Irinotecan Research Articles

Abstract CT135: A pilot clinical study of orotecan (oral irinotecan HCl, VAL-413) in patients with recurrent pediatric solid tumors

Abstract Background: Intravenous irinotecan hydrochloride (IRN-IV) is approved for the treatment of adult colorectal cancer. IRN-IV is also used off-label to treat a range of adult and pediatric tumors including recurrent Ewing sarcoma, rhabdomyosarcoma, neuroblastoma, hepatoblastoma, Wilms tumor, gynecologic cancers, lung cancer and medulloblastoma. Previously, a regimen of IRN-IV administered as a 60-min i.v. infusion daily for 5 days in combination with other agents such as temozolomide has been recommended use in treating children with solid tumors (Blaney. ClinCanRes, 2001). Protracted administration schedule of intravenous irinotecan is inconvenient for patients, so oral regimens utilizing IRN-IV have been developed (Wagner. ClinSarcRes, 2015). Unfortunately, the palatability of the intravenous preparation is poor, leading to reduced compliance especially in younger pediatric patients. Development of an advanced formulation to improve tolerability and patient compliance is an important unmet need. VAL-413 is a novel formulation developed to improve palatability of oral irinotecan. Methods: Eligibility: Up to 20 patients ≥ 1 year of age or ≤ 30 years of age with recurrent pediatric solid tumors and adequate bone marrow, renal and liver function, for whom irinotecan therapy is a treatment option will be enrolled. Trial Design: Two different dose levels of VAL-413, 90mg/m2/day or 110mg/m2/day will be studied in combination with fixed-dose temozolomide using a standard 3 + 3 phase I design. In the event the starting dose of 90 mg/m2/day is not tolerable due to toxicity, a lower dose of 75 mg/m2/day may be implemented. Treatment: During the first cycle of treatment, each patient will receive 4 daily doses of VAL-413 and one daily dose of the intravenous preparation of irinotecan taken orally (IRN-IVPO). During all subsequent cycles, only VAL-413 will be given with temozolomide in 5-day courses administered every 21 days, as tolerated. Outcome Measures: Toxicity is assessed by NCI CCTCAEv5; tumor response is assessed by RECIST 1.1. A palatability survey instrument will assess palatability of VAL-413 vs. IRN-IVPO; comparative intrapatient pharmacokinetics of irinotecan and its metabolites will be assessed. This trial is ongoing (CT.gov: NCT04337177), with no DLT observed to date. Citation Format: Jeffrey Bacha, Dennis Brown, Sarath Kanekal, Neil Sankar, Lorena Lopez, Noymi Yam, Lars Wagner, James Geller, Markos Leggas, Patrick Thompson, Javier Osterheld. A pilot clinical study of orotecan (oral irinotecan HCl, VAL-413) in patients with recurrent pediatric solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT135.

Abstract 6716: Preclinical evaluation of nano-liposomal irinotecan in pediatric solid tumor patient-derived xenografts

Abstract Background: Pediatric solid tumors are rare and the use of well characterized preclinical models can be a helpful tool to prioritize novel drug combinations and formulations which are challenging to test in a limited patient population. Irinotecan (IRN) has shown efficacy in diverse pediatric cancers where children are often treated on an extended low-dose schedule rather than a single large dose commonly used in adults. The use of nano-liposomal irinotecan (nal-IRI) is a promising strategy as 95% of the drug remains encapsulated during systemic exposure while maintaining prolonged exposure in the tumor. Adult clinical trials have shown reduced side effects without compromising efficacy but nal-IRI has had limited use thus far in pediatric cancers. Methods: Orthotopic xenograft models of Ewing sarcoma (EWS, 4 models) and rhabdomyosarcoma (RMS, 2 models) were generated by injecting luciferase labeled cells into the femur and hind-leg muscle of nude mice respectively. Pharmacokinetic (PK) studies on normal and tumor-bearing mice were performed for both nal-IRI and standard IRN to determine matched human AUC-guided dosing and schedule of chemotherapy agents. Mice were randomized to single agent and relevant combinations of nal-IRI with PARP inhibitors and temozolomide (EWS) and with vincristine and temozolomide (RMS) and compared to the same regimens using standard IRN. Therapy was given on a clinically relevant schedule with each course consisting of 21 days and tumor response was measured weekly using bioluminescence. Results: PK studies showed that plasma levels of the active metabolite of IRN (SN-38) drop quickly for both standard IRN and nal-IRI single dosed mice while the levels of SN-38 were maintained in the tumor for several days using the nal-IRI formulation. In all 6 models tested, nal-IRI combinations were as or more effective when compared to regimens using standard IRN. No significant toxicity was seen in mice treated with nal-IRI combinations. Conclusions: The substitution of nal-IRI for standard IRN remains a promising strategy in pediatrics with the potential to reduce side effects as well as hospital visits due to the dosing schedule with nal-IRI given once per cycle where standard IRN is often given for 5 or 10 days in children. Our preclinical PK data confirmed the liposomal formulation resulted in sustained SN-38 levels in the tumor and efficacy was maintained or improved in pediatric cancer models. The combination of nal-IRI with temozolomide and talazoparib is now being tested in a multi-center randomized phase I/II trial for children with relapsed solid tumors and this data supports consideration for use in other pediatric cancer trials both in the upfront and relapse setting. Citation Format: Elizabeth Stewart, Kaley Blankenship, Burgess Freeman, Sara Federico, Michael Dyer. Preclinical evaluation of nano-liposomal irinotecan in pediatric solid tumor patient-derived xenografts [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6716.

