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Qin H, Tan Y, Diao L, Hui AM, Wu Z, Zhou Y, Sun J, Xiang X, Qiu J, Hu W. Effect of High-Fat Food on the Pharmacokinetic Profile and Safety of SAF-189s, an ALK/ROS1 Inhibitor, in Healthy Chinese Adults. Drugs R D 2023; 23:465-473. [PMID: 37934354 PMCID: PMC10676332 DOI: 10.1007/s40268-023-00446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study was conducted to investigate the effect of high-fat meals on the pharmacokinetics (PK) and safety profile of SAF-189s, a novel ALK/ROS1 inhibitor. METHODS This was a single-center, phase I, open-label, crossover study in which healthy adults (≥18 years) were randomized (1:1) to two sequences of SAF-189s administration (fasted-fed or fed-fasted) separated by a 14-day washout. After a ≥10-h overnight fast, volunteers received SAF-189s 160 mg orally in a fasted state or 30 min after a high-fat, high-calorie meal. Similarity of pharmacokinetic parameters was concluded if the 90% CI for the geometric mean ratio (GMR) between the fed and fasted group fell within the predefined range of 0.80-1.25. RESULTS In total, 24 subjects were enrolled and 23 completed the study. SAF-189s maximum plasma concentration (Cmax; GMR: 109.1% [90% CI 103.1-115.4]) was comparable under fed (high-fat meal, n = 24) versus fasted (n = 23) conditions, with no effect on area under the plasma concentration-time curve from time 0 to t (AUC0-t; GMR: 105.1% [90% CI 100.3-110.2]) and AUC from time 0 to infinity (AUC0-∞; GMR: 105.5% [90% CI, 100.6-110.6]). In both groups, the median time to maximum plasma concentration (tmax) was around 6 h and mean plasma half-life (t½) was around 35 h. Fed administration led to a lower incidence of treatment-emergent adverse events (TEAEs; 29.2% vs 54.2%), including gastrointestinal disorders (4.2% vs 41.7%) and headache (0.0% vs 12.5%), versus fasted administration. CONCLUSIONS A high-fat meal had minimal effect on the pharmacokinetic profile of SAF-189s compared with a fasted state following a single dose of 160 mg. Administration with a high-fat meal led to a lower incidence of TEAEs.
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Affiliation(s)
- Huiling Qin
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Yan Tan
- Shanghai Fosun Pharmaceutical Development Co., Ltd., 1289 Yishan Road, Shanghai, 200233, China
| | - Lei Diao
- Shanghai Fosun Pharmaceutical Development Co., Ltd., 1289 Yishan Road, Shanghai, 200233, China
| | - Ai-Min Hui
- EnCureGen Pharma, 9 Yayingshi Road, Huangpu District, Guangzhou, 510700, China
| | - Zhuli Wu
- Shanghai Fosun Pharmaceutical Development Co., Ltd., 1289 Yishan Road, Shanghai, 200233, China
| | - Yongchun Zhou
- Wanbang Biopharmaceuticals, 6 Yangshan Road, Economic Zone, Xuzhou, 221004, Jiangsu, China
| | - Juan Sun
- Shanghai Fosun Pharmaceutical Development Co., Ltd., 1289 Yishan Road, Shanghai, 200233, China
| | - Xiao Xiang
- Shanghai Fosun Pharmaceutical Development Co., Ltd., 1289 Yishan Road, Shanghai, 200233, China
| | - Jingjun Qiu
- Shanghai Fosun Pharmaceutical Development Co., Ltd., 1289 Yishan Road, Shanghai, 200233, China
| | - Wei Hu
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China.
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Sun Y, Li C, Wang X, Zheng Y, Wu Z, Hui AM, Diao L. Model-informed dose selection for an investigational human epidermal growth factor receptor 2 antibody-drug conjugate FS-1502 in patients with human epidermal growth factor receptor 2-expressing advanced malignant solid tumours. Br J Clin Pharmacol 2023. [PMID: 37926561 DOI: 10.1111/bcp.15955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
AIMS The dose-escalation phase (phase Ia study) of a novel human epidermal growth factor receptor 2 (HER2) antibody-drug conjugate (ADC) FS-1502 included a dose range from 0.1 to 3.5 mg/kg in HER2-expressing advanced malignant solid tumours. However, the defined maximum tolerated dose was not reached. This model-informed approach integrated population pharmacokinetic (PopPK) modelling and exposure-response (E-R) analysis to facilitate dose selection for phase II. METHODS The PopPK model was constructed using PK data from 109 Chinese patients who received doses of 0.1-3.5 mg/kg FS-1502 every 3 (Q3W) or 4 weeks during a phase I dose-escalation and dose expansion trial. The structural model consisted of compartment models for FS-1502 and unconjugated monomethyl auristatin F. E-R was explored for the percentage change in tumour size, overall response rate and treatment-related adverse events. RESULTS A semi-mechanistic 2-analyte PopPK model was developed. The FS-1502 PK data were best described by a 2-compartment PK model with parallel linear and nonlinear Michaelis-Menten eliminations. The PK of unconjugated monomethyl auristatin F was described by a 2-compartment model with first-order elimination. E-R analysis supported the clinically meaningful efficacy of FS-1502 at 2.3 mg/kg and above. However, 2.3 mg/kg Q3W was considered to have a better benefit-risk balance due to a lower incidence of safety events without a significant reduction in efficacy compared to 3.0 mg/kg Q3W. CONCLUSION This PopPK and E-R analysis guided the recommended phase II dose selection of 2.3 mg/kg Q3W and supported body weight-based dosing for an investigational HER2 ADC FS-1502.
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Affiliation(s)
- Yi Sun
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | - Chao Li
- Anheart Therapeutics, New York, New York, USA
| | - Xingli Wang
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | - Yi Zheng
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | - Zhuli Wu
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | | | - Lei Diao
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
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Hu X, Li W, Zeng K, Xu Z, Li C, Kang Z, Li S, Huang X, Han P, Lin H, Hui AM, Tan Y, Diao L, Li B, Wang X, Wu Z, Lin X. Phase 1 dose-escalation study to evaluate the safety, tolerability, pharmacokinetics, and anti-tumor activity of FCN-159 in adults with neurofibromatosis type 1-related unresectable plexiform neurofibromas. BMC Med 2023; 21:230. [PMID: 37400844 DOI: 10.1186/s12916-023-02927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/07/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Surgery is a common treatment strategy for patients with neurofibromatosis type 1 (NF1)-related plexiform neurofibroma (PN) and has limited efficacy. FCN-159 is a novel anti-tumorigenic drug via selective inhibition of MEK1/2. This study assesses the safety and efficacy of FCN-159 in patients with NF1-related PN. METHODS This is a multicenter, open-label, single-arm, phase I dose-escalation study. Patients with NF1-related PN that was non-resectable or unsuitable for surgery were enrolled; they received FCN-159 monotherapy daily in 28-day cycles. RESULTS Nineteen adults were enrolled in the study, 3 in 4 mg, 4 in 6 mg, 8 in 8 mg, and 4 in 12 mg. Among patients included in dose-limiting toxicity (DLT) analysis, DLTs (grade 3 folliculitis) were reported in 1 of 8 patients (16.7%) receiving 8 mg and 3 of 3 (100%) patients receiving 12 mg. The maximum tolerated dose was determined to be 8 mg. FCN-159-related treatment-emergent adverse events (TEAEs) were observed in 19 patients (100%); most of which were grade 1 or 2. Nine (47.4%) patients reported grade 3 study-drug-related TEAEs across all dose levels, including four experiencing paronychia and five experiencing folliculitis. Of the 16 patients analyzed, all (100%) had reduced tumor size and six (37.5%) achieved partial responses; the largest reduction in tumor size was 84.2%. The pharmacokinetic profile was approximately linear between 4 and 12 mg, and the half-life supported once daily dosing. CONCLUSIONS FCN-159 was well tolerated up to 8 mg daily with manageable adverse events and showed promising anti-tumorigenic activity in patients with NF1-related PN, warranting further investigation in this indication. TRIAL REGISTRATION ClinicalTrials.gov, NCT04954001. Registered 08 July 2021.
