Entrectinib, a potent oral inhibitor of the tyrosine kinases TRKA/B/C, ROS1, and ALK, was evaluated in two Phase 1 studies in patients with advanced or metastatic solid tumors, including patients with active CNS disease. Here we summarize the overall safety and report the antitumor activity of entrectinib in a cohort of patients with tumors harboring NTRK1/2/3, ROS1, or ALK gene fusions, naïve to prior TKI treatment targeting the specific gene, and who were treated at doses that achieved therapeutic exposures consistent with the RP2D. Entrectinib was well tolerated, with predominantly Grades 1/2 adverse events that were reversible with dose modification. Responses were observed in NSCLC, colorectal cancer, mammary analog secretory carcinoma, melanoma, and renal cell carcinoma, as early as 4 weeks after starting treatment and lasting as long as > 2 years. Notably, a complete CNS response was achieved in a patient with SQSTM1-NTRK1-rearranged lung cancer.

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RET fusions are oncogenic drivers of various tumors, including non-small cell lung cancers (NSCLC). The safety and antitumor activity of the multikinase RET inhibitor RXDX-105 were explored in a phase I/Ib trial. A recommended phase II dose of 275 mg fed daily was identifi ed. The most common treatment-related adverse events were fatigue (25%), diarrhea (24%), hypophosphatemia (18%), maculopapular rash (18%), and nonmaculopapular rash (17%). In the phase Ib cohort of RET inhibitor-naïve patients with RET fusion-positive NSCLCs, the objective response rate (ORR) was 19% (95% CI, 8%-38%, n = 6/31). Interestingly, the ORR varied signifi cantly by the gene fusion partner ( P < 0.001, Fisher exact test): 0% (95% CI, 0%-17%, n = 0/20) with KIF5B (the most common upstream partner for RET fusion-positive NSCLC), and 67% (95% CI, 30%-93%, n = 6/9) with non-KIF5B partners. The median duration of response in all RET fusion-positive NSCLCs was not reached (range, 5 to 18+ months). SIGNIFICANCE:Although KIF5B-RET is the most common RET fusion in NSCLCs, RET inhibition with RXDX-105 resulted in responses only in non-KIF5B-RET-containing cancers. Novel approaches to targeting KIF5B-RET-containing tumors are needed, along with a deeper understanding of the biology that underlies the differential responses observed. RESULTS PatientsA total of 152 patients were treated with RXDX-105; 55 were treated in the phase I dose-escalation portion of the study, and 97 were treated in the phase Ib dose-expansion portion of the study ( Table 1 and Supplementary Fig. S1). The median age was 63 (range, 27-90) years, and the majority (89%) of patients were pretreated and received one or more prior systemic therapies. The most common tumor type Research.on August 5, 2020.doses that ranged from 20 mg daily up to a dose of 275 mg daily without dietary restrictions. In the last two cohorts, RXDX-105 was administered at 275 mg daily and 350 mg daily in the fed state.

Purpose While multikinase inhibitors with RET activity are active in RET-rearranged thyroid and lung cancers, objective response rates are relatively low and toxicity can be substantial. The development of novel RET inhibitors with improved potency and/or reduced toxicity is thus an unmet need. RXDX-105 is a small molecule kinase inhibitor that potently inhibits RET. The purpose of the preclinical and clinical studies was to evaluate the potential of RXDX-105 as an effective therapy for cancers driven by RET alterations. Experimental design The RET-inhibitory activity of RXDX-105 was assessed by biochemical and cellular assays, followed by in vivo tumor growth inhibition studies in cell line– and patient-derived xenograft models. Antitumor activity in patients was assessed by imaging and Response Evaluation Criteria in Solid Tumors (RECIST). Results Biochemically, RXDX-105 inhibited wild-type RET, CCDC6-RET, NCOA4-RET, PRKAR1A-RET, and RET M918T with low to subnanomolar activity while sparing VEGFR2/KDR and VEGFR1/FLT. RXDX-105 treatment resulted in dose-dependent inhibition of proliferation of CCDC6-RET–rearranged and RET C634W-mutant cell lines and inhibition of downstream signaling pathways. Significant tumor growth inhibition in CCDC6-RET, NCOA4-RET, and KIF5B-RET–containing xenografts was observed, with the concomitant inhibition of p-ERK, p-AKT, and p-PLCγ. Additionally, a patient with advanced RET-rearranged lung cancer had a rapid and sustained response to RXDX-105 in both intracranial and extracranial disease. Conclusions These data support the inclusion of patients bearing RET alterations in ongoing and future molecularly enriched clinical trials to explore RXDX-105 efficacy across a variety of tumor types.