Molecular mechanism of resveratrol combined with irinotecan in treatment of colorectal cancer

This study aimed to investigate the mechanism of resveratrol(RES) combined with irinotecan(IRI) in the treatment of colorectal cancer(CRC). The targets of RES, IRI, and CRC were obtained from databases, and the targets of RES combined with IRI in the treatment of CRC were acquired by Venn diagram. The protein functional cluster analysis, GO and KEGG enrichment analyses were performed. In addition, the protein-protein interaction(PPI) network was constructed. The core target genes were screened out and the target-signaling pathway network was set up. IGEMDOCK was used to dock the core target gene molecules. Besides, the relationship between the expression level of key target genes and the prognosis and immune infiltration of CRC was analyzed. Based on the in vitro cell experiment, the molecular mechanism of RES combined with IRI in the treatment of CRC was explored and analyzed. According to the results, 63 potential targets of RES combined with IRI were obtained for CRC treatment. Furthermore, cluster analysis revealed that protein functions included 23% transmembrane signal receptors, 22% protein modifying enzymes, and 14% metabolite converting enzymes. GO analysis indicated that BPs were mainly concentrated in protein autophosphorylation, CCs in receptor complex and plasma membrane, and MFs in transmembrane receptor protein tyrosine kinase activity. Moreover, KEGG signaling pathways were mainly enriched in central carbon metabolism in cancer. The key targets of RES combined with IRI in the treatment of CRC were PIK3CA, EGFR, and IGF1R, all of which were significantly positively correlated with the immune infiltration of CRC. As shown by the molecular docking results, PIK3CA had the most stable binding with RES and IRI. Compared with the results in the control group, the proliferation ability and EGFR protein expression of CRC cells in the RES-treated group, the IRI-treated group, and the RES+IRI treated group significantly decreased. Moreover, the cell proliferation ability and EGFR protein expression level of CRC cells in the RES+IRI treated group were remarkably lower than those in the IRI-treated group. In conclusion, PIK3CA, EGFR, and IGF1R are the key targets of RES combined with IRI in CRC treatment. In addition, RES can inhibit the proliferation of CRC cells and improve IRI chemoresistance by downregulating the EGFR signaling pathway.

Nivolumab versus irinotecan as third- or later-line treatment for advanced gastric cancer: a multi-center retrospective study.

The present study aimed to compare the efficacy and safety of nivolumab (NIVO) and irinotecan (IRI) and to identify clinical factors that facilitate treatment selection. Patients with advanced gastric cancer (AGC) who underwent NIVO or IRI treatment between November 2016 and June 2018 at three institutions were retrospectively reviewed. The inclusion criteria were histologically confirmed gastric/gastroesophageal adenocarcinoma pretreated with fluoropyrimidines and taxanes, no previous NIVO or IRI treatment, and adequate organ function. Main outcome measures were objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse events. Interaction between treatment groups and clinical factors regarding OS were tested using a multivariate Cox proportional hazards model adjusted for relevant variables. Both NIVO (n = 71) and IRI (n = 61) groups had similar baseline characteristics, except for sex distribution. NIVO and IRI groups had ORR of 20% and 6%, median PFS of 1.6 and 1.8months, and median OS of 6.4 and 6.4months, respectively. Interaction analysis did not reveal any significant interaction between NIVO and IRI related to OS for various factors. NIVO group tended to have fewer ≥ grade 3 adverse events than IRI group, especially neutropenia (3% vs. 28%) and febrile neutropenia (1% vs. 8%). In the NIVO group, one patient developed pneumonitis, and four patients developed skin reactions. Although no remarkable differences in efficacy were found between IRI and NIVO for AGC, NIVO had a better safety profile compared to IRI. We found no clinical markers that can assist treatment decisions.

Binding of combined irinotecan and epicatechin to a pH-responsive DNA tetrahedron for controlled release and enhanced cytotoxicity

pH-Responsive aptamer-linked DNA nanostructures can actively target cancer cells to release drugs in the cells’ acidic environment. Tea polyphenols can be used as cancer-preventive agents to enhance the efficacy of chemotherapeutic drugs. In this study, we constructed a pH-responsive DNA tetrahedron with MUC1 aptamer (MUC1-TD) to co-load irinotecan hydrochloride (CPT-11) and (-)-epicatechin (EC). The thermodynamic parameters for the interaction of CPT-11 and/or EC with MUC1-TD were investigated using fluorescence spectroscopy and calorimetry. The binding of CPT-11 to MUC1-TD was found to be stronger than that of EC. Differential scanning calorimetry and fluorescence quenching experiments demonstrated the intercalative binding between CPT-11/EC and MUC1-TD. The in vitro release rate of CPT-11 was faster at pH 5.0 than at pH 7.4, confirming the pH-responsive of MUC1-TD. In vitro cytotoxicity results indicated that CPT-11 loaded by MUC1-TD was more cytotoxic than free CPT-11. Further, we found that the cytotoxicity of CPT-11 was further enhanced in the presence of EC due to a synergy between them. Additionally, cell uptake experiments showed that CPT-11 and EC loaded by MUC1-TD were mainly distributed in the nucleus of human breast cancer cells (MCF-7). These findings indicate that pH-responsive DNA nanostructures are a promising delivery system for co-loading chemotherapeutic drugs and natural polyphenols.

