379 results on '"Ross A. Soo"'
Search Results
352. P3-143: Disease control with a second Epidermal Growth Factor Receptor (EGFR) tyrosine kinase inhibitor (TKI) after failure of a first TKI in Asian patients with non-small cell lung cancer (NSCLC)
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Tan Min Chin, Ross A. Soo, Siew Woon Lim, Richie Soong, and Alvin Wong
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Pulmonary and Respiratory Medicine ,Oncology ,medicine.medical_specialty ,biology ,business.industry ,non-small cell lung cancer (NSCLC) ,medicine.disease ,Disease control ,respiratory tract diseases ,Internal medicine ,medicine ,biology.protein ,Growth factor receptor inhibitor ,Epidermal growth factor receptor ,business ,neoplasms ,Tyrosine kinase ,Egfr tyrosine kinase - Published
- 2007
353. Dynamic contrast enhanced MRI (DCE MRI) for assessment of effects of anti-angiogenic therapy: Comparison of the transfer constant (Ktrans) to blood flow and permeability derived by a distributed parameters model
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Tong San Koh, Choon Hua Thng, Ai-Bee Ong, Boon Cher Goh, Rod A. Humerickhouse, Norita Sukri, James B. K. Khoo, Ross A. Soo, Bee Choo Tai, and H. Rumpel
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Cancer Research ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Anti angiogenic ,Magnetic resonance imaging ,Blood flow ,Dynamic contrast ,Oncology ,Permeability (electromagnetism) ,Transfer constant ,Dynamic contrast-enhanced MRI ,medicine ,Arterial input function ,Radiology ,business ,Biomedical engineering - Abstract
14109 Background: Transfer constant (Ktrans) and IAUC60 normalized with arterial input function are commonly used dynamic contrast enhanced magnetic resonance imaging (DCE MRI) parameters. The distributed parameters model (DP) is a DCE MRI model that enables derivation of blood flow and capillary permeability-surface area product (PS). We aim to study the distributed parameters model as an alternative method of angiogenesis assessment and correlate the above parameters to drug exposure and patient outcome in a Phase I anti- angiogenic trial. Methods: Fifteen evaluable patients from an on-going Phase I trial (ABT 869) with 3 dose escalations formed the study population. Pharmacokinetic study was performed on Day 1 and the area under the concentration time curve extrapolated to infinity (AUCinfinity) was used as an indicator of drug exposure. All patients underwent DCE MRI at baseline, Day 3 and Day 15 with temporal resolution of 4 seconds. Gadolinium concentrations were estimated using a dual flip angle method. Patients demonstrating progressive disease in first 2 evaluation scans (cycle 2 or 4) based on RECIST criteria were considered progressors and all other patients non-progressors. Receiver operating curve (ROC) analysis was performed. Correlation with AUCinfinity was analyzed. Results: There is good correlation (Spearman’s coefficient -0.67, p = 0.008) between AUCinfinity and DP derived PS and less strong correlation with normalized IAUC60 (Spearman’s coefficient -0.57, p = 0.03). There is no correlation for Ktrans (Spearman’s coefficient 0.04). ROC analysis for predicting progressors versus non-progressors showed a higher ROC area for PS compared to Ktrans (0.83 versus 0.47, p = 0.037). Normalized IAUC60 showed a slightly lower area compared to PS (0.77 versus 0.83) but the difference is not significant (p = 0.58). Conclusions: PS derived from DP model shows better correlation with drug exposure and may predict patient outcome better than Ktrans. [Table: see text]
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- 2007
354. Disease control with a second epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) after failure of a first TKI in Asian patients with non-small cell lung cancer (NSCLC)
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S. W. Lim, Alvin Wong, Ross A. Soo, Tan Min Chin, and Richie Chuan Teck Soong
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Cancer Research ,biology ,business.industry ,non-small cell lung cancer (NSCLC) ,medicine.disease ,Disease control ,respiratory tract diseases ,Egfr tki ,Gefitinib ,Oncology ,medicine ,Cancer research ,biology.protein ,Erlotinib ,Epidermal growth factor receptor ,business ,Egfr tyrosine kinase ,medicine.drug - Abstract
18104 Background: Asian NSCLC patients are known to have higher response rates to the EGFR TKI gefitinib (G) and erlotinib (E). Anecdotal reports suggest some activity for a second EGFR TKI after failure of the first. Methods: A retrospective review of the electronic pharmacy records, clinical and radiographic records of patients with advanced NSCLC at the National University Hospital who received both G and E in the previous 2 years was conducted. Objectives were to assess the disease control (response/stable disease) of the second TKI after failure of the first and characterize the clinical, pathological and molecular features of patients benefiting from a 2nd TKI. Results: 14 patients with advanced NSCLC who received a 2nd EGFR TKI after progression on the 1st TKI were identified. Patient characteristics: Chinese 12, female 10, and non-smokers 13. Histologic subtype: adenocarcinoma 7, bronchioloalveolar carcinoma (BAC) 3, squamous-cell carcinoma 1, NSCLC unspecified 3. 12 patients received cytotoxic chemotherapy with a median of 2 lines, (range 1–5). G and E was used as 1st/2nd/3rd/=4th line treatment in 8/2/2/2 and 0/4/2/8 patients respectively. G was used before E in 13 cases and disease control was seen in 8/14 (57%) patients. With a 2nd TKI after disease progression, disease control was seen 4/14 (28%) patients. Patient characteristics were: adenocarcinoma 3, BAC 1, all were never smokers and all received and responded to prior G. Median duration of control in these 4 patients for G was 8 (range 7–12) months, and subsequently to E was 2.5 (range 2–8) months. Disease control was associated with symptomatic improvement. Conclusion: This study documents disease control in 28% of Asian NSCLC patients treated with a second EGFR TKI after failure of a first. The molecular basis for these observations is currently being investigated. No significant financial relationships to disclose.
