Activity In Squamous Cell Carcinoma Research Articles

The SRC family kinase inhibitor NXP900 demonstrates potent antitumor activity in squamous cell carcinomas

NXP900 is a selective and potent SRC family kinase (SFK) inhibitor, currently being dosed in a phase 1 clinical trial, that locks SRC in the “closed” conformation, thereby inhibiting both kinase-dependent catalytic activity and kinase-independent functions. In contrast, several multi-targeted kinase inhibitors that inhibit SRC, including dasatinib and bosutinib, bind their target in the active “open” conformation, allowing SRC and other SFKs to act as a scaffold to promote tumorigenesis through non-catalytic functions. NXP900 exhibits a unique target selectivity profile with sub-nanomolar activity against SFK members over other kinases. This results in highly potent and specific SFK pathway inhibition. Here, we demonstrate that esophageal squamous cell carcinomas (ESCC) and head and neck squamous cell carcinomas (HNSCC) are exquisitely sensitive to NXP900 treatment in cell culture and in vivo, and we identify a patient population that could benefit from treatment with NXP900.

Preliminary results of phase I/II study to evaluate safety and efficacy of combination pucotenlimab with epidermal growth factor receptor-ADC (EGFR-ADC) MRG003 in patients with EGFR positive solid tumors.

6013 Background: Pucotenlimab (HX008) is a recombinant humanized PD-1 inhibitor approved for marketing in China, and MRG003 is an EGFR-ADC which has shown promising anti-tumor activity in squamous cell carcinoma of the head and neck (SCCHN) and nasopharyngeal carcinoma (NPC) in multiple clinical studies. In the preclinical studies, the combination of them has demonstrated a synergistic antitumor effect. This study was aimed to assess the safety and efficacy of the combination therapy in patients (pts) with locally advanced or metastatic solid tumors known to express EGFR. Methods: In this Phase I/II dose escalation and expansion study, eligible pts were treated with 3.0 mg/kg HX008 combined with MRG003 every 3 weeks, with an escalated dosing ranging from 1.5 mg/kg to 2.3 mg/kg. The primary endpoints were maximum tolerated dose (MTD), recommended Phase II dose (RP2D) of combination and objective response rate (ORR). Secondary endpoints included duration of response (DOR), disease control rate (DCR), and progression-free survival (PFS). Results: As of 30 January 2024 (cut-off date), 33 pts (9 NPC, 1 SCCHN and 3 other solid tumors pts in Phase I, 14 NPC and 6 SCCHN pts in Phase II) were enrolled in this study with a median age of 52 (31,65), and 25 pts (76%) were male. 11 (33%) pts were ECOG PS 0. The most commonly reported treatment-related adverse events (TRAEs) included pruritus (46%), rash (33%), AST increased (30%), anemia (30%). Grade 3-4 TRAEs occurred in 4 pts (12%), and mainly was white blood cell count decreased (9%) and hypokalemia (6%). The only DLT event occurred in the 2.3mg/kg dose group, and the RP2D of MRG003 determined was 2.0mg/kg by SMC. Out of the 27 evaluable pts, 17 pts achieved PR and 7 pts achieved SD, thus the ORR and DCR were 63.0% (95%CI: 42.4, 80.6) and 88.9% (95%CI: 70.8, 97.7), respectively. In the Phase II, among 9 evaluable EGFR-positive NPC pts progression after first-line treatment of PD-1 plus platinum-based chemotherapy, 2 CR, 5 PR and 2 SD were observed, ORR and DCR were 77.8% (95%CI:40.0, 97.2) and 100% (95%CI:66.4, 100), respectively. Five evaluable systemic treatment naïve SCCHN pts with EGFR-positive, 3 PR and 1 SD were observed, ORR and DCR were 60% (95%CI:14.7, 94.7) and 80% (95%CI:28.4, 99.5), respectively. The DOR and PFS in the study were immature. The longest patient treated has had a DOR for more than 17 months and still ongoing. Conclusions: The Phase I/II study pts treated with HX008 in combination with MRG003 demonstrated good tolerability and encouraging antitumor activity in NPC and SCCHN, especially in PD-1 treatment failed NPC pts. The Phase II study is currently ongoing. Research Sponsor: Shanghai Miracogen Inc. Clinical trial information: NCT05688605.