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Affiliation(s)
- Xiaojie Hu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Wenbin Li
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Kang Zeng
- Department of Dermatology, NanFang Hospital Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, Guangdong, 510515, China
| | - Zhongyuan Xu
- Clinical Pharmacy Center, Nanfang Hospital Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, Guangdong, 510515, China
| | - Changxing Li
- Department of Dermatology, NanFang Hospital Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, Guangdong, 510515, China
| | - Zhuang Kang
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Shenglan Li
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xin Huang
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd, 1289 Yishan Road, Shanghai, 200233, China
| | - Pu Han
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd, 1289 Yishan Road, Shanghai, 200233, China
| | - Hongmei Lin
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd, 1289 Yishan Road, Shanghai, 200233, China
| | - Ai-Min Hui
- Fosun Pharma USA Inc., 91 Hartwell Ave Suite 305, Lexington, MA, 02421, USA
- EnCureGen Pharma, 9 Yayingshi Road, Guangzhou, 510525, China
| | - Yan Tan
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd, 1289 Yishan Road, Shanghai, 200233, China
| | - Lei Diao
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd, 1289 Yishan Road, Shanghai, 200233, China
| | - Ben Li
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd, 1289 Yishan Road, Shanghai, 200233, China
| | - Xingli Wang
- Shanghai Fosun Pharmaceutical Development Co., Ltd, 1289 Yishan Road, Shanghai, 20033, China
| | - Zhuli Wu
- Shanghai Fosun Pharmaceutical Development Co., Ltd, 1289 Yishan Road, Shanghai, 20033, China.
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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Li J, Tan Y, Li K, Hui AM, Wu Z, Han P, Wei Z, Qiu J, Diao L, Wang X. Effect of Food (Low and High Fat) on Pharmacokinetics of FCN-159, a Selective MEK Inhibitor, in Healthy Chinese Males. Adv Ther 2023; 40:1074-1086. [PMID: 36627544 DOI: 10.1007/s12325-022-02375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/27/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION FCN-159 is a novel, oral, potent, selective MEK1/2 inhibitor in clinical development for the treatment of NRAS-mutant advanced melanoma and neurofibromatosis type 1. We investigated the effect of food on the pharmacokinetics (PK), safety, and tolerability of FCN-159. METHODS In this single-center, open-label, phase 1 study with a three-period, three-sequence, crossover design, healthy Chinese male subjects (n = 24) were randomized (1:1:1) to receive a single, oral 8 mg dose of FCN-159 in the fasted state (overnight, > 10 h), and with a low-fat and a high-fat meal, separated by a 10-day washout. PK parameters including time to maximum plasma concentration (Cmax) and area under the concentration-time curve (AUC) were compared using geometric least-squares mean ratios (GLSMR), with the fasted state as the reference. A 90% CI for the GLSMR within 80-125% indicated no significant food effect. RESULTS A low-fat meal (n = 23) did not affect the PK profile of FCN-159: G LSMR for AUC from time 0 to t (AUC0-t), 106.9% (90% CI 99.9-114.4%); AUC from time 0 to infinity (AUC0-∞), 106.8% (90% CI 100.0-114.0%); Cmax, 96.4% (90% CI 83.9-110.8%). A high-fat meal (n = 24) did not affect exposure to FCN-159 (GLSMR for AUC0-t, 99.4%; 90% CI 99.0-106.3%; AUC0-∞, 99.5 5%; 90% CI 93.2-106.1%), but modestly reduced Cmax by 15% (GLSMR 84.9%; 90% CI 74.0-97.3%). Both the low-fat and high-fat meals slightly prolonged the median time to Cmax by 0.5 h (90% CI 0.5-1.0 h). FCN-159 was generally well tolerated, with a lower incidence of treatment-emergent adverse events following administration in the fasted state than with a low-fat or high-fat meal (20.8%, 39.1%, and 37.5%, respectively). CONCLUSION Food did not affect the PK profile of FCN-159 to a clinically meaningful extent compared with administration in the fasted state.
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Affiliation(s)
- Jiangfan Li
- Department of Clinical Pharmacology, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, 101149, China
| | - Yan Tan
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., 1289 Yishan Road, Shanghai, 200233, China
| | - Kexin Li
- Clinical Trial Center, Beijing Hospital, Beijing, 100730, China
| | - Ai-Min Hui
- Fosun Pharma USA Inc., 91 Hartwell Ave Suite 305, Lexington, MA, 02421, USA
| | - Zhuli Wu
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., 1289 Yishan Road, Shanghai, 200233, China
| | - Pu Han
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., 1289 Yishan Road, Shanghai, 200233, China
| | - Zhen Wei
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., 1289 Yishan Road, Shanghai, 200233, China
| | - Jingjun Qiu
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., 1289 Yishan Road, Shanghai, 200233, China
| | - Lei Diao
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., 1289 Yishan Road, Shanghai, 200233, China.
| | - Xuhong Wang
- Department of Clinical Pharmacology, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, 101149, China.
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Li Q, Wang X, Cheng Y, Liu Y, Chang J, Wang Z, Wu C, Wang M, Hui AM, Wu Z, Jin Y, Huang X, Zhong L, Diao L, Zhao H, Xu B. Abstract P4-01-07: FS-1502, an anti-HER2 ADC, in Patients with HER2-Expressing Advanced Solid Tumors: A Phase 1a Dose-Escalation Study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: FS-1502 is a HER2-targeting antibody drug-conjugate with a cleavable β-glucuronide linker and an antimitotic agent (monomethyl auristatin F) which showed promising antitumor activity in preclinical studies. We are evaluating the safety and tolerability of FS-1502 in patients with HER2-expressing advanced solid tumors (NCT03944499). Methods: Patients with HER2-expresssing advanced solid tumors who had failed prior standard of care therapies were enrolled in a single-arm, open-label, dose-escalation phase Ia study in China. FS-1502 was given IV once in 21-day or 28-day cycles. The primary endpoint was incidence of dose-limiting toxicity (DLT). Adverse events (AEs), objective response rate (ORR) and duration of response (DoR) were also assessed. Data cutoff was December 30, 2021. Results: A total of 67 patients, 64 with breast cancer and 3 with other solid tumors, with median 3 prior therapies (range 1-10), were enrolled in 5 sites and treated with FS-1502 at doses of 0.1-3.5 mg/kg. Two DLTs, as defined by the protocol, were observed, with one G2 decrease in creatinine clearance at 3.0 mg/kg and one G3 thrombocytopenia with hemorrhage at 3.5 mg/kg. No Grade 4/5 events were observed. Grade 3 TRAEs were observed in 24 (35.8%) patients with the most common AEs of hypokalemia (14.9%) and decreased platelet count (9.0%). ORRs were observed at doses at or above 1.0 mg/kg with an ORR of 66.7% (4/6) at the recommended phase 2 dose (RP2D) of 2.3 mg/kg. Median duration of response (DoR) across all dose levels was 9.2 months (95%CI 5.6-NR). ORR for HER2-low patients was 42.9% (3/7). Plasma concentration and exposure (AUC) based on total ADC and total antibody increased dose proportionally at ≥1.0 mg/kg, with a T1/2 of 2.4-4.9 days. The incidence and magnitude of immunogenicity were low. While no MTD was determined, the 2.3mg/kg dose once in a 21-day cycle was selected as the RP2D based on safety, antitumor activity and PK data. Conclusions: FS-1502 was well-tolerated and demonstrated encouraging antitumor activity in both HER2-high and -low patients. Phase Ib and phase II clinical trials with FS-1502 are currently ongoing in various solid tumor indications including breast, gastric, and colorectal cancer.