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- 2007
355. Correction to: Celecoxib reduces microvessel density in patients treated with nasopharyngeal carcinoma and induces changes in gene expression. Ann Oncol 2006; 17: 1625–1630
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Thomas C. Putti, Qian Tao, B. Mow, Stephen I-Hong Hsu, Patrick Tan, Wen Son Hsieh, Kwok Seng Loh, Kong-Bing Tan, Ross A. Soo, Luke Kim Siang Tan, Y. F. Lai, Amit Aggarwal, W. L. Soon, Boon Cher Goh, and J. Wu
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Oncology ,medicine.medical_specialty ,business.industry ,Hematology ,medicine.disease ,Nasopharyngeal carcinoma ,Internal medicine ,Gene expression ,Celecoxib ,Cancer research ,Medicine ,In patient ,business ,medicine.drug ,Microvessel density - Published
- 2007
356. 279 POSTER Pharmacodynamic effects of seliciclib (r-roscovitine, cyc202) in patients with undifferentiated nasopharyngeal cancer (NPC) using a window trial design
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Judy H. Chiao, Bee Keow Peh, S.R. Green, T. Loh, Ross A. Soo, Manuel Salto-Tellez, Wen Son Hsieh, Richie Soong, Boon Cher Goh, and Y.F. Lai
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Oncology ,Cancer Research ,medicine.medical_specialty ,business.industry ,R-roscovitine ,Pharmacology ,chemistry.chemical_compound ,chemistry ,Pharmacodynamics ,Internal medicine ,medicine ,In patient ,business ,Seliciclib ,Nasopharyngeal cancer - Published
- 2006
357. Analysis of gemcitabine pathway genotypes in ethnic Asians and their relationship with outcome in non-small cell lung cancer (NSCLC) patients
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Richie Chuan Teck Soong, Ross A. Soo, How Sung Lee, Boon Cher Goh, Soo-Chin Lee, Lingzhi Wang, Swee-Siang Ng, P. Y. Chong, and L. S. Tham
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Oncology ,Cancer Research ,medicine.medical_specialty ,business.industry ,Ethnic group ,non-small cell lung cancer (NSCLC) ,medicine.disease ,Gemcitabine ,Internal medicine ,Drug metabolising enzymes ,Genotype ,Toxicity ,medicine ,business ,medicine.drug - Abstract
2008 Background: Genotypic variation for drug metabolising enzymes, targets and transporters is associated with inter-patient and inter-ethnic variability in toxicity and efficacy. Gemcitabine is a nucleoside anti-metabolite used in a range of solid tumors. Aims: 1) to determine genotype distribution of genes involved in gemcitabine pharmacology pathway in ethnic groups; 2) to evaluate the association between genotypes and treatment related outcomes in patients with chemo-naive, advanced NSCLC receiving gemcitabine based chemotherapy on a prospective study. Methods: Candidate genes involved in gemcitabine pharmacology were identified from a comprehensive search of public databases (NCBI, PharmGKB), and publications. 25 variants of 9 candidate genes (RRM-1, SLC28A1, SLC28A2, SLC28A3, SLC29A2, POLA2, DCTD, CDA, TS) were genotyped from blood in 94 healthy donors and 76 cancer patients (breast 22, NSCLC 54) with pyrosequencing. Chi-squared, Kruskall-Wallis, and Kaplan-Meier analysis were used to evaluate associations between genotypes and ethnic groups and clinical end points. Results: Significant differences in genotype distribution between Chinese, Malay and Indian were seen in 5/25 loci (see table ). In NSCLC patients, POLA2 2089 (G > A) was associated with neutropenia (p = 0.022), SLC28A1-1576 (C > T) with neutropenia nadir (p = 0.030) and thrombocytopenia nadir (p = 0.037), RRM-1 -524 (T > C) with neutropenia (p = 0.024) and SLC28A2–283 (CA 18.3 vs CC 8.5 months, p = 0.004), and SLC28A2–22 (CC 8.0 vs CT 18.3 months, p = 0.002) with survival. Conclusions: Our results suggest there is significant genotypic variability among ethnic groups. Variants in gemcitabine transporters and targets may be useful indicators of gemcitabine related toxicity and survival. Further studies should be performed to confirm these preliminary findings. [Table: see text] No significant financial relationships to disclose.
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- 2006
358. Seliciclib (R-roscovitine) induces apoptosis in undifferentiated nasopharyngeal cancer (NPC) in vivo and in vitro
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Manuel Salto-Tellez, Y.-F. Lai, Simon Green, T. Loh, Ross A. Soo, Wen Son Hsieh, B.-K. Peh, C.-Y. Cui, Boon Cher Goh, and B. Mow
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Cancer Research ,Cell cycle checkpoint ,Biology ,In vitro ,law.invention ,chemistry.chemical_compound ,Oncology ,chemistry ,Apoptosis ,law ,Cyclin-dependent kinase ,In vivo ,Cancer research ,biology.protein ,Suppressor ,Seliciclib ,Nasopharyngeal cancer - Abstract
3145 Cyclin dependent kinase (CDK) inhibition mimics tumor suppressor protein function and induces cell cycle arrest and apoptosis in cancer cell lines. Seliciclib, an orally administered inhibitor...
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- 2005
359. Overexpression of Cyclooxygenase-2 in Nasopharyngeal Carcinoma and Association With Epidermal Growth Factor Receptor Expression
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Boon Cher Goh, Thomas C. Putti, Loh Kwok-Seng, Kang Hoe Lee, Qian Tao, Wen Son Hsieh, Ross A. Soo, and Luke Tan
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Adult ,Male ,Vascular Endothelial Growth Factor A ,Transcription, Genetic ,Nitric Oxide Synthase Type II ,chemistry.chemical_compound ,Growth factor receptor ,Epidermal growth factor ,Tumor Cells, Cultured ,otorhinolaryngologic diseases ,medicine ,Humans ,Epidermal growth factor receptor ,Adaptor Proteins, Signal Transducing ,Aged ,biology ,business.industry ,Intracellular Signaling Peptides and Proteins ,Membrane Proteins ,Nasopharyngeal Neoplasms ,General Medicine ,Methylation ,DNA Methylation ,LIM Domain Proteins ,Middle Aged ,medicine.disease ,Immunohistochemistry ,ErbB Receptors ,Vascular endothelial growth factor ,Cytoskeletal Proteins ,stomatognathic diseases ,Vascular endothelial growth factor A ,Otorhinolaryngology ,chemistry ,Nasopharyngeal carcinoma ,Cyclooxygenase 2 ,Prostaglandin-Endoperoxide Synthases ,DNA methylation ,Cancer research ,biology.protein ,Female ,Surgery ,Nitric Oxide Synthase ,Carrier Proteins ,business - Abstract
Objectives To examine the association between cyclooxygenase-2 (COX-2) expression with epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), inducible nitric oxide synthase (iNOS), and latent membrane protein 1 (LMP-1) expression and with COX-2 promoter methylation status in primary nasopharyngeal cancer (NPC) tumors and to determine COX-2 promoter methylation status in NPC cell lines. Design Retrospective study. Setting Patients with NPC were referred to the Department of Otolaryngology–Head and Neck Surgery for treatment. Patients Formalin-fixed, paraffin-embedded NPC specimens from 42 patients were obtained. Interventions Immunohistochemical expression of COX-2, EGFR, VEGF, iNOS, and LMP-1 was performed in 42 NPC samples. COX-2 promoter methylation status was studied in 20 separate specimens and in 4 NPC cell lines. Main Outcome Measures (1) COX-2, EGFR, VEGF, iNOS, and LMP-1 expression; and (2) COX-2 promotor methylation status. Results COX-2 was overexpressed in 79% of NPC specimens and was associated with EGFR status ( P = .03) but not with LMP-1 or iNOS. In primary NPC tissue, methylation of the COX-2 promoter was seen in 4 of 7 COX-2–negative and 1 of 13 COX-2–positive immunohistochemical cases. COX-2 promoter methylation was found in the CNE-1 cell line. Conclusions Nasopharyngeal cancer may be a useful target for selective COX-2 inhibition. The absence of promoter methylation may be a necessary component of COX-2 overexpression, and promoter methylation may be one of the mechanisms that regulate COX-2 expression.