Phase II basket trial evaluating the efficacy of pembrolizumab (PE) combined with vorinostat (VO) in patients (pts) with recurrent and/or metastatic squamous cell carcinoma (SCC).

2597 Background: Epigenetic modulation plays a major role in escaping tumor immunosurveillance and confers resistance to immune checkpoint inhibitors. Preclinical evidence suggests that modulating the epigenome might improve the efficacy of immunotherapy. Patients and Methods: PEVOsq is an open-label, non-randomized, multi-center, basket phase II trial, evaluating the efficacy of pembrolizumab in combination with vorinostat in patients with recurrent and/or metastatic squamous cell carcinoma of the cervix, head and neck, anus, vulva/vagina, penis, and lung. Patients had to be PD1/PD-L1 antagonist-naïve. There was no selection based on PD-L1 expression nor on HPV status, and no restriction in terms of prior lines of treatments. Pembrolizumab dose was 200 mg Q3W IV, and vorinostat 400 mg QD PO. Sample size was determined for each cohort using an A’Hern design. Primary endpoint was objective response rate (ORR) according to RECISTv1.1. Secondary endpoints included safety, progression-free survival (PFS), overall survival (OS), and duration of response (DOR). Results: Among 112 included patients, 111 were evaluable for safety and 107 for efficacy. The lung cohort was closed prematurely because of lack of enrollment. Median age was 61 years old [range: 18-85] and the median number of prior lines of therapies was 1 [range: 0-4]. ORR, PFS, G3/4 treatment related adverse events (TRAE), and OS are reported. 28 patients (26%) had an objective response and median DOR was 9.7 months [95%CI: 3.1-15.2]. Results per PD-L1 status will be presented at the meeting. Pembrolizumab and vorinostat were stopped for toxicity in 9% and 39% of patients, respectively. 60% of patients had a dose-reduced of vorinostat for toxicity. Pembrolizumab safety was as expected. Main vorinostat toxicities included hematological toxicity, gastrointestinal disorders, and asthenia and creatinine increase. Conclusions: Pembrolizumab combined with vorinostat showed encouraging antitumor activity in squamous cell carcinoma with unselected PD1/PD-L1 status, especially in cervical and anal cancer, although vorinostat dose had to be reduced because of toxicity in a substantial proportion of patients. Clinical trial information: NCT04357873 . [Table: see text]

