Novel drug shows promise in treating metastatic kidney cancer

                    

Metastatic kidney cancer remains largely incurable. Despite a dozen treatments and several immunotherapies, survival rates beyond 5 years remain around 10 percent. A study published in the Journal of Clinical Oncology reports initial findings with a novel drug belonging to a new class of medicines called HIF-2a inhibitors that show promise in treating metastatic kidney cancer.

Among 51 patients with aggressive kidney cancer that had progressed through four prior treatments on average, PT2385, the first HIF-2a inhibitor to be evaluated in clinical trials, blocked tumor growth for at least 4 months in 40 percent of the patients. Furthermore, cancer growth was stopped for more than a year in 25 percent of the patients. In addition, side effects were minimal.

"The combination of activity and tolerability is very encouraging," said corresponding author Dr. Kevin Courtney, Assistant Professor of Internal Medicine at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center. "We treated multiple patients on this trial in the Kidney Cancer Program at UT Southwestern, more than at any other institution. In our experience, this HIF-2a inhibitor offers a combination of safety and potential activity that is unique compared to current treatments for advanced kidney cancer."

PT2385, developed by Peloton Therapeutics Inc., represents the culmination of two decades of research at UT Southwestern beginning with the discovery of HIF-2a by Dr. Steven McKnight, Professor of Biochemistry who holds the Distinguished Chair in Basic Biomedical Research, and Dr. David Russell, Vice Provost, Dean of Research, and holder of the Eugene McDermott Distinguished Chair in Molecular Genetics. Next was the finding of a vulnerability in HIF-2a by Dr. Richard Bruick, Professor of Biochemistry and the Michael L. Rosenberg Scholar in Biomedical Research, and Dr. Kevin Gardner, Professor of Biophysics. This research was followed by the identification of chemicals that exploit a crevice in HIF-2a to destroy its activity. These chemicals were then licensed to Peloton Therapeutics, in the UT Southwestern BioCenter at Southwestern Medical District, which developed the HIF-2a blocking drug.

In a manuscript published in Nature last year, Dr. James Brugarolas, Professor of Internal Medicine, showed that blocking HIF-2a successfully reduced the growth of 50 percent of kidney cancers that were transplanted from patients into mice. In fact, the HIF-2a drug had greater activity in this study and was better tolerated than sunitinib, the most commonly prescribed drug for kidney cancer.

Dr. Brugarolas, who directs the Kidney Cancer Program and is the Principal Investigator of one of only two Specialized Programs of Research Excellence (SPORE) in kidney cancer designated by the National Cancer Institute, is now working to identify patients who are most likely to benefit from treatment with PT2385. "One of the biggest challenges we face across all treatments for kidney cancer is pairing the right drug with the right patient," said Dr. Brugarolas, who also holds the Sherry Wigley Crow Cancer Research Endowed Chair in Honor of Robert Lewis Kirby, M.D.

"HIF-2a, which fuels cell growth, is the most important driver of kidney cancer and the development of a drug that is helping patients is a remarkable outgrowth of our research," said Dr. Russell.

UT Southwestern Medical Center owns stock in Peloton Therapeutics and has a financial interest in the clinical trial described in the Journal of Clinical Oncology article. Drs. Bruick, Gardner, and McKnight have financial interests related to consulting; and Drs. McKnight, Bruick, and Gardner related to investment.

http://www.utsouthwestern.edu/newsroom/articles/year-2017/kidney-cancer-drug.html

Novel drug shows promise in treating metastatic kidney cancer

Combo immunotherapy may herald new standard of care for kidney cancer

Combination therapy with two immunotherapy drugs produces an unprecedented doubling of response rates from 20 percent to 40 percent, a new study shows.

The multicenter trial involving 100 patients showed that the addition of ipilimumab to nivolumab, which is currently FDA-approved for treatment of kidney cancer, leads to responses that can last beyond two years. Half of the patients in the study, which appears in the Journal of Clinical Oncology, had metastases that had grown while they were on previous therapy.

"For this group of patients, these are very significant results," said lead author Dr. Hans Hammers, Associate Professor of Internal Medicine and co-leader of the Kidney Cancer Program at the Harold C. Simmons Comprehensive Cancer Center of UT Southwestern Medical Center.

The results set the stage for a pivotal Phase III trial, which has completed enrollment of patients. Should the results of this study be repeated in the larger Phase III trial, it would lead to a new standard of care for kidney cancer patients, said Dr. Hammers, formerly of Johns Hopkins medical system, who holds the Eugene P. Frenkel, M.D. Scholar in Clinical Medicine at UT Southwestern.

While significant advances in the treatment for kidney cancer over the last decade have led to the approval of a dozen drugs, these drugs are mostly palliative, lacking the potential for cure. "By contrast, durable responses lasting many years can be achieved with immunotherapy," said Dr. Hammers.

Activation of the immune system, however, can lead to serious complications, requiring potent anti-inflammatory drugs. "While side effects of immunotherapy can be significant, they are typically reversible, and unlike current therapies, don't significantly dampen patients' daily quality of life," said Dr. Hammers.