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- 2005
360. Evidence for Disease Control with Erlotinib after Gefitinib Failure in Typical Gefitinib-Sensitive Asian Patients with Non-small Cell Lung Cancer
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Serena Bee-Kee Seah, Richie Soong, Min En Nga, Alvin Wong, Khoon-Leong Chuah, Siew Woon Lim, Ross A. Soo, and Tan Min Chin
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Oncology ,Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Lung Neoplasms ,EGFR Gene Mutation ,Erlotinib Hydrochloride ,Gefitinib ,Non-small cell lung cancer ,Internal medicine ,Carcinoma, Non-Small-Cell Lung ,medicine ,Humans ,heterocyclic compounds ,Epidermal growth factor receptor ,Lung cancer ,skin and connective tissue diseases ,Protein Kinase Inhibitors ,neoplasms ,Aged ,Retrospective Studies ,biology ,Asian ,business.industry ,Middle Aged ,medicine.disease ,respiratory tract diseases ,ErbB Receptors ,Survival Rate ,Erlotinib ,Lymphatic Metastasis ,Mutation ,biology.protein ,Disease Progression ,Quinazolines ,Adenocarcinoma ,Female ,business ,Tyrosine kinase ,Progressive disease ,medicine.drug - Abstract
Introduction The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib are gaining an increasing role in the management of advanced non-small cell lung cancer (NSCLC). There is mounting interest in the benefit of administering a second TKI after failure of the first TKI, especially in Asian patients, in whom they are expected to be more efficacious. Methods We did a retrospective analysis of patients receiving both gefitinib and erlotinib in our institution during a 2-year period. Patients were to have received the second TKI after progressive disease on the first TKI. EGFR gene mutation analysis was done on patient tumor samples. Results Fourteen patients were included in the analysis, all of whom received erlotinib after progression on gefitinib. Chinese race, females, never-smokers, and adenocarcinoma subtype were predominant in their respective categories. Disease control rate was 64.3% (9 of 14) for gefitinib. Disease control rate for erlotinib administered after progression on gefitinib was 35.7% (5 of 14). All patients who achieved disease control with erlotinib after progression on gefitinib were never-smokers with adenocarcinoma subtype, who had prior disease control on gefitinib. Presence of EGFR mutations predicted for disease control with gefitinib, and for disease control with erlotinib after gefitinib failure. Conclusion A significant proportion of typical gefitinib-sensitive Asian NSCLC patients can have disease control with erlotinib after gefitinib failure. The role of subsequent administration of a second EGFR TKI after failure of the first TKI in advanced NSCLC should be further pursued.
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361. Protocol for a systematic review with prospective individual patient data meta-analysis in EGFR-mutant NSCLC with brain metastases to assess the effect of SRS+osimertinib compared to osimertinib alone: the STARLET Collaboration
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Ross Andrew Soo, Mark Doherty, Arjun Sahgal, Ai Peng Tan, Mei Chin Lim, Benjamin J Solomon, Kristy P Robledo, Yu Yang Soon, Chee Khoon Lee, Mark B Pinkham, Fiona Hegi-Johnson, Shilo Lefresne, Cheryl Ho, Adrian G Sacher, Alan Nichol, Ambika Parmar, David B Shultz, Ivan WK Tham, Jeremy Tey, Cheng Nang Leong, Wee Yao Koh, Yiqing Huang, Yvonne Li En Ang, Jiali Low, and Clement Yong
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Medicine - Abstract
Background Patients with advanced non-small-cell lung cancer (NSCLC) with activating mutations in the epidermal growth factor receptor (EGFR) gene are a heterogeneous population who often develop brain metastases (BM). The optimal management of patients with asymptomatic brain metastases is unclear given the activity of newer-generation targeted therapies in the central nervous system. We present a protocol for an individual patient data (IPD) prospective meta-analysis to evaluate whether the addition of stereotactic radiosurgery (SRS) before osimertinib treatment will lead to better control of intracranial metastatic disease. This is a clinically relevant question that will inform practice.Methods Randomised controlled trials will be eligible if they include participants with BM arising from EGFR-mutant NSCLC and suitable to receive osimertinib both in the first-line and second-line settings (P); comparisons of SRS followed by osimertinib versus osimertinib alone (I, C) and intracranial disease control included as an endpoint (O). Systematic searches of Medline (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), PsychInfo, ClinicalTrials.gov and the WHO’s International Clinical Trials Registry Platform’s Search Portal will be undertaken. An IPD meta-analysis will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome is intracranial progression-free survival, as determined by response assessment in neuro-oncology-BM criteria. Secondary outcomes include overall survival, time to whole brain radiotherapy, quality of life, and adverse events of special interest. Effect differences will be explored among prespecified subgroups.Ethics and dissemination Approved by each trial’s ethics committee. Results will be relevant to clinicians, researchers, policymakers and patients, and will be disseminated via publications, presentations and media releases.Prospero registration CRD42022330532.