Phase II trial of eribulin in advanced/recurrent cervical cancer

<h3>Objectives:</h3> Eribulin (E), a Halichondrin B analog from the marine sponge H. okadai has clinical efficacy in pretreated metastatic breast cancer and liposarcoma as well as preclinical antitumor activity in squamous cell carcinoma (SCC). We conducted a 2-stage Phase 2 study of E in patients (pts) with advanced/recurrent cervical cancer (CC) to examine its clinical activity and evaluate potential biomarkers for predictors of response. <h3>Methods:</h3> Pts with advanced/recurrent CC after ≤1 prior chemotherapy (CT) regimen, measurable disease and ECOG performance status ≤2 were treated with E (1.4mg/m² IV day 1 and 8, every 21 days) with tumor assessments every 2 cycles. Primary endpoint was 6-month progression-free survival PFS6; secondary were best overall response (RECISTv1.1), toxicity (CTCAEv4.03) and overall survival (OS); and exploratory were associations of tumor biomarkers involved in apoptosis/proliferation, the unfolded protein response and tubulin subtypes with clinical activity. A total of 30 evaluable pts would ensure 80% power when the true PFS6=26% with a 1-sided α ≤0.1 (Ho: PFS6=10%). A prespecified futility analysis gating stage 2 was set if 0/15pts showed at least SD at 6 months (mos). Immunohistochemistry was performed on archival tumor samples. Overexpression was defined when both intensity and distribution scores are ≥2. <h3>Results:</h3> A total of 32 pts were enrolled, median age 51 years (range 29-76), 22 had SCC, the median number of cycles was 4 (range 1-77). A total of 29 pts had received prior CT with cisplatin/gemcitabine (12) and cisplatin/paclitaxel/bevacizumab (12) as the most common regimens. A total of 14 pts had received prior paclitaxel (PTX). A total of 6/32 pts (19%) achieved > PFS6; median PFS is 2.5 mos (95% CI: 1.2, 4.2). Median OS is 6.5 mos (95% CI: 4.5, 12.7). A total of 2 pts were inevaluable for response having received less than 2 cycles. Among the 30 evaluable pts, 1 (3%) had a complete response, 5 (17%) had a partial response and 13 (43%) had stable disease (clinical benefit rate 63%). Grade 3/4 adverse events occurring in > 10 % of pts are anemia (12pts), neutropenia (7pts) and leukopenia (6pts). A total of 2 pts were removed from study due to paresthesia. Pts who received prior PTX responded less favorably than those who did not (p=.002) and had a significantly shorter PFS at 1.2 mos (95% CI: 1.1, 2.0) compared to 3.5 mos (95% CI: 2.6, 5.4) for those who did not (p=.008). Analysis of correlative predictors of response revealed significant associations between βII and βIII tubulin subtypes as well as BAX. Patients who did not overexpress βII and BAX were more likely to respond to E (p=.040, p=.002, respectively). On univariate analysis, PFS was shorter in patients with BAX overexpression 1.2 mos (95% CI: 1.1, 2.6) vs 4.6 mos (95% CI: 2.7, 7.8, p=.006) in those without. This was also observed in OS with 4.3 mos (95% CI: 2.7, 6.5) in those who overexpressed BAX vs 1.3 mos (7.7, 28.3, p=.006) in those who did not overexpress. In multivariate analyses, prior PTX (HR 4.80, 95% CI: 1.12, 20.7), βIII tubulin overexpression (HR 5.22, 95% CI: 1.52, 17.93), and BAX overexpression (HR 3.61, 95% CI 1.11, 11.73) remained significant factors in PFS. Similar results were observed for OS. <h3>Conclusions:</h3> Eribulin shows some limited activity in patients with recurrent/advanced CC with a favorable toxicity profile. Prior paclitaxel exposure is associated with decreased E response. βII, βIII tubulin subtypes and BAX are predictors of response and survival. While the primary end point was not met, Eribulin may be an option for women with paclitaxel-naïve recurrent/advanced CC.

Molecular Mechanisms of Antiproliferative and Apoptosis Activity by 1,5-Bis(4-Hydroxy-3-Methoxyphenyl)1,4-Pentadiene-3-one (MS13) on Human Non-Small Cell Lung Cancer Cells.

Diarylpentanoid (DAP), an analog that was structurally modified from a naturally occurring curcumin, has shown to enhance anticancer efficacy compared to its parent compound in various cancers. This study aims to determine the cytotoxicity, antiproliferative, and apoptotic activity of diarylpentanoid MS13 on two subtypes of non-small cell lung cancer (NSCLC) cells: squamous cell carcinoma (NCI-H520) and adenocarcinoma (NCI-H23). Gene expression analysis was performed using Nanostring PanCancer Pathways Panel to determine significant signaling pathways and targeted genes in these treated cells. Cytotoxicity screening revealed that MS13 exhibited greater inhibitory effect in NCI-H520 and NCI-H23 cells compared to curcumin. MS13 induced anti-proliferative activity in both cells in a dose- and time-dependent manner. Morphological analysis revealed that a significant number of MS13-treated cells exhibited apoptosis. A significant increase in caspase-3 activity and decrease in Bcl-2 protein concentration was noted in both MS13-treated cells in a time- and dose-dependent manner. A total of 77 and 47 differential expressed genes (DEGs) were regulated in MS13 treated-NCI-H520 and NCI-H23 cells, respectively. Among the DEGs, 22 were mutually expressed in both NCI-H520 and NCI-H23 cells in response to MS13 treatment. The top DEGs modulated by MS13 in NCI-H520—DUSP4, CDKN1A, GADD45G, NGFR, and EPHA2—and NCI-H23 cells—HGF, MET, COL5A2, MCM7, and GNG4—were highly associated with PI3K, cell cycle-apoptosis, and MAPK signaling pathways. In conclusion, MS13 may induce antiproliferation and apoptosis activity in squamous cell carcinoma and adenocarcinoma of NSCLC cells by modulating DEGs associated with PI3K-AKT, cell cycle-apoptosis, and MAPK pathways. Therefore, our present findings could provide an insight into the anticancer activity of MS13 and merits further investigation as a potential anticancer agent for NSCLC cancer therapy.