Citation Format: Qiao Li, Xian Wang, Ying Cheng, Yunjiang Liu, Jianhua Chang, Zhuo Wang, Chunjiao Wu, Mingxia Wang, Ai-Min Hui, Zhuli Wu, Yongli Jin, Xin Huang, Liping Zhong, Lei Diao, Han Zhao, Binghe Xu. FS-1502, an anti-HER2 ADC, in Patients with HER2-Expressing Advanced Solid Tumors: A Phase 1a Dose-Escalation Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-07.
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Affiliation(s)
- Qiao Li
- 1Cancer Hospital Chinese Academy of Medical Sciences
| | - Xian Wang
- 2SIR RUN RUN SHAW HOSPITAL, ZHEJIANG UNVERSITY SCHOOL OF MEDICINE
| | - Ying Cheng
- 3Jilin Cancer Hospital, 1066 Jinhu Road, China (People’s Republic)
| | - Yunjiang Liu
- 4The Fourth Hospital of Hebei Medical University
| | - Jianhua Chang
- 5Shenzhen Hospital, Cancer Hospital, Chinese Academy of Medical Sciences, China (People’s Republic)
| | - Zhuo Wang
- 6SIR RUN RUN SHAW HOSPITAL, ZHEJIANG UNVERSITY SCHOOL OF MEDICINE
| | - Chunjiao Wu
- 7Jilin Cancer Hospital, China (People’s Republic)
| | - Mingxia Wang
- 8The Fourth Hospital of Hebei Medical University, China (People’s Republic)
| | | | - Zhuli Wu
- 10Beijing Fosun Pharmaceutical Research and Development Co., Ltd
| | - Yongli Jin
- 11Beijing Fosun Pharmaceutical Research and Development Co., Ltd
| | - Xin Huang
- 12Beijing Fosun Pharmaceutical Research and Development Co., Ltd
| | - Liping Zhong
- 13Beijing Fosun Pharmaceutical Research and Development Co., Ltd
| | - Lei Diao
- 14Beijing Fosun Pharmaceutical Research and Development Co., Ltd
| | - Han Zhao
- 15Beijing Fosun Pharmaceutical Research and Development Co., Ltd
| | - Binghe Xu
- 16Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Shi J, Li W, Tong Z, Zang A, Zeng X, Wang S, Huang T, Wang Y, Song Y, Kang L, Lv Z, Shi Y, Yang H, Wu J, Yin Y, Liang Y, Tan J, Ming J, Yang Y, Luo S, Gui X, Hui AM, Wu Z, Tian L, Yang Y, Diao L, Zhang W, Zhang Y, Liu Y. Abstract P4-01-21: Phase 2 Study of the CDK4/6 Inhibitor FCN-437c in Combination With Fulvestrant or Letrozole and Goserelin in Patients With HR+, HER2– Advanced Breast Cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: FCN-437c is a second-generation CDK4/6 inhibitor. Phase 1b clinical results indicated improved antitumor activity in patients (pts) with HR+, HER2– advanced breast cancer (ABC), treated with FCN-437c + letrozole.
Methods: This Phase 2, multicenter, open-label clinical study evaluated the antitumor activity, pharmacokinetics (PK), and safety of FCN-437c + fulvestrant in post-menopausal pts (Cohort 1, treatment-naïve or 2L), FCN-437c + letrozole + goserelin in pre-menopausal pts (Cohort 2, treatment-naïve). Pts received FCN-437c (200 mg QD) in a 21-day-on and 7-day-off schedule either in combination with fulvestrant (500 mg D1) or letrozole (2.5 mg QD) + goserelin (3.6 mg once per cycle) in 28-day cycles. The primary endpoint was overall response rate (ORR) and secondary endpoints were progression-free survival (PFS), overall survival (OS), PK, and safety.
Results: At study cutoff (Feb 7, 2022), 36 pts were enrolled in Cohort 1 and 31 pts were in Cohort 2; 42 (62.7%) pts had visceral metastases and 9 (13.4%) pts had bone-only metastases. In Cohort 1, 18 pts were treatment-naïve, 15 pts had received 1L treatment, and 3 pts had received ≥2L treatment. In Cohort 2, 25 pts were treatment-naïve and 6 pts had received 1L treatment. Overall, 27 pts in the per-protocol set achieved partial response (PR), resulting in an ORR of 40.9% (95% CI, 29.0-53.7). Median follow-up was 12.8 months, and median PFS (mPFS), OS, and DOR were not reached. However, at 12 months, the PFS rate was 67.7% (95% CI, 53.2-78.6) and the OS rate was 95.9% (95% CI, 84.5-99.0); the 6-month DOR rate was 96.0% (95% CI, 74.8-99.4). In Cohort 1 (n=35), 11 pts achieved PR: the ORR was 31.4% (16.9-49.3%) and mPFS was 12.9 months (95% CI, 9.2-NR); the 6-month DOR rate was 100%. In Cohort 2 (n=31), 16 pts achieved PR: the ORR was 51.6% (95% CI, 33.1-69.9%). mPFS, OS, and DOR were not reached; the 6-month DOR rate was 92.9% (95% CI, 59.08-98.96) (Table). Treatment-emergent adverse events (TEAEs) were observed in all pts. Majority of AE were G1 or 2 except for hematological TEAE. 58 (86.6%) pts reported grade ≥3 TEAEs, mainly neutropenia (74.6%), leukopenia (49.3%), hypertriglyceridemia (6.0%), lymphocyte count decrease (4.5%), and γ-glutamyltransferase increase (3.0%): most were reversed through dose interruption and symptomatic therapy. Steady-state PK parameters were analyzed after 15-21 days of QD administration: Cohort 1: median Tmax was 3 h, geomean T1/2 was 44.6 h, geomean Cmax was 1650.7 ng/mL, and geomean AUC0-24h was 29,148.08 h*ng/mL; the geomean accumulation ratios of AUC0-24h and RCmax were 2.18 and 1.74, respectively, compared with first dose. Cohort 2: median Tmax was 4 h, geomean T1/2 was 35.7 h, geomean Cmax was 1314.34 ng/mL, and geomean AUC0-24h was 22,889.96 h*ng/mL; the geomean accumulation ratios of AUC0-24h and RCmax were 1.95 and 1.63, respectively, compared with first dose.
