Cixutumumab and temsirolimus for patients with bone and soft-tissue sarcoma: a multicentre, open-label, phase 2 trial

BACKGROUND: Preclinical studies have shown synergistic antitumour activity by inhibition of insulin-like growth factor-1 receptor (IGF-1R) and mTOR. The expression of IGF-1R seems to be crucial for this effect. We investigated the safety and efficacy of the combination of the IGF-1R antibody cixutumumab and the mTOR inhibitor temsirolimus in patients with chemotherapy-refractory bone and soft-tissue sarcomas according to IGF-1R expression by immunohistochemistry. METHODS: We undertook a multicentre, open-label, phase 2 study in 19 cancer centres in the USA. Patients aged at least 16 years with a histologically confirmed diagnosis of bone or soft-tissue sarcoma were allocated on the basis of IGF-1R expression by immunohistochemistry to one of three treatment groups: IGF-1R-positive soft-tissue sarcoma (group A), IGF-1R-positive bone sarcomas (group B), or IGF-1R-negative bone and soft-tissue sarcoma (group C). Patients received weekly treatment with cixutumumab (6 mg/kg, intravenous) and temsirolimus (25 mg, intravenous flat dose) in 6-week cycles. A Simon optimal two-stage design was used for every arm. The primary endpoint was progression-free survival (PFS) at 12 weeks by intention-to-treat analysis in the first 54 patients assigned to every treatment arm. Although patients still remain on treatment, this trial has completed enrolment and this represents the final analysis. This study is registered with ClinicalTrials.gov, number NCT01016015. FINDINGS: Between Nov 18, 2009, and April 11, 2012, 388 patients were screened for IGF-1R expression and 54 were assigned to each arm. 17 of 54 patients in the IGF-1R-positive soft-tissue sarcoma group (31%; one-sided 95% CI lower bound 21%; two-sided 90% CI 21-43), 19 of 54 in IGF-1R-positive bone sarcoma group (35%; one-sided 95% CI lower bound 24%; two-sided 90% CI 24-47), and 21 of 54 in the IGF-1R-negative group (39%, one-sided 95% CI lower bound 28%; two-sided 90% CI 28-51) were progression free at 12 weeks. On April 6, 2011, the protocol was amended to include three additional patients in the IGF-1R-positive soft-tissue sarcoma group (total of 57 patients) and nine more in the IGF-1R-negative group (total of 63 patients). There were 2546 adverse events reported during the study, 214 (8%) of which were grade 3-4. The most common grade 3-4 toxicities in the 174 treated patients were anaemia in 16 (9%) patients, hyperglycaemia in 18 (10%), hypophosphataemia in 16 (9%), lymphopenia in 25 (14%), oral mucositis in 19 (11%), and thrombocytopenia in 19 (11%). INTERPRETATION: The combination of cixutumumab and temsirolimus shows clinical activity in patients with sarcoma and forms a basis for future trials. However, IGF-1R expression by immunohistochemistry is not predictive of clinical outcome after treatment with this combination. FUNDING: National Cancer Institute and CycleforSurvival Fund, Memorial Sloan-Kettering Cancer Center

Volatile organic compounds emitted by Trichoderma species mediate plant growth

Background: Many Trichoderma species are applied as biofungicides and biofertilizers to agricultural soils to enhance crop growth. These filamentous fungi have the ability to reduce plant diseases and promote plant growth and productivity through overlapping modes of action including induced systemic resistance, antibiosis, enhanced nutrient efficiency, and myco-parasitism. Trichoderma species are prolific producers of many small metabolites with antifungal, antibacterial, and anticancer properties. Volatile metabolites of Trichoderma also have the ability to induce resistance to plant pathogens leading to improved plant health. In this study, Arabidopsis plants were exposed to mixtures of volatile organic compounds ( VOCs) emitted by growing cultures of Trichoderma from 20 strains, representing 11 different Trichoderma species. Results: We identified nine Trichoderma strains that produced plant growth promoting VOCs. Exposure to mixtures of VOCs emitted by these strains increased plant biomass (37.1–41.6 %) and chlorophyll content (82.5–89.3 %). Trichoderma volatile-mediated changes in plant growth were strain-and species-specific. VOCs emitted by T. pseudokoningii (CBS 130756) were associated with the greatest Arabidopsis growth promotion. One strain, T. atroviride (CBS 01-209), in our screen decreased growth (50.5 %) and chlorophyll production (13.1 %). Similarly, tomatoes exposed to VOCs from T. viride (BBA 70239) showed a significant increase in plant biomass (\u3e99 %), larger plant size, and significant development of lateral roots. We also observed that the tomato plant growths were dependent on the duration of the volatile exposure. A GC–MS analysis of VOCs from Trichoderma strains identified more than 141 unique compounds including several unknown sesquiterpenes, diterpenes, and tetraterpenes. Conclusions: Plants grown in the presence of fungal VOCs emitted by different species and strains of Trichoderma exhibited a range of effects. This study demonstrates that the blend of volatiles produced by actively growing fungi and volatile exposure time in plant development both influence the outcome of volatile-mediated interactions. Only some of our growth promoting strains produced microbial VOCs known to enhance plant growth. Compounds such as 6-pentyl-2H-pyran-2-one were not common to all promoting strains. We found that biostimulatory strains tended to have a larger number of complex terpenes which may explain the variation in growth induced by different Trichoderma strains