Small molecule inhibition of matrix metalloproteinases as a potential therapeutic for metastatic activity in squamous cell carcinoma

PurposeOne strategy for treating cancer is to prevent metastatic spread. Matrix metalloproteinase are considered potential targets for cancer therapy because of their role in degrading the extracellular matrix and fostering tumor progression. In some cancer models, the small molecule 1,2,3,4,6-Penta-O-galloyl-β-d-glucose (PGG) exhibited inhibitory properties against matrix metalloproteinase (MMP) related metastatic activity. This study explored whether PPG may limit the potential for metastatic spread in oral squamous cell carcinoma.Materials and methodsThis study used Cal-27 cells, a cell line derived from a squamous cell carcinoma line of human tongue origin, and antibodies for MMP-1, -2, -3, -9, -13, MT1-MMP signal transducers and activators of transcription 3 (Stat3), and pStat3. Cells were treated with PGG at different concentrations to evaluate MMP and Stat3 activation. Expansion assays were performed using Matrigel matrixes to measure Cal-27 invasiveness in the presence of PGG.ResultsPGG decreased the expression of MMP-2, -9 and -13 in the Cal-27 cell line, decreased phosphorylation of Stat3 and reduced gene expression of MMP-2, -9 and -13. As observed in Matrigel expansion assays, PGG limited the invasiveness of Cal-27 cells in a dose-dependent manner.ConclusionPPG is a small molecule inhibitor with the potential to reduce the expression of the matrix metalloproteinases and to limit the invasiveness of the squamous cell carcinoma line, Cal-27. By controlling the expression of molecules responsible for metastasis, PPG may offer a new therapeutic option for treating oral squamous cell carcinoma.

Immunohistochemical study of Ki-67, PHH3, and CK15 protein expression in oral epithelial malignancy

To investigate the expression of Ki-67, phosphohistone H-3 (PHH3), and cytokeratin 15 (CK15) proteins in the cells of the oral mucosa (OM) according to the degree of its malignant transformation. OM biopsy specimens from 69 patients diagnosed with focal epithelial hyperplasia, intraepithelial squamous cell neoplasia, cancer in situ, and squamous cell carcinoma were examined. Tissue antigens were determined using mouse Ki-67 monoclonal antibodies, rabbit PHH3 polyclonal antibodies, and mouse CK15 monoclonal antibodies. There was an increase in epithelial proliferative and mitotic activities in squamous cell carcinoma and a sharp decrease in the expression of CK15 in the cytoplasm in cancer in situ and squamous cell carcinoma of the OM. The protein CK15 can be used for the differential diagnosis between high-grade dysplasia and OM epithelial malignancy at the stage of carcinoma in situ and squamous cell carcinoma.

2′-deoxy-2′-[18F] fluoro-D-glucose positron emission tomography, diffusion-weighted magnetic resonance imaging, and choline spectroscopy to predict the activity of cetuximab in tumor xenografts derived from patients with squamous cell carcinoma of the head and neck

We investigated changes on 2′-deoxy-2′-[18F]fluoro-D-glucose positron emission tomography (18FDG-PET), diffusion-weighted magnetic resonance imaging (DW-MRI), and choline spectroscopy as early markers of cetuximab activity in squamous cell carcinoma of the head and neck (SCCHN).SCCHN patient-derived tumor xenografts models were selected based on their cetuximab sensitivity. Three models were resistant to cetuximab and two were sensitive (one was highly sensitive and the other one was moderately sensitive). Cetuximab was infused on day 0 and 7. Maximal standardized uptake values (SUVmax), apparent diffusion coefficient (ADC), and total choline pool were measured at baseline and at day 8. To investigate the possible clinical relevance of our pre-clinical findings, we also studied the SUVmax and ADC modifications induced by cetuximab in five patients.Cetuximab induced a significant decrease in SUVmax and an increase in ADC at day 8 compared to baseline in the most cetuximab-sensitive model but not in the other models. At day 8, in one resistant model, SUVmax was decreased compared to baseline and was significantly lower than the controls. Choline spectroscopy was not able to predict cetuximab activity. The five patients treated with cetuximab had a 18FDG-PET partial response. One patient had a partial response according to RECISTv1.1. Interestingly, this last had also an increase in ADC value above 25%.Our preclinical data support the use of PDTX to investigate imaging techniques to detect early treatment response. Our pre-clinical and clinical data suggest that DW-MRI and 18FDG-PET should be further investigated to predict cetuximab activity.

