levels (DL). All pts received cycles 1-2 with IV TAP, and cycles 3-6 with IV/IP therapy, on a 21day schedule. Adverse events were evaluated on cycles 3-4 for dose limiting toxicity (DLT) and dose escalation decisions. RESULTS Twenty-one pts were enrolled, of which 17 were evaluable for DLT. Most pts had Stage IV disease (76%) and serous/clear cell histology (59%). The MTD was determined to be DL 3 (cycles 3-6 including paclitaxel 90mg/m(2) IP, doxorubicin 45mg/m(2) IV, cisplatin 50mg/m(2)). Three DLT events occurred and were related to grades 3-4 metabolic toxicities. There was one grade 2 sensory neuropathy event and myelosupression was tolerable without the use of G-CSF. 88% of evaluable pts completed 6cycles of therapy. With a median follow-up of 22months, 46% of patients remain progression-free at 2years. CONCLUSION We described an IV/IP based modification of a standard TAP regimen in endometrial cancer. Based on the high rate of completing 6cycles of therapy, low rates of neuropathy, and promising PFS, further study of IP therapy in endometrial cancer is warranted.
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Affiliation(s)
- D Scott McMeekin
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | - Michael W Sill
- NRG Oncology Statistics and Data Management Center, Buffalo, NY, United States.
| | - Joan L Walker
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | - Kathleen N Moore
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | | | - Premal H Thaker
- Washington University School of Medicine, St. Louis, MO, United States.
| | - Tina Rizack
- Women and Infants, Providence, RI, United States.
| | - James S Hoffman
- The Hospital of Central Connecticut, New Britain, CT, United States.
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30
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Huh WK, Brady WE, Moore KN, Lankes HA, Monk BJ, Aghajanian C, Dizon DS, Armstrong DK, Thaker PH, Fracasso PM. A phase 2 study of live-attenuated listeria monocytogenes cancer immunotherapy (ADXS11-001) in the treatment of persistent or recurrent cancer of the cervix (GOG-0265). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps5617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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)
- Warner King Huh
- The University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | | | | | | | - Bradley J. Monk
- Creighton University School of Medicine at St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | | | - Don S. Dizon
- Massachusetts General Hospital/Dana-Farber Harvard Cancer Center, Boston, MA
| | - Deborah K Armstrong
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Premal H. Thaker
- Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO
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31
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Myint ZW, Sen JM, Watts NL, Druzgal TJ, Nathan BR, Ward MD, Boyer JE, Fracasso PM. Reversible posterior leukoencephalopathy syndrome during regorafenib treatment: a case report and literature review of reversible posterior leukoencephalopathy syndrome associated with multikinase inhibitors. Clin Colorectal Cancer 2013; 13:127-30. [PMID: 24461491 DOI: 10.1016/j.clcc.2013.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/19/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Zaw W Myint
- Division of Hematology/Oncology, Department of Medicine and the UVA Cancer Center, University of Virginia Health System, Charlottesville, VA.
| | - Jeremy M Sen
- Department of Pharmacy Services, University of Virginia Health System, Charlottesville, VA
| | - Nicole L Watts
- Department of Pharmacy Services, University of Virginia Health System, Charlottesville, VA
| | - Thomas J Druzgal
- Division of Neuroradiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Barnett R Nathan
- Department of Neurology, University of Virginia Health System, Charlottesville, VA
| | - Melanie D Ward
- Department of Neurology, University of Virginia Health System, Charlottesville, VA
| | - James E Boyer
- Division of Hematology/Oncology, Department of Medicine and the UVA Cancer Center, University of Virginia Health System, Charlottesville, VA
| | - Paula M Fracasso
- Division of Hematology/Oncology, Department of Medicine and the UVA Cancer Center, University of Virginia Health System, Charlottesville, VA
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32
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Vergote IB, Garcia A, Micha J, Pippitt C, Bendell J, Spitz D, Reed N, Dark G, Fracasso PM, Ibrahim EN, Armenio VA, Duska L, Poole C, Gennigens C, Dirix LY, Leung AC, Zhao C, Soufi-Mahjoubi R, Rustin G. Randomized multicenter phase II trial comparing two schedules of etirinotecan pegol (NKTR-102) in women with recurrent platinum-resistant/refractory epithelial ovarian cancer. J Clin Oncol 2013; 31:4060-6. [PMID: 24081946 PMCID: PMC4878105 DOI: 10.1200/jco.2012.45.1278] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Etirinotecan pegol (NKTR-102) is a unique, long-acting topoisomerase-I inhibitor with prolonged systemic exposure to SN38 (7-ethyl-10-hydroxycamptothecin), the active metabolite of irinotecan. This randomized phase II trial investigated two dosing schedules of etirinotecan pegol in patients with platinum-resistant/refractory ovarian carcinoma. PATIENTS AND METHODS A total of 71 eligible patients were randomly assigned to receive etirinotecan pegol 145 mg/m(2) every 14 or 21 days until progression or unacceptable adverse events (AEs). The primary end point was objective response rate (ORR) by RECIST (version 1.0). Secondary end points included response by Gynecologic Cancer Intergroup criteria, duration of ORR, progression-free survival (PFS), and overall survival (OS). RESULTS The overall confirmed ORR was 20% (95% CI, 10% to 30%): 20% for once every 14 days, and 19% for once every 21 days. Median response duration was 4.1 months for once every 14 days and 4.0 months for once every 21 days. Median PFS for every 14 and every 21 days was 4.1 and 5.3 months, respectively, and median OS was 10.0 and 11.7 months, respectively. Etirinotecan pegol was well tolerated, with the most common grade 3 to 4 AEs being dehydration (24%) and diarrhea (23%). Diarrhea, dehydration, nausea, and neutropenia were less frequent with the schedule of once every 21 days than with that of once every 14 days. CONCLUSION Both schedules of etirinotecan pegol showed activity in patients with heavily pretreated ovarian cancer, with encouraging ORR and PFS rates. The schedule of once every 21 days was better tolerated and had slightly longer PFS and OS rates. The treatment schedule of etirinotecan pegol 145 mg/m(2) once every 21 days was selected for the expanded phase II study and is preferred for future phase III studies. These findings provide support to directly compare etirinotecan pegol versus one of the approved drugs (eg, pegylated liposomal doxorubicin or topotecan) in platinum-resistant ovarian cancer.