We have previously demonstrated a link between alpha2,6-Sialyltransferase (alpha2,6-ST; E.C. 2.4.99.1) expression and differentiation of colon tumors. So far, information is not available relative to the expression of alpha2,6-ST in tumors and the survival of patients with colorectal cancer. We have examined the expression of alpha2,6-ST in a variety of colorectal adenocarcinomas (n = 46) at different stages of differentiation (G1 to G3) by immunoperoxidase assay using monoclonal antibody (MAb) 6B9. Clinical outcome of the patients in a 5-year follow-up study has been correlated with the expression of alpha2,6-ST in tumors surgically removed from the same patients. No significant difference in the alpha2,6-ST expression was noted when age, sex, and tumor locations (colon, rectum) were included as parameters. However, 52% of the moderate (G2) and well-differentiated (G1) adenocarcinomas showed stronger alpha2,6-ST expression compared with poorly differentiated (G3) adenocarcinomas. Notably, absence to moderate levels of tumor alpha2,6-ST expression was correlated with 100% survival in patients with stage I and II tumors compared with 64% survival in patients with strong tumor alpha2,6-ST expression (p < 0.01). These studies suggest a negative correlation between the expression of alpha2,6-ST in tumors and a good clinical outcome in colorectal cancer patients.

Splenosis is a rare finding of ectopic splenic tissue found within the thoracic cavity, abdomen or peritoneal cavity. Most cases occur in the abdomen and the thoracic location is a comparatively rare finding. In thoracic splenosis the splenic tissue most often grows in the form of a nodule and the autotransplantation is usually caused by a previous operation and/or most commonly a penetrating or blunt trauma to the thoracoabdominal region, resulting in splenic rupture and in some cases left diaphragmatic tear. In majority of the cases the patients are asymptomatic and are incidentally diagnosed with left hemithorax pulmonary lesions found via chest radiography or thoracic computed tomography. We present a 45-year-old Caucasian male who was incidentally diagnosed with parenchymal thoracic splenosis secondary to a gunshot wound to the abdomen 13 years ago that resulted in distal pancreatectomy, splenectomy and gastrorrhaphy. In this case report we will briefly discuss the current updates in the literature regarding thoracic splenosis, and highlight the fact that the findings raise the suspicion of malignancy requiring numerous investigations yet early recognition of thoracic splenosis can prevent unnecessary tests and procedures. Preoperative diagnosis of splenosis should be made with the use of nuclear imaging studies such as the 99mTc heat-damaged erythrocyte study rather than computed tomography-guided biopsy or invasive surgery.KeywordsThoracic splenosis; Computed tomography; Ppancreatectomy; Splenectomy; Gastrorrhaphy