MOLECULAR BASIS OF MODERN TARGETED THERAPY FOR SQUAMOUS CELL CARCINOMA OF THE TONGUE AND ORAL MUCOSA WITH MONOCLONAL ANTIBODIES

The review presents an analysis of current data on the molecular mechanisms of targeted drugs action based on monoclonal antibodies aimed at main signaling pathways that change their activity in squamous cell carcinoma of the tongue and mucosa of the oral cavity. The main cellular signaling pathways and disturbances in their functioning, involved in the pathogenesis of this group of diseases, as well as the mechanisms of action of monoclonal antibodies on the ERBB 1 and 2 receptors (cetuximab, matuzumab, trastuzumab), VEGF ligands (bevacizumab, aflibercept), IGF- receptors (fizitumumab) and MET-receptor ligands (AV299 and AMG102) described in detail. The literature analysis showed that the therapeutic potential of monoclonal antibodies to ERBB-, VEGF-, IGF and MET receptors is far from exhausted, and the effectiveness of such therapy can be improved by the combined action of several antibodies.

Exome sequencing reveals recurrent REV3L mutations in cisplatin-resistant squamous cell carcinoma of head and neck.

Dacomitinib, an irreversible pan-HER inhibitor, had shown modest clinical activity in squamous cell carcinoma of head and neck (SCCHN) patients. Therefore, validated predictive biomarkers are required to identify patients most likely to benefit from this therapeutic option. To characterize the genetic landscape of cisplatin-treated SCCHN genomes and identify potential predictive biomarkers for dacomitinib sensitivity, we performed whole exome sequencing on 18 cisplatin-resistant metastatic SCCHN tumors and their matched germline DNA. Platinum-based chemotherapy elevated the mutation rates of SCCHN compared to chemotherapy-naïve SCCHNs. Cisplatin-treated SCCHN genomes uniquely exhibited a novel mutational signature characterized by C:G to A:T transversions at CCR sequence contexts that may have arisen due to error-prone translesional synthesis. Somatic mutations in REV3L, the gene encoding the catalytic subunit of DNA polymerase ζ involved in translesional synthesis, are significantly enriched in a subset of patients who derived extended clinical benefit to dacomitinib (P = 0.04). Functional assays showed that loss-of-function of REV3L dramatically enhanced the sensitivity of SCCHN cells to dacomitinib by the loss of both translesion synthesis and homologous recombination pathways. Our data suggest that the ‘platinum’ mutational signature and inactivation of REV3L may inform treatment options in patients of recurrent SCCHN.

AXL Mediates Resistance to PI3Kα Inhibition by Activating the EGFR/PKC/mTOR Axis in Head and Neck and Esophageal Squamous Cell Carcinomas

Phosphoinositide-3-kinase (PI3K)-α inhibitors have shown clinical activity in squamous cell carcinomas (SCCs) of head and neck (H&N) bearing PIK3CA mutations or amplification. Studying models of therapeutic resistance, we have observed that SCC cells that become refractory to PI3Kα inhibition maintain PI3K-independent activation of the mammalian target of rapamycin (mTOR). This persistent mTOR activation is mediated by the tyrosine kinase receptor AXL. AXL is overexpressed in resistant tumors from both laboratory models and patients treated with the PI3Kα inhibitor BYL719. AXL dimerizes with and phosphorylates epidermal growth factor receptor (EGFR), resulting in activation of phospholipase Cγ (PLCγ)-protein kinase C (PKC), which, in turn, activates mTOR. Combined treatment with PI3Kα and either EGFR, AXL, or PKC inhibitors reverts this resistance.

Correlation of T-cell inflamed phenotype with mesenchymal subtype, expression of PD-L1, and other immune checkpoints in head and neck cancer.

6009 Background: Immunotherapy with checkpoint blockade has shown encouraging activity in squamous cell carcinomas including a case report in tongue cancer (Herbst 2013). PD-L1 expression is common...

