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Lesimple T, de Miguel MJ, Le Tourneau C, Ponz-Sarvise M, Sablin MP, Benito DS, Hanna B, Chang H, Wei X, Garcia MO, Lardelli P, Sánchez T, Palau JLP, Nikolova Z, Calvo E. Abstract P033: CC-95775, a reversible, oral bromodomain and extra-terminal (BET) inhibitor in patients with advanced solid tumors (STs): Results of a phase 1 study. Mol Cancer Ther 2021. [DOI: 10.1158/1535-7163.targ-21-p033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: BET proteins are epigenetic readers and activators of oncogenic pathways in cancer. CC-95775 is a novel oral small molecule bromodomain inhibitor. It is a non-specific inhibitor with potent activity against all 4 BET family members (BRD2, BRD3, BRD4, BRDT), and shows additional activity towards several non-BET bromodomain proteins. Methods: CC-95775-ST-001 is a phase 1 dose-escalation study of CC-95775 in patients with advanced STs. Primary objectives were to determine safety and recommended phase 2 dose (RP2D). Secondary and exploratory objectives were pharmacokinetics (PK), pharmacodynamics (PD) and antitumor activity. Four dose levels (DLs), from 400 to 1200 mg, administered on 4 consecutive days (Day 1 to Day 4) followed by 24 days off, every four weeks (Q4W), were evaluated. Results: As of 16 Apr 2021, 24 evaluable patients were enrolled and treated. The RP2D was 1200 mg (300 mg on days 1-4 and 24 days off, Q4W). One patient treated at 800 mg and two at 1200 mg had dose-limiting toxicities: QT prolongation, left ventricular ejection fraction (LVEF) decreased and abnormal T wave. The most common treatment-related adverse event (TRAE) was thrombocytopenia in 11 patients (45.8%), 2 of them grade 3 (8.3%) and 1 grade 4 (4.2%). Safety profile consisted mainly of gastrointestinal and general disorders. Five patients (20.8%) had transient serious TRAEs: nausea, QT prolongation, abnormal T wave, posterior reversible encephalopathy syndrome and acute kidney injury. Eleven patients 11 (45.8) had disease stabilization, 9 of them with a duration of ≥ 16 weeks and 4 of them ≥ 24 weeks: melanoma, chondrosarcoma, adenoid cystic carcinoma and chordoma. Plasma exposures increased in a dose-proportional manner across DLs. Across all dose groups, median Tmax was between ~ 2-4 h post-dose, indicating rapid absorption. The terminal half-life was approximately 30 h and repeated dosing leads to drug accumulation, as expected: ~2 - 3 fold for AUC and Cmax. CC-95775 induced ≥50% decrease of the PD biomarker CCR1 at the 4-hour timepoint in the 1200 mg cohort. Conclusions: CC-95775 was well tolerated and showed preliminary antitumor activity in heavily pretreated patients with advanced malignancies. The RP2D was 1200 mg Q4W. The favorable PD profile improved tolerability and enabled less frequent dosing. Further evaluation of CC-95775 alone or in combination in STs is warranted.
Citation Format: Thierry Lesimple, María José de Miguel, Cristophe Le Tourneau, Mariano Ponz-Sarvise, Marie Paule Sablin, Diego Salas Benito, Bishoy Hanna, Henry Chang, Xin Wei, Marta Ocejo Garcia, Pilar Lardelli, Tania Sánchez, Josep Lluís Parra Palau, Zariana Nikolova, Emiliano Calvo. CC-95775, a reversible, oral bromodomain and extra-terminal (BET) inhibitor in patients with advanced solid tumors (STs): Results of a phase 1 study [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P033.
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Subbiah V, Sankhala KK, Ratan R, Sanz Garcia E, Boni V, Gil T, Villalobos VM, Chawla SP, Lardelli P, Siguero M, Kahatt CM, Soto-Matos A, Ferrari S. Efficacy and safety of lurbinectedin (PM1183) in Ewing sarcoma: Final results from a phase 2 study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.11519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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)
- Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ravin Ratan
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Valentina Boni
- START Madrid CIOCC Hospital Universitario Sanchinarro, Madrid, Spain
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Trigo Perez JM, Leary A, Besse B, Castellano DE, Ponce Aix S, ARRONDEAU J, Moreno V, Doger B, Lopez R, Awada A, Jungels C, Forster MD, Boni V, Lardelli P, Siguero M, Kahatt CM, Soto-Matos A, Kristeleit RS. Efficacy and safety of lurbinectedin (PM1183) in small cell lung cancer (SCLC): Results from a phase 2 study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.8570] [Citation(s) in RCA: 10] [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)
| | | | | | | | | | | | - Victor Moreno
- START Madrid-FJD, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Bernard Doger
- START Madrid-FJD, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Rafael Lopez
- IDIS; CIBERONC,Hospital Clínico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | - Ahmad Awada
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Christiane Jungels
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Valentina Boni
- START Madrid-CIOCC, Hospital Universitario San Chinarro, Madrid, Spain
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Forster M, Olmedo M, Calvo E, Moreno V, Lopez Criado M, Lopez-Vilariño J, Kahatt C, Lardelli P, Nuñez R, Soto-Matos A. Activity of lurbinectedin as single agent and in combination in patients with advanced small cell lung cancer (SCLC). Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Olmedo Garcia M, Forster M, Calvo E, Moreno V, Lopez Criado M, Lopez-Vilarino de Ramos J, Kahatt C, Lardelli P, Luepke-Estefan X, Soto-Matos A. Activity of lurbinectedin as single agent and in combination in patients with advanced small cell lung cancer (SCLC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx386.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ghouadni A, Delaloge S, Lardelli P, Kahatt C, Byrski T, Blum JL, Gonçalves A, Campone M, Nieto A, Alfaro V, Cullell-Young M, Lubinski J. Higher antitumor activity of trabectedin in germline BRCA2 carriers with advanced breast cancer as compared to BRCA1 carriers: A subset analysis of a dedicated phase II trial. Breast 2017; 34:18-23. [DOI: 10.1016/j.breast.2017.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/13/2017] [Accepted: 04/16/2017] [Indexed: 11/28/2022] Open
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Forster MD, Moreno V, Boni V, Guerra E, Poveda A, Kristeleit R, Kahatt CM, Lardelli P, Lopez Vilarino JA, Cuevas NM, Soto-Matos A, Calvo E. Activity of lurbinectedin (PM01183) as single agent and in combination in patients with endometrial cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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
5586 Background: Lurbinectedin (L) is a new anticancer drug that blocks trans-activated transcription, induces DNA double-strand breaks and modulates the tumor microenvironment. Advanced endometrial cancer (EC) is an unmet medical need. Methods: Activity in EC patients was reviewed in 3 trials: a phase IB study of lurbinectedin combined with doxorubicin (L+DOX), a phase I study of PM combined with paclitaxel (L+TAX) and a phase II single-agent basket trial (L). Baseline characteristics, safety and efficacy were analyzed. Results: 97 patients were evaluated: 34 (2 cohorts) with L+DOX, 11 with L+TAX and 52 with L. Median age was similar in the 3 studies. Endometrioid was the most frequent histology. Median (range) of prior chemotherapy lines for advanced disease was: L+DOX, 1(0-2); L+TAX, 2(1-3); L, 1(0-2). Responses were observed in the 3 studies (see table). Main adverse event was myelosuppression (grade 3-4 neutropenia/thrombocytopenia/febrile neutropenia: L+DOX Cohort A, 94%/26%/40%; L+DOX Cohort B, 79%/10%/16%; L+TAX, 54%/0%/0%; L, 33%/6%/6%). Non-hematological toxicity was mostly grade 1-2: fatigue, nausea and vomiting, and transaminase increase. Conclusions: Lurbinectedin is active as single agent and in combination in patients with advanced EC, with remarkable activity in terms of response rate, duration of response and PFS when combined with doxorubicin. Safety was acceptable in L+DOX Cohort B, L+TAX and L, and myelosuppression was well managed. Clinical trial information: NCT01970540. [Table: see text]
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Affiliation(s)
| | - Victor Moreno
- START Madrid-FJD, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Valentina Boni
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Eva Guerra
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | | | | | | | | | - Emiliano Calvo
- START Madrid, Centro Integral Oncológico Clara Campal, Madrid, Spain
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Balmana Gelpi J, Lubinski JA, Arun B, Byrski T, Telli ML, Isakoff SJ, Fernandez C, Lardelli P, Kahatt CM, Soto-Matos A, Delaloge S. Antitumor activity of trabectedin and lurbinectedin in germline BRCA2 carriers with metastatic breast cancer (MBC) as compared to BRCA1 carriers: Analysis of two phase II trials. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