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- 2024
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362. Randomized Phase II Study of Carboplatin and Paclitaxel With Either Linifanib or Placebo for Advanced Nonsquamous Non-Small-Cell Lung Cancer
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José Rodrigues Pereira, Petr Kolman, Mikhail Shtivelband, Viswanath Devanarayan, Dawn M. Carlson, Ross A. Soo, Justin L. Ricker, Evelyn McKeegan, Chandra P. Belani, Mark D. McKee, K. Pittman, Suresh S. Ramalingam, Vera Gorbunova, Jiang Qian, Rita Axelrod, J.G.M. Segalla, Taofeek K. Owonikoko, Qin Qin, A. Makhson, Gordan Srkalovic, and Carlos H. Barrios
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Adult ,Male ,Vascular Endothelial Growth Factor A ,Cancer Research ,medicine.medical_specialty ,Indazoles ,Lung Neoplasms ,Paclitaxel ,Administration, Oral ,Phases of clinical research ,Kaplan-Meier Estimate ,Placebo ,Gastroenterology ,Disease-Free Survival ,Drug Administration Schedule ,Carboplatin ,chemistry.chemical_compound ,Carcinoma, Non-Small-Cell Lung ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Carcinoma ,Humans ,Receptors, Platelet-Derived Growth Factor ,Lung cancer ,Aged ,business.industry ,Phenylurea Compounds ,Area under the curve ,ORIGINAL REPORTS ,Middle Aged ,medicine.disease ,Surgery ,Linifanib ,Treatment Outcome ,Oncology ,chemistry ,Female ,business - Abstract
Purpose Linifanib, a potent, selective inhibitor of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) receptors, has single-agent activity in non–small-cell lung cancer (NSCLC). We evaluated linifanib with carboplatin and paclitaxel as first-line therapy of advanced nonsquamous NSCLC. Patients and Methods Patients with stage IIIB/IV nonsquamous NSCLC were randomly assigned to 3-week cycles of carboplatin (area under the curve 6) and paclitaxel (200 mg/m2) with daily placebo (arm A), linifanib 7.5 mg (arm B), or linifanib 12.5 mg (arm C). The primary end point was progression-free survival (PFS); secondary efficacy end points included overall survival (OS) and objective response rate. Results One hundred thirty-eight patients were randomly assigned (median age, 61 years; 57% men; 84% smokers). Median PFS times were 5.4 months (95% CI, 4.2 to 5.7 months) in arm A (n = 47), 8.3 months (95% CI, 4.2 to 10.8 months) in arm B (n = 44), and 7.3 months (95% CI, 4.6 to 10.8 months) in arm C (n = 47). Hazard ratios (HRs) for PFS were 0.51 for arm B versus A (P = .022) and 0.64 for arm C versus A (P = .118). Median OS times were 11.3, 11.4, and 13.0 months in arms A, B, and C, respectively. HRs for OS were 1.08 for arm B versus A (P = .779) and 0.88 for arm C versus A (P = .650). Both linifanib doses were associated with increased toxicity, including a higher incidence of adverse events known to be associated with VEGF/PDGF inhibition. Baseline plasma carcinoembryonic antigen/cytokeratin 19 fragments biomarker signature was associated with PFS improvement and a trend toward OS improvement with linifanib 12.5 mg. Conclusion Addition of linifanib to chemotherapy significantly improved PFS (arm B), with a modest trend for survival benefit (arm C) and increased toxicity reflective of known VEGF/PDGF inhibitory effects.
363. EAST-LC: Randomized controlled phase III trial of S-1 versus docetaxel (DOC) in patients with non-small cell lung cancer (NSCLC) who had received a platinum-based treatment: Results from patient-reported outcomes (PROs)
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Hiroshi Nokihara, Y. Cheng, Shuko Morita, Yukito Ichinose, K. Goto, M. Nishio, Tony Mok, Nobuyuki Yamamoto, J. Chang, Tomohide Tamura, Wan-Teck Lim, Kazuhiko Nakagawa, J.C-H. Yang, Tsuyoshi Takahashi, Shaoyong Lu, Shunichi Sugawara, Makoto Maemondo, Ross A. Soo, Y-K. Shi, and Lanjun Zhang
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Oncology ,medicine.medical_specialty ,business.industry ,non-small cell lung cancer (NSCLC) ,Hematology ,Treatment results ,medicine.disease ,Docetaxel ,Internal medicine ,Medicine ,In patient ,business ,medicine.drug
364. A phase IB trial of 5-azacitidine (5AC) and suberoylanilide hydroxamic acid (SAHA) in patients with metastatic or locally recurrent nasopharyngeal carcinoma (NPC) and NK-T cell lymphoma
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Wan-Teck Lim, John Soon Wah Low, Qian Tao, Soo-Chin Lee, Thomas Kwok Seng Loh, Wen Son Hsieh, Ross A. Soo, Joel M. Reid, Eng Huat Tan, Paul Murray, Boon Cher Goh, Richard F. Ambinder, Matthew M. Ames, Edwin P. Hui, Anthony T.C. Chan, and Pei Li Lim
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Cancer Research ,business.industry ,Azacitidine ,medicine.disease ,Immune system ,Oncology ,Lytic cycle ,Immunology ,Cancer research ,Medicine ,T-cell lymphoma ,Histone deacetylase ,Epigenetics ,business ,Gene ,Demethylation ,medicine.drug - Abstract
e17017 Background: Epigenetic up-regulation of EBV and cellular genes via demethylation and histone deacetylase inhibition can induce EBV lytic replication enhancing immune mediated tumor killing and up-regulation of tumor suppressor genes resulting in tumor apoptosis. Methods: Patients (Pt) with relapsed or refractory NPC and NK-T cell lymphomas were enrolled to determine safety, tolerability, pharmacokinetics (PK), pharmacodynamics and preliminary anti-tumor activity using a dose escalation design. 5AC was administered on days 1 to 10 sub-cutaneously while SAHA was administered on days 1 to 14 orally. PK for SAHA, EBV viral load, characterization of circulating EBV, Immunohistochemistry (IHC) and EBV promoter methylation analysis in tumor tissue were performed. Results: 11 pt have been treated (M:F 8:3, median age 48, R: 35-71) at 3 dose levels – 5AC 50 mg/m2 and SAHA 200 mg b.i.d. (dose level 1), 5AC 37.5 mg/m2 and SAHA 200 mg q. am and 100 mg q. pm (dose level 2), and 5AC 25 mg/m2 and SAHA 100 mg b.i.d (dose level 3). Median number of previous treatment regimens was 3 (R:1-6). Dose limiting toxicities (DLT) were seen in 2/2 pts at dose level 1: grade 4 thrombocytopenia (1 pt), grade 3 nausea, vomiting and fatigue (2 pts), and grade 5 hepatic failure (1 pt). Two of six patients at dose level 2 experienced DLT: grade 3 fatigue (1 pt) and worsening of pre-existing Sweet’s Syndrome (1 pt). Common AEs (G1/2) included fatigue (73%), cough (64%), anorexia (55%), and injection site reaction (45%). One minor response was seen and 5 pt had prolonged stable disease (>16 weeks), including one patient for 88 weeks. Analysis of post-treatment tumor biopsies showed demethylation of EBV lytic cycle gene promoters after treatment. SAHA PK, IHC results for EBV gene expression in tumor tissue, EBV viral load and characterization of circulating EBV will be presented. Conclusions: 5AC/SAHA appears to be tolerable at dose level 3 with suggestion of clinical benefit. Analysis of post-treatment tumor and blood samples suggests that modulation of EBV gene expression may play a role in the mechanism underlying clinical benefit. Continued accrual at dose level 3 is ongoing. Clinical trial information: NCT00336063.