Phase II Study of Cetuximab in Combination with Docetaxel in Patients with Recurrent and/or Metastatic Squamous Cell Carcinoma of the Head and Neck after Platinum-Containing Therapy: A Multicenter Study of the Arbeitsgemeinschaft Internistische Onkologie

Background: Cetuximab and docetaxel have single-agent activity in squamous cell carcinoma of the head and neck (SCCHN). The efficacy of their combination was evaluated in platinum-pretreated patients with recurrent and/or metastatic SCCHN. Patients and Methods: A total of 84 patients were treated with docetaxel 35 mg/m² weekly for a maximum of 6 cycles and concomitant cetuximab 250 mg/m² weekly until disease progression or unacceptable toxicity. The primary endpoint was the objective response rate and secondary endpoints included the response rate in relation to platinum sensitivity, progression-free survival (PFS), overall survival (OS) and toxicity. Results: Nine (11%) patients achieved a partial response and 34 (40%) stable disease, resulting in a disease control rate of 51%. Response to treatment was 49% in previously platinum-sensitive and 50% in previously platinum-resistant disease. The median PFS was 3.1 months and the median OS 6.7 months. The most common grade 3 or 4 adverse events were mucositis (8%), pneumonia (8%), fatigue (8%) and skin reactions (14%). Sepsis occurred in 3 patients. Conclusion: Cetuximab plus docetaxel is an active treatment regimen with moderate toxicity in SCCHN patients. However, no superiority in comparison with monotherapy could be shown. Responsiveness and survival were independent of previous platinum sensitivity.

The role of cetuximab in the management of head and neck cancers

Introduction: The standard of care for patients with locally-advanced head and neck cancer is chemoradiation or surgical resection followed by radiation treatment with or without chemotherapy and despite aggressive, multimodality therapies with their associated toxicities, attempts are being made to improve efficacy while reducing toxicity. Cetuximab is a chimeric mAb directed against the EGFR that showed clinical activity in squamous cell carcinoma of head and neck (SCCHN).Areas covered: Cetuximab is beneficial in recurrent and metastatic setting, as well as in the definitive setting. In a landmark study by Bonner et al., cetuximab was found to be effective in prolonging survival in conjunction with radiation treatment in locally-advanced tumors versus radiation therapy alone. The Erbitux in First-Line Treatment of Recurrent or Metastatic Head and Neck Cancer (EXTREME) trial also showed an improvement in conjunction with chemotherapy in recurrent and metastatic tumors.Expert opinion: Cetuximab is an important therapeutic option in SSCHN, and will continue to be used in metastatic and definitive settings. While cetuximab is a valuable tool in the treatment of SCCHN, more studies are needed to maximize the efficacy of this mAb in clinical settings and to identify the subpopulation of patients that truly benefit from its use.

Developmental factor IRF6 exhibits tumor suppressor activity in squamous cell carcinomas.

The transcription factor interferon regulatory factor 6 (IRF6) regulates craniofacial development and epidermal proliferation. We recently showed that IRF6 is a component of a regulatory feedback loop that controls the proliferative potential of epidermal cells. IRF6 is transcriptionally activated by p63 and induces its proteasome-mediated down-regulation, thereby limiting keratinocyte proliferative potential. We hypothesized that IRF6 may also be involved in skin carcinogenesis. Hence, we analyzed IRF6 expression in a large series of squamous cell carcinomas (SCCs) and found a strong down-regulation of IRF6 that correlated with tumor invasive and differentiation status. IRF6 down-regulation in SCC cell lines and primary tumors correlates with methylation on a CpG dinucleotide island located in its promoter region. To identify the molecular mechanisms regulating IRF6 potential tumor suppressive activity, we performed a genome-wide analysis by combining ChIP sequencing for IRF6 binding sites and gene expression profiling in primary human keratinocytes after siRNA-mediated IRF6 depletion. We observed dysregulation of cell cycle-related genes and genes involved in differentiation, cell adhesion, and cell-cell contact. Many of these genes were direct IRF6 targets. We also performed in vitro invasion assays showing that IRF6 down-regulation promotes invasive behavior and that reintroduction of IRF6 into SCC cells strongly inhibits cell growth. These results indicate a function for IRF6 in suppression of tumorigenesis in stratified epithelia.