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Affiliation(s)
- Ignace B. Vergote
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Agustin Garcia
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - John Micha
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Charles Pippitt
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Johanna Bendell
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Daniel Spitz
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Nicholas Reed
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Graham Dark
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Paula M. Fracasso
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Emad N. Ibrahim
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Vincent A. Armenio
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Linda Duska
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Chris Poole
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Christine Gennigens
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Luc Y. Dirix
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Abraham C.F. Leung
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Carol Zhao
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Raoudha Soufi-Mahjoubi
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
| | - Gordon Rustin
- Ignace B. Vergote, University Hospital Leuven, Leuven; Christine Gennigens, Centre Hospitalier Universitaire de Liège, Liège; Luc Y. Dirix, Gasthuis Zusters Antwerpen, Antwerp, Belgium; Agustin Garcia, University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles; John Micha, Gynecologic Oncology Associates, Newport Beach; Emad N. Ibrahim, Beaver Medical Group, Redlands; Abraham C.F. Leung, Carol Zhao, and Raoudha Soufi-Mahjoubi, Nektar Therapeutics, San Francisco, CA; Charles Pippitt, Piedmont Hematology Oncology Associates, Winston Salem, NC; Johanna Bendell, Sarah Cannon Research Institute, Nashville, TN; Daniel Spitz, Palm Beach Cancer Institute, West Palm Beach, FL; Nicholas Reed, Beatson Oncology Centre, Glasgow; Graham Dark, Freeman Hospital, Newcastle upon Tyne; Chris Poole, University Hospital Coventry, Coventry; Gordon Rustin, Mount Vernon Hospital, Northwood, United Kingdom; Paula M. Fracasso and Linda Duska, University of Virginia Health System, Charlottesville, VA; and Vincent A. Armenio, Pharma Resource, Providence, RI
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Fracasso PM, Goodner SA, Creekmore AN, Morgan HP, Foster DM, Hardmon AA, Engel SJ, Springer BC, Mathews KJ, Fisher EB, Walker MS. Coaching intervention as a strategy for minority recruitment to cancer clinical trials. J Oncol Pract 2013; 9:294-9. [PMID: 24130255 PMCID: PMC3825290 DOI: 10.1200/jop.2013.000982] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Lack of trust and rapport with health care providers has been identified in the under-representation of racial/ethnic minorities within clinical trials. Our study used a coach to promote trust among minority patients with advanced cancer. PATIENTS AND METHODS Minority patients with advanced breast, colorectal, lung, or prostate carcinoma were randomly assigned to receive a coach Intervention (CI) or usual care (UC). All patients completed baseline and 6-month telephone interviews to assess demographics, trust in health care providers, attitudes toward clinical trials, and quality of life. Patients randomly assigned to CI were assigned a coach, who made biweekly contacts for 6 months to address general issues, progress or development in cancer care, and available resources. Patients randomly assigned to UC received the standard of care, without this intervention. Clinical trial enrollment was assessed. RESULTS Over 21 months, we screened 268 patients and enrolled 73 African Americans and two Asian Americans. Patients were randomly assigned to CI (n = 38) or to UC (n = 37). Longitudinal analyses were conducted on 69 patients who completed the 6-month follow-up assessment. Trial enrollment was 16 and 13 patients for the CI and UC groups, respectively. This difference was not significant (P = .351). Higher quality of life (1-point odds ratio on Functional Assessment of Cancer Treatment-General = 1.033, P = .036) and positive attitudes toward trials predicted enrollment. There was no significant difference between these groups in quality of life, attitudes toward clinical trials, perceptions of racism, trust in doctors, or depression. CONCLUSIONS Quality of life and positive attitude toward trials predicted trial enrollment, regardless of assignment to CI or UC.
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Affiliation(s)
- Paula M. Fracasso
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Sherry A. Goodner
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Allison N. Creekmore
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Helen P. Morgan
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Denise M. Foster
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Angela A. Hardmon
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Seth J. Engel
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Brian C. Springer
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Katherine J. Mathews
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Edwin B. Fisher
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Mark S. Walker
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
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Monk BJ, Brady WE, Lankes HA, Facciabene A, Manjarrez K, Hershberg RM, Fracasso PM, Bell-McGuinn KM, Walker JL, McCourt CK, Aghajanian C, Coukos G. VTX-2337, a TLR8 agonist, plus chemotherapy in recurrent ovarian cancer: Preclinical and phase I data by the Gynecologic Oncology Group. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.3077] [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
3077 Background: Given the absence of clear molecular drivers in high-grade serous ovarian cancer, targeting the tumor micro-environment with immunotherapy is an emerging approach. VTX-2337 is a potent, small molecule agonist of TLR8 which stimulates the innate immune response, and was previously evaluated as a single agent in cancer patients. We report data combining VTX-2337 with chemotherapy in recurrent ovarian cancer. Methods: VTX-2337 was tested in an ovarian cancer mouse model with an intact human immune system. Additionally, an open-label phase I study of VTX-2337 + pegylated liposomal doxorubicin (PLD) in recurrent ovarian cancer (NCT01294293, N=13) was performed. PLD (40 mg/m2) was given on day 1 of a 28-day cycle. Three dose levels of VTX-2337 (2.5, 3.0, 3.5 mg/m2, N=13) were serially tested and given by SC injection on days 3, 10, and 17. VTX-2337 (3.0 mg/m2) was also tested with paclitaxel (80 mg/m2; N=7) given on days 1, 8, and 15 of a 28 day cycle. Responses were evaluated using RECIST1.1. PK and serum immune cytokines were measured. Patients remained on therapy until toxicity or progression. Results: In the mouse model, clinical responses to PLD were increased. Innate immunity along with CD8+ T cell responses were also induced. In humans, treatment with PLD + VTX-2337 increased various cytokines and chemokines (G-CSF, MCP-1, MIP-1β, TNF-α). The PK of PLD was not affected by VTXE2337. The combination was well tolerated with no DLTs. AEs consisted of those seen with single-agent PLD (Gr 3/4 toxicities, N=6) or VTXE2337 (Gr 1/2 injection site reaction, transient fever, flu-like symptoms). There was 1 partial response (13%) and 63% had stable disease. Paclitaxel + VTX-2337 was also well tolerated. Conclusions: VTX-2337 enhances the effect of PLD in a preclinical model of ovarian cancer, and the combination is well-tolerated in patients. Clinical data and biomarkers consistent with immunostimulation, provide rationale for the on-going randomized, placebo-controlled, phase II trial comparing PLD vs PLD + VTX-2337 (GOG-3003, NCT01666444). Clinical trial information: NCT01666444.