Conclusion: FCN-437c in combination with fulvestrant or letrozole + goserelin demonstrates antitumor activity and safety and is well tolerated in pts with HR+, HER2– ABC. This combination therapy will be further investigated in 2 ongoing Phase 3 trials (NCT05438810 and NCT05439499).
Clinical trial number: NCT05004142. Research Sponsor: Avanc Pharmaceutical Co., Ltd
Table. Clinical outcomes for patients in the per-protocol set.
Citation Format: JiaJie Shi, Wei Li, Zhongsheng Tong, Aimin Zang, Xiaohua Zeng, Shui Wang, Tao Huang, Ying Wang, Yanqiu Song, Lihua Kang, Zheng Lv, Yehui Shi, Hua Yang, Jing Wu, Yongmei Yin, Yan Liang, Jie Tan, Jie Ming, Yaping Yang, Simin Luo, Xiujuan Gui, Ai-Min Hui, Zhuli Wu, Ling Tian, Yuchen Yang, Lei Diao, Wenjing Zhang, Yongjiao Zhang, Yunjiang Liu. Phase 2 Study of the CDK4/6 Inhibitor FCN-437c in Combination With Fulvestrant or Letrozole and Goserelin in Patients With HR+, HER2– Advanced Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-21.
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Affiliation(s)
- JiaJie Shi
- 1The Fourth Hospital of Hebei Medical University
| | - Wei Li
- 2The First Hospital of Jilin University, Changchun
| | | | - Aimin Zang
- 4Affiliated Hospital of Hebei University
| | | | | | - Tao Huang
- 7Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Ying Wang
- 8Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
| | | | - Lihua Kang
- 10The First Hospital of Jilin University
| | - Zheng Lv
- 11The First Hospital of Jilin University
| | - Yehui Shi
- 12Department of Breast Medical Oncology, Tianjin Medical University Cancer Institute and Hospital
| | - Hua Yang
- 13Affiliated Hospital of Hebei University
| | - Jing Wu
- 14Chongqing University Cancer Hospital
| | - Yongmei Yin
- 15Department of Medical Oncology, Jiangsu Province Hospital, Nanjing
| | - Yan Liang
- 16Department of Breast Surgery, Jiangsu Province Hospital, Nanjing
| | - Jie Tan
- 17Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Jie Ming
- 18Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Yaping Yang
- 19Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
| | - Simin Luo
- 20Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
| | - Xiujuan Gui
- 21Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
| | | | - Zhuli Wu
- 23Beijing Fosun Pharmaceutical Research and Development Co., Ltd
| | | | - Yuchen Yang
- 25Beijing Fosun Pharmaceutical Research and Development Co., Ltd
| | - Lei Diao
- 26Beijing Fosun Pharmaceutical Research and Development Co., Ltd
| | - Wenjing Zhang
- 27Beijing Fosun Pharmaceutical Research and Development Co., Ltd
| | - Yongjiao Zhang
- 28Beijing Fosun Pharmaceutical Research and Development Co., Ltd
| | - Yunjiang Liu
- 29The Fourth Hospital of Hebei Medical University
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Hui AM, Li J, Zhu L, Tang R, Ye H, Lin M, Ge L, Wang X, Peng F, Wu Z, Guo X, Shi Y, Pan H, Zhu J, Song Z, Qiu J, Wang W, Zheng J, Ozhelvaci O, Shpyro S, Bushway M, Derhovanessian E, Kühnle MC, Luxemburger U, Muik A, Shishkova Y, Khondker Z, Hu S, Lagkadinou E, Şahin U, Türeci Ö, Zhu F. Immunogenicity and safety of BNT162b2 mRNA vaccine in Chinese adults: A phase 2 randomised clinical trial. Lancet Reg Health West Pac 2022; 29:100586. [PMID: 36120090 PMCID: PMC9472569 DOI: 10.1016/j.lanwpc.2022.100586] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND BNT162b2, an mRNA vaccine against COVID-19, is being utilised worldwide, but immunogenicity and safety data in Chinese individuals are limited. METHODS This phase 2, randomised, double-blind, placebo-controlled trial included healthy or medically stable individuals aged 18-85 years enrolled at two clinical sites in China. Participants were stratified by age (≤55 or >55 years) and randomly assigned (3:1) by an independent randomisation professional to receive two doses of intramuscular BNT162b2 30 μg or placebo, administered 21 days apart. Study participants, study personnel, investigators, statisticians, and the sponsor's study management team were blinded to treatment assignment. Primary immunogenicity endpoints were the geometric mean titers (GMTs) of neutralising antibodies to live severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and seroconversion rates (SCR) 1 month after the second dose. Safety assessments included reactogenicity within 14 days of vaccination, adverse events (AEs), and clinical laboratory parameters. Randomised participants who received at least one dose were included in the efficacy and safety analyses on a complete case basis (incomplete/missing data not imputed). Results up to 6 months after the second dose are reported. FINDINGS Overall, 959 participants (all of Han ethnicity) who were recruited between December 5th, 2020 and January 9th, 2021 received at least one injection (BNT162b2, n=720; placebo, n=239). At 1 month after the second dose, the 50% neutralising antibody GMT was 294.4 (95% CI; 281.1-308.4) in the BNT162b2 group and 5.0 (95% CI; 5.0-5.0) in the placebo group. SCRs were 99.7% (95% CI; 99.0%-100.0%) and 0% (95% CI; 0.0%-1.5%), respectively (p<0.0001 vs placebo). Although the GMT of neutralising antibodies in the BNT162b2 group was greatly reduced at 6 months after the second dose, the SCR still remained at 58.8%. BNT162b2-elicited sera neutralised SARS-CoV-2 variants of concern. T-cell responses were detected in 58/73 (79.5%) BNT162b2 recipients. Reactogenicity was mild or moderate in severity and resolved within a few days after onset. Unsolicited AEs were uncommon at 1 month following vaccine administration, and there were no vaccine-related serious AEs at 1 month or 6 months after the second dose. INTERPRETATION BNT162b2 vaccination induced a robust immune response with acceptable tolerability in Han Chinese adults. However, follow-up duration was relatively short and COVID-19 rates were not assessed. Safety data collection is continuing until 12 months after the second dose. FUNDING BioNTech - sponsored the trial. Shanghai Fosun Pharmaceutical Development Inc. (Fosun Pharma) - conducted the trial, funded medical writing. CLINICALTRIALSGOV REGISTRATION NUMBER NCT04649021. Trial status: Completed.