574 Background: BRCA 1/2-associated breast cancer share homologous recombination deficiency, but also have independent and potentially actionable roles. Novel drugs with innovative mechanism of action, lacking cross-resistance with other used agents are needed for BRCA 1/2 MBC. Trabectedin (TR) and its analog, lurbinectedin (L), have shown to be active in BRCA 1/2 MBC. This study was sought to determine if there was a difference in activity of these agents between BRCA1 and 2 carriers. Methods: Safety and efficacy in MBC BRCA 1/2 were analyzed in 2 separate phase II trials of single agent TR and L. Results: 88 patients were evaluated: 34 with TR, 54 with L. Median age: 46 and 43, respectively. Median (range) prior chemotherapy lines: TR, 4 (1-10); L, 2 (0-5). Clinical responses were seen in the 2 trials (see table) and were higher in BRCA2 than in BRCA1 (33% vs 9% with TR and 61% vs 26% with L). Main adverse event was myelosuppression (grade 3-4 neutropenia / thrombocytopenia / febrile neutropenia: TR, 62.1%/24.3%/10.8% L, 66.7%/20.4%/20.4%). Non-hematological toxicity was mostly grade 1-2: fatigue, nausea/vomiting and high transaminases (grade 3/4 TR, 40.5%, L 18.5%). Conclusions: Remarkable activity of trabectedin and lurbinectedin as single agents was observed in BRCA 2 associated MBC. This finding warrants further investigation. One potential mechanistic rationale is the role of both lurbinectedin and BRCA 2 in transcription. Safety was acceptable and manageable in both studies. Clinical trial information: NCT01525589. [Table: see text]
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Affiliation(s)
| | - Jan Antoni Lubinski
- Pomeranian Medical University, International Hereditary Cancer Center, Szczecin, Poland
| | - Banu Arun
- MD Anderson Cancer Center, Houston, TX
| | - Tomasz Byrski
- Pomeranian Medical University, International Hereditary Cancer Center, Szczecin, Poland
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Forster M, Sessa C, Von Moos R, Brown N, Metaxas Y, Griguolo G, Lardelli P, Iglesias J, Fernandez-Teruel C, Jandali U, Soto-Matos S, Stathis A. Phase I study of lurbinectedin (PM01183) in combination with cisplatin (CDDP) with or without aprepitant in patients (pts) with advanced solid tumors. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30519-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Awada A, Cortés J, Martín M, Aftimos P, Oliveira M, López-Tarruella S, Espie M, Lardelli P, Extremera S, Fernández-García EM, Delaloge S. Phase 2 Study of Trabectedin in Patients With Hormone Receptor–Positive, HER-2–Negative, Advanced Breast Carcinoma According to Expression of Xeroderma Pigmentosum G Gene. Clin Breast Cancer 2016; 16:364-371. [DOI: 10.1016/j.clbc.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/05/2016] [Accepted: 05/09/2016] [Indexed: 11/30/2022]
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Blum JL, Gonçalves A, Efrat N, Debled M, Conte P, Richards PD, Richards D, Lardelli P, Nieto A, Cullell-Young M, Delaloge S. A phase II trial of trabectedin in triple-negative and HER2-overexpressing metastatic breast cancer. Breast Cancer Res Treat 2016; 155:295-302. [DOI: 10.1007/s10549-015-3675-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 12/01/2022]
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Forster M, Sessa C, Von Moos R, Brown N, Metaxas Y, Griguolo G, Lardelli P, Coronado C, Juan L, Fernandez-Teruel C, Soto-Matos A, Stathis A. 316 Phase I study of lurbinectedin (PM01183) in combination with cisplatin (C) with or without aprepitant (Ap) in patients (pts) with advanced solid tumors. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Provencio Pulla M, Tabernero J, Moreno V, Trigo Perez JM, Lopez R, Kristeleit R, Awada A, Leary A, Alexandre J, Delord JP, Ferrari S, Santoro A, Bajetta E, Subbiah V, Weitman S, Villalobos VM, Raymond E, Sundlov A, Lardelli P, Chawla SP. A multicenter phase II basket clinical trial of lurbinectedin (PM01183) in selected advanced solid tumors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps2604] [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)
| | | | | | | | - Rafael Lopez
- Hospital Clinico Universitario de Santiago de Compostela, Santiago De Compostela, Spain
| | | | | | | | - Jerome Alexandre
- Medical Oncology, Paris Descartes University, Cochin - Port Royal Hospital, AP-HP, Paris, France
| | | | | | | | - Emilio Bajetta
- Istituto di Oncologia, Policlinico di Monza, Monza, Italy
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics (Phase 1 Program), The University of Texas MD Anderson Cancer Center, Houston, TX
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Nicoletto MO, Baldoni A, Casarin A, Nardin M, Baretta Z, Randon G, Lardelli P, Nieto A, Alfaro V, Rigamonti C, Conte PF. Trabectedin in combination with pegylated liposomal doxorubicin: A retrospective analysis in patients with platinum-sensitive relapsed ovarian cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e16540] [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)
| | | | | | | | - Zora Baretta
- Instituto Oncologico Veneto, IOV-IRCCS, Padova, Italy
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Aracil M, Lardelli P, Nieto A, Galmarini C. 35 BRCA1 expression exploratory analysis in patients of the phase III trial of trabectedin vs. doxorubicin-based chemotherapy as first-line therapy in translocation-related sarcomas. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70161-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Blay JY, Leahy MG, Nguyen BB, Patel SR, Hohenberger P, Santoro A, Staddon AP, Penel N, Piperno-Neumann S, Hendifar A, Lardelli P, Nieto A, Alfaro V, Chawla SP. Randomised phase III trial of trabectedin versus doxorubicin-based chemotherapy as first-line therapy in translocation-related sarcomas. Eur J Cancer 2014; 50:1137-47. [PMID: 24512981 DOI: 10.1016/j.ejca.2014.01.012] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 02/03/2023]
Abstract
AIM This randomised phase III trial evaluated first-line trabectedin versus doxorubicin-based chemotherapy (DXCT) in patients with advanced/metastatic translocation-related sarcomas (TRS). METHODS Patients were randomly assigned (1:1) to receive trabectedin 1.5mg/m2 24-h intravenous (i.v.) infusion every 3 weeks (q3wk) (Arm A), or doxorubicin 75 mg/m2 i.v., q3wk, or doxorubicin 60 mg/m2 i.v. plus ifosfamide (range, 6-9 g/m2) i.v. q3wk (Arm B). Progression-free survival (PFS) by independent review was the primary efficacy end-point. RESULTS One hundred and twenty-one patients were randomised; 88 of them had TRS confirmed by central pathology review (efficacy population). Twenty-nine PFS events were assessed by independent review (16 with trabectedin; 13 with DXCT). PFS showed non-significant difference between arms (stratified log rank test, p=0.9573; hazard ratio=0.86, p=0.6992). At the time of this analysis, 63.9% and 58.3% of patients were alive in trabectedin and DXCT arms, respectively. There was no statistically significant difference in survival curves. Response rate according to Response Evaluation Criteria in Solid Tumours (RECIST) v.1.0 was significantly higher in DXCT arm (27.0% versus 5.9%), but response according to Choi criteria showed fewer differences between treatment arms (45.9% versus 37.3%). Safety profile was as expected for both arms, with higher incidence of severe neutropenia, alopecia and mucositis in the DXCT arm. CONCLUSION Neither trabectedin nor doxorubicin-based chemotherapy showed significant superiority in the first-line treatment of patients with advanced translocation-related sarcoma.
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Affiliation(s)
| | - Michael G Leahy
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | - Armando Santoro
- Humanitas Cancer Center, Istituto Clinico Humanitas IRCCS, Rozzano, Italy
| | | | | | | | | | | | - Antonio Nieto
- PharmaMar, Clinical R&D, Colmenar Viejo, Madrid, Spain
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Delaloge S, Wolp-Diniz R, Byrski T, Blum JL, Gonçalves A, Campone M, Lardelli P, Kahatt C, Nieto A, Cullell-Young M, Lubinski J. Activity of trabectedin in germline BRCA1/2-mutated metastatic breast cancer: results of an international first-in-class phase II study. Ann Oncol 2014; 25:1152-8. [PMID: 24692579 DOI: 10.1093/annonc/mdu134] [Citation(s) in RCA: 37] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breast cancer is a heterogeneous disease defined by both germline and somatic abnormalities. In preclinical models, tumors carrying homologous recombination defects are highly sensitive to trabectedin. This phase II trial evaluated the efficacy and safety of trabectedin in BRCA1/2 germline mutation carriers with pretreated metastatic breast cancer (MBC). PATIENTS AND METHODS Trabectedin 1.3 mg/m(2) as a 3-h i.v. infusion was administered every 3 weeks until progression or intolerance. The primary efficacy end point was the objective response rate (ORR) as per RECIST. Secondary efficacy end points comprised time-to-event end points, and changes in tumor volume and expression of tumor marker CA15.3. Safety was evaluated using the NCI-CTCAE. RESULTS Forty BRCA1/2 germline mutation carriers with MBC were included. Confirmed partial response (PR) occurred in 6 of 35 assessable patients [ORR = 17%; 95% confidence interval (CI) 7% to 34%] and lasted 1.4-6.8 months. Median PFS was 3.9 months (95% CI 1.6-5.5 months). Eight patients (21%) showed changes in tumor volume, and 14 (40%) a clinical benefit. Trabectedin-related adverse events were generally mild/moderate, the most common being fatigue, nausea, constipation and anorexia. Severe laboratory abnormalities (neutropenia, transaminase increases) were mostly transient and noncumulative, and were managed by dose adjustments. CONCLUSIONS With the caveat of the limited patient number, trabectedin monotherapy showed activity and was well tolerated in heavily pretreated MBC patients selected for germline BRCA mutation. These results prompt further evaluation of trabectedin alone or combined with other specific drugs in this indication. CLINICALTRIALSGOV NCT00580112.