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Affiliation(s)
- Bradley J. Monk
- Creighton University School of Medicine at St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | | | | | - Andrea Facciabene
- Ovarian Cancer Research Center, University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Joan L. Walker
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | - George Coukos
- University of Pennsylvania, Ovarian Cancer Research Center, Philadelphia, PA
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Huh WK, Brady WE, Moore KN, Lankes HA, Monk BJ, Aghajanian C, Dizon DS, Fracasso PM. A phase II study of live-attenuated Listeria monocytogenes immunotherapy (ADXS11-001) in the treatment of persistent or recurrent cancer of the cervix (GOG-0265). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.tps3121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3121 Background: This is a GOG/NCI-sponsored phase II study (NCT01266460, GOG 0265) of ADXS11-001 in patients with persistent or recurrent cancer of the cervix. ADXS11-001 is a live attenuated Listeria monocytogenes (Lm) immunotherapy bioengineered to secret a HPV-E7 fusion protein targeting HPV-E7 transformed cells. A previous phase I dose escalation study determined the safety of ADXS11-001 in patients with late stage cervical cancer (Maciag PA. Vaccine. 2009 Jun 18;27(30):3975-83). The primary objectives of this study are to evaluate the tolerability and safety of ADXS11-001, and to assess the activity of ADXS11-001 in patients with persistent or recurrent cancer of the cervix. Secondary objectives are progression-free survival, overall survival and objective tumor response. Methods: Patient eligibility criteria: Females age ≥ 18 years with persistent or recurrent squamous or non-squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma of the cervix with documented disease progression (disease not amenable to curative therapy). Patients must have measurable disease as defined by RECIST 1.1; at least one “target lesion” as defined by RECIST 1.1; have had one prior systemic chemotherapeutic regimen for management of their disease; have adequate organ function and must be free of active infection and not on antibiotics. This protocol is a 2-stage design with 12-month survival as the primary endpoint and with a planned sample size of up to 67 patients. Patients will receive ADXS11-001 at a dose of 1x109 CFU on Day 1 and repeat every 28 days for 3 total doses in the absence of disease progression or unacceptable toxicity, with each dose followed at 72 hours by a 7 day course of ampicillin, 500 mg QID. Tumor tissue and serum samples may be collected periodically for translational research. After completion of study treatment, patients are followed every 3 months for 2 years and then every 6 months for 3 years. As of January 31, 2013, enrollment has been completed in the 6-patient safety lead-in portion of the study. Clinical trial information: NCT01266460.
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Affiliation(s)
| | | | | | | | - Bradley J. Monk
- Creighton University School of Medicine at St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | | | - Don S. Dizon
- Women and Infants Hospital of Rhode Island, Providence, RI
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Dillon PM, Moskaluk C, Fracasso PM, Petroni GR, Thomas CY. Phase II study of dovitinib (TKI258) in patients with progressive metastatic adenoid cystic carcinoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6021 Background: Adenoid cystic carcinoma (ACC) is an uncommon malignancy of secretory glands for which there is no standard systemic therapy. At least 90% of ACC tumors carry a t(6;9)(q22–23;p23–24) chromosome translocation that results in overexpression of the MYB oncogene that in turn upregulates FGF2 and other growth factors. Dovitinib is a multiple receptor kinase inhibitor that could potentially block autocrine activation of the FGFR and VEGFR-mediated angiogenesis. In a mouse model, dovitinib suppressed the growth of low passage ACC xenografts. Methods: In this open-label, single-arm trial, patients (n=21) with metastatic ACC that progressed in the last 6 months were treated with dovitinib 500 mg/d, 5-days on/2-days off. The primary endpoint was objective response rate using a two-stage design to test a null and alternative rate of 1% and 18%, respectively, with 90% power and type I error <5%. Secondary endpoints were progression-free survival, safety, quality of life, biomarker studies, and change in tumor growth rate. Results: All 21 patients (median age 54.3, range 29-74) had previous treatment with chemotherapy, radiotherapy or targeted agents. Median duration of treatment to date is 5.7 months (range 2-10 months) and is ongoing in 11 patients. Nine of 21 patients required dose reductions. Grade 3/4 drug-related adverse events included thromboembolism (4), hematuria (1), dehydration (1), pneumonia (2), hypertriglyceridemia (3), diarrhea (2), stomach pain (2), anxiety (1), transaminitis (3) and cytopenias (4). One death occurred unrelated to study drug. Among 19 evaluable patients, 2 had partial responses by RECIST criteria (1 with lung metastases and 1 with tracheal recurrence and stable bone metastases). Both experienced improvements in pain ratings and are free of disease progression at 8+ and 5+ months. Stable disease >6 months was observed in 9 patients while 6 others with shorter follow-up have not progressed. Four patients progressed early (<4 months) and two are too early to assess. Conclusions: Dovitinib produces objective partial responses and prolonged tumor stabilization with acceptable toxicity in patients with progressive ACC. Clinical trial information: NCT01524692.