365. Global named patient use (NPU) program of afatinib, an oral ErbB family blocker, in heavily pretreated advanced non-small cell lung carcinoma (NSCLC) patients who progressed following prior therapies, including erlotinib or gefitinib (E/G)
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Agnieszka Cseh, N.D. Forman, Ross A. Soo, Chun-Ming Tsai, Frederico Cappuzzo, Martin Schuler, Tony Mok, Robert M. Lorence, Maximilian Hochmair, S. Linden, and Gerd Stehle
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Oncology ,medicine.medical_specialty ,Lung ,ERBB Family ,business.industry ,Afatinib ,Hematology ,medicine.disease ,medicine.anatomical_structure ,Gefitinib ,Internal medicine ,medicine ,Carcinoma ,Erlotinib ,Non small cell ,business ,medicine.drug
366. A phase 2, multicenter, open-label study of anti-LAG-3 ieramilimab in combination with anti-PD-1 spartalizumab in patients with advanced solid malignancies
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Chia-Chi Lin, Elena Garralda, Patrick Schöffski, David S. Hong, Lillian L. Siu, Miguel Martin, Michela Maur, Rina Hui, Ross A Soo, Joanne Chiu, Tian Zhang, Brigette Ma, Chrisann Kyi, Daniel SW Tan, Philippe A. Cassier, John Sarantopoulos, Andrew Weickhardt, Richard D. Carvajal, Jennifer Spratlin, Taito Esaki, Fréderic Rolland, Wallace Akerley, Barbara Deschler-Baier, Lawrence Rispoli, Tanay S. Samant, Niladri Roy Chowdhury, Daniel Gusenleitner, Eunice L. Kwak, Vasileios Askoxylakis, and Filippo De Braud
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Efficacy ,ieramilimab ,LAG-3 inhibitor ,safety ,spartalizumab ,Immunologic diseases. Allergy ,RC581-607 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
ABSTRACTIeramilimab, a humanized anti-LAG-3 monoclonal antibody, was well tolerated in combination with the anti-PD-1 antibody spartalizumab in a phase 1 study. This phase 2 study aimed to further investigate the efficacy and safety of combination treatment in patients with selected advanced (locally advanced or metastatic) solid malignancies. Eligible patients with non-small cell lung cancer (NSCLC), melanoma, renal cell carcinoma (RCC), mesothelioma, and triple-negative breast cancer (TNBC) were grouped depending on prior anti-PD-1/L1 therapy (anti-PD-1/L1 naive or anti-PD-1/L1 pretreated). Patients received ieramilimab (400 mg) followed by spartalizumab (300 mg) every 3 weeks. The primary endpoint was objective response rate (ORR), along with safety, pharmacokinetics, and biomarker assessments. Of 235 patients, 142 were naive to anti-PD-1/L1 and 93 were pretreated with anti-PD-1/L1 antibodies. Durable responses (>24 months) were seen across all indications for patients naive to anti-PD-1/L1 and in melanoma and RCC patients pretreated with anti-PD1/L1. The most frequent study drug-related AEs were pruritus (15.5%), fatigue (10.6%), and rash (10.6%) in patients naive to anti-PD-1/L1 and fatigue (18.3%), rash (14.0%), and nausea (10.8%) in anti-PD-1/L1 pretreated patients. Biomarker assessment indicated higher expression of T-cell-inflamed gene signature at baseline among responding patients. Response to treatment was durable (>24 months) in some patients across all enrolled indications, and safety findings were in accordance with previous and current studies exploring LAG-3/PD-1 blockade.
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- 2024
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367. Glycine Decarboxylase Activity Drives Non-Small Cell Lung Cancer Tumor-Initiating Cells and Tumorigenesis
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Elaine Hsuen Lim, Boon Seng Soh, Bee Choo Tai, Wong Poo Sing, Paul Robson, Monireh Soroush Noghabi, Yin Huei Pang, Kishore Bhakoo, Li Li Sun, He Yang, Senthil Raja Jayapal, Haw Siang Ang, Ross A. Soo, John Kit Chung Tam, Agasthian Thirugananam, Christie Tan, Qiang Yu, Ng Shyh-Chang, Amit Rai, Philipp Kaldis, Wayne Mitchell, Wen Cai Zhang, Siming Ma, Sanjay Swarup, Massimo Nichane, Bing Lim, Min En Nga, Shivshankar Umashankar, and Dokeu A. Ahmed
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Fetal Proteins ,Lung Neoplasms ,Cell Adhesion Molecules, Neuronal ,Molecular Sequence Data ,Transplantation, Heterologous ,Cell ,Glycine ,Stem cell factor ,Biology ,medicine.disease_cause ,General Biochemistry, Genetics and Molecular Biology ,Serine ,Antigens, CD ,Carcinoma, Non-Small-Cell Lung ,Cell Line, Tumor ,Neoplasms ,medicine ,Humans ,Amino Acid Sequence ,Lung cancer ,Biochemistry, Genetics and Molecular Biology(all) ,Thermus thermophilus ,RNA-Binding Proteins ,Glycine Dehydrogenase (Decarboxylating) ,medicine.disease ,Molecular biology ,DNA-Binding Proteins ,Transplantation ,Cell Transformation, Neoplastic ,medicine.anatomical_structure ,Cell culture ,Cancer research ,Carcinogenesis ,Sequence Alignment - Abstract
SummaryIdentification of the factors critical to the tumor-initiating cell (TIC) state may open new avenues in cancer therapy. Here we show that the metabolic enzyme glycine decarboxylase (GLDC) is critical for TICs in non-small cell lung cancer (NSCLC). TICs from primary NSCLC tumors express high levels of the oncogenic stem cell factor LIN28B and GLDC, which are both required for TIC growth and tumorigenesis. Overexpression of GLDC and other glycine/serine enzymes, but not catalytically inactive GLDC, promotes cellular transformation and tumorigenesis. We found that GLDC induces dramatic changes in glycolysis and glycine/serine metabolism, leading to changes in pyrimidine metabolism to regulate cancer cell proliferation. In the clinic, aberrant activation of GLDC correlates with poorer survival in lung cancer patients, and aberrant GLDC expression is observed in multiple cancer types. This link between glycine metabolism and tumorigenesis may provide novel targets for advancing anticancer therapy.