The 70-gene signature (MammaPrint) has been developed to predict the risk of distant metastases in breast cancer and select those patients who may benefit from adjuvant treatment. Given the strong association between locoregional and distant recurrence, we hypothesize that the 70-gene signature will also be able to predict the risk of locoregional recurrence (LRR). 1,053 breast cancer patients primarily treated with breast-conserving treatment or mastectomy at the Netherlands Cancer Institute between 1984 and 2006 were included. Adjuvant treatment consisted of radiotherapy, chemotherapy, and/or endocrine therapy as indicated by guidelines used at the time. All patients were included in various 70-gene signature validation studies. After a median follow-up of 8.96 years with 87 LRRs, patients with a high-risk 70-gene signature (n = 492) had an LRR risk of 12.6% (95% CI 9.7-15.8) at 10 years, compared to 6.1% (95% CI 4.1-8.5) for low-risk patients (n = 561; P < 0.001). Adjusting the 70-gene signature in a competing risk model for the clinicopathological factors such as age, tumour size, grade, hormone receptor status, LVI, axillary lymph node involvement, surgical treatment, endocrine treatment, and chemotherapy resulted in a multivariable HR of 1.73 (95% CI 1.02-2.93; P = 0.042). Adding the signature to the model based on clinicopathological factors improved the discrimination, albeit non-significantly [C-index through 10 years changed from 0.731 (95% CI 0.682-0.782) to 0.741 (95% CI 0.693-0.790)]. Calibration of the prognostic models was excellent. The 70-gene signature is an independent prognostic factor for LRR. A significantly lower local recurrence risk was seen in patients with a low-risk 70-gene signature compared to those with high-risk 70-gene signature.

Background: Entrectinib is a potent oral inhibitor of the tyrosine kinases TrkA, TrkB, TrkC (encoded by the genes NTRK1, NTRK2, NTRK3, respectively), ROS1, and ALK with IC50 &lt; 2 nM (biochemical kinase assay). It has been evaluated in two Phase 1 studies (STARTRK-1 and ALKA-372-001) in patients with advanced or metastatic solid tumors harboring NTRK1/2/3, ROS1, or ALK molecular alterations, with or without asymptomatic or controlled CNS disease. Previously, we reported 600 mg daily as the Recommended Phase 2 Dose (RP2D) and an objective response rate of 72% in 18 tyrosine kinase inhibitor (TKI)-naïve patients with NTRK1/2/3 (4), ROS1 (8), or ALK (6) rearrangements treated at or above the RP2D (Siena et al, ESMO 2015). Methods: A 3+3 dose escalation was used to assess safety, pharmacokinetics, and identify the RP2D of entrectinib. Here we provide an update on anti-tumor activity (RECIST v1.1) and safety with continued follow-up of the cohort of patients with gene rearrangements. Results: At a median follow-up of 11 months, 11 of the 18 patients remain on study. Objective responses were observed in 3 of 4 (75%) NTRK1/2/3, 6 of 8 (75%; 1 complete response) ROS1 and 4 of 6 (67%) ALK patients, respectively. Responses were observed in NSCLC, colorectal cancer, mammary analog secretory carcinoma, and other solid tumors, as early as cycle 1 and lasting as long as &gt; 2 years. Notably, a 46-year old male patient with SQSTM1-NTRK1-rearranged NSCLC previously treated with 4 lines of chemotherapy and immunotherapy achieved an overall partial response with a complete response in the brain. He remains on study in response at 10 months. The most common (&gt;10%) treatment-related adverse events (AEs) at the RP2D were fatigue/asthenia (47%), dysgeusia (32%), constipation (26%), dizziness (21%), paresthesia (21%), diarrhea (16%), myalgia (16%), and weight gain (16%). Three treatment-related serious AEs were reported (2 occurred above the RP2D); all resolved with dose modifications. Conclusions: Entrectinib continues to display promising anti-tumor activity in TKI-naive patients across different solid tumor types harboring an NTRK1/2/3, ROS1, or ALK gene rearrangement. Similar patients are now being enrolled in STARTRK-2, a global Phase 2 basket study of entrectinib. Citation Format: Alexander Drilon, Filippo G. De Braud, Salvatore Siena, Sai-Hong I. Ou, Manish Patel, Myung-Ju Ahn, Jeeyun Lee, Todd M. Bauer, Anna F. Farago, Stephen V. Liu, Natasha Reddinger, Rupal Patel, David Luo, Edna Chow Maneval, Pratik S. Multani, Robert C. Doebele, Alice T. Shaw. Entrectinib, an oral pan-Trk, ROS1, and ALK inhibitor in TKI-naïve patients with advanced solid tumors harboring gene rearrangements: Updated phase I results. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr CT007.