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1.  Germline polymorphisms in genes involved in the IGF1-pathway predict efficacy of cetuximab in wild-type KRAS mCRC patients 
Purpose
The insulin-like growth factor 1 (IGF1) signalling pathway is an important growth-regulatory pathway, which plays a crucial role in colorectal cancer (CRC) proliferation, differentiation, migration, angiogenesis, and apoptosis. Previous studies showed that hyperactivation of the IGF1-Receptor (IGF1R) may result in resistance to anti-EGFR targeted treatment. We tested whether germline variations within the IGF1-pathway are associated with clinical outcome in wild-type KRAS (wt KRAS) drug-refractory metastatic CRC (mCRC) patients who were treated with cetuximab monotherapy (IMC-0144).
Experimental Design
Formalin-fixed paraffin-embedded (FFPE) tissue samples of 130 drug-refractory mCRC patients enrolled in IMC-0144, a phase II clinical trial of cetuximab monotherapy, were analyzed. gDNA was extracted from dissected FFPE tumor tissue and KRAS mutation status and six potentially functional IGF1 and IGF1R polymorphisms were analyzed using direct DNA-sequencing or PCR-RFLP. Tumor response analysis was based on recursive partitioning and survival analyses were based on univariate and multivariate hazard regression models.
Results
In univariate and multivariate analyses five IGF-pathway SNPs were significantly associated with progression-free-survival (PFS) and/or overall survival (OS). In multivariate combined risk allele analysis the additive model for PFS and OS was significantly associated with the number of risk alleles in wt KRAS patients (p=0.001 and p=0.02, respectively). In addition, wt KRAS patients harbouring IGF1 rs2946834 A/A genotype had a 50 % ORR compared to 0% for A/G genotype.
Conclusions
These results indicate that IGF1-pathway polymorphisms are potential predictive/prognostic molecular markers for cetuximab efficacy in wt KRAS mCRC patients. Prospective biomarker embedded clinical trials are warranted to validate our findings.
doi:10.1158/1078-0432.CCR-10-2092
PMCID: PMC2982939  PMID: 20935157
KRAS; IGF1; IGF1R; Metastatic colon cancer; cetuximab
2.  The future of cytotoxic therapy: selective cytotoxicity based on biology is the key 
Breast Cancer Research  2003;5(3):154-159.
Although mortality from breast cancer is decreasing, 15% or more of all patients ultimately develop incurable metastatic disease. It is hoped that new classes of target-based cytotoxic therapeutics will significantly improve the outcome for these patients. Many of these novel agents have displayed cytotoxic activity in preclinical and clinical evaluations, with little toxicity. Such preferential cytotoxicity against malignant tissues will remain tantamount to the Holy Grail in oncologic therapeutics because this portends improved patient tolerance and overall quality of life, and the capacity to deliver combination therapy. Combinations of such rationally designed target-based therapies are likely to be increasingly important in treating patients with breast carcinoma. The anticancer efficacy of these agents will, however, remain dependent on the involvement of the targets of these agents in the biology of the individual patient's disease. Results of DNA microarray analyses have raised high hopes that the analyses of RNA expression levels can successfully predict patient prognosis, and indicate that the ability to rapidly 'fingerprint' the oncogenic profile of a patient's tumor is now possible. It is hoped that these studies will support the identification of the molecules driving a tumor's growth, and the selection of the appropriate combination of targeted agents in the near future.
PMCID: PMC165009  PMID: 12793897
breast cancer; preferential cytotoxicity; target-based
3.  Phase I Pharmacologic and Biologic Study of Ramucirumab (IMC-1121B), a Fully Human Immunoglobulin G1 Monoclonal Antibody Targeting the Vascular Endothelial Growth Factor Receptor-2 
Journal of Clinical Oncology  2010;28(5):780-787.
Purpose
To evaluate the safety, maximum-tolerated dose (MTD), pharmacokinetics (PKs), pharmacodynamics, and preliminary anticancer activity of ramucirumab (IMC-1121B), a fully human immunoglobulin G1 monoclonal antibody targeting the vascular endothelial growth factor receptor (VEGFR)-2.
Patients and Methods
Patients with advanced solid malignancies were treated once weekly with escalating doses of ramucirumab. Blood was sampled for PK studies throughout treatment. The effects of ramucirumab on circulating vascular endothelial growth factor-A (VEGF-A), soluble VEGFR-1 and VEGFR-2, tumor perfusion, and vascularity using dynamic contrast-enhanced magnetic resonance imaging were assessed.
Results
Thirty-seven patients were treated with 2 to 16 mg/kg of ramucirumab. After one patient each developed dose-limiting hypertension and deep venous thrombosis at 16 mg/kg, the next lower dose (13 mg/kg) was considered the MTD. Nausea, vomiting, headache, fatigue, and proteinuria were also noted. Four (15%) of 27 patients with measurable disease had a partial response (PR), and 11 (30%) of 37 patients had either a PR or stable disease lasting at least 6 months. PKs were characterized by dose-dependent elimination and nonlinear exposure consistent with saturable clearance. Mean trough concentrations exceeded biologically relevant target levels throughout treatment at all dose levels. Serum VEGF-A increased 1.5 to 3.5 times above pretreatment values and remained in this range throughout treatment at all dose levels. Tumor perfusion and vascularity decreased in 69% of evaluable patients.
Conclusion
Objective antitumor activity and antiangiogenic effects were observed over a wide range of dose levels, suggesting that ramucirumab may have a favorable therapeutic index in treating malignancies amenable to VEGFR-2 inhibition.
doi:10.1200/JCO.2009.23.7537
PMCID: PMC2834394  PMID: 20048182

Results 1-3 (3)