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Ma CX, Ellis MJC, Petroni GR, Guo Z, Cai SR, Ryan CE, Craig Lockhart A, Naughton MJ, Pluard TJ, Brenin CM, Picus J, Creekmore AN, Mwandoro T, Yarde ER, Reed J, Ebbert M, Bernard PS, Watson M, Doyle LA, Dancey J, Piwnica-Worms H, Fracasso PM. A phase II study of UCN-01 in combination with irinotecan in patients with metastatic triple negative breast cancer. Breast Cancer Res Treat 2012; 137:483-92. [PMID: 23242585 PMCID: PMC3539064 DOI: 10.1007/s10549-012-2378-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 12/04/2012] [Indexed: 12/20/2022]
Abstract
Mutations in TP53 lead to a defective G1 checkpoint and the dependence on checkpoint kinase 1 (Chk1) for G2 or S phase arrest in response to DNA damage. In preclinical studies, Chk1 inhibition resulted in enhanced cytotoxicity of several chemotherapeutic agents. The high frequency of TP53 mutations in triple negative breast cancer (TNBC: negative for estrogen receptor, progesterone receptor, and HER2) make Chk1 an attractive therapeutic target. UCN-01, a non-selective Chk1 inhibitor, combined with irinotecan demonstrated activity in advanced TNBC in our Phase I study. The goal of this trial was to further evaluate this treatment in women with TNBC. Patients with metastatic TNBC previously treated with anthracyclines and taxanes received irinotecan (100–125 mg/m2 IV days 1, 8, 15, 22) and UCN-01 (70 mg/m2 IV day 2, 35 mg/m2 day 23 and subsequent doses) every 42-day cycle. Peripheral blood mononuclear cells (PBMC) and tumor specimens were collected. Twenty five patients were enrolled. The overall response (complete response (CR) + partial response (PR)) rate was 4 %. The clinical benefit rate (CR + PR + stable disease ≥6 months) was 12 %. Since UCN-01 inhibits PDK1, phosphorylated ribosomal protein S6 (pS6) in PBMC was assessed. Although reduced 24 h post UCN-01, pS6 levels rose to baseline by day 8, indicating loss of UCN-01 bioavailability. Immunostains of γH2AX and pChk1S296 on serial tumor biopsies from four patients demonstrated an induction of DNA damage and Chk1 activation following irinotecan. However, Chk1 inhibition by UCN-01 was not observed in all tumors. Most tumors were basal-like (69 %), and carried mutations in TP53 (53 %). Median overall survival in patients with TP53 mutant tumors was poor compared to wild type (5.5 vs. 20.3 months, p = 0.004). This regimen had limited activity in TNBC. Inconsistent Chk1 inhibition was likely due to the pharmacokinetics of UCN-01. TP53 mutations were associated with a poor prognosis in metastatic TNBC.
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Affiliation(s)
- Cynthia X Ma
- Section of Breast Oncology, Division of Oncology, Department of Medicine, Washington University School of Medicine, Campus Box 8056, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
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Moore KN, Sill MW, Miller DS, McCourt C, De Geest K, Rose PG, Cardenes HR, Mannel RS, Farley JH, Schilder RJ, Fracasso PM. A phase I trial of tailored radiation therapy with concomitant cetuximab and cisplatin in the treatment of patients with cervical cancer: A gynecologic oncology group study. Gynecol Oncol 2012; 127:456-61. [DOI: 10.1016/j.ygyno.2012.08.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/13/2012] [Accepted: 08/20/2012] [Indexed: 10/27/2022]
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Ma CX, Ellis MJ, Petroni GR, Lockhart AC, Naughton M, Pluard TJ, Brenin C, Picus J, Creekmore AN, Mwandoro TN, Guo Z, Cai S, Ryan C, Yarde E, Hoog J, Dancey J, Watson M, Piwnica-Worms H, Fracasso PM. Clinical and correlative science results in a phase II study of UCN-01in combination with irinotecan in recurrent triple-negative breast cancer (TNBC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3047 Background: Chk1 inhibitors enhance chemotherapy efficacy by inducing “mitotic catastrophe” in p53 deficient TNBC preclinical models. Irinotecan (I) combined with UCN-01, a nonselective Chk1 inhibitor, showed promising activity in TNBC in our phase I study. The primary objective of the phase II trial was to determine the efficacy and toxicity. Correlatives included assessing tumor molecular subtype, TP53, PTEN and pathways targeted by UCN-01. Methods: Pts with measurable, metastatic (met) TNBC, prior anthracycline (A) and taxane (T), received I (100-125 mg/m2 IV on days (d) 1, 8, 15, 22) and UCN-01 (70 mg/m2 IV on d2 and 35 mg/m2 on d23 and later doses) on a 42-d cycle (C). Archival tumors and serial peripheral blood mononuclear cells (PBMC) and optional tumor biopsies were collected. Results: Twenty five pts were enrolled. All had prior A and T. The median no. of prior regimens for met disease was 3 (range 1-4). Toxicities included neutropenia, diarrhea, nausea, vomiting, and hyperglycemia. Best responses included 1 PR, 8 SD (range 2.3-8.6 mos) for a clinical benefit rate (CR+PR+SD>6 mos) of 3/25 (12%), 95% CI (3, 31%). The median PFS and OS were 2.3 and 11.3 mos, respectively. pS6 was examined since UCN-01 inhibits PDK1. pS6 was reduced in PBMC 24h post UCN-01, but close to baseline by d8. Immunostain of cleaved caspase 3 (CC3), pHistone H3 (pHH3), γH2AX, and pS6 were done on serial biopsies from 4 pts with adequate biopsy materials. In all cases, pS6 was reduced 24h post UCN-01. Results for other markers were variable. One case with TP53 deletion showed an induction of CC3, with an increase in pHH3 and γH2AX, suggesting abrogation of cell cycle arrest and enhanced DNA damage. Among 15 with sufficient specimen for analysis, most were basal-like (basal 10, basal/HER2-E 1, HER2-E 2, Luminal B 2) by PAM50, low in PTEN level (11) and carried mutations in TP53 (8). Median OS was 5.5 (95% CI: 2, 11.3) mos in TP53 mutant and 20.3 (95% CI: 2.9, - ) mos in wild type populations (p=0.004). Conclusions: This regimen had limited activity in TNBC. Despite the long half-life, drug activity is not detectable by d8 based on PBMC analysis. Our data indicates that future trials in TNBC should consider p53 status.
