Predicting Melanoma Response to BAY 43-9006/Chemotherapy

描述（由申请人提供）：由于发病率的增加和疾病转移后缺乏有效治疗，黑色素瘤的死亡率正在上升。最有希望的新疗法之一是卡铂（C）、紫杉醇（T）和BAY 43 -9006（B），其在转移性黑素瘤的I/II期试验中显示非常高的响应率和异常长的平均疾病进展时间。ECOG正在开展一项比较CT与CTB的随机试验，称为E2603。BAY 43-9006的确切机制尚不清楚，对CTB的反应似乎与B-RAF激活突变无关。我们假设（a）B-RAF抑制以外的机制参与了这种药物组合的活性，（B）CT B仅对一部分黑色素瘤患者有益。我们努力寻找预测个体患者反应的标志物，以便最终只治疗那些可能有反应的患者。我们将筛选与治疗反应相关的选定标志物，并对最佳预测标志物进行综合分析。我们将使用一种新的，客观的，自动化的定量方法组织微阵列分析（AQUA），以评估蛋白质的表达，从三个组是已知的诱导这些药物; MARK途径，凋亡途径和促血管生成蛋白。我们将从针对这些蛋白质的子集的抗体的严格验证开始，然后对来自I/II期研究中用CTB治疗的50名患者的肿瘤进行初步评价。将在300例存档黑素瘤标本和300例良性痣中进一步评价应答者和非应答者之间表达差异的标志物，以评估转移性黑素瘤中标志物表达的患病率。同时，将前瞻性采集入组E2603的患者的标本。在组织微阵列上使用AQUA，我们将研究两个治疗组中应答者和非应答者之间标志物表达的差异，目的是开发一种检测方法来特异性预测对CTB的应答。我们将评估单个标记以及标记组。

DESCRIPTION (provided by applicant): Mortality from melanoma is rising due to the increase in incidence and lack of effective therapy once the disease has metastasized. One of the most promising new therapies is carboplatin (C), paclitaxel (T) and BAY43-9006 (B), which revealed very high response rates with unusually long mean time to disease progression in a Phase l/ll trial in metastatic melanoma. ECOG is opening a randomized trial comparing CT to CTB, called E2603. The precise mechanism of BAY 43-9006 is unknown, and response to CTB appears not to be associated with B-RAF activating mutations. We hypothesize that (a) mechanisms other than B-RAF inhibition are involved in the activity of this combination of drugs and (b) CTB will benefit only a subset of melanoma patients. We strive to find markers that predict response in the individual patient in order to ultimately treat only those patients that are likely to respond. We will screen selected markers for association with response to therapy, and perform comprehensive analysis on the best predictive markers. We will use a novel, objective, automated quantitative method of tissue microarray analysis (AQUA) to evaluate expression of proteins from three groups that are known to be induced by these drugs; the MARK pathway, apoptotic pathways and pro-angiogenic proteins. We will start with rigorous validation of antibodies to a subset of these proteins, followed by initial evaluation on tumors from 50 patients treated with CTB in the Phase l/ll study. Markers with differences in expression between responders and non-responders will be further evaluated on 300 archival melanoma specimens and 300 benign nevi to assess prevalence of markers expression in metastatic melanomas. Concurrently, specimens from patients enrolled in E2603 will be prospectively collected. Using AQUA on tissue microarrays, we will study differences in marker expression between responders and non-responders on both treatment arms, with the goal of developing an assay to specifically predict response to CTB. We will assess individual markers as well as panels of markers.