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Affiliation(s)
| | - Jingxin Li
- NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Li Zhu
- Taizhou People's Hospital, Taizhou, China
| | - Rong Tang
- NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Huayue Ye
- Taizhou Vaccine Clinical Research Centre, Taizhou, China
| | - Mei Lin
- Taizhou People's Hospital, Taizhou, China
| | - Lei Ge
- Fosun Pharma, Beijing, China
| | | | - Fuzhong Peng
- Taizhou Vaccine Clinical Research Centre, Taizhou, China
| | | | - Xiling Guo
- NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Yunfeng Shi
- NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Hongxing Pan
- NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Jiahong Zhu
- Lianshui Center for Disease Control and Prevention, Lianshui, China
| | - Zhizhou Song
- Lianshui Center for Disease Control and Prevention, Lianshui, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Fengcai Zhu
- NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
- Centre for Global Health, Nanjing Medical University, Nanjing, China
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Patnaik A, Hamilton E, Xing Y, Rasco DW, Smith L, Lee YL, Fang S, Wei J, Hui AM. A Phase I Dose-Escalation and Dose-Expansion Study of FCN-437c, a Novel CDK4/6 Inhibitor, in Patients with Advanced Solid Tumors. Cancers (Basel) 2022; 14:cancers14204996. [PMID: 36291780 PMCID: PMC9599640 DOI: 10.3390/cancers14204996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors have provided clinical benefits for a subset of patients with advanced breast cancer; however, treatment resistance generally emerges over time in patients with breast cancer, and the efficacy of existing CDK4/6 inhibitors in patients with other cancers is modest. The aim of this study was to explore the safety and preliminary antitumor efficacy of a novel, orally available CDK4/6 inhibitor, FCN-437c, in patients with advanced solid tumors. The results demonstrated promising signs of durable tumor response and disease control in this patient population. The safety profile was consistent with that of approved CDK4/6 inhibitors, with no concerning signals in terms of pulmonary, cardiac, or thrombotic risk. The efficacy and safety of FCN-437c merit further study, and this novel agent holds promise as a new alternative treatment for patients with few options. Abstract A phase I study evaluated the safety, tolerability, and maximum-tolerated dose (MTD)/recommended phase II dose (RP2D) of FCN-437c, a novel, orally available cyclin-dependent kinase inhibitor (CDK4/6i), in participants with advanced/metastatic solid tumors (aSTs). FCN-437c was escalated from 50 mg (once daily [QD] on days 1–21 of 28-day cycles) to the MTD/RP2D. In the dose-expansion phase, patients with CDK4/6i-treated breast cancer, or KRAS-mutant (KRASmut) non-small-cell lung cancer (NSCLC) received the MTD. Twenty-two patients were enrolled. The most common tumors in the dose-escalation phase (n = 15) were breast, colorectal, and lung (each n = 4 [27.3%]). The dose-expansion phase included five (71.4%) patients with breast cancer and two (28.6%) with KRASmut NSCLC. Twenty (90.9%) participants experienced FCN-437c–related adverse events. Dose-limiting toxicities occurred in two (33.3%) participants (200-mg dose, dose-escalation phase): grade 3 neutropenia and grade 4 neutrophil count decreased. Due to toxicities reported at 150 mg QD, the MTD was de-escalated to 100 mg QD. One (4.5%) participant (KRASmut NSCLC, 100-mg dose) achieved a partial response lasting 724+ days, and five (22.7%) had stable disease lasting 56+ days. In conclusion, FCN-437c was well tolerated with encouraging signs of antitumor activity and disease control. Further exploration of FCN-437c in aSTs is warranted.
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Affiliation(s)
- Amita Patnaik
- South Texas Accelerated Research Therapeutics, San Antonio, TX 78229, USA
| | - Erika Hamilton
- Breast and Gynecologic Research Program, Sarah Cannon Research Institute, Tennessee Oncology PLLC, Nashville, TN 37203, USA
| | - Yan Xing
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Drew W. Rasco
- South Texas Accelerated Research Therapeutics, San Antonio, TX 78229, USA
| | - Lon Smith
- South Texas Accelerated Research Therapeutics, San Antonio, TX 78229, USA
| | - Ya-Li Lee
- Fosun Pharma USA Inc., Lexington, MA 02421, USA
| | - Steven Fang
- Fosun Pharma USA Inc., Lexington, MA 02421, USA
| | - Jiao Wei
- Fosun Pharma USA Inc., Lexington, MA 02421, USA
- Correspondence:
| | - Ai-Min Hui
- Fosun Pharma USA Inc., Lexington, MA 02421, USA
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Mao L, Guo J, Zhu L, Jiang Y, Yan W, Zhang J, Hui AM, Yang Y, Diao L, Tan Y, Zhao H, Jiang Y, Wu Z, Si L. A first-in-human, phase 1a dose-escalation study of the selective MEK1/2 inhibitor FCN-159 in patients with advanced NRAS-mutant melanoma. Eur J Cancer 2022; 175:125-135. [PMID: 36113242 DOI: 10.1016/j.ejca.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND A phase 1a first-in-human study evaluated the safety/tolerability, preliminary antitumour activity and pharmacokinetics of the oral MEK1/2 inhibitor FCN-159 in Chinese patients with advanced, NRAS-mutant melanoma. PATIENTS AND METHODS Patients received a single FCN-159 dose at assigned levels, proceeding to continuous dosing (once daily [QD] for 28-day cycles) if no dose-limiting toxicities (DLTs) occurred within the next 3 days. Dose escalation was initiated after review of data for the previous dose level. The primary end-point was incidence of DLTs after the first dose. RESULTS Thirty-three patients were enrolled across nine FCN-159 dose groups (0.2-15 mg QD). One DLT occurred: grade 3 folliculitis in the 15-mg group. There was one grade >3 treatment-emergent adverse event (TEAE), death of unknown aetiology (not FCN-159 related). The most common FCN-159-related TEAE was rash (36.4%), and the incidence of grade ≥3 FCN-159-related TEAEs was 15.2%. Antitumour activity at QD doses <6 mg was limited; therefore, efficacy data are presented only for doses ≥6 mg (n = 21). The objective response and clinical benefit rates were 19.0% (four partial responses) and 52.4%, respectively. Median (95% confidence interval) duration of response and progression-free survival were 4.8 months (2.8-not reached) and 3.8 months (1.8-5.6), respectively. FCN-159 exposure increased dose-proportionately; geometric mean terminal half-life was 29.9-56.9 h. CONCLUSIONS FCN-159 was well tolerated and demonstrated promising antitumour activity at doses ≥6 mg QD in patients with advanced, NRAS-mutant melanoma. The recommended phase 2 dose was 12 mg QD. CLINICALTRIALS GOV IDENTIFIER NCT03932253. https://clinicaltrials.gov/ct2/show/NCT03932253.
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Affiliation(s)
- Lili Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lingjun Zhu
- Jiangsu Province Hospital, Nanjing, Jiangsu Province, China
| | - Yu Jiang
- West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Wangjun Yan
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jian Zhang
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ai-Min Hui
- Fosun Pharma USA Inc., Lexington, MA, USA
| | - Yuchen Yang
- Fosun Pharmaceutical Co., Ltd., Shanghai, China
| | - Lei Diao
- Fosun Pharmaceutical Co., Ltd., Shanghai, China
| | - Yan Tan
- Fosun Pharmaceutical Co., Ltd., Shanghai, China
| | - Han Zhao
- Fosun Pharmaceutical Co., Ltd., Shanghai, China
| | | | - Zhuli Wu
- Fosun Pharmaceutical Co., Ltd., Shanghai, China.
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China.
