Myelopreservation with the CDK4/6 inhibitor trilaciclib in patients with small-cell lung cancer receiving first-line chemotherapy: a phase Ib/randomized phase II trial.

BACKGROUND: Chemotherapy-induced damage of hematopoietic stem and progenitor cells (HSPC) causes multi-lineage myelosuppression. Trilaciclib is an intravenous CDK4/6 inhibitor in development to proactively preserve HSPC and immune system function during chemotherapy (myelopreservation). Preclinically, trilaciclib transiently maintains HSPC in G1 arrest and protects them from chemotherapy damage, leading to faster hematopoietic recovery and enhanced antitumor immunity. PATIENTS AND METHODS: This was a phase Ib (open-label, dose-finding) and phase II (randomized, double-blind placebo-controlled) study of the safety, efficacy and PK of trilaciclib in combination with etoposide/carboplatin (E/P) therapy for treatment-naive extensive-stage small-cell lung cancer patients. Patients received trilaciclib or placebo before E/P on days 1-3 of each cycle. Select end points were prespecified to assess the effect of trilaciclib on myelosuppression and antitumor efficacy. RESULTS: A total of 122 patients were enrolled, with 19 patients in part 1 and 75 patients in part 2 receiving study drug. Improvements were seen with trilaciclib in neutrophil, RBC (red blood cell) and lymphocyte measures. Safety on trilaciclib+E/P was improved with fewer ≥G3 adverse events (AEs) in trilaciclib (50%) versus placebo (83.8%), primarily due to less hematological toxicity. No trilaciclib-related ≥G3 AEs occurred. Antitumor efficacy assessment for trilaciclib versus placebo, respectively, showed: ORR (66.7% versus 56.8%, P = 0.3831); median PFS [6.2 versus 5.0 m; hazard ratio (HR) 0.71; P = 0.1695]; and OS (10.9 versus 10.6 m; HR 0.87; P = 0.6107). CONCLUSION: Trilaciclib demonstrated an improvement in the patient's tolerability of chemotherapy as shown by myelopreservation across multiple hematopoietic lineages resulting in fewer supportive care interventions and dose reductions, improved safety profile, and no detriment to antitumor efficacy. These data demonstrate strong proof-of-concept for trilaciclib's myelopreservation benefits. CLINICAL TRAIL NUMBER: NCT02499770.

Structural comparisons of fibronectins isolated from early and late passage cells.

Fibronectins isolated from culture media conditioned by the growth of early (young) and late (old) passage human fibroblasts were compared by affinity chromatography and polyacrylamide gel electrophoresis. The results indicated that fibronectins from young and old cells were similar, but not identical. The fibronectin synthesized by old cells migrated more slowly on NaDodSO4 polyacrylamide gels in the presence of reducing agent than did fibronectin from young cells. The apparent molecular weight difference for purified fibronectins compared on gradient gels was estimated to be 5-10 000 daltons. The molecular weight difference was also evident in unpurified fibronectins in whole conditioned media. Both young and old fibronectins formed disulfide bonded dimers in the absence of reducing agents indicating that the molecular weight difference was not generated by proteolytic cleavage at the C-terminus of the molecule. Further, both fibronectins were bound by heparin-Sepharose, thiol-activated-Sepharose, and gelatin-Sepharose resins. Comparison of peptide maps, generated by limited proteolytic digestion revealed several differences. In particular, a polypeptide of molecular weight approx. 160 000 was larger in old cell fibronectin than in young cell fibronectin. This polypeptide had heparin binding activity, but lacked affinity for gelatin.

Interaction of fibronectin with collagen: age-specific defect in the biological activity of human fibroblast fibronectin.

Fibronectins isolated fro early-passage and late-passage (in vitro aged) human fibroblasts were shown to differ in their ability to support cell adhesion and to influence cell morphology. Because fibroblast adhesion requires interactions between fibronectin, the cell surface, and the component of the extracellular matrix, we examined those functions in isolated cellular fibronectin. In comparison to fibronectin isolated from early-passage cells, fibronectin from late-passage cells bound poorly to native collagen types I and II. No differences were observed in the binding of the two fibronectins to denatured collagen. The binding of both fibronectins to native collagen was similarly promoted by heparin. Cell binding activity was evaluated by using a Boyden chamber assay to measure chemotaxis in response to either fibronectin. No differences were detected in cell binding. Comparisons of molecular weights by NaDodSO4/polyacrylamide gel electrophoresis reveals that fibronectin from late-passage cells is larger than that from early-passage cells. That difference is observed both in fibronectins isolated from conditioned media and in fibronectins isolated from the cell layer. These data support the hypothesis that late-passage cells produce a structurally and functionally distinct fibronectin. The defective binding to native collagen may account for some aspects of the aged phenotype.

Lymphoblastoid cell variant in contact-mediated cell spreading.

We have isolated a clone of human lymphoblastoid cells that is capable of undergoing the phenomenon of contact-mediated cell spreading in vitro. We have detected this behavior when using both transmission electron microscopy (TEM), and differential interference contrast microscopy. Upon cell-cell contact, cells become loosely adherent and then begin to extend cellular processes that contact other cells and the substrate. We have also selected a variant clone that has lost the capability for cell spreading. The adhesions-defective variant becomes adhesion-positive and appears morphologically identical with the adhesive cells only in response to specific amino sugars. In the presence of those sugars the adhesion response is correlated with a shift in the apparent molecular weight of an iodinatable component. We propose that contact-mediated cell spreading in lymphoblastoid cells is mediated by a non-transferable cell surface-associated glycoconjugate. The synthesis of that glycoconjugate is defective in the non-adhesive clone, unless the cells are grown in glucosamine or mannosamine.