ABSTRACT
BACKGROUND: To establish the maximum tolerated dose of abiraterone acetate plus prednisone (AA) combined with salvage radiotherapy (SRT) and goserelin in a phase 1 study in men with rising PSA following radical prostatectomy. METHODS: AA was given during one month before SRT at 1000 mg PO once daily, then 750 mg (Dose Level 1, DL1) or 1000 mg (DL2) during 5 months combined with 6-months goserelin by injection on the first day of irradiation (scheme NEO) or one month before starting SRT (scheme CONCO). RESULTS: In scheme NEO at DL1, 2/9 patients did not achieve castration levels of testosterone. 4/9 patients (44%) presented with grade 3 liver enzyme elevation. In scheme CONCO testosterone dropped to undetectable levels. At DL1, 6 patients were recruited, with no dose limiting toxicities. At DL2, 2/3 patients presented with grade 3 liver enzyme elevation occurring during SRT. CONCLUSIONS: When AA was administered without goserilin, only 78% achieved castration levels. AA combined with SRT and goserilin did not increase pelvic toxicity, but lead to an unsuspected high frequency of grade 3 liver toxicity. The phase II recommended dose of AA combined to goserelin and SRT is 750 mg.
ABSTRACT
The main molecular targeting of lung cancer [non-small cell lung cancer (NSCLC)] concerns mutations of epidermal growth factor receptor (EGFR). The awaited responsiveness of tumors carrying these mutations is high with for instance 60% to 80% with tyrosine kinase inhibitors hitting EGFR mutations. The EGFR T790M as a secondary mutation is responsible for the occurrence of a resistance phenomenon. A multitude of drugs have been produced and tested with the property of a specific binding at the EGFR T790M site. There is currently an evolution oriented to a robust genotyping methods allowing the identification of given molecular anomalies (pyrosequencing for instance) towards the consideration of a much larger set of molecular anomalies under the form of a global genotyping realized with the use of next-generation sequencing (NGS). This phase of whole genome analysis necessitates the introduction of a specialized staff for data treatment. A possible substitution plasma/tumor for the mutation analyses is perceptible in lung cancer, a preference being however given to the intratumoral direct investigation when this is feasible. EGFR mutations as targetable anomalies are illustrative examples, that the management of NSCLC is currently drawing a significant benefit from personalized therapy.
Subject(s)
Antineoplastic Agents/therapeutic use , ErbB Receptors/antagonists & inhibitors , ErbB Receptors/genetics , Lung Neoplasms/drug therapy , Molecular Targeted Therapy , Mutation , Protein Kinase Inhibitors/therapeutic use , DNA Mutational Analysis , ErbB Receptors/metabolism , Genetic Predisposition to Disease , Humans , Lung Neoplasms/enzymology , Lung Neoplasms/genetics , Lung Neoplasms/pathology , Patient Selection , Phenotype , Precision Medicine , Predictive Value of TestsABSTRACT
Optimal identification of the risk of developing cardiotoxicity upon trastuzumab (TZM) treatment appears necessary as this risk may impair treatment compliance and compromise long-term recovery. To better understand and predict cardiac toxicity, the molecular mechanisms underlying this phenomenon need to be known. HER2 is present at the cell surface of cardiomyocytes. Neuregulin is produced by cardiac endothelial cells and binds to HER4, thus leading to dimerization with HER2 and subsequent cell signaling necessary for normal cardiac function. Decreasing HER2 activity has a major impact on cardiomyocyte function. However, the precise molecular mechanisms responsible for TZM-induced cardiac dysfunction are still unclear. This mini-review aims to summarize genetic, pharmacological and medical data helping to identify mechanisms that could explain cardiotoxicity. Of potential interest, these mechanisms highlight the importance of HER2 genetic polymorphism (Val655Ile) in the identification of patients at risk of developing TZM-induced cardiac effects.