Docetaxel and irinotecan in recurrent or metastatic head and neck cancer

Docetaxel and irinotecan have single-agent antitumor activity in squamous cell carcinoma of the head and neck (SCCHN). The authors sought to evaluate their combination in the treatment of patients with recurrent or metastatic SCCHN. Eligibility criteria included recurrent or metastatic SCCHN with measurable disease, good performance status, and adequate laboratory parameters. Patients received docetaxel 35 mg/m(2) and irinotecan 60 mg/m(2), intravenously, on Days 1 and 8, every 21 days, until disease progression. The authors assessed UGT1A1 genotype, vascular endothelial growth factor (VEGF) in serum, and cyclooxygenase-2 and VEGF in baseline tumor tissue. Fifty-two patients were analyzable: 20 chemotherapy naive (Group A) and 32 previously treated with 1 chemotherapy regimen (Group B); 73% of patients had distant metastasis, and 60% were paclitaxel-exposed. In Group A, 3 (15%) patients achieved a partial response; in Group B, 1 (3%) patient achieved a partial response. Median progression-free survival (PFS) and overall survival were 3.3 and 8.2 months in Group A and 1.9 and 5.0 months in Group B, respectively. Common serious toxicities were diarrhea, fatigue, and anorexia. Patients with high serum VEGF had a median PFS of 2.8 months versus 1.7 months for patients with low VEGF (P = .085). Docetaxel and irinotecan had acceptable toxicities, but efficacy results in unselected patients with recurrent or metastatic SCCHN did not suggest an advantage over docetaxel alone or platinum-based regimens.

Prognostic significance of nuclear and cytoplasmic expression of metallothioneins as related to proliferative activity in squamous cell carcinomas of oral cavity.

Metallothioneins (MT) are low molecular weight proteins with high metal and cystein contents. This study was designed to test the hypothesis that cytoplasmic and nuclear MT expression are of prognostic importance in patients with squamous cell carcinomas of the oral cavity, treated by surgery with subsequent radiotherapy. The second aim of the study was to test the potential correlation between the nuclear and cytoplasmic MT expressions as compared to expression of proliferation markers and other clinicopathological variables. The studies were performed on tumor samples from 50 patients with diagnosis of squamous cell carcinoma of the oral cavity floor or of oral part of the tongue. All the patients were subjected to radical surgery, accompanied by removal of lymph nodes and post-operative radiotherapy. No significant correlation could be detected between percentage and intensity of MT expression on one hand and proportions of cells with Mcm-2 (minichromosome maintenance protein 2), Ki-67 expressions, nor the grade of malignancy (G) on the other. A significantly shorter survival was detected among patients with tumors of MT expression rated 9 or 12 according to the Remmele scale and among patients with a high percentage (> 50%) of nuclear MT staining. In mulivariate analyses, only OTT (Overall Treatment Time), lymph node involvement and high expression of Mcm-2 were found to be independent risk factors for decreased patient's survival. This is relevant evidence that MT overexpression could be related to worse prognosis in patients with oral cancer. We have found no relationship between MT expression and proliferative activity.

Concomitant hyperfractionated accelerated radiotherapy (HART) with cisplatin and concurrent cetuximab for locoregionally advanced squamous cell head and neck cancer: a phase I dose escalation trial