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Affiliation(s)
- S Delaloge
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - R Wolp-Diniz
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - T Byrski
- Department of Medical Oncology, International Hereditary Cancer Center, Sczeczin, Poland
| | - J L Blum
- Department of Oncology, Baylor-Charles A. Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, USA
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille
| | - M Campone
- Department of Medical Oncology, Institut de Cancérologie de l'OUEST, Nantes, France
| | - P Lardelli
- Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | - C Kahatt
- Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | - A Nieto
- Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | | | - J Lubinski
- Department of Medical Oncology, International Hereditary Cancer Center, Sczeczin, Poland
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Sessa C, Del Conte G, Christinat A, Cresta S, Perotti A, Gallerani E, Lardelli P, Kahatt C, Alfaro V, Iglesias JL, Fernández-Teruel C, Gianni L. Phase I clinical and pharmacokinetic study of trabectedin and cisplatin given every three weeks in patients with advanced solid tumors. Invest New Drugs 2013; 31:1236-43. [DOI: 10.1007/s10637-013-9942-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 02/19/2013] [Indexed: 10/27/2022]
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Awada A, Cortes J, Martin M, Aftimos P, Oliveira M, Espie M, Lardelli P, Extremera S, Kahatt CM, Delaloge S. Final results of a phase II trial of trabectedin (T) in patients with hormone receptor-positive, HER2-negative advanced breast cancer, according to xeroderma pigmentosum gene (XPG) expression. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.547] [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
547 Background: Hormone receptor (HR)-positive, HER2-negative metastatic breast cancer (BC) is currently associated with 3-4 years survival and, after ≥2 relapses, therapeutic approaches are reduced. XPG expression is frequently modified in BC. T forms cytotoxic complexes with XPG inducing apoptosis, thus, the inhibitory effects of T may depend on XPG presence. In fact, a better response to T in BC pts with XPG RNA overexpression has been observed. Methods: Pts withHR positive, HER2 negative advanced BC, pretreated with anthracyclines and/or taxanes, who had progressed after 2-5 chemotherapy lines, were stratified according to their XPG expression from paraffin embedded tumor samples, to stratum A (XPG high [>3]) or to stratum B (XPG low [≤3]) (threshold was selected from median XPG expression values observed in a previous trial) and treated with T (1.3 mg/m2 in 3-hour iv infusion every 3 weeks). Primary endpoint: to evaluate the efficacy of T as progression free survival rate at 4 months (PFS4) according to XPG expression. Secondary endpoints: Comparison of PFS, overall response rate, duration of response, overall survival and safety in XPG high and XPG low pts. Statistical methods: A 2-stage design was chosen: at a 1st stage, 20 pts were enrolled in each stratum. A futility analysis (O’Brien Fleming boundary) based on the primary endpoint was done once 40 evaluable pts were recruited. If ≥ 7 out of 20 pts achieved PFS4, recruitment would continue to a maximum of 50 pts per stratum. Results: 44 pts (21 XPG high and 23 XPG low) were enrolled from three countries and five centers. Efficacy is shown in the Table. Most frequent AEs were nausea (54%) and fatigue (70%). ALT increase G4 occurred in 7% of pts and neutropenia G4 in 28%. Conclusions: Trabectedin showed modest activity in advanced HR-positive, HER2-negative BC previously treated with anthracyclines and taxanes, with an acceptable safety profile. XPG does not seem to be a predictor of outcome to T treatment in this patient population. Clinical trial information: 2010-022968-13. [Table: see text]
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Affiliation(s)
- Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | | | - Miguel Martin
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Philippe Aftimos
- University Jules Bordet. Universite Libre de Bruxelles, Brussels, Belgium
| | - Mafalda Oliveira
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
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Hendifar AE, Chawla SP, Leahy MG, Italiano A, Patel S, Santoro A, Staddon AP, Penel N, Piperno-Neumann S, Demetri GD, Hayward L, White J, Gouw LG, De Miguel B, Lardelli P, Soto A, Nieto A, Blay JY. Results of the randomized phase III trial of trabectedin (T) versus doxorubicin-based chemotherapy (DXCT) as first-line therapy in patients (pts) with translocation-related sarcoma (TRS). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.10517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10517 Background: T is the first of a new class of anticancer agents with a transcription-targeted mechanism of action. In vitro,T interferes with the aberrant transcription factors binding to DNA promoters in TRS. Methods: Pts with advanced TRS of the subtypes: myxoid liposarcoma (ML), alveolar soft part sarcoma, angiomatoid fibrous histiocytoma, clear cell sarcoma, desmoplastic small round cell tumor, low grade endometrial stromal sarcoma, low grade fibromyxoid sarcoma, myxoid chondrosarcoma and synovial sarcoma, stratified by performance status (0 vs 1-2) and subtype (ML vs other TRS) were randomized (1:1 ratio) to T (1.5 mg/m2 in 24h iv infusion q3wk) or doxorubicin, either single agent 75 mg/m2 q3wk, or 60 mg/m2 combined with ifosfamide (6-9 g/m2 q3wk) as 1st line treatment. Primary endpoint: efficacy of T vs DXCT by comparing progression-free survival (PFS). Secondary: PFS at 6 months (PFS6), response rate (RR), PFS/RR by subtype (ML vs other TRS); overall survival (OS), safety. Results: 121 pts enrolled from 22 centers, 88 were confirmed by central pathology review and evaluable for the primary efficacy endpoint by independent review assessment (IR), and all 121 pts randomized were evaluable by investigators’ assessment (IA). The main limitation of the study analyses in both arms was high censoring rate (70% IR; 61% IA) mostly due to surgery (~30%) or chemotherapy/ radiotherapy (~30%). PFS results are shown in the Table. PFS6 was not different between arms (IR: 66.4% vs 80.8% p=0.18/IA: 60.7% vs 62.4% p=0.88). Current median OS:not reached (NR) for T (24.1-NR) and 21.7 mo. for DXCT (21.2-NR).Safety: Most frequent AEs in both arms were nausea (70% vs 65%), vomiting (44% vs 26%) and fatigue (64% vs 63%). ALT increase G4 occurred in 10% pts treated with T and neutropenia G4 in 25% of pts in the T arm vs 52% in the DXCT arm. Conclusions: Although with a high censoring rate, this prospective study suggests thatPFS/OS with trabectedin are not significantly different from DXCT in first-line treatment. Clinical trial information: NCT00796120. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Larry Hayward
- Edinburgh Cancer Research UK Center, Western General Hospital, Edinburgh, United Kingdom
| | - Jeff White
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Launce G. Gouw
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | | | | | - Jean-Yves Blay
- University Claude Bernard Lyon I, Centre Léon Bérard, Lyon, France
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Blay JY, Leahy MG, Bui Nguyen B, Patel S, Santoro A, Hohenberger P, Demetri GD, Lardelli P, Perez I, Chawla SP. Randomized multicenter phase III trial of trabectedin (T) versus doxorubicin-based chemotherapy as first-line therapy in patients with translocation-related sarcoma (TRS). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.tps10101] [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
TPS10101 Background: One third of sarcoma histotypes have specific chromosomal translocations which result in abnormal transcription factors, integral to the change to a malignant phenotype. T is the first of a new class of anti-tumor agents with a transcription-targeted mechanism of action. In vitro evidence exists of the ability of T to interfere with the aberrant transcription factor’s binding to DNA promoters in TRS. Patients with TRS, such as myxoid/round cell liposarcomas (MRCL) have benefited from long-lasting tumor control in response to T. Methods: A randomized, phase III study of T (1.5 mg/m2 in 24-h intravenous infusion every 3 weeks [q3wk]) vs doxorubicin 75 mg/m2 q3wk, or doxorubicin 60 mg/m2 with ifosfamide 6-9 g/m2 q3wk) as first line treatment in patients with advanced TRS. Primary aim: to determine the efficacy of T vs doxorubicin-based therapy by comparing progression-free survival (PFS) in each arm. Secondary aims: comparison of PFS rates at six months, response rate (RR), PFS and RR by histological type (MRCL vs other subtypes), overall survival, safety, exploratory response evaluation by Choi criteria and pharmacogenomic analyses. Patients with confirmed TRS of the following subtypes: MRCL, alveolar soft part sarcoma,angiomatoid fibrous histiocytoma, clear cell sarcoma, desmoplastic small round cell tumor, low grade endometrial stromal sarcoma, low grade fibromyxoid sarcoma,myxoid chondrosarcoma and synovial sarcoma, are stratified by performance status (PS 0 vs 1-2) and sarcoma subtype (MRCL vs other subtypes) and randomized (1:1 ratio) to T or doxorubicin ± ifosfamide. Confirmation of the translocation by fluorescence in situ hybridization is compulsory for inclusion in the primary efficacy analysis. An adaptive design was chosen to test the reduction in relative risk of progression or death with T, an interim analysis will be conducted with 45 PFS events from 80 evaluable patients. To date 117 patients have been enrolled from six countries and 29 centers. An independent data monitoring committee met on 15 November 2011 and concluded that the trial should continue as planned.