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368. Novel SNP improves differential survivability and mortality in non-small cell lung cancer patients
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Tzia Liang Mah, Ross A. Soo, Joo Chuan Tong, Frank Eisenhaber, Li Nanpu, Wei Peng Yong, Natalia Liem, Srinath Sridharan, Xin Ning Adeline Yap, Vellaisemy Kuralmani, Sharmila Adhikari, Sebastian Maurer-Stroh, Vachiranee Limviphuvadh, and Mengling Feng
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Adult ,Male ,Models, Molecular ,dbSNP ,Lung Neoplasms ,Genotype ,Protein Conformation ,Active Transport, Cell Nucleus ,Single-nucleotide polymorphism ,Biology ,Bioinformatics ,Survival Outcome ,Deoxycytidine ,Polymorphism, Single Nucleotide ,Non-small cell lung cancer ,Carcinoma, Non-Small-Cell Lung ,medicine ,Biomarkers, Tumor ,Genetics ,SNP ,Humans ,Mortality ,Lung cancer ,Genetic variant ,Survival analysis ,Aged ,Cell Nucleus ,Research ,Computational Biology ,Biomarker ,Middle Aged ,medicine.disease ,DNA Polymerase I ,Prognosis ,Survival Analysis ,Gemcitabine ,Cancer cell ,Mutation ,Cancer research ,Female ,medicine.drug ,Biotechnology - Abstract
Background Non-small cell lung cancer (NSCLC) is a major cause of cancer-related death worldwide due to poor patient prognosis and clinical outcome. Here, we studied the genetic variations underlying NSCLC pathogenesis based on their association to patient outcome after gemcitabine therapy. Results Bioinformatics analysis was used to investigate possible effects of POLA2 G583R (POLA2+1747 GG/GA, dbSNP ID: rs487989) in terms of protein function. Using biostatistics, POLA2+1747 GG/GA (rs487989, POLA2 G583R) was identified as strongly associated with mortality rate and survival time among NSCLC patients. It was also shown that POLA2+1747 GG/GA is functionally significant for protein localization via green fluorescent protein (GFP)-tagging and confocal laser scanning microscopy analysis. The single nucleotide polymorphism (SNP) causes DNA polymerase alpha subunit B to localize in the cytoplasm instead of the nucleus. This inhibits DNA replication in cancer cells and confers a protective effect in individuals with this SNP. Conclusions The results suggest that POLA2+1747 GG/GA may be used as a prognostic biomarker of patient outcome in NSCLC pathogenesis.
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369. Advances in the management of non-small-cell lung cancer harbouring exon 20 insertion mutations
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Jia Li Low, Sun Min Lim, Jii Bum Lee, Byoung Chul Cho, and Ross A Soo
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Epidermal growth factor receptor ( EGFR ) mutation is one of the key oncogenic mutations in non-small-cell lung cancer with adenocarcinoma histology. Exon 19 deletions and exon 21 L858R substitutions account for 90%, while EGFR exon 20 insertions constitute 4–10% of EGFR mutations and are the third most prevalent activating EGFR mutations. EGFR exon 20 insertions are associated with decreased sensitivity to EGFR tyrosine kinase inhibitors and, until recently, effective targeted therapy against these tumours remained an unmet clinical need and chemotherapy was the only treatment of choice available. The approval of amivantamab and mobocertinib for patients who have progressed after chemotherapy represents an important step forward in the management of these patients. Here in this review, we summarize the epidemiology, structure and the tumour microenvironment of EGFR exon 20 insertion and also review the systemic treatments, including targeted therapies and ongoing clinical trials in EGFR exon 20 insertion mutations, as well as detection methods for EGFR exon 20 insertion. Lastly, resistant mechanisms and future directions are addressed.
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- 2023
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370. Phase I/II study of the LAG-3 inhibitor ieramilimab (LAG525) ± anti-PD-1 spartalizumab (PDR001) in patients with advanced malignancies
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Tian Zhang, Filippo de Braud, Taito Esaki, Wallace Akerley, Chrisann Kyi, Richard D Carvajal, Daniel Gusenleitner, Patrick Schöffski, Miguel Martin, David S Hong, Amy Prawira, Jürgen Krauß, Nidhi Patel, Rina Hui, Andrew Weickhardt, Niladri Roy Chowdhury, Daniel S W Tan, María Ochoa-de-Olza, John Sarantopoulos, Ross A Soo, Michela Maur, Barbara Deschler-Baier, Allen Lau, Tanay S Samant, Tyler Longmire, Catherine A Sabatos-Peyton, Radha Ramesh, Tiancen Hu, Ana Carion, Padmaja Yerramilli-Rao, Vasileios Askoxylakis, and Eunice L Kwak
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2022
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371. Statistical Process Control Charts for Monitoring Next-Generation Sequencing and Bioinformatics Turnaround in Precision Medicine Initiatives
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Sneha Rajiv Jain, Wilson Sim, Cheng Han Ng, Yip Han Chin, Wen Hui Lim, Nicholas L. Syn, Nur Haidah Bte Ahmad Kamal, Mehek Gupta, Valerie Heong, Xiao Wen Lee, Nur Sabrina Sapari, Xue Qing Koh, Zul Fazreen Adam Isa, Lucius Ho, Caitlin O’Hara, Arvindh Ulagapan, Shi Yu Gu, Kashyap Shroff, Rei Chern Weng, Joey S. Y. Lim, Diana Lim, Brendan Pang, Lai Kuan Ng, Andrea Wong, Ross Andrew Soo, Wei Peng Yong, Cheng Ean Chee, Soo-Chin Lee, Boon-Cher Goh, Richie Soong, and David S.P. Tan
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precision medicine ,computational biology ,next generation sequencing ,precision oncology ,bioinformatics ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
PurposePrecision oncology, such as next generation sequencing (NGS) molecular analysis and bioinformatics are used to guide targeted therapies. The laboratory turnaround time (TAT) is a key performance indicator of laboratory performance. This study aims to formally apply statistical process control (SPC) methods such as CUSUM and EWMA to a precision medicine programme to analyze the learning curves of NGS and bioinformatics processes.Patients and MethodsTrends in NGS and bioinformatics TAT were analyzed using simple regression models with TAT as the dependent variable and chronologically-ordered case number as the independent variable. The M-estimator “robust” regression and negative binomial regression were chosen to serve as sensitivity analyses to each other. Next, two popular statistical process control (SPC) approaches which are CUSUM and EWMA were utilized and the CUSUM log-likelihood ratio (LLR) charts were also generated. All statistical analyses were done in Stata version 16.0 (StataCorp), and nominal P < 0.05 was considered to be statistically significant.ResultsA total of 365 patients underwent successful molecular profiling. Both the robust linear model and negative binomial model showed statistically significant reductions in TAT with accumulating experience. The EWMA and CUSUM charts of overall TAT largely corresponded except that the EWMA chart consistently decreased while the CUSUM analyses indicated improvement only after a nadir at the 82nd case. CUSUM analysis found that the bioinformatics team took a lower number of cases (54 cases) to overcome the learning curve compared to the NGS team (85 cases).ConclusionAs NGS and bioinformatics lead precision oncology into the forefront of cancer management, characterizing the TAT of NGS and bioinformatics processes improves the timeliness of data output by potentially spotlighting problems early for rectification, thereby improving care delivery.