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Affiliation(s)
- Cynthia X. Ma
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | | | | | | | - Joel Picus
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Zhanfang Guo
- Washington University School of Medicine, St. Louis, MO
| | - Shirong Cai
- Washington University School of Medicine, St. Louis, MO
| | | | - Erin Yarde
- University of Virginia Health System, Charlottesville, VA
| | - Jeremy Hoog
- Washington University School of Medicine, St. Louis, MO
| | - Janet Dancey
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Mark Watson
- Washington University School of Medicine, St. Louis, MO
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Rose PG, Sill MW, McMeekin DS, Ahmed A, Salani R, Yamada SD, Wolfson AH, Fusco N, Fracasso PM. A phase I study of concurrent weekly topotecan and cisplatin chemotherapy with whole pelvic radiation therapy in locally advanced cervical cancer: a gynecologic oncology group study. Gynecol Oncol 2012; 125:158-62. [PMID: 22198338 PMCID: PMC4533103 DOI: 10.1016/j.ygyno.2011.12.431] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 12/08/2011] [Accepted: 12/09/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine the maximum tolerated dose (MTD) and acute dose-limiting toxicities (DLT) of intravenous topotecan administered with weekly cisplatin during pelvic radiation therapy in patients with locally advanced cervical cancer. METHODS Patients were treated at one of two dose levels receiving intravenous topotecan at 0.5mg/m(2) and cisplatin at either 30 or 40 mg/m(2) given weekly for 6 weeks concurrently with pelvic radiation and intracavitary brachytherapy. The primary endpoint for the escalation study was acute dose-limiting toxicities occurring within 30 days of completing radiation therapy. RESULTS Eleven patients were enrolled. Dose-limiting toxicity consisting of Grade 3 nausea and vomiting lasting >24h in one patient and grade 3 febrile neutropenia in another patient occurred at the first dose level of weekly topotecan 0.5mg/m(2) and cisplatin 40 mg/m(2). This necessitated de-escalation to weekly cisplatin 30 mg/m(2) in combination with topotecan 0.5mg/m(2) and pelvic radiation. This dose level was tolerable in 6 evaluable patients with only one DLT consisting of grade 4 thrombocytopenia, grade 3 abdominal pain and grade 3 elevated gamma glutamyl transpeptidase (GGT). CONCLUSIONS In women with locally advanced cervical cancer, intravenous topotecan 0.5mg/m(2) and cisplatin 30 mg/m(2) given weekly for 6 weeks with concurrent pelvic radiation and intracavitary brachytherapy were tolerable. Further expansion of the feasibility cohort of this study was suspended based on the results of a phase 3 trial comparing the efficacy of platinum combinations in advanced and recurrent cervical cancer.
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Affiliation(s)
- Peter G Rose
- Case Western Reserve University, Cleveland, OH 44195, USA.
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Gould N, Sill MW, Mannel RS, Thaker PH, Disilvestro P, Waggoner S, Yamada SD, Armstrong DK, Wenzel L, Huang H, Fracasso PM, Walker JL. A phase I study with an expanded cohort to assess the feasibility of intravenous paclitaxel, intraperitoneal carboplatin and intraperitoneal paclitaxel in patients with untreated ovarian, fallopian tube or primary peritoneal carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 2011; 125:54-8. [PMID: 22155262 DOI: 10.1016/j.ygyno.2011.12.417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To define the maximum tolerated dose (MTD) and assess the feasibility of intravenous (IV) paclitaxel, intraperitoneal (IP) carboplatin, and IP paclitaxel in women with newly diagnosed Stages II-IV ovarian, fallopian tube, or primary peritoneal carcinoma. METHODS Patients received escalating doses of paclitaxel IV and carboplatin IP on day 1 and paclitaxel IP 60 mg/m(2) on day 8. A standard 3+3 design was used in the escalation phase. A two-stage group sequential design with 20 patients at the MTD was used in the feasibility phase. Patient-reported neurotoxicity was assessed pre and post treatment. RESULTS Patients were treated with paclitaxel 175 mg/m(2) IV and carboplatin IP from AUC 5-7 on day 1 and paclitaxel 60 mg/m(2) IP on day 8. The MTD was estimated at carboplatin AUC 6 IP and 25 patients enrolled at this dose level. Within the first 4 cycles, seven (35%) of twenty evaluable patients had dose-limiting toxicities (DLTs) including grade 4 thrombocytopenia (1), grade 3 neutropenic fever (3), >2 week delay due to ANC recovery (1), grade 3 LFT (1), and grade 3 infection (1). De-escalation to paclitaxel 135 mg/m(2) IV was given to improve the safety. After six evaluable patients completed 4 cycles without a DLT, bevacizumab was added and six evaluable patients completed 4 cycles with one DLT (grade 3 hyponatremia). CONCLUSIONS Paclitaxel at 175 mg/m(2) IV, carboplatin AUC 6 IP day 1 and paclitaxel 60 mg/m(2) IP day 8 yield 18-56% patients with DLTs. The tolerability of the regimen in combination with bevacizumab was indicated in a small cohort.
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Affiliation(s)
- Natalie Gould
- Division of Gynecologic Oncology, Women's Cancer Center of Nevada, Las Vegas, NV 89169, USA.