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Lu J, Jamieson BD, Hui AM. Avatrombopag ethnic sensitivity analysis in chronic liver disease and thrombocytopenia patients: individual-level pooled analysis. Therap Adv Gastroenterol 2022; 15:17562848221105976. [PMID: 35795378 PMCID: PMC9252017 DOI: 10.1177/17562848221105976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Few data have been published on the ethnic sensitivity of effectiveness, pharmacokinetics (PK), and pharmacodynamics (PD) of avatrombopag for the management of thrombocytopenia in patients with chronic liver disease (CLD). METHODS An ethnic sensitivity analysis was performed based on the results from two phase III studies (ADAPT-1 and ADAPT-2), with a primary endpoint of the proportion of patients without the requirement of platelet transfusion or rescue treatment for bleeding after randomization to 7 days following a scheduled procedure, and three phase I studies in healthy subjects. Cochran-Mantel-Haenszel and Fisher's exact tests were used to compare the differences in effectiveness in different ethnicities and overall population. RESULTS In total, 435 patients (placebo, n = 158; avatrombopag, n = 277) were stratified into various ethnic groups: 121 East Asians, including the subgroup of 27 Chinese, and 259 Caucasians. The proportion of patients who did not receive a platelet transfusion and those with a platelet count ⩾50 × 109/L in the avatrombopag 40 and 60 mg groups were higher than that of placebo for all ethnicities and in the overall population. Statistical significance was obtained in the overall population and for all ethnicities other than Chinese patients, a group with a very small sample size. No significant difference was observed in the proportion of responders in each ethnic group compared to overall population (p > 0.05). The incidence of adverse events in East Asians was similar to that in both Caucasians and the overall population. CONCLUSION Avatrombopag was effective and safe in the management of thrombocytopenia in Chinese patients with CLD. Ethnicity does not appear to influence the efficacy, safety, PK, or PD of avatrombopag.
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Affiliation(s)
- Jun Lu
- Clinical Research Department, Shanghai Fosun Pharmaceutical Development, Co., Ltd, Shanghai, China
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11
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Zhang L, Gan L, Li K, Xie P, Tan Y, Wei G, Yuan X, Pratt R, Zhou Y, Hui AM, Fang Y, Zuo L, Zheng Q. Ethnicity evaluation of ferric pyrophosphate citrate among Asian and Non-Asian populations: a population pharmacokinetics analysis. Eur J Clin Pharmacol 2022; 78:1421-1434. [PMID: 35711066 PMCID: PMC9365747 DOI: 10.1007/s00228-022-03328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/24/2022] [Indexed: 11/27/2022]
Abstract
Purpose To evaluate the potential ethnic differences of ferric pyrophosphate citrate (FPC, Triferic) in healthy subjects and patients with hemodialysis-dependent stage 5 chronic kidney disease (CKD-5HD) and identify covariates that may influence pharmacokinetics (PK) of FPC. Methods Data were collected from 2 Asian and 4 non-Asian clinical studies involving healthy subjects and CKD-5HD patients. Three population PK models were developed: M1 for intravenous (IV) administration of FPC in healthy subjects; M2 for dialysate administration of FPC in CKD-5HD patients; M3 for pre-dialyzer administration of FPC in CKD-5HD patients. All the models were fitted to concentration versus time data of FPC using the nonlinear mixed effect approach with the NONMEM® program. All statistical analyses were performed using SAS version 9.4. Results In total, 26 Asians and 65 non-Asians were included in the final model analysis database. Forty healthy subjects were administered FPC via intravenous (IV) route and 51 patients with CKD-5HD via dialysate (N = 50) and pre-dialyzer blood circuit administration (N = 51). The PK parameters of FPC IV were similar. The population PK model showed good parameter precision and reliability as shown by model evaluation, and no relevant influence of ethnicity on PK parameters was observed. In healthy subjects, the maximum observed plasma concentration (Cmax) and area under the plasma concentration–time curve (AUC) decreased with increase in lean body mass (LBM) and the average serum total iron at 6 h before the baseline period (Feav), whereas, in both patient populations, Cmax and AUC decreased with increase in LBM and decrease in Febaseline. Other factors such as gender, age, Feav, and ethnicity had no influence on PK exposures in patients. The influence of LBM on PK exposures in patients was smaller than that in healthy subjects (ratio of AUC0-24 for the 5th [68 kg] and 95th [45 kg] patient’s LBM was almost 1). The influence of Feav and LBM on PK exposures was < 50%. Conclusion The population pharmacokinetics model successfully described the PK parameters of FPC in healthy subjects and CKD-5HD patients and were comparable between Asian and non-Asian populations. Supplementary information The online version contains supplementary material available at 10.1007/s00228-022-03328-9.
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Affiliation(s)
- Lingxiao Zhang
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liangying Gan
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Kexin Li
- Clinical trial center, Beijing hospital, National center of gerontology, Institute of geriatric medicine, Chinese academy of medical sciences, Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, Beijing, China
| | - Panpan Xie
- Clinical trial center, Beijing hospital, National center of gerontology, Institute of geriatric medicine, Chinese academy of medical sciences, Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, Beijing, China
| | - Yan Tan
- Global R&D Center, Shanghai Fosun Pharmaceutical Development, Co, Ltd, Shanghai, China
| | - Gang Wei
- Global R&D Center, Shanghai Fosun Pharmaceutical Development, Co, Ltd, Shanghai, China
| | - Xiaojuan Yuan
- Jiangsu Wanbang Biopharmaceuticals Co., Ltd, Xuzhou, China
| | | | - Yongchun Zhou
- Jiangsu Wanbang Biopharmaceuticals Co., Ltd, Xuzhou, China
| | - Ai-Min Hui
- Global R&D Center, Shanghai Fosun Pharmaceutical Development, Co, Ltd, Shanghai, China
| | - Yi Fang
- Department of Pharmacy, Peking University People's Hospital, Beijing, China.
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China.
| | - Qingshan Zheng
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Hu X, Zeng K, Xu Z, Li W, Li C, Kang Z, Li S, Hui AM, Wu Z, Huang X, Han P, Li B, Lin X. A multicenter, open-label, single-arm, phase 1 dose-escalation study to evaluate the safety, tolerability, and anti-tumor activity of FCN-159 in adults with neurofibromatosis type 1. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3011 Background: Neurofibromatosis type 1 (NF1) is an autosomal-dominant genetic disease that increases susceptibility to malignant tumors. Up to 50% of patients with NF1 present with plexiform neurofibroma (PN). Surgery, a common treatment strategy for patients with PN, has limited efficacy. NF1 is caused by mutations in the gene that encodes neurofibromin; the NF1 mutation then leads to tumorigenesis via dysregulation of the Ras/Raf/MEK/ERK pathway. FCN-159 is anti-tumorigenic via highly potent, selective inhibition of MEK1/2. This study aims to assess the safety of FCN-159 in patients with NF1-related PN. Methods: This is a multicenter, open-label, single-arm, phase 1 dose-escalation and phase 2 dose-expansion study (NCT04954001). Patients with NF1-related PN that was not completely resectable or not suitable for surgery were enrolled in the study; they received FCN-159 monotherapy continuously in 28-day cycles. Here, we report safety and clinical efficacy data from adults enrolled in phase 1. Results: As of the data cutoff of December 1, 2021, 19 adults from 3 hospitals in China have been enrolled in the phase 1 dose-escalation study, 3 in 4 mg, 4 in 6 mg, 8 in 8 mg, and 4 in 12 mg. The most common neurofibroma-related complications were disfigurement and pain, occurring in 10 patients (52.6%) and 4 patients (21.1%) at baseline, respectively. Four patients experienced dose-limiting toxicity; G3 folliculitis was reported in 1 patient (16.7%) receiving the 8-mg dose and 3 (100%) patients receiving the 12-mg dose. The maximum tolerated dose was determined to be 8 mg. Study-drug-related treatment-emergent adverse events (TEAEs) were observed in all 19 patients (100%); the majority were grade 1 or 2 in severity. Nine (47.4%) patients reported grade 3 study drug-related TEAEs; 4 patients experienced paronychia and 5 experienced folliculitis, which were the most common causes of dose reduction (42.1%) and drug interruption (21.2%). One patient experienced a serious adverse event of rhegmatogenous retinal detachment, but this was considered unrelated to the study drug as it was preexisting at baseline. Of the 16 patients with at least 1 post-baseline tumor assessment, all (100%) had reduced tumor size and 6 (37.5%) had a reduction in tumor size of > 20%. Three out of 6 patients with a second tumor assessment result had further tumor shrinkage; tumor volumes in the remaining 3 patients were similar to those at first assessment. The largest reduction in tumor size was 84.2%. Conclusions: Overall, FCN-159 at 8 mg is well tolerated, with easy to manage adverse events, and showed promising anti-neurofibroma activity in phase 1; this warrants further investigation in a phase 2 study on efficacy and safety in this indication. Clinical trial information: NCT04954001.