A Paradigm Shifts: Neoadjuvant Therapy for Clearly Resectable Pancreatic Cancer.

Over the past decade, neoadjuvant therapy has become the standard of care for patients with borderline resectable and locally advanced pancreatic cancer. The surgical community remains divided regarding the value of neoadjuvant therapy for patients who present with clearly resectable disease. Thus far, randomized controlled trials comparing neoadjuvant therapy with conventional upfront surgical strategies for patients with clearly resectable pancreatic cancer have been plagued by poor accrual, and are often underpowered. Nonetheless, meta-analyses of the results of these trials suggest that neoadjuvant therapy can be offered as an acceptable standard of care for patients with clearly resectable pancreatic cancer. Previous trials used neoadjuvant gemcitabine, but more recent studies have demonstrated superior survival for patients who were able to tolerate neoadjuvant FOLFIRINOX (leucovorin, 5-fluorouracil, irinotecan hydrochloride, and oxaliplatin). The increased utilization of FOLFIRINOX may be shifting the treatment paradigm in favor of neoadjuvant therapy among patients with clearly resectable disease. Randomized controlled trials assessing the value of neoadjuvant FOLFIRINOX in clearly resectable pancreatic cancer, which are expected to provide more conclusive recommendations, are still ongoing. This review outlines the rationale, considerations, and current level of evidence for the use of neoadjuvant therapy in patients with clearly resectable pancreatic cancer.

The efficacy and side effects of rigosertib combined with chemotherapy in KRAS mutant colorectal cancer mice

Objective: To investigate the effect of rigosertib (RGS) combined with classic chemotherapy drugs including 5-fluorouracil, oxaliplatin, and irinotecan in colorectal cancer. Methods: Explore the synergy effects of RGS and 5-fluorouracil (5-FU), oxaliplatin (OXA), and irinotecan (IRI) on colorectal cancer by subcutaneously transplanted tumor models of mice. The mice were randomly divided into control group, RGS group, 5-FU group, OXA group, IRI group, 5-FU+ RGS group, OXA+ RGS group and IRI+ RGS group. The synergy effects of RGS and OXA on KRAS mutant colorectal cancer cell lines in vitro was detected by CCK-8. Ki-67 immunohistochemistry and TdT-mediated dUTP nick-end labeling (TUNEL) staining were performed on the mouse tumor tissue sections, and the extracted tumor tissue was analyzed by western blot. The blood samples of mice after chemotherapy and RGS treatment were collected, blood routine and liver and kidney function analysis were conducted, and H&E staining on liver sections was performed to observe the side effects of chemotherapy and RGS. Results: The subcutaneously transplanted tumor models were established successfully in all groups. 55 days after administration, the fold change of tumor size of OXA+ RGS group was 37.019±8.634, which is significantly smaller than 77.571±15.387 of RGS group (P=0.029) and 92.500±13.279 of OXA group (P=0.008). Immunohistochemical staining showed that the Ki-67 index of tumor tissue in control group, OXA group, RGS group and OXA+ RGS group were (100.0±16.8)%, (35.6±11.3)%, (54.5±18.1)% and (15.4±3.9)%, respectively. The Ki-67 index of OXA+ RGS group was significantly lower than that in control group (P=0.014), but there was no significant difference compared to OXA group and RGS group (OXA: P=0.549; RGS: P=0.218). TUNEL fluorescence staining showed that the apoptotic level of OXA+ RGS group was 3.878±0.547, which was significantly higher than 1.515±0.442 of OXA group (P=0.005) and 1.966±0.261 of RGS group (P=0.008). Western blot showed that the expressions of apoptosis related proteins such as cleaved-PARP, cleaved-caspase 3 and cleaved-caspase 8 in the tumor tissues of mice in the OXA+ RGS group were higher than those in control group, OXA group and RGS group. After the mice received RGS combined with chemotherapy drugs, there was no significant effect on liver and kidney function indexes, but the combined use of oxaliplatin and RGS significantly reduced the white blood cells [(0.385±0.215)×10(9)/L vs (5.598±0.605)×10(9)/L, P<0.001] and hemoglobin[(56.000±24.000)g/L vs (153.333±2.231)g/L, P=0.001] of the mice. RGS, chemotherapy combined with RGS and chemotherapy alone did not significantly increase the damage to liver cells. Conclusions: The combination of RGS and oxaliplatin has a stronger anti-tumor effect on KRAS mutant colorectal cancer. RGS single agent will not cause significant bone marrow suppression and hepatorenal injury in mice, but its side effects may increase correspondingly after combined with chemotherapy.