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Dizon DS, Sill MW, Gould N, Rubin SC, Yamada SD, Debernardo RL, Mannel RS, Eisenhauer EL, Duska LR, Fracasso PM. Phase I feasibility study of intraperitoneal cisplatin and intravenous paclitaxel followed by intraperitoneal paclitaxel in untreated ovarian, fallopian tube, and primary peritoneal carcinoma: a gynecologic oncology group study. Gynecol Oncol 2011; 123:182-6. [PMID: 21820161 DOI: 10.1016/j.ygyno.2011.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 07/11/2011] [Accepted: 07/13/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE Intraperitoneal chemotherapy has shown a survival advantage over intravenous chemotherapy for women with newly diagnosed optimally debulked epithelial ovarian, fallopian tube, or primary peritoneal carcinoma. However, significant toxicity has limited its acceptance. In an effort to reduce toxicity, the Gynecologic Oncology Group conducted a Phase I study to evaluate the feasibility of day 1 intravenous (IV) paclitaxel and intraperitoneal (IP) cisplatin followed by day 8 IP paclitaxel on an every 21-day cycle. METHODS Patients with Stage IIB-IV epithelial ovarian, fallopian tube, primary peritoneal carcinomas or carcinosarcoma received paclitaxel 135mg/m(2) IV over 3h followed by cisplatin 75mg/m(2) IP on day 1 and paclitaxel 60 mg/m(2) IP on day 8 of a 21 day cycle with 6 cycles planned. Dose-limiting toxicity (DLT) was defined as febrile neutropenia or dose-delay of greater than 2 weeks due to failure to recover counts, or Grade 3-5 non-hematologic toxicity occurring within the first 4 cycles of treatment. RESULTS Twenty of 23 patients enrolled were evaluable and nineteen (95%) completed all six cycles of therapy. Three patients experienced a DLT consisting of infection with normal absolute neutrophil count, grade 3 hyperglycemia, and grade 4 abdominal pain. CONCLUSIONS This modified IP regimen which administers both IV paclitaxel and IP cisplatin on day one, followed by IP paclitaxel on day eight, of a twenty-one day cycle appears feasible and is an attractive alternative to the intraperitoneal treatment regimen administered in GOG-0172.
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Affiliation(s)
- Don S Dizon
- The Warren Alpert Medical School of Brown University, Providence, RI 02905, USA.
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Kunos CA, Sill MW, Buekers TE, Walker JL, Schilder JM, Yamada SD, Waggoner SE, Mohiuddin M, Fracasso PM. Low-dose abdominal radiation as a docetaxel chemosensitizer for recurrent epithelial ovarian cancer: a phase I study of the Gynecologic Oncology Group. Gynecol Oncol 2011; 120:224-8. [PMID: 21075438 PMCID: PMC3026069 DOI: 10.1016/j.ygyno.2010.10.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/13/2010] [Accepted: 10/17/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to determine the maximum tolerated dose and dose-limiting toxicity (DLT) of whole abdomen radiation as a chemosensitizer of weekly docetaxel for women with recurrent epithelial ovarian fallopian tube, or peritoneal cancers. PATIENTS AND METHODS Women were enrolled on one of three dose levels of docetaxel (20, 25, or 30 mg/m(2)) administered weekly with concurrent low-dose whole abdominal radiation given as 60 cGy bid 2 days weekly for a total of 6 weeks. RESULTS Thirteen women were enrolled and received 70 weekly treatments of docetaxel in combination with radiation therapy. At the first dose level, docetaxel 25mg/m(2), grade 3 fatigue and thrombocytopenia were observed. At the next dose level, docetaxel 30 mg/m(2), grade 3 febrile neutropenia, grade 4 thrombocytopenia with epistaxis, and grade 3 diarrhea were observed. Given these dose-limiting toxicities, a lower dose of docetaxel 20mg/m(2) was administered and found to be tolerable. No objective responses were observed among the 10 patients with measurable disease; however, the median progression-free survival (PFS) in all patients was 3.3 months, and 3 of the patients with measurable disease were free of tumor progression after 6 months (30%; 90% confidence interval 8.7-61%). CONCLUSIONS Twice weekly low-dose whole abdomen radiation during weekly docetaxel 20 mg/m(2) was well-tolerated. Given the PFS demonstrated in these women with resistant ovarian cancer, further study of whole abdominal radiation and concurrent chemotherapy may be warranted.
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Affiliation(s)
- Charles A. Kunos
- Department of Radiation Oncology, University Hospitals Case Medical Center, Cleveland, OH 44106
| | - Michael W. Sill
- Gynecologic Oncology Group Statistical and Data Center, Buffalo, NY 14263
| | | | - Joan L. Walker
- Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Oklahoma 73190
| | - Jeanne M. Schilder
- Section of GYN Oncology, Indiana University Medical Center, Indianapolis, IN 46202
| | - S. Diane Yamada
- Section of Gynecologic Oncology, University of Chicago, Chicago, IL 60637
| | - Steven E. Waggoner
- Department of Obstetrics and Gynecology, University Hospital Case Western Medical Center, Cleveland, OH 44106
| | - Mohammed Mohiuddin
- Department of Radiation Oncology, University of Kentucky, Lexington, KY 40536
| | - Paula M. Fracasso
- Department of Medicine, University of Virginia, Charlottesville, VA 22908
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Thigpen JT, Alberts D, Birrer M, Copeland L, Coleman RL, Markman M, Bast RC, Eisenhauer EL, Fleming G, Fracasso PM, Gershenson DM, Herzog T, Monk BJ, Ozols RF, Rustin G, Brady MF, Shrader M, Ranganathan A. Current Challenges and Future Directions in the Management of Ovarian Cancer: Proceedings of the First Global Workshop on Ovarian Cancer. ACTA ACUST UNITED AC 2010. [DOI: 10.3816/coc.2010.n.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Aft R, Naughton M, Trinkaus K, Watson M, Ylagan L, Chavez-MacGregor M, Zhai J, Kuo S, Shannon W, Diemer K, Herrmann V, Dietz J, Ali A, Ellis M, Weiss P, Eberlein T, Ma C, Fracasso PM, Zoberi I, Taylor M, Gillanders W, Pluard T, Mortimer J, Weilbaecher K. Effect of zoledronic acid on disseminated tumour cells in women with locally advanced breast cancer: an open label, randomised, phase 2 trial. Lancet Oncol 2010; 11:421-8. [PMID: 20362507 DOI: 10.1016/s1470-2045(10)70054-1] [Citation(s) in RCA: 224] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Treatment with bisphosphonates decreases bone loss and can increase disease-free survival in patients with breast cancer. The aim of our study was to assess the effect of zoledronic acid on clearance of disseminated tumour cells (DTCs) from the bone marrow in women undergoing neoadjuvant chemotherapy for breast cancer. METHODS Patients were recruited for this open-label, phase 2 randomised trial between March 17, 2003, and May 19, 2006, at a single centre. Eligible patients had clinical stage II-III (> or = T2 and/or > or = N1) newly diagnosed breast cancer, Eastern Cooperative Oncology Group performance status of 0 or 1, and normal cardiac, renal, and liver function. 