TS Overexpression in SCLC: Mechanism and Therapeutic Targeting

Small Cell Lung Cancer Clinical Trial

Official title:

TS Overexpression in SCLC: Mechanism and Therapeutic Targeting

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03741829
• Other study ID #: IRB00043264
• Secondary ID: Pilot Funds 1134
• Status: Completed
• Start date: June 14, 2017
• Est. completion date: January 3, 2020

Study information

• Verified date: February 2020
• Source: Wake Forest University Health Sciences
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The purpose of this research study is to determine the amount of a protein named thymidine synthase that is being made by cancer and to develop laboratory models called PDX (patient derived xenografts) to learn more about SCLC (small cell lung cancer) and to begin testing new treatments.

Description:

Small cell lung cancer (SCLC) is a highly lethal malignancy that is not treatable with targeted therapies and that does not respond long-term to treatment with cytotoxic chemotherapy1. One distinguishing molecular characteristic of SCLC is very high expression levels of thymidylate synthase (TS). TS plays an important role in de novo nucleotide biosynthesis and the very high TS levels expressed in SCLC cells indicate that these cells require the de novo nucleotide biosynthetic pathway to proliferate. Thus, complete TS inhibition could result in highly favorable outcomes in SCLC patients. TS inhibitors have been evaluated in SCLC clinical trials and have anti-tumoral activity when combined with a second chemotherapeutic agent. However, treatment with TS inhibitors has not been shown to surpass other combination chemotherapy regimens. An important point regarding these clinical studies is that TS activity levels were not monitored as an endpoint of drug response, thus it is not known whether TS activity was efficiently inhibited.Investigators predict that complete TS inhibition will result in favorable outcomes.

With support from Wake Innovations, Investigators are developing a novel fluoropyrimidine polymer, CF10, which strongly inhibits TS. CF10 is a second generation fluoropyrimidine polymer. The first generation polymer, F10, showed excellent anti-cancer activity in animal models of acute myeloid leukemia, glioblastoma, and prostate cancer. CF10 is designed to have improved tumor penetration and better in vivo stability than F10. Investigators hypothesize that CF10 will be highly effective for treating SCLC both as a single agent and in combination with TS inhibitors that target alternative sites of the TS enzyme.

After establishing CF10 has activity as a single agent and in combination with folate-based TS inhibitors (e.g. pemetrexed) in SCLC cell lines and xenograft models, Investigators will test CF10 in patient-derived xenograft (PDX) models and in organoids derived from SCLC patient samples. Investigators will develop PDX models of SCLC and SCLC organoids using transbronchial fine needle aspiration (FNA) from SCLC patients at Baptist/WFBCCC collected by co-I's Bellinger, Dotson, and Thomas. Non-malignant cells will be collected using a brush biopsy to enable comparison of malignant and non-malignant tissue from the same patient with regard to mechanistic endpoints.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 12
• Est. completion date: January 3, 2020
• Est. primary completion date: January 3, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Patients undergoing a diagnostic FNA by the following diagnostic modalities utilizing FNA: Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS- TBNA) or conventional transbronchial FNA.

• Patients must have radiographic evidence for presumed lung cancer or have a previously diagnosed SCLC with clinical evidence of recurrence. Patients undergoing FNA of potential SCLC metastates to lymph nodes are also included (e.g., patients with abnormal mediastinal lymphadenopathy). FNA biopsies from separate locations in the same patient will be considered separate specimens.

• Age >18 years. Used to define adult age that can independently provide consent.

• Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

• Patients whose FNA biopsy is unable to provide classification by pathology or is non-diagnostic.

Related Conditions & MeSH terms

• Small Cell Lung Cancer
• Small Cell Lung Carcinoma

Locations

Country	Name	City	State
United States	Wake Forest University Health Sciences	Winston-Salem	North Carolina

Sponsors (2)

Lead Sponsor	Collaborator
Wake Forest University Health Sciences	National Cancer Institute (NCI)

Country where clinical trial is conducted

United States, 

References & Publications (9)

Anderson WC, Boyd MB, Aguilar J, Pickell B, Laysang A, Pysz MA, Bheddah S, Ramoth J, Slingerland BC, Dylla SJ, Rubio ER. Initiation and characterization of small cell lung cancer patient-derived xenografts from ultrasound-guided transbronchial needle aspirates. PLoS One. 2015 May 8;10(5):e0125255. doi: 10.1371/journal.pone.0125255. eCollection 2015. — View Citation