Pilot Study of Recurrent Ewing's Sarcoma Management with Vigil/Temozolomide/Irinotecan and Assessment of Circulating Tumor (ct) DNA.

Treatment options for recurrent or refractory Ewing's sarcoma (ES) are limited. Vigil is a novel autologous tumor cell therapy expressing bi-shRNA furin/GMCSF plasmid, which previously demonstrated monotherapy activity in advanced ES. Herein we report safety and evidence of benefit to Vigil for ES as potential treatment. In this pilot trial, eligible patients with recurrent or refractory ES who failed initial standard-of-care therapy received treatment with temozolomide (TEM) 100 mg/m2/day oral and irinotecan (IRI) 50 mg/m2/day oral, Days 1 to 5, in combination with Vigil (1 × 106-107 cells/mL/day intradermal, Day 15), every 21 days (Vigil/TEM/IRI). Objective response rate (ORR) by RECIST v1.1, progression-free survival (PFS), and overall survival (OS) were assessed. Circulating tumor (ct) DNA analysis was done by patient-specific droplet digital PCR on baseline and serially collected on-treatment samples. Eight of 10 enrolled patients were evaluable for safety and efficacy (mean age 24.6; 12.6-46.1 years old); 2 did not receive Vigil. Seven of 8 patients previously received TEM/IRI. No Vigil-related adverse events were reported. Common ≥Grade 3 chemotherapy-related toxicity included neutropenia (50%) and thrombocytopenia (38%). We observed two partial response patients by RECIST; both showed histologic complete response without additional cancer therapy. Median PFS was 8.2 months (95% confidence interval, 4.3-NA). Five patients showed stable disease or better for ≥6 months. Patient-specific EWS/FLI1 ctDNA was detectable in all 8 evaluable patients at baseline. Changes in ctDNA levels corresponded to changes in disease burden. Results demonstrated safety of combination Vigil/TEM/IRI.

A “Trojan Horse” Strategy: The Preparation of Bile Acid-Modifying Irinotecan Hydrochloride Nanoliposomes for Liver-Targeted Anticancer Drug Delivery System Study

The bile acid transport system is a natural physiological cycling process between the liver and the small intestine, occurring approximately 6-15 times during the day. There are various bile acid transporter proteins on hepatocytes that specifically recognize bile acids for transport. Therefore, in this paper, a novel liposome, cholic acid-modified irinotecan hydrochloride liposomes (named CA-CPT-11-Lip), was prepared based on the "Trojan horse" strategy. The liposomes preparation process was optimized, and some important quality indicators were investigated. The distribution of irinotecan hydrochloride in mice was then analyzed by high-performance liquid chromatography (HPLC), and the toxicity of liposomes to hepatocellular carcinoma cells (HepG-2) was evaluated in vitro. As a result, CA-CPT-11-Lip was successfully prepared. It was spherical with a particle size of 154.16 ± 4.92 nm, and the drug loading and encapsulation efficiency were 3.72 ± 0.04% and 82.04 ± 1.38%, respectively. Compared with the conventional liposomes (without cholic acid modification, named CPT-11-Lip), CA-CPT-11-Lip had a smaller particle size and higher encapsulation efficiency, and the drug accumulation in the liver was more efficient, enhancing the anti-hepatocellular carcinoma activity of irinotecan hydrochloride. The novel nanoliposome modified by cholic acid may help to expand the application of irinotecan hydrochloride in the treatment of hepatocellular carcinoma and construct the drug delivery system mode of drug liver targeting.

Regorafenib (REG) combined with irinotecan (IRI) versus IRI alone as second-line treatment in patients with metastatic gastro-oesophageal adenocarcinomas (mGA): A randomized phase II trial (PRODIGE 58 – UCGI 35 – REGIRI).