120 women were randomly assigned, using allocation concealment, to receive 4 mg zoledronic acid intravenously every 3 weeks (n=60), or no zoledronic acid (n=60), for 1 year concomitant with four cycles of neoadjuvant epirubicin (75 mg/m(2)) plus docetaxel (75 mg/m(2)) and two cycles of adjuvant epirubicin plus docetaxel. The primary endpoint was the number of patients with detectable DTCs at 3 months. Final analysis was done 1 year after the last patient was enrolled. Analyses were done for all patients with available data at 3 months. This study is registered with ClinicalTrials.gov, number NCT00242203. FINDINGS Of the 120 patients initially enrolled, one withdrew after signing consent and one patient's baseline bone marrow was not available. Both of these patients were in the control group. At 3 months, 109 bone-marrow samples were available for analysis. In the zoledronic acid group, bone marrow was not collected from one patient because of disease progression, one patient was taken off study because of severe diarrhoea, and two patients had not consented at the time of surgery. In the control group, bone marrow was not collected from two patients because of disease progression, one patient withdrew consent, and three patients were not consented at the time of surgery. At baseline, DTCs were detected in 26 of 60 patients in the zoledronic acid group and 28 of 58 patients in the control group. At 3 months, 17 of 56 patients receiving zoledronic acid versus 25 of 53 patients who did not receive zoledronic acid had detectable DTCs (p=0.054). The most common grade 3-4 toxicities were infection (five of 60 patients in the zoledronic acid group and six of 59 in the control group) and thrombosis (five of 60 in the zoledronic acid and two of 59 in the control group). There was one documented case of osteonecrosis in the zoledronic acid group. INTERPRETATION Zoledronic acid administered with chemotherapy resulted in a decreased proportion of patients with DTCs detected in the bone marrow at the time of surgery. Our study supports the hypothesis that the antimetastatic effects of zoledronic acid may be through effects on DTCs. FUNDING Novartis Pharmaceuticals and Pfizer Inc.
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Affiliation(s)
- Rebecca Aft
- Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
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Chu FM, Picus J, Fracasso PM, Dreicer R, Lang Z, Foster B. A phase 1, multicenter, open-label study of the safety of two dose levels of a human monoclonal antibody to human α(v) integrins, intetumumab, in combination with docetaxel and prednisone in patients with castrate-resistant metastatic prostate cancer. Invest New Drugs 2010; 29:674-9. [PMID: 20145975 DOI: 10.1007/s10637-010-9388-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 01/12/2010] [Indexed: 12/19/2022]
Abstract
PURPOSE We evaluated the safety and efficacy of intetumumab in combination with docetaxel in patients with castrate-resistant metastatic prostate cancer. Patients and methods In this phase 1, open-label, multicenter, nonrandomized study, 75 mg/m² docetaxel was administered on Day 1 of each of nine 21-day treatment cycles and intetumumab 5 or 10 mg/kg was administered on Days 1, 8, and 15 of Cycles 2 and 3 and on Day 1 of all subsequent cycles. The primary endpoint was the incidence of dose-limiting toxicities (DLTs) during Cycles 2 and 3. Secondary endpoints included serum prostate-specific antigen (PSA) response and objective response based on Response Evaluation Criteria in Solid Tumors (RECIST). RESULTS Ten patients were treated (5 mg/kg n = 3, 10 mg/kg n = 7). No DLTs occurred. Most treatment-emergent adverse events (TEAEs) occurred in the 10-mg/kg intetumumab group. Common TEAEs were neutropenia (10 mg/kg n = 6) and nausea (5 mg/kg n = 1, 10 mg/kg n = 5). Four 10-mg/kg-treated patients reported serious TEAEs; of these, only febrile neutropenia was considered probably intetumumab-related. In the 10-mg/kg group, four patients had a serum PSA response (two of whom responded within 3 months of treatment), one patient demonstrated partial tumor response for 11 weeks, and none had progressive disease at Cycle 9. No PSA or tumor response was observed in the 5-mg/kg group. CONCLUSIONS Intetumumab was generally safe and well tolerated in combination with docetaxel, with a higher incidence of TEAEs in the 10 mg/kg dose cohort. The efficacy of 10 mg/kg intetumumab in combination with docetaxel appears to warrant further study.
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Affiliation(s)
- Franklin M Chu
- San Bernardino Urological Associates Medical Group, San Bernardino, CA, USA.
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Wong KK, Fracasso PM, Bukowski RM, Lynch TJ, Munster PN, Shapiro GI, Jänne PA, Eder JP, Naughton MJ, Ellis MJ, Jones SF, Mekhail T, Zacharchuk C, Vermette J, Abbas R, Quinn S, Powell C, Burris HA. A phase I study with neratinib (HKI-272), an irreversible pan ErbB receptor tyrosine kinase inhibitor, in patients with solid tumors. Clin Cancer Res 2009; 15:2552-8. [PMID: 19318484 DOI: 10.1158/1078-0432.ccr-08-1978] [Citation(s) in RCA: 223] [Impact Index Per Article: 14.9] [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 The dose-limiting toxicities, maximum tolerated dose, pharmacokinetic profile, and preliminary antitumor activity of neratinib (HKI-272), an irreversible pan ErbB inhibitor, were determined in patients with advanced solid tumors. EXPERIMENTAL DESIGN Neratinib was administered orally as a single dose, followed by a 1-week observation period, and then once daily continuously. Planned dose escalation was 40, 80, 120, 180, 240, 320, 400, and 500 mg. For pharmacokinetic analysis, timed blood samples were collected after administration of the single dose and after the first 14 days of continuous daily administration. RESULTS Dose-limiting toxicity was grade 3 diarrhea, which occurred in one patient treated with 180 mg and in four patients treated with 400 mg neratinib; hence, the maximum tolerated dose was determined to be 320 mg. Other common neratinib-related toxicities included nausea, vomiting, fatigue, and anorexia. Exposure to neratinib was dose dependent, and the pharmacokinetic profile of neratinib supports a once-a-day dosing regimen. Partial response was observed for 8 (32%) of the 25 evaluable patients with breast cancer. Stable disease >or=24 weeks was observed in one evaluable breast cancer patient and 6 (43%) of the 14 evaluable non-small cell lung cancer patients. CONCLUSION The maximum tolerated dose of once-daily oral neratinib is 320 mg. The most common neratinib-related toxicity was diarrhea. Antitumor activity was observed in patients with breast cancer who had previous treatment with trastuzumab, anthracyclines, and taxanes, and tumors with a baseline ErbB-2 immunohistochemical staining intensity of 2+ or 3+. The antitumor activity, tolerable toxicity profile, and pharmacokinetic properties of neratinib warrant its further evaluation.