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Affiliation(s)
| | | | | | | | - Armando Santoro
- Humanitas Cancer Center, Istituto Clinico Humanitas IRCCS, Rozzano, Italy
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Awada A, Cortes J, Martin M, Aftimos P, Oliveira M, Espie M, Lardelli P, Extremera S, Kahatt CM, Fernandez-Garcia E, Delaloge S. A phase II trial of trabectedin (T) in patients with hormone receptor-positive, HER2-negative advanced breast cancer, according to xeroderma pigmentosum gene (XPG) expression. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.tps652] [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
TPS652 Background: Hormone receptor-positive, HER2-negative breast cancer (BC) is currently associated with 3-4 years overall survival in the metastatic setting and, after ≥2 relapses, therapeutic approaches are reduced. XPG expression is frequently modified in BC. T is a cytotoxic agent that forms a complex with the XPG, inducing cell apoptosis. As a single agent, T has shown anti-tumor activity in patients with poor prognosis BC, and a better response to T in BC patients with XPG RNA overexpression has been observed. Methods: This is an open-label, phase II study of T (1.3 mg/m2 in 3-hour intravenous infusion every 3 weeks) in patients with hormone receptor-positive, HER2-negative advanced BC, according to their primary tumor’s XPG expression. Primary endpoint: to evaluate the efficacy of T in terms of progression free survival rate at 4 months (PFS4) according to the patient’s XPG expression. Secondary endpoints: Comparison of PFS, overall response rate, duration of response, overall survival and safety profile in XPG-high and XPG-low patients. Assignment: BC patients who have previously received anthracyclins and/or taxanes and who progressed after 2-5 chemotherapy lines will be assigned according to their XPG expression from paraffin embedded tumor samples to stratum A (XPG-high [>3]) or to stratum B (XPG-low [≤3]) (threshold was selected from median XPG expression values observed in a previous trial). Statistical methods: A two-stage design was chosen: at a first stage 20 patients will be enrolled in each stratum. A futility analysis (O’Brien Fleming boundary) based on the primary endpoint (PFS4) will be conducted once 40 evaluable patients have been recruited. If ≥ 7 out of 20 patients achieve PFS4, recruitment will continue to a maximum sample size of 50 evaluable patients per stratum. If ≥ 22 out of 50 patients achieve PFS4, T will be considered active in this group (alpha error: 0.025, power: 80%). To date, 35 patients (16 XPG-high and 15 XPG-low) have been enrolled from three countries and five centers. Recruitment is ongoing.
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Affiliation(s)
| | - Javier Cortes
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Miguel Martin
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Mafalda Oliveira
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
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Michaelson MD, Bellmunt J, Hudes GR, Goel S, Lee RJ, Kantoff PW, Stein CA, Lardelli P, Pardos I, Kahatt C, Nieto A, Cullell-Young M, Lewis NL, Smith MR. Multicenter phase II study of trabectedin in patients with metastatic castration-resistant prostate cancer. Ann Oncol 2012; 23:1234-1240. [PMID: 21930687 PMCID: PMC3945398 DOI: 10.1093/annonc/mdr399] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/13/2011] [Accepted: 07/18/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This multicenter phase II trial evaluated the efficacy and safety of trabectedin in metastatic castration-resistant prostate cancer (CRPC). PATIENTS AND METHODS Two schedules were evaluated in three cohorts: weekly as 3-h i.v. infusion at 0.58 mg/m(2) for 3 out of 4 weeks (Cohort A, n = 33), and every 3 weeks (q3wk) as 24-h infusion at 1.5 mg/m(2) (Cohort B1, n = 5) and 1.2 mg/m(2) (Cohort B2, n = 20). The primary end point was prostate-specific antigen (PSA) response; secondary end points included safety, tolerability and time to progression (TTP). RESULTS Trabectedin resulted in PSA declines ≥ 50% in 12.5% (Cohort A) and 10.5% (Cohort B2) of patients. Among men pretreated with taxane-based chemotherapy, PSA response was 13.6% (Cohort A) and 15.4% (Cohort B2). PSA responses lasted 4.1-8.6 months, and median TTP was 1.5 months (Cohort A) and 1.9 months (Cohort B2). The dose of 1.5 mg/m(2) (approved for soft tissue sarcoma) given as 24-h infusion q3wk was not tolerable in these patients. At 1.2 mg/m(2) q3wk and 0.58 mg/m(2) weekly, the most common adverse events were nausea, fatigue and transient neutropenia and transaminase increase. CONCLUSIONS Two different trabectedin schedules showed modest activity in metastatic CRPC. Further studies may require identification of predictive factors of response in prostate cancer.
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Affiliation(s)
- M D Michaelson
- Massachusetts General Hospital Cancer Center, Boston, USA.
| | - J Bellmunt
- Medical Oncology Service, Hospital del Mar, Barcelona, Spain
| | - G R Hudes
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia
| | - S Goel
- Department of Oncology, Montefiore-Einstein Cancer Center, Bronx
| | - R J Lee
- Massachusetts General Hospital Cancer Center, Boston, USA
| | - P W Kantoff
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - C A Stein
- Department of Oncology, Montefiore-Einstein Cancer Center, Bronx
| | - P Lardelli
- Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | - I Pardos
- Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | - C Kahatt
- Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | - A Nieto
- Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | | | - N L Lewis
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia
| | - M R Smith
- Massachusetts General Hospital Cancer Center, Boston, USA
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Grosso F, D'Incalci M, Cartoafa M, Nieto A, Fernández-Teruel C, Alfaro V, Lardelli P, Roy E, Gómez J, Kahatt C, Soto-Matos A, Judson I. A comprehensive safety analysis confirms rhabdomyolysis as an uncommon adverse reaction in patients treated with trabectedin. Cancer Chemother Pharmacol 2012; 69:1557-65. [PMID: 22484722 PMCID: PMC3362698 DOI: 10.1007/s00280-012-1864-4] [Citation(s) in RCA: 20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 03/22/2012] [Indexed: 01/04/2023]
Abstract
PURPOSE This analysis determined the incidence of serious rhabdomyolysis events reported during trabectedin treatment since the first phase I clinical trial in April 1996 up to September 2010. METHODS Search was done in the Yondelis(®) Pharmacovigilance and Clinical Trials databases using a list of terms according to the Medical Dictionary for Regulatory Activities (MedDRA, v. 13.1), followed by a medical review of all cases retrieved. Total estimated sample was 10,841 patients: 2,789 from clinical trials; 3,926 from compassionate use programs; and 4,126 treated in the marketplace. Two groups were identified: (1) rhabdomyolysis and (2) clinically relevant creatine phosphokinase (CPK) increases without acute renal failure (ARF). Descriptive analysis included demographic, clinical/laboratory data, and contributing/confounding factors. Potential predictive factors were evaluated by multivariate stepwise logistic regression analysis. Possible changes of pharmacokinetics (PK) in patients with rhabdomyolysis were explored using a population PK model. RESULTS The global incidence of rhabdomyolysis was 0.7%, and most cases occurred in Cycle 2 of treatment. The incidence of fatal cases was 0.3%. None of the variables evaluated to detect potential risk factors of rhabdomyolysis were predictive. Additionally, CPK increases (without ARF) were detected in 0.4% of patients as an incidental finding with good prognosis. CONCLUSIONS Rhabdomyolysis is an uncommon event during trabectedin treatment. Multivariate analyses did not show any potential factor that could be predictive or represent a significantly higher risk of developing rhabdomyolysis. Nevertheless, close patient monitoring and adherence to drug administration guidelines may help to limit the incidence of this event.
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Affiliation(s)
- Federica Grosso
- SC Oncologia, SS Antonio and Biagio and C Arrigo General Hospital, Alessandria, Italy.
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25
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Gronchi A, Bui BN, Bonvalot S, Pilotti S, Ferrari S, Hohenberger P, Hohl RJ, Demetri GD, Le Cesne A, Lardelli P, Pérez I, Nieto A, Tercero JC, Alfaro V, Tamborini E, Blay JY. Phase II clinical trial of neoadjuvant trabectedin in patients with advanced localized myxoid liposarcoma. Ann Oncol 2012; 23:771-776. [PMID: 21642514 DOI: 10.1093/annonc/mdr265] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To evaluate neoadjuvant trabectedin (1.5 mg/m(2) 24-h i.v. infusion every 3 weeks; three to six cycles) in patients with locally advanced myoxid liposarcoma (ML) previously untreated with chemotherapy or radiation. PATIENTS AND METHODS Primary efficacy end point was pathological complete response (pCR) or tumoral regression rate. Objective response according to RECIST (v.1.0) was a secondary end point. RESULTS Three of 23 assessable patients had pCR [13%; 95% confidence interval (CI), 3% to 34%]. Furthermore, very good and moderate histological responses were observed in another 2 and 10 patients, respectively. Histological decrement in the cellular and vascular tumor component and maturation of tumor cells to lipoblasts were observed in both myoxid and myoxid/round cell variants. Seven patients had partial response according to RECIST (objective response rate of 24%; 95% CI, 10% to 44%). No disease progression was reported. Neoadjuvant trabectedin was usually well tolerated, with a safety profile similar to that described in patients with soft tissue sarcoma or other tumor types. CONCLUSION Trabectedin 1.5 mg/m(2) given as a 24-h i.v. infusion every 3 weeks is a therapeutic option in the neoadjuvant setting of ML.