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- 2021
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372. Targeting YAP to overcome acquired resistance to ALK inhibitors in ALK‐rearranged lung cancer
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Mi Ran Yun, Hun Mi Choi, You Won Lee, Hyeong Seok Joo, Chae Won Park, Jae Woo Choi, Dong Hwi Kim, Han Na Kang, Kyoung‐Ho Pyo, Eun Joo Shin, Hyo Sup Shim, Ross A Soo, James Chih‐Hsin Yang, Sung Sook Lee, Hyun Chang, Min Hwan Kim, Min Hee Hong, Hye Ryun Kim, and Byoung Chul Cho
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acquired resistance ,ALK ,non‐small cell lung cancer ,statin ,YAP ,Medicine (General) ,R5-920 ,Genetics ,QH426-470 - Abstract
Abstract Clinical benefit of ALK tyrosine kinase inhibitors (ALK‐TKIs) in ALK‐rearranged lung cancer has been limited by the inevitable development of acquired resistance, and bypass‐molecular resistance mechanisms remain poorly understood. We investigated a novel therapeutic target through screening FDA‐approved drugs in ALK‐TKI‐resistant models. Cerivastatin, the rate‐limiting enzyme inhibitor of the mevalonate pathway, showed anti‐cancer activity against ALK‐TKI resistance in vitro/in vivo, accompanied by cytoplasmic retention and subsequent inactivation of transcriptional co‐regulator YAP. The marked induction of YAP‐targeted oncogenes (EGFR, AXL, CYR61, and TGFβR2) in resistant cells was abolished by cerivastatin. YAP silencing suppressed tumor growth in resistant cells, patient‐derived xenografts, and EML4‐ALK transgenic mice, whereas YAP overexpression decreased the responsiveness of parental cells to ALK inhibitor. In matched patient samples before/after ALK inhibitor treatment, nuclear accumulation of YAP was mainly detected in post‐treatment samples. High expression of YAP in pretreatment samples was correlated with poor response to ALK‐TKIs. Our findings highlight a crucial role of YAP in ALK‐TKI resistance and provide a rationale for targeting YAP as a potential treatment option for ALK‐rearranged patients with acquired resistance to ALK inhibitors.
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- 2019
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373. Infrastructure for Developing Gastrointestinal Cancer Prognostic and Predictive Markers
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Haematology-Oncology, Ross Andrew Soo
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- 2014
374. A Study of the Pharmacodynamic Effects of Anti-Vascular Endothelial Growth Factor Therapy in Patients With Advanced Malignancies
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Ross Andrew Soo
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- 2010
375. Tumour-initiating cell-specific miR-1246 and miR-1290 expression converge to promote non-small cell lung cancer progression
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Wen Cai Zhang, Tan Min Chin, Henry Yang, Min En Nga, Declan Patrick Lunny, Edwin Kok Hao Lim, Li Li Sun, Yin Huei Pang, Yi Ning Leow, Shanneen Rossellini Y Malusay, Priscilla Xin Hui Lim, Jeravan Zili Lee, Benedict Jian Wei Tan, Ng Shyh-Chang, Elaine Hsuen Lim, Wan Teck Lim, Daniel Shao Weng Tan, Eng Huat Tan, Bee Choo Tai, Ross Andrew Soo, Wai Leong Tam, and Bing Lim
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Science - Abstract
miRNAs can function either as proto-oncogenes or tumour suppressors in several cancers; however their function in tumour initiating cells is unclear. Here, Zhang et al. show that tumour initiating cell-specific miR-1246 and miR-1290 promote lung cancer initiation and metastasis and could serve as prognostic markers.
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- 2016
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376. Dynamics of multiple resistance mechanisms in plasma DNA during EGFR‐targeted therapies in non‐small cell lung cancer
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Dana Wai Yi Tsui, Muhammed Murtaza, Alvin Seng Cheong Wong, Oscar M Rueda, Christopher G Smith, Dineika Chandrananda, Ross A Soo, Hong Liang Lim, Boon Cher Goh, Carlos Caldas, Tim Forshew, Davina Gale, Wei Liu, James Morris, Francesco Marass, Tim Eisen, Tan Min Chin, and Nitzan Rosenfeld
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circulating tumour DNA ,liquid biopsy ,lung cancer ,resistance mechanisms ,targeted therapy ,Medicine (General) ,R5-920 ,Genetics ,QH426-470 - Abstract
Abstract Tumour heterogeneity leads to the development of multiple resistance mechanisms during targeted therapies. Identifying the dominant driver(s) is critical for treatment decision. We studied the relative dynamics of multiple oncogenic drivers in longitudinal plasma of 50 EGFR‐mutant non‐small‐cell lung cancer patients receiving gefitinib and hydroxychloroquine. We performed digital PCR and targeted sequencing on samples from all patients and shallow whole‐genome sequencing on samples from three patients who underwent histological transformation to small‐cell lung cancer. In 43 patients with known EGFR mutations from tumour, we identified them accurately in plasma of 41 patients (95%, 41/43). We also found additional mutations, including EGFR T790M (31/50, 62%), TP53 (23/50, 46%), PIK3CA (7/50, 14%) and PTEN (4/50, 8%). Patients with both TP53 and EGFR mutations before treatment had worse overall survival than those with only EGFR. Patients who progressed without T790M had worse PFS during TKI continuation and developed alternative alterations, including small‐cell lung cancer‐associated copy number changes and TP53 mutations, that tracked subsequent treatment responses. Longitudinal plasma analysis can help identify dominant resistance mechanisms, including non‐druggable genetic information that may guide clinical management.