"Given the potential severity of the adverse effects, patients benefit from expert management available at centers of excellence," said Dr. James Brugarolas, Associate Professor of Internal Medicine and Leader of the Kidney Cancer Program at UT Southwestern.

Ongoing efforts in the Kidney Cancer Program focus on leveraging Nobel Prize-winning discoveries from UT Southwestern's Dr. Bruce Beutler leading to a new family of proteins that activate the immune system, the toll-like receptors. "Another avenue we are exploring, is the combination of immunotherapy and radiation," said Dr. Brugarolas.

Nobel Laureate Dr. Beutler, Regental Professor and Director of the Center for the Genetics of Host Disease, discovered an important family of receptors that allow mammals to sense infections when they occur, triggering a powerful inflammatory response. For this work, he received the 2011 Nobel Prize in Physiology or Medicine. Dr. Beutler, also Professor of Immunology, holds the Raymond and Ellen Willie Distinguished Chair in Cancer Research, in Honor of Laverne and Raymond Willie, Sr.

Kidney cancer is the sixth most common cancer type affecting both men and women. Classic chemotherapy has never worked well for kidney cancer. Targeted therapies have prolonged life expectancy, but are associated with daily side effects. Single-agent immunotherapies improve patients' survival, but only benefit a subset of patients. Combination immunotherapy with nivolumab and ipilimumab as tested in the kidney cancer study described here is already FDA-approved for treatment of melanoma, and is being tested for other cancers.

The Kidney Cancer Program at UTSW is one of two programs in the U.S. recognized with a Specialized Program of Research Excellence award by the National Cancer Institute. Discoveries at the Kidney Cancer Program have led to a new understanding of how kidney cancer develops and are leading to new treatments.

The Harold C. Simmons Comprehensive Cancer Center is the only NCI-designated Comprehensive Cancer Center in North Texas and one of just 48 NCI-designated Comprehensive Cancer Centers in the nation. Simmons Comprehensive Cancer Center includes 13 major cancer care programs. In addition, the Center's education and training programs support and develop the next generation of cancer researchers and clinicians. Simmons Comprehensive Cancer Center is among only 30 U.S. cancer research centers to be designated by the NCI as a National Clinical Trials Network Lead Academic Participating Site.

Grape seed and skin extract: A weapon in the fight against kidney disease caused by high-fat diets

Researchers examined the effect of GSSE processed from a grape cultivar ('Carignan') of Vitis vinifera from northern Tunisia on rats. Rats were fed a high-fat diet that induced a low-grade reno-lipotoxicity, that is, kidney damage associated with lipids. This was characterized by elevations in plasma urea and protein in the urine. The researchers found increased deposits of triglycerides (TG) (especially saturated fatty acids), increased signs of oxidative stress and depleted copper levels in the kidneys. There was also histological evidence of disturbance in the kidney structure. When the animals received GSSE at 500 mg/kg bw (which corresponds to 35g/day for a 70 kg human adult) along with the high-fat diet there was a partial reversal of the TG deposition as well as the histological damage. The authors suggest polyphenols including resveratrol are likely the components in GSSE responsible for the positive effects. Furthermore the GSSE prevented the oxidative stress and copper depletion.

"In our research, obesity-induced leaky kidney and proteinuria are shown to be prevented by GSSE, which suggests the use of GSSE as a preventive nutriceutical for high-risk patients," said co-author Kamel Charradi, a researcher with the Laboratory of Bioactive Substance at the Center of Biotechnology of Borj-Cedria (CBBC) in Tunisia. This research group has previously published work showing the benefits of GSSE in combating obesity, heart dysfunction, brain lipotoxicity and kidney cancer.....

Ref : http://www.nrcresearchpress.com/doi/story/10.4141/news.2013.02.27.116#.UTM-5KJTCYk

Grape seed and skin extract: A weapon in the fight against kidney disease caused by high-fat diets

Drug Duo of Ixabepilone and sunitinib Kills Chemotherapy-resistant Ovarian Cancer Cells......

In continuation of Sunitinib...

The use of two drugs never tried in combination before in ovarian cancer resulted in a 70 percent destruction of cancer cells already resistant to commonly used chemotherapy agents, say researchers at Mayo Clinic in Florida. Research  suggests that this combination (ixabepilone and sunitinib), might offer a much needed treatment option for women with advanced ovarian cancer. When caught at late stages, ovarian cancer is often fatal because it progressively stops responding to the chemotherapy drugs used to treat it. The finding also highlights the importance of the role of a molecule, RhoB, that the researchers say is activated by the drug duo. Neither drug is approved for use in ovarian cancer. Ixabepilone is a chemotherapy drug that, like other taxane drugs, targets the microtubules and stops dividing cells from forming a spindle. It has been approved for use in metastatic breast cancer. Sunitinib, approved for use in kidney cancer, belongs to a class of tyrosine kinase inhibitors that stops growth signals from reaching inside cancer cells.

                                           

     Sunitinib                                  Ixabepilone

Ref : http://www.mayoclinic.org/news2011-jax/6573.html