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Affiliation(s)
- A Gronchi
- Department of Surgery, National Cancer Institute, Milano, Italy.
| | - B N Bui
- Department of Medical Oncology, Institute Bergonié, Bourdaux
| | - S Bonvalot
- Departments of Surgery; Medical Oncology, Institute Gustave Roussy, Paris, France
| | - S Pilotti
- Department of Surgery, National Cancer Institute, Milano, Italy
| | - S Ferrari
- Department of Chemotherapy, Orthopedic Institute Rizzoli, Bologna, Italy
| | - P Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Germany
| | - R J Hohl
- Department of Internal Medicine, Carver College of Medicine, Division of Hematology, Oncology and Blood and Marrow Transplantation, Iowa
| | - G D Demetri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - A Le Cesne
- Departments of Surgery; Medical Oncology, Institute Gustave Roussy, Paris, France
| | - P Lardelli
- Department of Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | - I Pérez
- Department of Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | - A Nieto
- Department of Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | - J C Tercero
- Department of Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | - V Alfaro
- Department of Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | - E Tamborini
- Department of Surgery, National Cancer Institute, Milano, Italy
| | - J Y Blay
- Department of Medical Oncology; Léon Bérard Cancer Center, Lyon, France
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Geoerger B, Estlin EJ, Aerts I, Kearns P, Gibson B, Corradini N, Doz F, Lardelli P, Miguel BD, Soto A, Prados R, Vassal G. A phase I and pharmacokinetic study of plitidepsin in children with advanced solid tumours: An Innovative Therapies for Children with Cancer (ITCC) study. Eur J Cancer 2012; 48:289-96. [DOI: 10.1016/j.ejca.2011.10.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 10/26/2011] [Accepted: 10/26/2011] [Indexed: 10/15/2022]
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Cartoafa M, Kahatt C, Soto-Matos A, Roy E, Lardelli P. Acute myeloid leukemia unlikely related to trabectedin treatment. Acta Haematol 2012; 126:238-9; author reply 240. [PMID: 21952689 DOI: 10.1159/000330952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 07/19/2011] [Indexed: 01/20/2023]
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Massuti B, Cobo M, Camps C, Dómine M, Provencio M, Alberola V, Viñolas N, Rosell R, Tarón M, Gutiérrez-Calderón V, Lardelli P, Alfaro V, Nieto A, Isla D. Trabectedin in patients with advanced non-small-cell lung cancer (NSCLC) with XPG and/or ERCC1 overexpression and BRCA1 underexpression and pretreated with platinum. Lung Cancer 2011; 76:354-61. [PMID: 22197612 DOI: 10.1016/j.lungcan.2011.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/02/2011] [Accepted: 12/04/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies in sarcoma found that a composite gene signature, including high expression of nucleotide excision repair (NER) genes (XPG and/or ERCC1) and low expression of homologous recombination repair (HR) genes (BRCA1), identifies a highly sensitive population of patients with significantly improved outcome to trabectedin. This exploratory phase II trial evaluated a customized trabectedin treatment according to this gene signature in patients with non-small cell lung cancer (NSCLC) after the failure of standard platinum-based treatment. METHODS Patients were selected according to their mRNA expression (elevated XPG and/or ERCC1, with low BRCA1) using the following values as cutoff: XPG=0.99, ERCC1=3.47 and BRCA1=12.00. Trabectedin was administered as a 1.3mg/m(2) 3-hour intravenous infusion every 3 weeks (q3wk). The primary efficacy endpoint was the progression-free survival rate at 3 months. Objective response according to the Response Evaluation Criteria in Solid Tumors (RECIST) was a secondary efficacy endpoint. RESULTS Two of 18 evaluable patients (11.1%; 95% CI, 1.38-34.7%) achieved progression-free survival rate at 3 months. The primary efficacy objective (at least 3 of 18 patients being progression-free at 3 months) was not met, and therefore the trial was early finalized. No objective responses per RECIST were achieved. Four patients had stable disease. Median PFS was 1.3 months, and median overall survival was 5.9 months. Trabectedin was usually well tolerated, with a safety profile similar to that described in patients with other tumor types. CONCLUSIONS Customized treatment with trabectedin 1.3mg/m(2) 3-h q3wk according to composite gene signature (XPG and/or ERCC1 overexpression, and BRCA1 underexpression) was well tolerated, but had modest activity in NSCLC patients pretreated with platinum. Therefore, further clinical trials with trabectedin as single agent in this indication are not warranted.
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Soto-Matos A, Szyldergemajn S, Extremera S, Miguel-Lillo B, Alfaro V, Coronado C, Lardelli P, Roy E, Corrado CS, Kahatt C. Plitidepsin has a safe cardiac profile: a comprehensive analysis. Mar Drugs 2011; 9:1007-1023. [PMID: 21747745 PMCID: PMC3131558 DOI: 10.3390/md9061007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 05/25/2011] [Accepted: 05/31/2011] [Indexed: 12/11/2022] Open
Abstract
Plitidepsin is a cyclic depsipeptide of marine origin in clinical development in cancer patients. Previously, some depsipeptides have been linked to increased cardiac toxicity. Clinical databases were searched for cardiac adverse events (CAEs) that occurred in clinical trials with the single-agent plitidepsin. Demographic, clinical and pharmacological variables were explored by univariate and multivariate logistic regression analysis. Forty-six of 578 treated patients (8.0%) had at least one CAE (11 patients (1.9%) with plitidepsin-related CAEs), none with fatal outcome as a direct consequence. The more frequent CAEs were rhythm abnormalities (n = 31; 5.4%), mostly atrial fibrillation/flutter (n = 15; 2.6%). Of note, life-threatening ventricular arrhythmias did not occur. Myocardial injury events (n = 17; 3.0%) included possible ischemic-related and non-ischemic events. Other events (miscellaneous, n = 6; 1.0%) were not related to plitidepsin. Significant associations were found with prostate or pancreas cancer primary diagnosis (p = 0.0017), known baseline cardiac risk factors (p = 0.0072), myalgia present at baseline (p = 0.0140), hemoglobin levels lower than 10 g/dL (p = 0.0208) and grade ≥2 hypokalemia (p = 0.0095). Treatment-related variables (plitidepsin dose, number of cycles, schedule and/or total cumulative dose) were not associated. Electrocardiograms performed before and after plitidepsin administration (n = 136) detected no relevant effect on QTc interval. None of the pharmacokinetic parameters analyzed had a significant impact on the probability of developing a CAE. In conclusion, the most frequent CAE type was atrial fibrillation/atrial flutter, although its frequency was not different to that reported in the age-matched healthy population, while other CAEs types were rare. No dose-cumulative pattern was observed, and no treatment-related variables were associated with CAEs. Relevant risk factors identified were related to the patient's condition and/or to disease-related characteristics rather than to drug exposure. Therefore, the current analysis supports a safe cardiac risk profile for single-agent plitidepsin in cancer patients.
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Affiliation(s)
| | | | | | | | - Vicente Alfaro
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +34-93-4037094; Fax: +34-93-4491079
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Tedesco KL, Blum JL, Goncalves A, Lubinski J, Osborne CRC, Lardelli P, Tercero JC, Florez A, Holmes FA, Delaloge S. Final results of a phase II trial of trabectedin (T) in triple-negative, HER2-positive, and BRCA1/2 germ-line-mutated metastatic breast cancer (MBC) patients (pts). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sessa C, Gallerani E, Del Conte G, Christinat A, Perotti A, Lardelli P, Kahatt CM, Florez A, Fernandez C, Miani M, Gianni L. Phase I dose-finding study of trabectedin (T) in combination with cisplatin (C) in patients (pts) with advanced solid tumors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lebedinsky C, Gómez J, Park YC, Nieto A, Soto-Matos A, Parekh T, Alfaro V, Roy E, Lardelli P, Kahatt C. Trabectedin has a low cardiac risk profile: a comprehensive cardiac safety analysis. Cancer Chemother Pharmacol 2011; 68:1223-31. [PMID: 21416137 DOI: 10.1007/s00280-011-1614-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/04/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE This analysis provides a cross-study evaluation of the cardiac safety of trabectedin. METHODS Drug-related cardiac adverse events (CAEs) were retrieved from phase I-III clinical trials, pharmacovigilance databases, and spontaneously reported cases. Left ventricular ejection fraction (LVEF) was monitored in combination phase I studies with doxorubicin or pegylated liposomal doxorubicin (PLD) and in a phase III trial (with PLD). RESULTS CAEs [grade 4 cardiac arrest with severe pancytopenia and sepsis (n = 1 patient), grade 4 atrial fibrillation (n = 2), and grade 1 tachycardia (n = 1)] occurred in 4/283 patients (1.4%) in 6 single-agent phase I trials. CAEs (grade 1 sinus tachycardia in a hypertensive patient and grade 1 ventricular dysfunction) occurred in 2/155 patients (1.3%) in 4 phase I combination trials. Results from 19 single-agent phase II trials showed CAEs in 20/1,132 patients (1.8%): arrhythmias (tachycardia/palpitations; n = 13; 1.1%) were the most common. A rather similar rate of symptomatic CAEs was observed in both arms of a phase III trial in recurrent ovarian cancer: 6/330 patients (1.8%; PLD) and 11/333 patients (3.3%; trabectedin/PLD). No clinically relevant LVEF changes occurred in phase I combination trials. In the phase III trial, LVEF decreases from baseline were similar: 9% of patients (PLD) and 7% (trabectedin/PLD), with no relevant symptoms. During postmarketing experience in soft tissue sarcoma (2,046 patients treated), 4 CAEs (2 cardiac arrest, 2 cardiac failure; ~0.2%) occurred in patients with preexisting conditions. CONCLUSIONS Trabectedin has a low incidence of CAEs, consisting mainly of arrhythmias. This extensive data review indicates a low cardiac risk profile for trabectedin.
