1. Adjuvant Sirolimus Does Not Improve Outcome in Pet Dogs Receiving Standard-of-Care Therapy for Appendicular Osteosarcoma: A Prospective, Randomized Trial of 324 Dogs
- Author
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Amy K. LeBlanc, Timothy M. Fan, Heather Wilson-Robles, Corey F. Saba, Janean Fidel, Nicole C. Northrup, Annette N. Smith, Michael O. Childress, Shawna Klahn, Jennifer L. Willcox, David M. Vail, William C. Kisseberth, Megan E. Brown, Lisa G. Barber, Erika L. Krick, Haley Leeper, Kristine Burgess, Chand Khanna, Raelene M. Wouda, Susan E. Lana, Nikolaos Dervisis, Olya Martin, Angela L McCleary-Wheeler, Mary Lynn Higginbotham, J. Paul Woods, Jeffrey N. Bryan, Aswini Cherukuri, Steven E. Suter, Stephanie S Lindley, Daniel L. Gustafson, Brandan G Wustefeld-Janssens, Laura E. Selmic, Kristen M. Weishaar, Brian K. Flesner, Christina Mazcko, Jenna H Burton, Erika P. Berger, Sara D. Allstadt, Antonella Borgatti, Jennifer A. Mahoney, Cheryl E. Balkman, Kaitlin M. Curran, Anthony J. Mutsaers, and Cheryl A. London
- Subjects
Oncology ,Cancer Research ,medicine.medical_treatment ,law.invention ,Carboplatin ,0403 veterinary science ,chemistry.chemical_compound ,0302 clinical medicine ,Randomized controlled trial ,law ,Surgical ,Dog Diseases ,Prospective Studies ,Amputation ,Adjuvant ,Cancer ,Pediatric ,education.field_of_study ,Osteosarcoma ,TOR Serine-Threonine Kinases ,04 agricultural and veterinary sciences ,Pets ,Combined Modality Therapy ,Survival Rate ,Treatment Outcome ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,6.1 Pharmaceuticals ,medicine.drug ,Signal Transduction ,medicine.medical_specialty ,040301 veterinary sciences ,Population ,Clinical Trials and Supportive Activities ,Oncology and Carcinogenesis ,Bone Neoplasms ,Amputation, Surgical ,Article ,03 medical and health sciences ,Dogs ,Rare Diseases ,Clinical Research ,Internal medicine ,medicine ,Animals ,Chemotherapy ,Oncology & Carcinogenesis ,Adverse effect ,education ,Sirolimus ,business.industry ,Evaluation of treatments and therapeutic interventions ,medicine.disease ,Orphan Drug ,chemistry ,business - Abstract
Purpose: The mTOR pathway has been identified as a key nutrient signaling hub that participates in metastatic progression of high-grade osteosarcoma. Inhibition of mTOR signaling is biologically achievable with sirolimus, and might slow the outgrowth of distant metastases. In this study, pet dogs with appendicular osteosarcoma were leveraged as high-value biologic models for pediatric osteosarcoma, to assess mTOR inhibition as a therapeutic strategy for attenuating metastatic disease progression. Patients and Methods: A total of 324 pet dogs diagnosed with treatment-naïve appendicular osteosarcoma were randomized into a two-arm, multicenter, parallel superiority trial whereby dogs received amputation of the affected limb, followed by adjuvant carboplatin chemotherapy ± oral sirolimus therapy. The primary outcome measure was disease-free interval (DFI), as assessed by serial physical and radiologic detection of emergent macroscopic metastases; secondary outcomes included overall 1- and 2-year survival rates, and sirolimus pharmacokinetic variables and their correlative relationship to adverse events and clinical outcomes. Results: There was no significant difference in the median DFI or overall survival between the two arms of this trial; the median DFI and survival for standard-of-care (SOC; defined as amputation and carboplatin therapy) dogs was 180 days [95% confidence interval (CI), 144–237] and 282 days (95% CI, 224–383) and for SOC + sirolimus dogs, it was 204 days (95% CI, 157–217) and 280 days (95% CI, 252–332), respectively. Conclusions: In a population of pet dogs nongenomically segmented for predicted mTOR inhibition response, sequentially administered adjuvant sirolimus, although well tolerated when added to a backbone of therapy, did not extend DFI or survival in dogs with appendicular osteosarcoma.
- Published
- 2021