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- 2018
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377. Fatty acid synthase mediates EGFR palmitoylation in EGFR mutated non‐small cell lung cancer
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Azhar Ali, Elena Levantini, Jun Ting Teo, Julian Goggi, John G Clohessy, Chan Shuo Wu, Leilei Chen, Henry Yang, Indira Krishnan, Olivier Kocher, Junyan Zhang, Ross A Soo, Kishore Bhakoo, Tan Min Chin, and Daniel G Tenen
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acquired resistance ,EGFR‐TKI ,FASN ,NSCLC ,palmitoylation ,Medicine (General) ,R5-920 ,Genetics ,QH426-470 - Abstract
Abstract Metabolic reprogramming is widely known as a hallmark of cancer cells to allow adaptation of cells to sustain survival signals. In this report, we describe a novel oncogenic signaling pathway exclusively acting in mutated epidermal growth factor receptor (EGFR) non‐small cell lung cancer (NSCLC) with acquired tyrosine kinase inhibitor (TKI) resistance. Mutated EGFR mediates TKI resistance through regulation of the fatty acid synthase (FASN), which produces 16‐C saturated fatty acid palmitate. Our work shows that the persistent signaling by mutated EGFR in TKI‐resistant tumor cells relies on EGFR palmitoylation and can be targeted by Orlistat, an FDA‐approved anti‐obesity drug. Inhibition of FASN with Orlistat induces EGFR ubiquitination and abrogates EGFR mutant signaling, and reduces tumor growths both in culture systems and in vivo. Together, our data provide compelling evidence on the functional interrelationship between mutated EGFR and FASN and that the fatty acid metabolism pathway is a candidate target for acquired TKI‐resistant EGFR mutant NSCLC patients.
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- 2018
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378. Clinical validation of an ultra high-throughput spiral microfluidics for the detection and enrichment of viable circulating tumor cells.
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Bee Luan Khoo, Majid Ebrahimi Warkiani, Daniel Shao-Weng Tan, Ali Asgar S Bhagat, Darryl Irwin, Dawn Pingxi Lau, Alvin S T Lim, Kiat Hon Lim, Sai Sakktee Krisna, Wan-Teck Lim, Yoon Sim Yap, Soo Chin Lee, Ross A Soo, Jongyoon Han, and Chwee Teck Lim
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Medicine ,Science - Abstract
BackgroundCirculating tumor cells (CTCs) are cancer cells that can be isolated via liquid biopsy from blood and can be phenotypically and genetically characterized to provide critical information for guiding cancer treatment. Current analysis of CTCs is hindered by the throughput, selectivity and specificity of devices or assays used in CTC detection and isolation.Methodology/principal findingsHere, we enriched and characterized putative CTCs from blood samples of patients with both advanced stage metastatic breast and lung cancers using a novel multiplexed spiral microfluidic chip. This system detected putative CTCs under high sensitivity (100%, n = 56) (Breast cancer samples: 12-1275 CTCs/ml; Lung cancer samples: 10-1535 CTCs/ml) rapidly from clinically relevant blood volumes (7.5 ml under 5 min). Blood samples were completely separated into plasma, CTCs and PBMCs components and each fraction were characterized with immunophenotyping (Pan-cytokeratin/CD45, CD44/CD24, EpCAM), fluorescence in-situ hybridization (FISH) (EML4-ALK) or targeted somatic mutation analysis. We used an ultra-sensitive mass spectrometry based system to highlight the presence of an EGFR-activating mutation in both isolated CTCs and plasma cell-free DNA (cf-DNA), and demonstrate concordance with the original tumor-biopsy samples.Conclusions/significanceWe have clinically validated our multiplexed microfluidic chip for the ultra high-throughput, low-cost and label-free enrichment of CTCs. Retrieved cells were unlabeled and viable, enabling potential propagation and real-time downstream analysis using next generation sequencing (NGS) or proteomic analysis.
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- 2014
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379. Randomized phase II study of carboplatin and paclitaxel with either linifanib or placebo for advanced nonsquamous non-small-cell lung cancer.
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Ramalingam SS, Shtivelband M, Soo RA, Barrios CH, Makhson A, Segalla JG, Pittman KB, Kolman P, Pereira JR, Srkalovic G, Belani CP, Axelrod R, Owonikoko TK, Qin Q, Qian J, McKeegan EM, Devanarayan V, McKee MD, Ricker JL, Carlson DM, and Gorbunova VA
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- Administration, Oral, Adult, Aged, Antineoplastic Combined Chemotherapy Protocols adverse effects, Carboplatin administration & dosage, Carcinoma, Non-Small-Cell Lung mortality, Disease-Free Survival, Drug Administration Schedule, Female, Humans, Indazoles administration & dosage, Indazoles adverse effects, Kaplan-Meier Estimate, Lung Neoplasms mortality, Male, Middle Aged, Paclitaxel administration & dosage, Phenylurea Compounds administration & dosage, Phenylurea Compounds adverse effects, Receptors, Platelet-Derived Growth Factor antagonists & inhibitors, Treatment Outcome, Vascular Endothelial Growth Factor A antagonists & inhibitors, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Non-Small-Cell Lung drug therapy, Lung Neoplasms drug therapy
- Abstract
Purpose: Linifanib, a potent, selective inhibitor of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) receptors, has single-agent activity in non-small-cell lung cancer (NSCLC). We evaluated linifanib with carboplatin and paclitaxel as first-line therapy of advanced nonsquamous NSCLC., Patients and Methods: Patients with stage IIIB/IV nonsquamous NSCLC were randomly assigned to 3-week cycles of carboplatin (area under the curve 6) and paclitaxel (200 mg/m(2)) with daily placebo (arm A), linifanib 7.5 mg (arm B), or linifanib 12.5 mg (arm C). The primary end point was progression-free survival (PFS); secondary efficacy end points included overall survival (OS) and objective response rate., Results: One hundred thirty-eight patients were randomly assigned (median age, 61 years; 57% men; 84% smokers). Median PFS times were 5.4 months (95% CI, 4.2 to 5.7 months) in arm A (n = 47), 8.3 months (95% CI, 4.2 to 10.8 months) in arm B (n = 44), and 7.3 months (95% CI, 4.6 to 10.8 months) in arm C (n = 47). Hazard ratios (HRs) for PFS were 0.51 for arm B versus A (P = .022) and 0.64 for arm C versus A (P = .118). Median OS times were 11.3, 11.4, and 13.0 months in arms A, B, and C, respectively. HRs for OS were 1.08 for arm B versus A (P = .779) and 0.88 for arm C versus A (P = .650). Both linifanib doses were associated with increased toxicity, including a higher incidence of adverse events known to be associated with VEGF/PDGF inhibition. Baseline plasma carcinoembryonic antigen/cytokeratin 19 fragments biomarker signature was associated with PFS improvement and a trend toward OS improvement with linifanib 12.5 mg., Conclusion: Addition of linifanib to chemotherapy significantly improved PFS (arm B), with a modest trend for survival benefit (arm C) and increased toxicity reflective of known VEGF/PDGF inhibitory effects., (© 2015 by American Society of Clinical Oncology.)
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- 2015
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