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Tedesco KL, Blum JL, Goncalves A, Lubinski J, Ben-Baruch N, Osborne CR, Lardelli P, Tercero JC, Holmes FA, Delaloge S. A phase II trial of trabectedin (T) in patients (pts) with HER2-positive and BRCA1/2 germ-line-mutated metastatic breast cancer (MBC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Soto-Matos A, Szyldergemajn S, Extremera S, Miguel-Lillo B, Alfaro V, Coronado C, Lardelli P, Roy E, Corrado CS, Kahatt CM. Plitidepsin cardiac safety analysis. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gronchi A, Palmerini E, Demetri G, Perez I, Lardelli P, Pilotti S, Hohenberger P, Bui N, Milhem M, Bonvalot S. 9400 A phase II clinical trial of neoadjuvant trabectedin in patients with non metastatic advanced myxoid/round cell liposarcoma (MRCL). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71988-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yovine A, Casali P, Grosso F, Vermorken J, Demetri G, Whelan J, Almorín E, Lardelli P, Peñas M, Schöffski P. 9426 Trabectedin 3-hour infusion every 3 weeks in pre-treated advanced sarcoma patients: a compassionate-use administration experience. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)72014-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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37
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Pulido J, Lardelli P, de la Fuente L, Flores VM, Vallejo F, Regidor E. Impact of the demerit point system on road traffic accident mortality in Spain. J Epidemiol Community Health 2009; 64:274-6. [DOI: 10.1136/jech.2008.082461] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Capdevila J, Clive S, Tabernero J, Lardelli P, Soto-Matos A, Baselga J, Piera A, Pardos I, Rye R, Smyth JF. Phase I study of the novel anticancer drug PM00104 as a 24-hour IV infusion every 3 weeks (q3w) in patients (pts) with advanced solid tumors or lymphoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2568 Background: PM00104 is a novel synthetic alkaloid related to the marine compounds jorumycin and renieramycins. Preliminary preclinical studies suggest changes in cell cycle and DNA binding properties and transcriptional inhibition as main mechanisms of action. PM00104 has shown broad in vitro and in vivo anti-tumor activity (IC50 ≤ 10-8 M) with an acceptable toxicology profile. Methods: The aim of this phase I study was to assess the safety profile, dose-limiting toxicities (DLT), maximum tolerated dose (MTD), recommended dose (RD), pharmacokinetics (PK), relationship between PK and pharmacodynamics (PD) and anti-tumor activity of PM00104 administered as a 24-hour i.v. infusion q3w. Sequential cohorts of 3–6 pts were treated at 133, 266, 400, 800, 900, 1600, 3200, 4000 and 5000 μg/m2. Results: Twenty nine pts have been treated (18 male, 11 female; median age: 59, range: 44–78; ECOG PS ≤2). Five pts developed DLTs: 2 pts at 5000 μg/m2 (grade 4 thrombocytopenia/neutropenia and grade 3 nausea/vomiting in 1 pt; and grade 3 nausea in 1 pt); 1 at 4000 μg/m2 (grade 4 neutropenia/thrombocytopenia and grade 3 asthenia); 1 at 3200 μg/m2 (grade 3 tumor pain) and 1 at 266 μg/m2 (grade 3 transaminase increase). The MTD was reached at 5000 μg/m2 and the RD at 4000 μg/m2. At the RD 6 more pts have been included in order to further evaluate the safety profile and anti-tumor activity. Other adverse events included nausea and vomiting (more frequent at doses ≥800 μg/m2), fatigue, anorexia and diarrhea; most of them being of ≤grade 2 severity. No objective responses were seen but 3 pts with pancreatic adenocarcinoma, hepatocarcinoma and lower esophagus adenocarcinoma presented stable disease lasting >3 months. PM00104 shows a dose-proportional PK profile, the half-life being 20–30 hours and the volume of distribution around 1000 L. Conclusions: PM00104 has shown an acceptable safety profile with signs of anti-tumor activity in pts with advanced malignancies when administered as a 24-hour i.v. infusion q3w. PM00104 is also being evaluated with other administration schedules as monotherapy and in combination with other anti-tumor agents. [Table: see text]
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Affiliation(s)
- J. Capdevila
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - S. Clive
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - J. Tabernero
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - P. Lardelli
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - A. Soto-Matos
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - J. Baselga
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - A. Piera
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - I. Pardos
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - R. Rye
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
| | - J. F. Smyth
- Vall d'Hebron University Hospital, Barcelona, Spain; Western General Hospital Edinburgh, Edinburgh, United Kingdom; PharmaMar, Colmenar Viejo, Madrid, Spain
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Gronchi A, Le Cesne A, Bui NB, Palmerini E, Demetri G, Hohenberger P, Hohl RJ, Pilotti S, Perez I, Lardelli P. A phase II clinical trial of neoadjuvant trabectedin in patients with nonmetastatic advanced myxoid/round cell liposarcoma (MRCL). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.10525] [Citation(s) in RCA: 3] [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
10525 Background: Trabectedin (ET-743, Yondelis), a marine-derived alkaloid has demonstrated significant activity in the treatment of soft tissue sarcomas (STS) in phase III trials, and has recently received EMEA approval in this indication. A subtype that accounts for 10% of STS, MRCL, displays the fusion FUS-CHOP in 95% of all cases. Preliminary results of neoadjuvant trabectedin (T) in advanced MRCL show reduction in the radiological density of the tumor, clinical improvement, and a pathological complete response (pCR) in the resected tumor mass. A phase II study to further determine the response to T in the MRCL population is presented. Methods: In this multicenter Phase II trial, patients (pts) with locally advanced (stage III) or locally recurrent MRCL were treated for 3 - 6 cycles with T (1.5 mg/m2 q3wk) in the neoadjuvant setting. Main endpoints were: pCR rate, objective response rate by RECIST, and correlation of molecular parameters from tissue samples with clinical outcomes. Results: Twenty-five pts with locally advanced MRCL have been recruited, of whom 20 are evaluable. All had the translocation (t12q13, 16p11) which causes the chimeric FUS-CHOP. Median age was 53 (23–75) and male:female ratio was 1. Thirteen pts completed therapy and underwent curative surgery. Pathological assessment was performed in 10 pts: 2 achieved pCR, 1 as per central pathology review and 1 by local pathology assessment. In addition, 1 pt had a very good pathological response. Ten patients remain to be histologically evaluated. Response rate by RECIST from pts who completed therapy was: 6 partial responses (46%) and 7 disease stabilizations. Remarkably, pathological response does not entirely correlate with response by RECIST since the pts with pCR still had radiological disease but no malignant component was found in the excised tumor mass (only connective and reactive tissue). Two serious adverse reactions of severe rhabdomyolysis, and asthenia, nausea and transaminase elevation were reported. Most common toxicities were liver enzyme elevation, neutropenia and thrombocytopenia. Conclusions: These preliminary results in terms of objective and complete pathologic responses, strongly suggest that T may have a role in the neoadjuvant setting in pts with MRCL. [Table: see text]
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Affiliation(s)
- A. Gronchi
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Institute Gustave Roussy, Paris, France; Institute Bergonie, Bordeaux, France; Instituti Ortopedici Rizzoli, Bologna, Italy; Dana-Farber Cancer Institute, Boston, MA; Division of Surgical Oncology and Thoracic Surgery, Mann, Mannheim, Germany; University of Iowa, Iowa, IA; PharmaMar, Madrid, Spain
| | - A. Le Cesne
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Institute Gustave Roussy, Paris, France; Institute Bergonie, Bordeaux, France; Instituti Ortopedici Rizzoli, Bologna, Italy; Dana-Farber Cancer Institute, Boston, MA; Division of Surgical Oncology and Thoracic Surgery, Mann, Mannheim, Germany; University of Iowa, Iowa, IA; PharmaMar, Madrid, Spain
| | - N. B. Bui
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Institute Gustave Roussy, Paris, France; Institute Bergonie, Bordeaux, France; Instituti Ortopedici Rizzoli, Bologna, Italy; Dana-Farber Cancer Institute, Boston, MA; Division of Surgical Oncology and Thoracic Surgery, Mann, Mannheim, Germany; University of Iowa, Iowa, IA; PharmaMar, Madrid, Spain
| | - E. Palmerini
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Institute Gustave Roussy, Paris, France; Institute Bergonie, Bordeaux, France; Instituti Ortopedici Rizzoli, Bologna, Italy; Dana-Farber Cancer Institute, Boston, MA; Division of Surgical Oncology and Thoracic Surgery, Mann, Mannheim, Germany; University of Iowa, Iowa, IA; PharmaMar, Madrid, Spain
| | - G. Demetri
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Institute Gustave Roussy, Paris, France; Institute Bergonie, Bordeaux, France; Instituti Ortopedici Rizzoli, Bologna, Italy; Dana-Farber Cancer Institute, Boston, MA; Division of Surgical Oncology and Thoracic Surgery, Mann, Mannheim, Germany; University of Iowa, Iowa, IA; PharmaMar, Madrid, Spain
| | - P. Hohenberger
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Institute Gustave Roussy, Paris, France; Institute Bergonie, Bordeaux, France; Instituti Ortopedici Rizzoli, Bologna, Italy; Dana-Farber Cancer Institute, Boston, MA; Division of Surgical Oncology and Thoracic Surgery, Mann, Mannheim, Germany; University of Iowa, Iowa, IA; PharmaMar, Madrid, Spain
| | - R. J. Hohl
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Institute Gustave Roussy, Paris, France; Institute Bergonie, Bordeaux, France; Instituti Ortopedici Rizzoli, Bologna, Italy; Dana-Farber Cancer Institute, Boston, MA; Division of Surgical Oncology and Thoracic Surgery, Mann, Mannheim, Germany; University of Iowa, Iowa, IA; PharmaMar, Madrid, Spain
| | - S. Pilotti
