18F-FDG Is a Surrogate Marker of Therapy Response and Tumor Recovery after Drug Withdrawal during Treatment with a Dual PI3K/mTOR Inhibitor in a Preclinical Model of Cisplatin-Resistant Ovarian Cancer

Lheureux, Stéphanie; Lecerf, Charlotte; Briand, Mélanie; Louis, Marie-Hélène; Dutoit, Soizic; Jebahi, Abdelghani; Giffard, Florence; Fournier, Cécile; Batalla, A.; Poulain, Laurent; Aide, Nicolas

doi:10.1593/tlo.13100

Cited by 17 publications

(12 citation statements)

References 32 publications

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“…Thus, changes in tumor glucose uptake as measured by fluorodeoxyglucose positron emission tomography (FDG-PET) imaging may be used as a PD marker for PI3K and mTOR inhibition, and to define the optimal dosing in preclinical models (32). FDG-PET/CT scans were acquired at baseline and 1-4 hours after dosing with apitolisib on days 22 and 55, and were centrally assessed using the European Organization for Research and Treatment of Cancer (EORTC) criteria.…”

Section: Methodsmentioning

confidence: 99%

Phase I Study of Apitolisib (GDC-0980), Dual Phosphatidylinositol-3-Kinase and Mammalian Target of Rapamycin Kinase Inhibitor, in Patients with Advanced Solid Tumors

Dolly

Wagner

Bendell

et al. 2016

Clinical Cancer Research

116

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Purpose This first-in-human phase I trial assessed the safety, tolerability, and preliminary anti-tumor activity of apitolisib (GDC-0980), a dual inhibitor of class I phosphatidylinositol-3-(PI3K) and mammalian target of rapamycin (mTOR) kinases. Experimental Design Once-daily (QD) oral apitolisib was administered to patients with solid tumors for days 1-21 or 1-28 of 28-day cycles. Pharmacokinetic and pharmacodynamic parameters were assessed. Results Overall, 120 patients were treated at doses between 2-70 mg. The commonest ≥G3 toxicities related to apitolisib at the recommended phase 2 dose (RP2D) at 40mg QD included hyperglycemia (18%), rash (14%), liver dysfunction (12%), diarrhea (10%), pneumonitis (8%), mucosal inflammation (6%), and fatigue (4%). Dose-limiting toxicities (one patient each) were G4 fasting hyperglycemia at 40 mg (21/28-schedule), and G3 maculopapular rash and G3 fasting hyperglycemia at 70 mg (21/28-schedule). The pharmacokinetic profile was dose-proportional. Phosphorylated serine-473 AKT levels were suppressed by ≥90% in platelet-rich plasma within 4 hours at the maximum tolerated dose (50 mg). Pharmacodynamic decreases in FDG-PET uptake of >25% occurred in 66% (21/32) of patients dosed at 40 mg QD. Evidence of single agent activity included ten RECIST partial responses (confirmed for peritoneal mesothelioma, PIK3CA mutant head- and-neck cancer, and three pleural mesotheliomas). Conclusion Apitolisib exhibited dose-proportional pharmacokinetics with target modulation at doses ≥16 mg. The RP2D was 40 mg QD 28/28-schedule; severe on-target toxicities were apparent at ≥40 mg, particularly pneumonitis. Apitolisib was reasonably tolerated at 30 mg, the selected dose for pleural mesothelioma patients given limited respiratory reserve. Modest but durable anti-tumor activity was demonstrated.

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Section: Methodsmentioning

confidence: 99%

Phase I Study of Apitolisib (GDC-0980), Dual Phosphatidylinositol-3-Kinase and Mammalian Target of Rapamycin Kinase Inhibitor, in Patients with Advanced Solid Tumors

Dolly

Wagner

Bendell

et al. 2016

Clinical Cancer Research

116

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“…In addition, Akt potentiates the activity of the hexokinase (HK), which phosphorylates glucose molecules, thus preventing their efflux back into the extracellular space, as well as of the phosphofructokinase (PFK) enzyme, which catalyzes the key irreversible step of glycolysis (Deprez et al, 1997; Gottlob et al, 2001). In fact, the 18 F-FDG-PET signal intensity in tumors correlates closely with the level of PI3K/Akt pathway activity, and is attenuated by PI-3 kinase and receptor tyrosine kinase inhibitors (Benz et al, 2011; Lheureux et al, 2013; Ma et al, 2009). Furthermore, exogenous expression of a constitutively active form of Akt alone can stimulate glycolysis and is sufficient to restore cell size, viability, mitochondrial potential and ATP levels in growth factor-deprived cells in a manner that is dependent upon the presence of glucose in the culture medium (Plas et al, 2001; Rathmell et al, 2003).…”