Asai N, Ohkuni Y, Kaneko N, Yamaguchi E, Kubo A. Relapsed small cell lung cancer: treatment options and latest developments. Ther Adv Med Oncol. 2014 Mar;6(2):69-82. doi: 10.1177/1758834013517413. Review. — View Citation

Byers LA, Wang J, Nilsson MB, Fujimoto J, Saintigny P, Yordy J, Giri U, Peyton M, Fan YH, Diao L, Masrorpour F, Shen L, Liu W, Duchemann B, Tumula P, Bhardwaj V, Welsh J, Weber S, Glisson BS, Kalhor N, Wistuba II, Girard L, Lippman SM, Mills GB, Coombes KR, Weinstein JN, Minna JD, Heymach JV. Proteomic profiling identifies dysregulated pathways in small cell lung cancer and novel therapeutic targets including PARP1. Cancer Discov. 2012 Sep;2(9):798-811. doi: 10.1158/2159-8290.CD-12-0112. Epub 2012 Sep 6. — View Citation

Gmeiner WH, Debinski W, Milligan C, Caudell D, Pardee TS. The applications of the novel polymeric fluoropyrimidine F10 in cancer treatment: current evidence. Future Oncol. 2016 Sep;12(17):2009-20. doi: 10.2217/fon-2016-0091. Epub 2016 Jun 9. Review. — View Citation

Gmeiner WH, Lema-Tome C, Gibo D, Jennings-Gee J, Milligan C, Debinski W. Selective anti-tumor activity of the novel fluoropyrimidine polymer F10 towards G48a orthotopic GBM tumors. J Neurooncol. 2014 Feb;116(3):447-54. doi: 10.1007/s11060-013-1321-1. Epub 2013 Dec 18. — View Citation

Gmeiner WH, Willingham MC, Bourland JD, Hatcher HC, Smith TL, D'Agostino RB Jr, Blackstock W. F10 Inhibits Growth of PC3 Xenografts and Enhances the Effects of Radiation Therapy. J Clin Oncol Res. 2014 Jul-Aug;2(4). pii: 1028. — View Citation

Pardee TS, Gomes E, Jennings-Gee J, Caudell D, Gmeiner WH. Unique dual targeting of thymidylate synthase and topoisomerase1 by FdUMP[10] results in high efficacy against AML and low toxicity. Blood. 2012 Apr 12;119(15):3561-70. doi: 10.1182/blood-2011-06-362442. Epub 2012 Feb 23. — View Citation

Socinski MA, Weissman C, Hart LL, Beck JT, Choksi JK, Hanson JP, Prager D, Monberg MJ, Ye Z, Obasaju CK. Randomized phase II trial of pemetrexed combined with either cisplatin or carboplatin in untreated extensive-stage small-cell lung cancer. J Clin Oncol. 2006 Oct 20;24(30):4840-7. Erratum in: J Clin Oncol. 2007 Jan 1;25(1):167. — View Citation

Tanaka F, Wada H, Fukui Y, Fukushima M. Thymidylate synthase (TS) gene expression in primary lung cancer patients: a large-scale study in Japanese population. Ann Oncol. 2011 Aug;22(8):1791-7. doi: 10.1093/annonc/mdq730. Epub 2011 Feb 14. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Survival of mice at 60 days implanted with tumor and treated with CF10		60 days
Other	Number of samples with PDX model development		After biopsy collection, up to 1 year
Other	Levels of TS activity		After biopsy collection, up to 1 year
Other	Levels of Top1cc		After biopsy collection, up to 1 year
Other	Levels of DNA double strand breaks		After biopsy collection, up to 1 year
Other	Tumor volume		After biopsy collection, up to 1 year
Other	Number of apoptotic cells.		After biopsy collection, up to 1 year
Primary	TYMS (Thymidylate Synthetase) expression levels	TYMS (Thymidylate Synthetase) expression levels will be measured on biopsied malignant tissue as well as non-malignant tissue.	After biopsy collection, up to 1 year
Primary	miRNA expression levels	miRNA expression levels will be measured on biopsied malignant tissue as well as non-malignant tissue.	After biopsy collection, up to 1 year