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Affiliation(s)
- Xiaojie Hu
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Kang Zeng
- NanFang Hospital of Southern Medical University, Guangzhou, China
| | - Zhongyuan Xu
- NanFang Hospital of Southern Medical University, Guangzhou, China
| | - Wenbin Li
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Changxing Li
- NanFang Hospital of Southern Medical University, Guangzhou, China
| | - Zhuang Kang
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Shenglan Li
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | | | - Zhuli Wu
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Shanghai, China
| | - Xin Huang
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Shanghai, China
| | - Pu Han
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Shanghai, China
| | - Ben Li
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Shanghai, China
| | - Xiaoxi Lin
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Gan L, Xie P, Tan Y, Wei G, Yuan X, Lu Z, Pratt R, Zhou Y, Hui AM, Li K, Fang Y, Zuo L. Pharmacokinetics and Safety of Ferric Pyrophosphate Citrate in Chinese Subjects with and without Hemodialysis-Dependent Stage 5 Chronic Kidney Disease. Drugs R D 2022; 22:119-129. [PMID: 35380419 PMCID: PMC9167373 DOI: 10.1007/s40268-022-00384-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Anemia caused by iron depletion is common in patients with hemodialysis-dependent stage 5 chronic kidney disease (CKD-5HD) patients. To maintain the iron levels, external administration of iron is essential. Ferric pyrophosphate citrate (FPC) is a novel, water-soluble complex iron salt. The present study was conducted to evaluate the pharmacokinetic (PK) parameters and safety of FPC in adult healthy Chinese subjects and patients with CKD-5HD. METHODS Two open-label, single-center studies were conducted in healthy subjects and patients with CKD-5HD. Healthy subjects received a single intravenous dose of 6.5 mg FPC solution, while CKD-5HD patients were randomized to two different sequences of FPC administration at two sequential hemodialysis (HD) treatments (dose 1 and dose 2). Patients received 27.2 mg of FPC at a dialysate concentration of 95 μg/L for 4 h or a single 6.5 mg dose of FPC administered intravenously via the pre-dialyzer blood circuit. The primary objective was to determine the PK parameters of total serum iron (Fetot), while the secondary objective was the safety of the FPC solution. PK parameters were calculated using Phoenix WinNonlin 8.1 and other parameters were analyzed using SAS 9.4 software. Comparison between HD dose 2 and HD dose 1 was performed using the Wilcoxon rank-sum test and analysis of variance (ANOVA). RESULTS A total of 14 healthy subjects with a mean age of 30.8 ± 5.92 years and 12 HD patients with a mean age of 54.3 ± 16.47 years were included. In healthy subjects, the peak serum concentration was reached at the end of infusion of FPC, with an adjusted mean maximum concentration (Cmax,) of 33.46 ± 4.83 μmol/L at a mean time to reach Cmax (Tmax) of 4.09 ± 0.19 h. In patients with CKD-5HD, the adjusted mean Cmax of HD dose 2 was 25.37 ± 4.30 μmol/L at a Tmax, of 3.09 ± 0.32 h, whereas the Cmax, of HD dose 1 was 24.59 ± 4.77 μmol/L at a Tmax, of 3.96 ± 0.26 h. The Fetot concentration-time curves were observed to be similar for both administration methods (HD doses 1 and 2), while the PK parameters differed significantly for Tmax (p = 0.001; baseline correction) and area under the concentration-time curve from time zero to time t (AUCt) [p = 0.031 for cycle variance; without baseline correction] between HD doses 1 and 2. The geometric mean ratios (HD dose 1/HD dose 2) for Cmax and AUCt were within the 85-125% range (Cmax 96.56%; AUCt 96.07%). A total of three and two incidences of adverse events were reported in healthy subjects and patients with CKD-5HD, respectively. CONCLUSION FPC showed a good PK and safety profile and hence can be used as maintenance therapy for patients with CKD-5HD by choosing a better method of administration based on clinical feasibility and requirement. CLINICAL TRIAL REGISTRATION CTR20181113 and CTR20181119.
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Affiliation(s)
- Liangying Gan
- Department of Nephrology, Peking University People's Hospital, Unit 10C in Ward Building, 11 Xizhimennan Street, Xicheng District, Beijing, 100044, China
| | - Panpan Xie
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yan Tan
- Clinical Research Department, Shanghai Fosun Pharmaceutical Development, Co., Ltd, Shanghai, China
| | - Gang Wei
- Clinical Research Department, Shanghai Fosun Pharmaceutical Development, Co., Ltd, Shanghai, China
| | | | - Zhifei Lu
- Beijing Fosun Pharmaceutical Development, Co., Ltd, Beijing, China
| | | | | | - Ai-Min Hui
- Clinical Research Department, Shanghai Fosun Pharmaceutical Development, Co., Ltd, Shanghai, China
| | - Kexin Li
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Yi Fang
- Department of Pharmacy, Peking University People's Hospital, 133 Fuchengmennei Street, Xicheng District, Beijing, 100034, China.
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Unit 10C in Ward Building, 11 Xizhimennan Street, Xicheng District, Beijing, 100044, China.
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Abstract
mRNA vaccines have gained popularity over the last decade as a versatile tool for developing novel therapeutics. The recent success of coronavirus disease (COVID-19) mRNA vaccine has unlocked the potential of mRNA technology as a powerful therapeutic platform. In this review, we apprise the literature on the various types of cancer vaccines, the novel platforms available for delivery of the vaccines, the recent progress in the RNA-based therapies and the evolving role of mRNA vaccines for various cancer indications, along with a future strategy to treat the patients. Literature reveals that despite multifaceted challenges in the development of mRNA vaccines, the promising and durable efficacy of the RNA in pre-clinical and clinical studies deserves consideration. The introduction of mRNA-transfected DC vaccine is an approach that has gained interest for cancer vaccine development due to its ability to circumvent the necessity of DC isolation, ex vivo cultivation and re-infusion. The selection of appropriate antigen of interest remains one of the major challenges for cancer vaccine development. The rapid development and large-scale production of mRNA platform has enabled for the development of both personalized vaccines (mRNA 4157, mRNA 4650 and RO7198457) and tetravalent vaccines (BNT111 and mRNA-5671). In addition, mRNA vaccines combined with checkpoint modulators and other novel medications that reverse immunosuppression show promise, however further research is needed to discover which combinations are most successful and the best dosing schedule for each component. Each delivery route (intradermal, subcutaneous, intra tumoral, intranodal, intranasal, intravenous) has its own set of challenges to overcome, and these challenges will decide the best delivery method. In other words, while developing a vaccine design, the underlying motivation should be a reasonable combination of delivery route and format. Exploring various administration routes and delivery route systems has boosted the development of mRNA vaccines.