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Affiliation(s)
- Kwok-K Wong
- Dana-Farber Cancer Institute, and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Eiblmaier M, Meyer LA, Watson MA, Fracasso PM, Pike LJ, Anderson CJ. Correlating EGFR expression with receptor-binding properties and internalization of 64Cu-DOTA-cetuximab in 5 cervical cancer cell lines. J Nucl Med 2008; 49:1472-9. [PMID: 18703609 DOI: 10.2967/jnumed.108.052316] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED The anti-epidermal growth factor receptor (anti-EGFR) antibody cetuximab is clinically approved for the treatment of EGFR-expressing metastatic colorectal cancer and advanced head and neck cancer. Overexpression of EGFR has also been found in more than 70% of carcinomas of the cervix. The overall goal of this study was to determine whether (64)Cu-1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid (DOTA)-cetuximab has potential as an agent for measuring EGFR concentration by PET imaging in cervical cancer tumors. METHODS Cetuximab was conjugated to the bifunctional chelator DOTA and labeled with (64)Cu. EGFR messenger RNA (mRNA) expression was correlated with EGFR densities on the cell surface of 5 different cervical cancer cell lines and with receptor function, measured by internalization of (64)Cu-DOTA-cetuximab. Imaging in tumor-bearing mice with small-animal PET was performed using the highest-expressing cervical cancer cell line. RESULTS The affinity of (64)Cu-DOTA-cetuximab binding for the EGFR was similar in 4 EGFR-positive lines, varying from 0.1 to 0.7 nM. The mRNA expression corresponded well with EGFR densities and levels of internalization, with responses decreasing in the order of CaSki>ME-180>DoTc2 4510>HeLa>C-33A. Biodistribution and small-animal PET studies with (64)Cu-DOTA-cetuximab in CaSki tumor-bearing nude mice showed relatively high tumor uptake at 24 h after injection (13.2+/-1.2 percentage of injected activity per gram), although there was also significant retention of activity in the blood and liver accumulation. CONCLUSION (64)Cu-DOTA-cetuximab was successfully used to detect and quantify EGFR expression in cervical cancer tumors, and small-animal PET/CT of EGFR-expressing CaSki tumors suggests potential for PET/CT of EGFR-positive tumors.
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Affiliation(s)
- Martin Eiblmaier
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Lhommé C, Joly F, Walker JL, Lissoni AA, Nicoletto MO, Manikhas GM, Baekelandt MMO, Gordon AN, Fracasso PM, Mietlowski WL, Jones GJ, Dugan MH. Phase III study of valspodar (PSC 833) combined with paclitaxel and carboplatin compared with paclitaxel and carboplatin alone in patients with stage IV or suboptimally debulked stage III epithelial ovarian cancer or primary peritoneal cancer. J Clin Oncol 2008; 26:2674-82. [PMID: 18509179 DOI: 10.1200/jco.2007.14.9807] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To compare the safety and efficacy of carboplatin and paclitaxel administered with or without the multidrug resistance modulator valspodar (PSC 833) in untreated patients with advanced ovarian or primary peritoneal cancer. PATIENTS AND METHODS Seven hundred sixty-two patients with stage IV or suboptimally debulked stage III ovarian or primary peritoneal cancer were randomly assigned to receive either valspodar 5 mg/kg every 6 hours for 12 doses, paclitaxel 80 mg/m(2), and carboplatin area under the curve (AUC) 6 (PC-PSC; n = 381) or paclitaxel 175 mg/m(2) and carboplatin AUC 6 (PC; n = 381). Time to disease progression (TTP) was the primary end point. Secondary end points were overall survival time (OS), response rate (RR), safety, and tolerability. RESULTS With a median follow-up of 736 days (range, 1 to 2,280 days), the median TTP was 13.2 and 13.5 months in the PC-PSC and PC groups, respectively (P = .67); the median OS was 32 and 28.9 months, respectively (P = .94). The overall RR was higher in the PC group (41.5% v 33.6%; P = .02). Central and peripheral nervous system and GI toxicities were more common in the PC-PSC group. Ataxia occurred in 53.5% and 3.2% of PC-PSC-and PC-treated patients, respectively. Febrile neutropenia occurred more frequently in the PC-PSC group. More PC-PSC-treated patients discontinued therapy because of adverse events (AEs), experienced serious AEs, and required paclitaxel dose reductions. CONCLUSION The addition of valspodar to PC did not improve TTP or OS and was more toxic compared with PC in untreated patients with advanced ovarian or primary peritoneal cancer.
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Affiliation(s)
- Catherine Lhommé
- Institut Gustave-Roussy, Service de Gynécologie, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France.
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Fracasso PM, Picus J, Wildi JD, Goodner SA, Creekmore AN, Gao F, Govindan R, Ellis MJ, Tan BR, Linette GP, Fu CJ, Pentikis HS, Zumbrun SC, Egorin MJ, Bellet RE. Phase 1 and pharmacokinetic study of weekly docosahexaenoic acid-paclitaxel, Taxoprexin®, in resistant solid tumor malignancies. Cancer Chemother Pharmacol 2008; 63:451-8. [DOI: 10.1007/s00280-008-0756-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Accepted: 04/01/2008] [Indexed: 11/30/2022]
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