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Institute Gustave Roussy, Paris, France; Institute Bergonie, Bordeaux, France; Instituti Ortopedici Rizzoli, Bologna, Italy; Dana-Farber Cancer Institute, Boston, MA; Division of Surgical Oncology and Thoracic Surgery, Mann, Mannheim, Germany; University of Iowa, Iowa, IA; PharmaMar, Madrid, Spain
| | - I. Perez
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Institute Gustave Roussy, Paris, France; Institute Bergonie, Bordeaux, France; Instituti Ortopedici Rizzoli, Bologna, Italy; Dana-Farber Cancer Institute, Boston, MA; Division of Surgical Oncology and Thoracic Surgery, Mann, Mannheim, Germany; University of Iowa, Iowa, IA; PharmaMar, Madrid, Spain
| | - P. Lardelli
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Institute Gustave Roussy, Paris, France; Institute Bergonie, Bordeaux, France; Instituti Ortopedici Rizzoli, Bologna, Italy; Dana-Farber Cancer Institute, Boston, MA; Division of Surgical Oncology and Thoracic Surgery, Mann, Mannheim, Germany; University of Iowa, Iowa, IA; PharmaMar, Madrid, Spain
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Geoerger B, Doz F, Lowis S, Kearns P, Estlin E, Gibson B, Corradini N, Lardelli P, Vassal G. Phase I-II clinical and pharmacokinetic study of plitidepsin in children with malignant tumors. On behalf of the European ITCC (Innovative Therapies for Children with Cancer) Consortium. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.10028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Shiffman ML, Diago M, Tran A, Pockros P, Reindollar R, Prati D, Rodríguez-Torres M, Lardelli P, Blotner S, Zeuzem S. Chronic hepatitis C in patients with persistently normal alanine transaminase levels. Clin Gastroenterol Hepatol 2006; 4:645-52. [PMID: 16630770 DOI: 10.1016/j.cgh.2006.02.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Many patients with chronic hepatitis C virus (HCV) have persistently normal serum alanine transaminase (ALT) levels. We compared characteristics of chronic hepatitis C patients with patients with normal and elevated ALT levels using data from 3 randomized phase III trials of peginterferon alfa-2a (40 kDa). METHODS The characteristics of 480 patients with normal ALT values (on >or=3 occasions without any increases in ALT level over a 6- to 18-month period) and 1993 patients with elevated ALT levels were compared. Sixty-eight of the 480 patients with normal ALT levels were randomized to no treatment and monitored for 72 weeks. RESULTS More patients with normal ALT levels than patients with elevated ALT levels were women (59% vs 32%; P<.01). The serum HCV RNA titer was significantly lower in patients with normal ALT levels (P<.01 vs in patients with elevated ALT levels). Patients with normal ALT levels had significantly lower inflammation and fibrosis scores on liver biopsy examination than patients with elevated ALT levels, but almost two-thirds had portal fibrosis and 10% had bridging fibrosis. No correlation between baseline ALT activity, HCV RNA level, and liver histology was observed in patients with normal ALT levels. During the 72-week follow-up period, ALT activity elevated above the upper limit of normal in 53% of the untreated patients with normal levels of ALT. None became HCV RNA undetectable. CONCLUSIONS Chronic hepatitis C patients with normal ALT levels should be evaluated in a similar manner as patients with elevated ALT levels because they are at risk for developing significant liver disease. The decision to treat with peginterferon alfa and ribavirin should be based on multiple factors, rather than on ALT levels alone.
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Affiliation(s)
- Mitchell L Shiffman
- Virginia Commonwealth University Medical Center, Richmond, Virginia 23298, USA, and Hospital General de Valencia, Spain.
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42
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Prati D, Shiffman ML, Diago M, Gane E, Rajender Reddy K, Pockros P, Farci P, O'Brien CB, Lardelli P, Blotner S, Zeuzem S. Viral and metabolic factors influencing alanine aminotransferase activity in patients with chronic hepatitis C. J Hepatol 2006; 44:679-85. [PMID: 16487620 DOI: 10.1016/j.jhep.2006.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 01/09/2006] [Accepted: 01/12/2006] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIMS In chronic hepatitis C, disease progression and clinical manifestations are heterogenous. To clarify the role and interactions of viral and host factors in inducing liver cell injury, we examined the associations of several virological and metabolic variables with serum alanine aminotransferase levels. METHODS Patients with chronic hepatitis C enrolled in three phase III clinical trials of peginterferon alfa-2a (40KD) plus ribavirin (two studies analysing 'elevated' and one persistently 'normal' alanine aminotransferase) were included. RESULTS Multivariate analyses of 2,881 patients before treatment and of 1,403 patients with a sustained virological response indicated that gender, viral factors (genotype, HCV RNA titer) and indicators of metabolic syndrome (body mass index, blood pressure, blood glucose, cholesterol and triglyceride concentration) were associated with alanine aminotransferase levels. In addition, hepatitis C virus infection influenced serum lipids concentration according to a genotype-specific effect. CONCLUSIONS Heterogeneity in alanine aminotransferase levels in patients with chronic hepatitis C partially depends on the degree of derangement of fat and carbohydrate metabolism. As this is the result of an interaction of chronic hepatitis C infection with the patient's individual characteristics, treatment decisions should not be based on alanine aminotransferase level alone but rather on global evaluation of the patient.
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Affiliation(s)
- Daniele Prati
- Ospedale A. Manzoni, Lecco and IRCCS Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milan, Italy.
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43
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Zeuzem S, Diago M, Gane E, Reddy KR, Pockros P, Prati D, Shiffman M, Farci P, Gitlin N, O'Brien CB, Lamour F, Lardelli P. Peginterferon alfa-2a (40 kilodaltons) and ribavirin in patients with chronic hepatitis C and normal aminotransferase levels. Gastroenterology 2004; 127:1724-32. [PMID: 15578510 DOI: 10.1053/j.gastro.2004.09.050] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND & AIMS Patients with chronic hepatitis C and persistently normal alanine aminotransferase (ALT) levels have been routinely excluded from large randomized treatment trials; consequently, the efficacy and safety of antiviral therapy in this population are unknown. METHODS Patients with at least 3 normal ALT values over an 18-month period were randomized (3:3:1) to treatment with peginterferon alfa-2a 180 mug/wk plus ribavirin 800 mg/day for 24 weeks (212 patients), the same combination for 48 weeks (210 patients), or no treatment (69 patients) in a multinational study. All patients were monitored for 72 weeks. The primary measure of efficacy was sustained virologic response (SVR), defined as undetectable serum hepatitis C virus (HCV) RNA by qualitative polymerase chain reaction at the end of 24 weeks of untreated follow-up. RESULTS No patient cleared HCV RNA in the untreated control group. SVR rates of 30% and 52% were obtained in the 24- and 48-week treatment groups, respectively. In patients infected with HCV genotype 1, SVR rates of 13% and 40% were obtained with 24 and 48 weeks of treatment, respectively (P < .0001). In patients infected with genotypes 2 or 3, SVR rates were 72% and 78% with 24 and 48 weeks of treatment, respectively (P = .452). Treatment-related flares in ALT activity were not observed. CONCLUSIONS The efficacy and safety of peginterferon alfa-2a and ribavirin combination therapy in patients with chronic hepatitis C and persistently normal ALT levels are similar to that in patients with elevated ALT levels. The indication for treatment of hepatitis C can be evaluated independently from baseline ALT activity.
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Affiliation(s)
- Stefan Zeuzem
- Saarland University Hospital, Homburg/Saar, Germany.
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Howard I, Espigares E, Lardelli P, Martín JL, Espigares M. Evaluation of microbiological and physicochemical indicators for wastewater treatment. Environ Toxicol 2004; 19:241-249. [PMID: 15101039 DOI: 10.1002/tox.20016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The quality control of wastewater treatments was monitored using selected novel and classical physicochemical and microbiological indicators, and the associations of the treatments with the effluents was analyzed. The microbiological indicators monitored were heterotrophic plate count (HPC), total coliforms (TC), fecal coliforms (FC), fecal streptococci (FS), sulfite-reducing clostridia (SRC), Pseudomonas aeruginosa, and Salmonella spp. The stages of wastewater treatment also were evaluated through determination of ammonia; biological oxygen demand (BOD(5)); chemical oxygen demand (COD); chloride; conductivity; suspended dissolved and total solids; fats; nitrate, nitrite, and total nitrogen; pH; phosphate and total phosphorus. Additional indicators included the Escherichia coli growth inhibition (IGEC) bioassay for assessing whole effluent toxicity, spectral determinations between wavelengths (lambda) 190-650 nm, and total (TP) and soluble (SP) protein contents. Of the more common physicochemical parameters, only BOD(5), COD, suspended and total solids, and fats showed a statistically significant reduction between raw water and effluent; for the microbiological indicators, significant reduction was seen only for HPC, FC, and Ps. aeruginosa. We suggest that determinations of Ps. aeruginosa be commonly used as an indicator of wastewater quality. Spectral analysis--most notably the values of absorbance at 225, 255, and 295 nm-revealed a statistically significant correlation with several physicochemical parameters. Statistical analysis of SP and TP values showed them to be good indicators of contamination. The quantitative study of Salmonella spp. and the results of the IGEC bioassay show the need for close control of infectious and toxic risks in wastewater and effluents.