6029 Background: Cetuximab is a potent inhibitor of the epidermal growth factor receptor and has shown activity in squamous cell carcinoma of the head and neck (SCCHN) enhancing both radiotherapy and chemotherapy. This phase I dose-escalation clinical trial was designed to investigate the safety and tolerability of the combination of cisplatinum, cetuximab, and hyperfractionated accelerated radiotherapy. Methods: Patients (pts) with stage III or IV, M0 SCCHN were enrolled and treated with an initial dose of cetuximab (400mg/m2), followed by weekly doses of 250mg/m² during the hyperfractionated accelerated radiotherapy (HART), which started with a prescribed dose of 2.0 Gy per day for three weeks followed by 1.4 Gy twice daily to a total dose of 70.6 Gy to the gross tumor volume. Cisplatinum was administered weekly from the first day of radiotherapy until week 6 at escalating doses ranging from 20- 40 mg/m². Three patients were accrued in each cohort using a 3+3dose escalation trial design. Results: 14 patients were enrolled (median age: 53 years, range 44 to 62 years; median Karnofsky status: 90%, range 90% to 100%; cavum oris and oropharynx primary tumor: 50% of patients; T4: 71%; N2/3: 79%; stage IV disease: 93%). Three patients discontinued the study treatment. One was due to a hypersensitivity reaction after the initial dose of cetuximab, another was diagnosed with a secondary carcinoma and the third developed a stomach perforation in week 3. No dose-limiting toxicities were observed. The most common grade 3 adverse events were mucositis (46%), dysphagia (32%) and neutropenia (16%). Grade 3 cetuximab related toxicities included acne-like rash within the radiotherapy portals (38%) and hypersensitivity (7%). The objective remission rate was 91% (CR 33% and PR 58%, one patient unknown). No patients have died to date (Dec 2007). Conclusions: The trimodal regimen of cisplatinum with cetuximab and HART is active and well tolerated. The 40-mg dose of cisplatinum was chosen as the recommended phase II dose in combination with cetuximab plus HART based on acceptable toxicity when administered. No significant financial relationships to disclose.

Expression of EphA2 and VEGF in squamous cell carcinoma of the tongue: Correlation with the angiogenesis and clinical outcome

Eph-ephrin binding has been linked to tumor biology and VEGF has been reported to participate in the tumor angiogenesis regulated by Eph-ephrin. The present study was designed to evaluate the expression of EphA2 and VEGF in relation to angiogenesis and clinical outcome in squamous cell carcinoma of oral tongue. Immunohistochemical staining was used to determine the protein expression levels of EphA2 and VEGF in 59 surgically resected tongue carcinomas and 10 tumor-free mucosas. In all cases, microvessel density (MVD) was evaluated by counting CD34-reactive endothelial cells or endothelial cell clusters. Both EphA2 and VEGF staining activities in squamous cell carcinoma of oral tongue were more significant than those in normal mucosa (P<0.01). MVD had significant correlations with EphA2 and VEGF expression (P<0.01). The EphA2, VEGF, and MVD were significantly correlated with tumor size, clinical stage, lymph invasion, recurrence, and distant metastasis (P<0.05). Multivariate analysis showed EphA2, VEGF expression, MVD, and clinical stage had an independent prognostic effect on overall survival. We conclude that the overexpression of EphA2 and VEGF are related to malignancy in squamous cell carcinoma of oral tongue. Clinical outcomes raised the possibility that the overexpression of those proteins might contribute to tumor angiogenesis and have prognostic value in tongue cancer.

A randomized phase II study of ixabepilone (BMS-247550) given daily × 5 days every 3 weeks or weekly in patients with metastatic or recurrent squamous cell cancer of the head and neck: an Eastern Cooperative Oncology Group study

Ixabepilone is a tubulin-polymerizing agent with potential activity in squamous cell carcinoma of the head and neck (SCCHN). Patients were eligible who had incurable, measurable SCCHN and less than two prior regimens for metastatic/recurrent disease. Eastern Cooperative Oncology Group performance status of less than or equal to one and adequate renal/hepatic/hematological function were required. Patients were randomly assigned to receive ixabepilone 6 mg/m2/day × 5 days every 21 days (arm A) or 20 mg/m2 on days 1, 8, and 15 of a 28-day cycle (arm B). Each arm accrued taxane-naive and -exposed strata in a two-stage design. The primary end point was response. Eighty-five eligible patients entered; there was one response in a taxane-exposed patient among 32 patients on arm A. Five of 35 taxane-naive patients on arm B had partial responses (14%). No taxane-exposed patient on arm B responded. Common grades 3 and 4 toxic effects were fatigue, neutropenia, and sensory/motor neuropathy. Median survival for arm A taxane-naive and taxane-exposed patients is 5.6 and 6.5 months; for arm B, taxane-naive and taxane-exposed patients is 7.8 and 6.5 months. Weekly ixabepilone 20 mg/m2 is active in taxane-naive patients with SCCHN. A high incidence of motor and sensory grade 3 neuropathy resulted at this dose and schedule. Further development of ixabepilone in previously treated head and neck cancer is not warranted on the basis of these data.