387 Background: Several options have been evaluated as 2nd line treatment in mGA after failure of 1st line platinum based chemotherapy including taxanes and IRI as monotherapies or paclitaxel combined with ramucirumab but with a limited efficacy. REG monotherapy showed promising efficacy as 2nd or 3rd line treatment in mGA (Pavlakis N et al, J Clin Oncol. 2016). Methods: This comparative phase 2 multicenter randomized study was designed to evaluate the safety and efficacy of REG + IRI (REGIRI) vs IRI alone as 2nd line treatment in MGA patients (pts). Key eligibility criteria were histologically proven mGA (gastric or gastroesophageal junction (GEJ) tumor Siewert II and III), fluoropyrimidine and platinum-based first-line chemotherapy and ECOG PS ≤1. Pts received IRI 180 mg/m2 IV on D1 and D15. In REGIRI arm REG 160 mg/day was added on D2-D8 and D16-D22 every 28 days. Primary endpoint was overall survival (OS). A total of 122 events (154 pts) were required based on an assumption of 4-month (mo) gain in median OS (from 6 to 10 mo, HR=0.60), with a preplanned interim analysis of safety after 38 pts and efficacy after 40 OS events. Genotyping of cyclin-D1 was performed to evaluate the impact of treatment efficacy. Results: A total of 89 patients (REGIRI, n=44; IRI, n=45) with median age of 62 (range: 28-82) years and a mGA (67.4% with GEJ, 22.8% HER2+) were included out of the 154 initially planned by 21 sites in France. Study was prematurely stopped after interim analysis for unfavourable efficacy/toxicity ratio. With a median follow-up of 19.4 mo, 79 OS events were observed and median OS was 6.3 mo (95%CI[5.2-7.1]) with REGIRI vs 8.2 mo (95%CI[5.2-9.7]) with IRI (HR=1.11 CI95%[0.70-1.74], p=0.66). Median PFS was 2.2 mo vs 1.9 mo (NS) with REGIRI and IRI, respectively. Objective response rate was 15.9% and 13.3% respectively. Disease control rate was 45.5% and 33.3%. AEs grade ≥ 3 related to treatment were reported in 52.3% of pts in REGIRI arm vs 23.3% in IRI arm with 4 toxic deaths (diarrhea, sepsis and thromboembolic events) vs 1 (primary tumour perforation), respectively. The main severe toxicities were diarrhea: 18.2% vs 7% and febrile neutropenia: 8.2% vs 0%. Genotyping of cyclin D1 was performed on 72 pts: 19 presented A/A genotype, 38 A/G and 15 G/G. There were no differences in terms of OS according to genotyping. Conclusions: PRODIGE58/REGIRI trial was prematurely stopped after the interim analysis due to high toxicities reported in REGIRI arm with negative results on its primary endpoint. Further ancillary analysis are expected to identify toxicity risk factors and pts subgroups benefit with this combination. Clinical trial information: NCT03722108 .

ATM or CHEK2 alterations: Potential biomarkers of improved outcomes with irinotecan-containing chemotherapy in advanced pancreatic ductal adenocarcinoma.

754 Background: ATM and CHEK2 mutations are linked to homologous recombination DNA repair deficiency, with the potential for improved therapeutic response to DNA damaging agents. To investigate our clinical observation of improved outcomes with irinotecan (IRI) based chemotherapy in advanced/metastatic pancreatic ductal adenocarcinoma (PDAC) patients (pts) with somatic or germline ATM/ CHEK2 mutations, we examined our institutional real world experience. Methods: Between 2015-2021, 33 pts with ATM or CHEK2 mutations treated with chemotherapy were identified, of which 16 pts had advanced/metastatic disease. Progression-free survival (PFS) was calculated and compared (Kaplan Meier, log-rank test) in several ways to assess the impact of IRI vs platinum or other regimens. The event for PFS was progression (or death), and pts without progression were censored at treatment end, or at last follow up if treatment was ongoing. Results: Among 16 pts with advanced/metastatic PDAC, 8 (50%) had ATM (5 germline, 3 somatic) and 8 (50%), CHEK2 alterations (4 germline, 4 somatic). Overall, pts received 48 lines of chemotherapy (platinum-based-(No-IRI) N=14; IRI-based-(No-Platinum) N=8; both N=4; none N=22). For best-PFS among pts analysis, median line of best-PFS therapy for IRI-Ever (N=9 pts) was 2nd line (range 1-7) and for IRI-Never (N=7 pts) was 1st (range, 1-1); median PFS was 13 vs 3 months (mo) (IRI-Ever vs IRI-Never; p=0.0076). For PFS analysis within lines of treatment of each pt, median therapy line for both IRI-containing and No-IRI lines was 2nd line (range 1-7); median PFS for IRI-containing (N=12 lines of therapy) vs No-IRI (N=36) was 12.1 vs 3 mo (p&lt;0.001). Median PFS for best IRI-based-(No-Platinum) line (N=7) was 13 mo; for best platinum-based-(No-IRI) line (N=9) was 2.8 mo; and for best treatment containing no IRI or platinum (N=13) was 5.1 mo (P= 0.003) (median therapy line for each was 3, 2 and 1.5, respectively). Conclusions: Irinotecan is a topoisomerase 1 inhibitor that induces DNA strand breaks, potentially causing synthetic lethality in tumors with DNA damage repair deficits due to ATM or CHEK2 alterations. IRI-containing therapy out-performed other treatment types, including platinum-containing regimens, in pts with ATM or CHEK2-mutated advanced/metastatic PDAC. Prospective trials are warranted.