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Affiliation(s)
- I Howard
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Farmacia, Universidad de Granada, Campus Universitario de Cartuja, 18071 Granada, Spain
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Abstract
Dithiocarbamates (DTCs) are chemicals featuring a great chelating capacity. The toxicological study of DTCs is very important in view of their relatively simple synthesis and wide array of sanitary and industrial applications. In this study, the toxicity of some of the more recently synthesized DTCs is determined using an extremely simple bioassay, described in previous studies, based on the inhibition of growth of Escherichia coli (IGEC). The lowest-observed-effect concentration (LOEC), the median effective concentration (EC(50)) and no-observed-effect concentration (NOEC) of the following sodium dithiocarbamates was determined: N-benzyl-N-methyldithiocarbamate x 2H(2)O, N-benzyl-N-isopropyldithiocarbamate x 3H(2)O, N-benzyl-N-ethyldithiocarbamate x 2H(2)O, N-butyl-N-methyldithiocarbamate x 2H(2)O, N,N-dibenzyldithiocarbamate x 2H(2)O and N-benzyl-2-phenethyldithiocarbamate x 4H(2)O. Our results showed N,N-dibenzyl-DTC to be the least toxic of the tested substances, with an EC(50) value of 1,269.9 micro g ml(-1), whereas N-butyl-N-methyl-DTC and N-benzyl-N-methyl-DTC, with respective EC(50) values of 14.9 micro g ml(-1) and 23.5 micro g ml(-1), were the most toxic. Regression analysis showed, through exponential models, that the degree of toxicity of this group of substances correlated with the molecular weight of the compound, the molecular weight of the smallest chemical radical linked to the dithiocarbamate group and the number of benzene rings present in the molecule. The consideration of these models allows us to establish that in general terms the toxicity of DTCs decreases exponentially with a greater molecular weight and the number of benzene rings.
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Affiliation(s)
- N Segovia
- Department of Preventive Medicine and Public Health, University of Granada, Campus Universitario de Cartuja, 18071 Granada, Spain
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Bellón JA, Lardelli P, Luna JD, Delgado A. Validity of self reported utilisation of primary health care services in an urban population in Spain. J Epidemiol Community Health 2000; 54:544-51. [PMID: 10846198 PMCID: PMC1731703 DOI: 10.1136/jech.54.7.544] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [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: 11/04/2022]
Abstract
STUDY OBJECTIVE To assess the validity and factors related with the validity of self reported numbers of visits to a primary health care centre, in comparison with the recorded number. DESIGN Cross sectional study. SETTING The urban area served by the Zaidín-Sur Primary Health Care Centre (Granada, Spain). PARTICIPANTS Two population samples (236 high users and 420 normal users) who were seen at the centre from 1985 to 1991 were interviewed in 1993. MAIN RESULTS A net tendency to overreport the actual number of visits was observed. Absolute concordance between self reported and recorded utilisation decreased as time interval lengthened, although this mainly reflected the increase in maximum variability both with time interval length and with the number of recorded visits. Corrected Spearman rho coefficients obtained between the number of self reported and recorded visits ranged from 0.602 for the two weeks before the interview to 0.678 for the year before. Regression slopes of self reported utilisation upon recorded utilisation did not change between periods. In multiple regression analyses the actual number of visits was the main factor associated with both underreporting and overreporting. Older age was also significantly associated with underreporting. Poor health status and high satisfaction with health care were significantly associated with overreporting. CONCLUSIONS There was a substantial degree of inaccuracy in self reported utilisation, with a net tendency to overreport the number of visits. In relative terms, however, accuracy of self reports did not seem to decrease appreciably as the recall time lengthened. To compare the accuracy of different measures, it is important to take into account the maximum variability of each one. Otherwise, contradictory results may be obtained.
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Affiliation(s)
- J A Bellón
- Unidad Docente de Medicina Familiar y Comunitaria de Granada, Centro de Salud Zaidín-Sur, Granada, Spain
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47
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Abstract
BACKGROUND The reasons for high use of primary care, and in particular the role of psychosocial factors, remain unclear. METHODS We identified and interviewed 236 frequent attenders and 420 normal users, matched by age and sex, of a public Health Centre in Granada, Spain. Users were questioned about mental health (GHQ-28), social support (Duke-UNC-11), family dysfunction (family APGAR) and health beliefs (health belief model, locus of health control and medical care expectations). We also measured a set of individual, social and illness variables. RESULTS Multiple logistic regression analyses showed that mental health was the main factor associated with frequent attender status (odds ratio = 3.1; 2.4-3.9). The association was stronger than that between frequent attender status and perceived illness, and between the former and reported chronic illness. Family dysfunction and perceived susceptibility to and severity of disease were also significantly but more weakly associated with frequent attender status. Affective support was more strongly associated with FA status than was confidant support, but both associations disappeared when mental health and family function were controlled for. CONCLUSIONS Our findings document the association of psychosocial factors and primary health care use. We suggest that the effective management of mental health problems from a family-based approach may reduce primary health care high use.
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Affiliation(s)
- J A Bellón
- Zaidín-Sur Health Centre, Medical School of Family and Community Medicine, Department of Preventive Medicine and Biostatistics, University of Granada, Spain
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48
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Madariaga L, Amurrio C, Martín G, García-Cebrian F, Bicandi J, Lardelli P, Suarez MD, Cisterna R. Detection of anti-interferon-gamma autoantibodies in subjects infected by Mycobacterium tuberculosis. Int J Tuberc Lung Dis 1998; 2:62-8. [PMID: 9562113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
SETTING Among the cytokines involved in defensive mechanisms against Mycobacterium tuberculosis infection, special attention has been given to interferon-gamma (IFN-gamma); a local synthesis of this cytokine as well as IL-2 (type 1 cytokines) at the site of disease in patients with tuberculous pleuritis has been demonstrated. Moreover, high levels of IgG autoantibodies against IFN-gamma have been shown in several clinical situations. It has been suggested that these antibodies could serve to limit the intensity or duration of the immune response or be able to interfere with the pathophysiological effects of IFN-gamma. OBJECTIVE To investigate the potential role of anti-IFN-gamma antibodies in the course of M. tuberculosis infection. DESIGN Investigation of the presence of these antibodies in sera from healthy and ill subjects infected with M. tuberculosis in relation to the extent of the disease and the presence of IFN-gamma in sera by enzyme-linked-immunosorbent assay (ELISA). In order to investigate the presence of these antibodies at the site of infection we included 12 pleural fluids from tuberculosis patients and 9 pleural fluids from other origins. RESULTS In the course of M. tuberculosis infection the production of anti-IFN-gamma IgG antibodies is induced, being particularly higher in healthy skin test converters. Among tuberculosis patients, the presence of anti-IFN-gamma autoantibodies is significantly associated with detectable levels of the cytokine in sera. Levels of anti-IFN-gamma antibodies in moderately advanced and far advanced tuberculosis patients are significantly greater than in healthy individuals. These antibodies increase at the site of infection. CONCLUSION Anti-IFN-gamma antibodies must be considered as a new element in the immune response to M. tuberculosis. It would be of great interest to investigate this point especially at the site of infection.
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Affiliation(s)
- L Madariaga
- Department of Immunology, Microbiology and Parasitology, Basque Country University School of Medicine, Bilbao, Spain
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49
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Abstract
Three subtypes of retinoic acid receptors (RAR), termed RAR alpha, RAR beta, and RAR gamma, have been described. They are composed of different structural domains, including distinct domains for DNA and ligand binding. RARs specifically bind all-trans-retinoic acid (RA), 9-cis-RA, and retinoid analogs. In this study, we examined the functional role of cysteine and arginine residues in the ligand-binding domain of hRAR alpha (hRAR alpha-LBD, amino acids 154 to 462). All conserved cysteine and arginine residues in this domain were mutated by site-directed mutagenesis, and the mutant proteins were characterized by blocking reactions, ligand-binding experiments, transactivation assays, and protease mapping. Changes of any cysteine residue of the hRAR alpha-LBD had no significant influence on the binding of all-trans RA or 9-cis RA. Interestingly, residue C-235 is specifically important in antagonist binding. With respect to arginine residues, only the two single mutations of R-276 and R-394 to alanine showed a dramatic decrease of agonist and antagonist binding whereas the R272A mutation showed only a slight effect. For all other arginine mutations, no differences in affinity were detectable. The two mutations R217A and R294A caused an increased binding efficiency for antagonists but no change in agonist binding. From these results, we can conclude that electrostatic interactions of retinoids with the RAR alpha-LBD play a significant role in ligand binding. In addition, antagonists show distinctly different requirements for efficient binding, which may contribute to their interference in the ligand-inducible transactivation function of RAR alpha.
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Affiliation(s)
- F P Lamour
- Preclinical Research, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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50
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Cisterna R, Campelo C, Gorriño T, Malavé C, Sarría L, Lardelli P, Fernandez de Aranguiz A, Madariaga L. Association between HIV and other DNA viruses in vitro. Eur J Clin Microbiol Infect Dis 1995; 14:591-6. [PMID: 7588843 DOI: 10.1007/bf01690730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To investigate the association of human immunodeficiency virus (HIV) with various DNA viruses, including hepatitis B virus (HBV), cytomegalovirus (CMV) and Epstein-Barr virus, (EBV), simultaneous detection of HIV p24 antigen, HBV surface antigen and DNA, CMV-DNA and EBV-DNA expression was performed in phytohemagglutinin-stimulated peripheral blood mononuclear (PBMC) culture supernatants obtained from 54 individuals at risk for HIV infection. HIV expression in PBMC culture supernatants never occurred alone; expression of other viruses was always detected in the 24 samples expressing HIV antigen in vitro. Furthermore, in 16 patients expression of other viruses was detected without HIV expression, and in 14 patients none of the tested viruses were detected. These results indicate a strong association between the presence of HIV antibody and expression of DNA viruses in vitro (p = 0.0001). The coexpression of these viruses could be related to the evolution of HIV infection and AIDS.
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Affiliation(s)
- R Cisterna
- Immunology, Microbiology and Parasitology Department, University of Basque Country, Bilbao, Spain
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