Section: Deregulated Uptake Of Glucose and Amino Acidsmentioning

confidence: 99%

The Emerging Hallmarks of Cancer Metabolism

2016

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Tumorigenesis is dependent on the reprogramming of cellular metabolism as both direct and indirect consequence of oncogenic mutations. A common feature of cancer cell metabolism is the ability to acquire necessary nutrients from a frequently nutrient-poor environment and utilize these nutrients to both maintain viability and build new biomass. The alterations in intracellular and extracellular metabolites that can accompany cancer-associated metabolic reprogramming have profound effects on gene expression, cellular differentiation and the tumor microenvironment. In this Review, we have organized known cancer-associated metabolic changes into six hallmarks: (1) deregulated uptake of glucose and amino acids, (2) use of opportunistic modes of nutrient acquisition, (3) use of glycolysis/TCA cycle intermediates for biosynthesis and NADPH production, (4) increased demand for nitrogen, (5) alterations in metabolite-driven gene regulation, and (6) metabolic interactions with the microenvironment. While few tumors display all six hallmarks, most display several. The specific hallmarks exhibited by an individual tumor may ultimately contribute to better tumor classification and aid in directing treatment.

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“…By day 7, there was no difference between control and treated groups. These results were detailed in another publication [ 16 ] and were used as the reference standard in the present work.…”

Section: Resultsmentioning

confidence: 99%

Quantifying and correcting for tail vein extravasation in small animal PET scans in cancer research: is there an impact on therapy assessment?

et al. 2015

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Background: Tail vein injection under short anesthesia is the most commonly used route for administering radiopharmaceuticals. However, the small caliber of the vein in rodents may lead to tracer extravasation and thereby compromise quantitative accuracy of PET. We aimed to evaluate a method for correction of interstitial radiotracer leakage in the context of pre-clinical therapeutic response assessment. Methods: In two separate studies involving 16 nude rats, a model of human ovarian cancer was xenografted and each was treated with a Phosphoinositide 3-kinase/mammalian target of rapamycin inhibitor or used as a control. Tracer injections were performed via the tail vein by a single operator. Two observers qualitatively evaluated the resulting images and if appropriate drew a volume of interest (VOI) over the injection site to record extravasated activities. Uncorrected and corrected tumors' mean standardized uptake value (SUV) mean was computed (corrected injected activity = calibrated activity − decay corrected residual syringe activity − decay corrected tail extravasated activity). Molecular analyses were taken as a gold standard. The frequency and magnitude of extravasation were analyzed, as well as the inter-observer agreement and the impact of the correction method on tumor uptake quantification. Results: Extravasation never exceeded 20 % of the injected dose but occurred in more than 50 % of injections. It was independent of groups of animals and protocol time points with p values of 1.00 and 0.61, respectively, in the first experiment and 0.47 and 0.13, respectively, in the second experiment. There was a good inter-observer agreement for qualitative analysis (kappa = 0.72) and a moderate agreement when using quantitative analysis (ρ c = 0.94). In both experiments, there was significant difference between uncorrected and corrected SUV mean . Despite this significant difference, mean percent differences between uncorrected and corrected SUVmean in the first and the second experiments were -3.61 and -1.78, respectively. Concerning therapy assessment, in both experiments, significant differences in median %SUV mean between control and treated groups were observed over all time points with either uncorrected and corrected data (p < 0.05).

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18F-FDG Is a Surrogate Marker of Therapy Response and Tumor Recovery after Drug Withdrawal during Treatment with a Dual PI3K/mTOR Inhibitor in a Preclinical Model of Cisplatin-Resistant Ovarian Cancer

Cited by 17 publications

References 32 publications

Phase I Study of Apitolisib (GDC-0980), Dual Phosphatidylinositol-3-Kinase and Mammalian Target of Rapamycin Kinase Inhibitor, in Patients with Advanced Solid Tumors

Phase I Study of Apitolisib (GDC-0980), Dual Phosphatidylinositol-3-Kinase and Mammalian Target of Rapamycin Kinase Inhibitor, in Patients with Advanced Solid Tumors

The Emerging Hallmarks of Cancer Metabolism

Quantifying and correcting for tail vein extravasation in small animal PET scans in cancer research: is there an impact on therapy assessment?

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