Development of a clinical microarray system for genetic analysis screening

ObjectivesResearch on the relationship between diseases and genes and the advancement of genetic analysis technologies have made genetic testing in medical care possible. There are various methods for genetic testing, including PCR-based methods and next-generation sequencing; however, screening tests in clinical laboratories are becoming more diverse; therefore, novel measurement systems and equipment are required to meet the needs of each situation. In this study, we aimed to develop a novel microarray-based genetic analysis system that uses a Peltier element to overcome the issues of conventional microarrays, such as the long measurement time and high cost. MethodsWe constructed a microarray system to detect the UDP-glucuronosyltransferase gene polymorphisms UGT1A1*6 and UGT1A1*28 in patients eligible for irinotecan hydrochloride treatment for use in clinical laboratories. To evaluate the performance of the system, the hybridization temperature and reaction time were determined, and the results were compared with those obtained using a conventional hybridization oven. ResultsThe hybridization temperature reached its target in 1/27th of the time required by the conventional system. We assessed 111 human clinical samples and found that our results agreed with those obtained using existing methods. The total time for the newly developed device was reduced by 85 min compared to that for existing methods, as the automated DNA microarray eliminates the time that existing methods spend on manual operation. ConclusionsThe surface treatment technology used in our system enables high-density and strong DNA fixation, allowing the construction of a measurement system suitable for clinical applications.

Enhanced degradation mechanism of anticancer drug irinotecan through low-frequency ultrasound assisted reactive electrochemical membrane

The effect of low-frequency ultrasound (US, 20 kHz, 104 W) on the degradation of anticancer drug irinotecan (IRI) using reactive electrochemical membrane (REM) was investigated. Results demonstrated that higher k value (0.103 min−1) and mineralization efficiency (94.6%) as well as lower energy consumption (0.906 Wh L−1) were observed in US-REM system. The effects of influence factors including US power, volume flow rate, current density and initial IRI concentration on the degradation of IRI were studied in US-REM system. The relative contributions of •OH, SO4•− and O2•− (indirect oxidation) to IRI degradation using REM were all increased with the assistance of US. The production rate of •OH using US-REM increased by 19.7% compared with that using REM. Seven intermediates of IRI degradation using both REM and US-REM were identified, and the main degradation pathways of IRI were hydroxylation, oxidation and ring cleavage. The enhanced degradation and mineralization of IRI in US-REM system could mainly be attributed to higher •OH production and higher contribution of free radicals.

Efficacy of Chemotherapy Plus Bevacizumab in Recurrent Glioblastoma Multiform: A Real-life Study.

Bevacizumab and chemotherapy are used in glioblastoma multiforme (GBM) relapse. However, the choice of chemotherapeutic agent remains an open question and this study aimed to evaluate the efficacy and safety of different combinations. Between June 2005 and August 2020, all patients treated with chemotherapy plus bevacizumab (BVZ) for recurrent glioblastoma in the Georges-François Leclerc Cancer Center, Dijon, France were included in this retrospective comparative study. The primary objective was progression-free survival (PFS) and as secondary objectives, overall survival (OS), disease control rate (DCR), and safety were investigated. Factors associated with response were also analyzed. A total of 160 patients were screened: 100 received fotemustine plus BVZ (62%) and 62 (38%) received another cytotoxic agent plus BVZ: 35 (22%) irinotecan (IRI), 18 (11%) temozolomide (TEM), and 7 (4%) lomustine (LOM). In the whole population, median PFS was 4.47 months, median OS was 9 months, and 3-month DCR was 51%. Regarding survival according to treatment, median OS was significantly lower in the fotemustine group compared to that in other cytotoxic agents: 7.3 vs. 19.9 months. In the fotemustine group, steroids use at baseline and low Karnofsky performance status were associated with poor median OS. Grade 3-4 adverse events were found in 21.9%, with no difference between groups, but 7 patients had grade 5 adverse events in the fotemustine group. Using real-life data, this study showed lower efficacy of fotemustine and bevacizumab, as compared to IRI or TEM or LOM-BVZ combinations.

Structural insight and analysis of TLR4 interactions with IAXO-102, TAK-242 and SN-38: an in silico approach.

Toll-like receptor 4 (TLR4) has attracted interest due to its role in chemotherapy-induced gastrointestinal inflammation. This structural study aimed to provide in silico rational of the recognition and potential binding of TLR4 ligands IAXO-102, TAK-242, and SN-38 (the toxic metabolite of the chemotherapeutic irinotecan hydrochloride), which could contribute to rationale development of therapeutic anti-inflammation drugs targeting TLR4 in the gastrointestinal tract. In silico docking was performed between the human TLR4-MD-2 complex and ligands (IAXO-102, TAK-242, SN-38) using Autodock Vina, setting the docking grids to cover either the upper or the lower bound of TLR4. The conformation having the lowest binding energy value (kcal/mol) was processed for post-hoc analysis of the best-fit model. Hydrogen bonding was calculated by using ChimeraX. Binding energies of IAXO-102, TAK-242 and SN-38 at the upper bound of TLR4-MD-2 ranged between - 3.8 and - 3.1, - 6.9 and - 6.3, and - 9.0 and - 7.0, respectively. Binding energies of IAXO-102, TAK-242 and SN-38 at the lower bound ranged between - 3.9 and - 3.5, - 6.5 and - 5.8, and - 8.2 and - 6.8, respectively. Hydrogen bonding at the upper bound of TLR4/MD-2 with IAXO-102, TAK-242 and SN-38 was to aspartic acid 70, cysteine 133 and serine 120, respectively. Hydrogen bonding at the lower bound of TLR4-MD-2 with IAXO-102, TAK-242 and SN-38 was to serine 528, glycine 480 and glutamine 510, respectively. The in silico rational presented here supports further investigation of the binding activity of IAXO-102 and TAK-242 for their potential application in the prevention of gastrointestinal inflammation caused by SN-38.

