title: Translational predictive biomarker analysis of the phase 1b sorafenib and bevacizumab study expansion cohort.
abstract: Predictive biomarkers are needed to triage patients to the best therapy. We prospectively planned examination of sequential blood, biopsy, and functional imaging with which to confirm the mechanism and to identify potential predictive biomarkers in a phase Ib clinical trial expansion of patients with solid tumors receiving sorafenib/bevacizumab. The maximally tolerated doses of sorafenib at 200 mg twice daily with bevacizumab at 5 mg/kg every other week were given to biopsiable patients. Patients were randomized to receive either sorafenib or bevacizumab monotherapy for the first 28-day cycle with the second drug added with cycle 2. Biopsies, dynamic contrast-enhanced MRI, and fluorodeoxyglucose-proton emission tomography were done pre-therapy and at 2 and 6 weeks (2 weeks into combination therapy). Tumor and serum proteomics, Ras/Raf mutational analysis, and functional imaging results were examined individually and across the dataset to identify potential changes predictive of response to therapy and those that confirm the biochemical drug mechanism(s). Therapy with sorafenib/bevacizumab resulted in clinical benefit in 45% of this mixed solid tumor group. ERK activation and microvessel density were decreased with monotherapy treatment with sorafenib or bevacizumab, respectively; whereas a decreased signal over the group of total AKT, phospho(p)-VEGF receptor2, p-endothelial nitric-oxide synthase, b-RAF, and cleaved poly(ADP-ribose) polymerase was associated with earlier progression of disease. Tumor metabolic activity decreased in those patients with clinical benefits lasting longer than 4 months, and activity increased with progression of disease. Cleavage of caspase 3 and poly(ADP-ribose) polymerase was increased, and Ki67 expression decreased in patients with prolonged clinical benefits, consistent with decreased proliferation and increased apoptosis. The conglomerate analysis, incorporating pharmacodynamic and tumor biochemistry, demonstrated sorafenib/bevacizumab-targeted vascular activity in the tumor. Results suggest potential biomarkers for which changes, as a group, during early therapeutic exposure may predict clinical benefit.
authors: Medical Oncology Branch, Johns Hopkins, 1650 Orleans St., Rm. 4M10, Baltimore, Maryland 21231, USA.
authors: Nilofer
authors: N
authors: Azad
authors: Minshu
authors: M
authors: Yu
authors: Ben
authors: B
authors: Davidson
authors: Peter
authors: P
authors: Choyke
authors: Clara C
authors: CC
authors: Chen
authors: Bradford J
authors: BJ
authors: Wood
authors: Aradhana
authors: A
authors: Venkatesan
authors: Ryan
authors: R
authors: Henning
authors: Kathy
authors: K
authors: Calvo
authors: Lori
authors: L
authors: Minasian
authors: Daniel C
authors: DC
authors: Edelman
authors: Paul
authors: P
authors: Meltzer
authors: Seth M
authors: SM
authors: Steinberg
authors: Christina M
authors: CM
authors: Annunziata
authors: Elise C
authors: EC
authors: Kohn
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000068258:Bevacizumab; D054316:Biomarkers, Pharmacological / Q000378:metabolism*; D015331:Cohort Studies; D018450:Disease Progression; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D048049:Extracellular Signal-Regulated MAP Kinases / Q000235:genetics / Q000378:metabolism; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D005833:Genital Neoplasms, Female / Q000098:blood supply / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D052250:Nitric Oxide Synthase Type III / Q000235:genetics / Q000378:metabolism; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D011065:Poly(ADP-ribose) Polymerases / Q000235:genetics / Q000378:metabolism; D011237:Predictive Value of Tests; D051057:Proto-Oncogene Proteins c-akt / Q000235:genetics / Q000378:metabolism; D015398:Signal Transduction; D012878:Skin Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D000077157:Sorafenib; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000235:genetics / Q000378:metabolism
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D054316:Biomarkers, Pharmacological; D010671:Phenylurea Compounds; D009536:Niacinamide; D000068258:Bevacizumab; D000077157:Sorafenib; C496314:NOS3 protein, human; D052250:Nitric Oxide Synthase Type III; D011065:Poly(ADP-ribose) Polymerases; D040301:Vascular Endothelial Growth Factor Receptor-2; D051057:Proto-Oncogene Proteins c-akt; D048049:Extracellular Signal-Regulated MAP Kinases