Synthesis and development of novel magnetic polymeric sorbent to simultaneous extraction of three anti-cancers using dispersive micro solid phase extraction procedure in biological and water samples

A suitable sample preparation method based on dispersive micro solid-phase extraction was developed to extract and per-concentrate three anti-cancers, including Imatinib (IMT), methotrexate (MTX), and irinotecan (IRT), before their determination using HPLC-UV. A novel magnetic sorbent containing an aluminum-metal organic framework (CAU-1), magnetic Fe3O4 nanoparticles, and a polymeric component (Polyaniline) was prepared to extract anti-cancers. The sorbent composite was optimized using an optimal mixture design. The optimum value of CAU-1, magnetic Fe3O4 nanoparticles and polyaniline in the sorbent composite was 0.528, 0.338, and 1.13 g, respectively. Factors influencing the IMT, MTX and IRT determination were optimized using a two-stage experimental design strategy. The method has limit of detections in the concentration range of 0.06–0.33 ng mL−1 for the IMT, MTX and IRT determination in water and urine samples. The linear ranges for the IMT, MTX and IRT determination were 0.3–256, 0.2–297, and 0.4–289 ng mL−1 with R2 of 0.9923, 0.9931, and 0.9918 in water samples, respectively. The intra and inter-day RSDs for the IMT, MTX and IRT determination were between 3.9 and 5.2 and 4.6–6.2 % for analyzing water and urine samples, respectively. The sorbent provided good reusability of six cycles of extraction/desorption procedure without a significant decrease in the extraction recovery toward the anti-cancers. The method’s ability was investigated by analyzing urine and real water samples, indicating that the method exhibited a proper recovery and RSD % in the range of 88.0–95.8 % and 5.8–7.3 %, respectively.

Surprising efficacy twist of two established cytostatics revealed by a-la-carte 3D cell spheroid preparation protocol

Three-dimensional cell culture systems are increasingly used for biological and anticancer drug screening as they mimic the structure and microenvironment of tumors more closely than conventional two-dimensional cell models. In this study, the growth kinetics of colon adenocarcinoma-derived spheroids (HT-29 cell line) cultivated in liquid marble micro-bioreactors and nonadherent PDMS-coated well plates was investigated in detail and enabled precise control of the spheroid size by the seed cell density and cultivation time. The therapeutic effect of 5-fluorouracil and irinotecan hydrochloride in 2D monolayer cell culture and 3D tumor spheroids revealed an unexpected twist in their efficacy due to different ability to penetrate through 3D microtissue. For 5-fluorouracil, the inhibitory concentration IC50 after 48 h exposure increased from 11.3 µM for a 2D cell culture to 707.7 µM for a 3D spheroid. In the case of irinotecan, IC50 increased from 24.9 µM to 77.8 µM. Despite its higher molar weight, irinotecan appeared to penetrate the 3D spheroid structure more efficiently than 5-fluorouracil. While 5-fluorouracil mainly caused a suppression of spheroid growth from the outside, irinotecan affected the entire spheroid and caused its originally compact structure to disintegrate. The acquired results highlight the need to screen cancer chemotherapeutics on 3D tumor models, as contrasting results can be obtained compared to standard 2D cell cultures.

Postmortem study of organ-specific toxicity in glioblastoma patients treated with a combination of temozolomide, irinotecan and bevacizumab.

Systemic chemotherapy includingmonotherapy with temozolomide (TMZ) or bevacizumab (BEV); two-drug combinations, such as irinotecan (IRI) and BEV, TMZ and BEV and a three-drug combination with TMZ, IRI and BEV (TIB) have been used in treating patients with progressive high-grade gliomas including glioblastoma (GBM). Most patients tolerated these regimens well with known side effects of hypertension, proteinuria, and reversible clinical myelosuppression (CM). However, organ- or system- specific toxicities from chemotherapy agents have never been examined by postmortem study. This is the largest cohort used to address this issue in glioma patients. Postmortem tissues (from all major systems and organs) were prospectively collected and examined by standard institution autopsyand neuropathologicalproceduresfrom 76 subjects, including gliomas (N = 68, 44/M, and 24/F) and brain metastases (N = 8, 5/M, and 3/F) between 2009 and 2019. Standard hematoxylin and eosin(H&E) were performed on all major organs including brain specimens.Electronic microscopic(EM) study was carried out on 14 selected subject's kidney samples per standard EM protocol. Medical records were reviewed with adverse events (AEs) analyzed and graded according to the Common Terminology Criteria for Adverse Events (CTCAE), version 4.03. A swimmer plot was utilized to visualize the timelines of patient history by treatment group. The binary logistic regression models were performed to explore any associations between treatment strategies and incident myelosuppression. Twenty-four glioma subjects were treated with TIB [median: 5.5 (range: 1-25) cycles] at tumor recurrence.Exposure to IRI significantly increased the frequency of CM (p = 0.05). No unexpected adverse events clinically, or permanent end-organ damage during postmortem examination was identified in gliomasubjects who had received standard or prolonged duration of BEV, TMZ or TIB regimen-based chemotherapies except rare events of bone marrow suppression.The most common causes of death (COD) were tumor progression (63.2%, N = 43) followed by aspiration pneumonia (48.5%, N = 33) in glioma subjects. No COD was attributed to acute toxicity from TIB. The study also demonstrated that postmortem kidney specimen is unsuitable for studying renal ultrastructural pathological changes due to autolysis. There is no organ or system toxicity by postmortem examinations among glioma subjects who received BEV, TMZ or TIB regimen-based chemotherapies regardless of durations except for occasional bone marrow suppression and reversible myelosuppression clinically.IRI, but not the extended use of TMZ, significantly increased CM in recurrent glioma patients. COD most commonly resulted from glioma tumor progression with infiltration to brain stem and aspiration pneumonia.

ChemoSeed®: A Novel Implantable Device for the Treatment of High Grade Gliomas

Abstract AIMS The treatment of high grade gliomas (HGGs) is extremely toxic, while offering a dismal prognosis of 15 months survival. Irinotecan (IRN) is a second-line therapy due to its dose-limiting toxicities when delivered systemically. The aim of this research is to formulate IRN into ChemoSeed for local administration to the resection margin of HGGs and evaluate it for toxicity and efficacy in a Patient-Derived Xenograft mouse resection model. METHOD 30 and 40% w/w IRN-loaded ChemoSeeds were manufactured using hot melt extrusion and were subsequently implanted into the resection cavity of HGG tumour bearing mice. RESULTS The 30% w/w IRN-loaded ChemoSeeds showed moderate local toxicity two days after implantation, which diminished by day 4. The 40% w/w IRN-loaded ChemoSeeds showed signs of moderate local toxicity up to six days post implantation, diminishing by day 8 with mild toxicity returning at day 14. Histopathology of the implantation site showed signs of the onset of necrosis at day 45 and 14 for the 30% and 40% w/w IRN-loaded ChemoSeeds. Hematological analysis and clinical chemistry showed no signs of serious systemic toxicity for either the 30 or 40% w/w IRN-loaded ChemoSeeds. The 30% w/w IRN-loaded ChemoSeeds had an 80% survival at day 148, with no sign of tumour recurrence, while the 40% w/w group showed signs of tumour recurrence at day 21, with all mice dead by day 70. CONCLUSION This study demonstrates that the 30% w/w IRN-loaded ChemoSeeds are a promising novel treatment for HGGs that could be quickly translated into the clinic.

Causes of Death Among Patients With Initially Inoperable Pancreas Cancer After Induction Chemotherapy and Ablative 5-fraction Stereotactic Magnetic Resonance Image Guided Adaptive Radiation Therapy

PurposeNearly all patients with pancreatic ductal adenocarcinoma (PDAC) eventually die of progressive cancer after exhausting treatment options. Although distant metastases (DMs) are a common cause of death, autopsy studies have shown that locoregional progression may be directly responsible for up to one-third of PDAC-related deaths. Ablative stereotactic magnetic resonance-guided adaptive radiation therapy (A-SMART) is a novel treatment strategy that appears to improve locoregional control compared with nonablative radiation therapy, potentially leading to improved overall survival. Methods and MaterialsA single-institution retrospective analysis was performed of patients with nonmetastatic inoperable PDAC treated between 2018 to 2020 using the MRIdian Linac with induction chemotherapy, followed by 5-fraction A-SMART. We identified causes of death that occurred after A-SMART. ResultsA total of 62 patients were evaluated, of whom 42 (67.7%) had died. The median follow-up time was 18.6 months from diagnosis and 11.0 months from A-SMART. Patients had locally advanced (72.6%), borderline resectable (22.6%), or resectable but medically inoperable PDAC (4.8%). All patients received induction chemotherapy, typically leucovorin calcium (folinic acid), fluorouracil, irinotecan hydrochloride, and oxaliplatin (69.4%) or gemcitabine/nab-paclitaxel (24.2%). The median prescribed dose was 50 Gy (range, 40-50), corresponding to a median biologically effective dose of 100 Gy10. Post-SMART therapy included surgery (22.6%), irreversible electroporation (9.7%), and/or chemotherapy (51.6%). Death was attributed to locoregional progression, DMs, cancer-related cachexia/malnutrition, surgery/irreversible electroporation complications, other reasons not due to cancer progression, or unknown causes in 7.1%, 45.2%, 11.9%, 9.5%, 11.9%, and 14.3% of patients, respectively. Intra-abdominal metastases of the liver and peritoneum were responsible for 84.2% of deaths from DMs. ConclusionsTo our knowledge, this is the first contemporary evaluation of causes of death in patients with PDAC receiving dose-escalated radiation therapy. We demonstrated that the predominant cause of PDAC-related death was from liver and peritoneal metastases; therefore novel treatment strategies are indicated to address occult micrometastatic disease at these sites.