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Affiliation(s)
- Jiao Wei
- Shanghai Fosun Pharmaceutical Industrial Development, Co., Ltd., 1289 Yishan Road, Shanghai 200233, China; Fosun Pharma USA Inc, 91 Hartwell Avenue, Suite 305, Lexington, MA 02421, USA
| | - Ai-Min Hui
- Shanghai Fosun Pharmaceutical Industrial Development, Co., Ltd., 1289 Yishan Road, Shanghai 200233, China; Fosun Pharma USA Inc, 91 Hartwell Avenue, Suite 305, Lexington, MA 02421, USA.
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Al-Rajabi RMT, Richardson GE, Uprety D, Williamson SK, Hamid A, Baranda JC, Mamdani H, Lee Y, Li C, . N, Wei J, Hui AM. A multicenter, open-label, phase I/II study of FN-1501 in patients with advanced solid tumors and acute myeloid leukemia. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e15083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15083 Background: FN-1501, a potent inhibitor of receptor FMS-like tyrosine kinase 3 (FLT3) and CDK4/6, KIT, PDGFR, VEGFR2, ALK and RET tyrosine kinase proteins, has demonstrated significant in vivo anti-tumor activity in a broad range of solid tumor and leukemia xenograft models. FLT3 mutations have an established role as a therapeutic target in Acute Myeloid Leukemia (AML), where the gene plays a critical role in the growth, differentiation, and survival of hematopoietic cells. An open-label, Phase I/II study ( NCT03690154 ) is evaluating the safety and PK profile of FN-1501 as monotherapy in patients (pts) with advanced solid tumors and relapsed, refractory (R/R) AML. Methods: Pts received FN-1501 IV thrice weekly for 2 weeks followed by 1 week off treatment in 21-day cycles. Dose escalation follows a 3+3 design. Primary objectives include determination of maximum tolerated dose (MTD), safety, and recommended phase 2 dose (RP2D). Secondary objectives include pharmacokinetics (PK) and preliminary anti-tumor activity. Exploratory objectives include the relationship between pharmacogenetic mutations (e.g., FLT3, TP53, KRAS, NRAS), safety, efficacy and pharmacodynamic effects of FN-1501. Dose expansion at RP2D was designed to further explore safety and efficacy. Results: As of Dec 3, 2021 data cut-off (DCO), 47 pts with advanced solid tumors (N = 46) or AML (N = 1) were enrolled at doses ranging from 2.5 to 226 mg. The median age was 65 (range 30-92) with 57% female and 43% male. The median prior lines of treatment were 5 (range 1-12). Forty pts with median exposure of 9.5 cycles (range 1-18 cycles) were evaluable for dose limiting toxicity (DLT). Treatment-related adverse events (TRAEs) were reported in 64% of pts. The most common treatment-emergent adverse events (TEAEs) defined as those occurring in ≥ 20% of patients primarily consisted of reversible grade 1-2 fatigue (34%), nausea (32%) and diarrhea (26%). The most common grade ≥ 3 events occurring in ≥ 5% of pts consisted of diarrhea and hyponatremia. Dose escalation was discontinued due to DLTs of grade 3 thrombocytopenia (N = 1) and grade 3 infusion related reaction (N = 1) in 2 pts in the 226 mg dose group (2nd DLT reported after DCO). At the time of DCO, 33 pts were evaluable for disease response showing 1 with partial response (PR) (47% target lesion shrinkage), 15 with stable disease (SD) and 17 with progression of disease (PD). The PR lasted > 4 months (mts) in a patient with endometrial carcinoma (ca) at the 40 mg dose level. The longest treatment exposures were recorded in 6 pts with SD of 2.6 to > 12 mts (thymoma [1]; ovarian ca [2]; renal cell ca [1]; laryngeal ca [1] and intestinal adeno ca [1]) at doses ranging from 15 mg to 170 mg. Conclusions: FN-1501 IV has shown reasonable safety, tolerability, and preliminary activity against solid tumors up to 170 mg. Dose escalation was terminated based on 2 DLTs occurring at the 226 mg dose level. Clinical trial information: NCT03690154.
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Affiliation(s)
| | | | | | | | - Anis Hamid
- Cabrini Health Malvern VIC, Malvern, Australia
| | | | - Hirva Mamdani
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Yali Lee
- Shanghai Fosun Pharmaceutical Industrial Development Co., Ltd., Shanghai, China
| | - Chao Li
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | - Nitika .
- Shanghai Fosun Pharmaceutical Industrial Development Co., Ltd., Shanghai, China
| | - Jiao Wei
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | - Ai-Min Hui
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
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Yang JJ, Zhou J, Cheng Y, Li M, Zhao Q, Zhang Z, Zang A, Fan Y, Hui AM, Zhou Y, Wu Z, Sun J, Pan Z, Qiu J, Wu YL. SAF-189s in advanced, ALK-positive, non–small cell lung cancer: Results from a first-in-human phase 1/2, multicenter study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9076 Background: SAF-189s is a potent, brain-penetrant, next-generation anaplastic lymphoma kinase (ALK) inhibitor with preclinical activity against most known resistance mutations of ALK. We investigated safety, population pharmacokinetics, efficacy, and antitumor activity of SAF-189s in advanced, ALK-positive (ALK+) non-small cell lung cancer (NSCLC). Methods: In this first-in-human phase 1/2 trial (NCT04237805), patients aged ≥18 years with histologically or cytologically confirmed, advanced, ALK+ NSCLC (with or without brain metastases) and an Eastern Cooperative Oncology Group performance status of 0–2 were recruited from 41 hospitals in China. Oral SAF-189s was given in escalating doses of 20–210 mg once daily in continuous, 21-day cycles until disease progression, unacceptable toxicity, consent withdrawal, or death. Phase 1 data were presented at ASCO 2020. Here, we report updated phase 1 results and preliminary phase 2 data. Results: At a clinical cutoff date of January 18, 2022, 45 patients with prior systemic therapy enrolled in phase 1 and 150 were enrolled in phase 2. SAF-189s was well tolerated, the most common grade 3–4 treatment-related adverse events were hyperglycemia (7%), hypertension (6%) and diarrhea (3%). No treatment-related death was reported. 160 mg was chosen as the recommended phase 2 dose. In phase 1, 11 (24%) patients were ALK inhibitor (ALKi)-naive and 34 (76%) were ALKi-pretreated. Median progression-free survival (PFS) was 33.1 and 22.1 months (95% CI 6.9–not reached: 13.8–26.6) in ALKi-naive and ALKi-pretreated patients, respectively. Disease control rates (DCRs) were 100% in both ALKi-naive and ALKi-pretreated patients. Most patients in phase 2 were ALKi-naive (n=104, 69%), 26 (17%) received prior crizotinib only and 20 (12%) were pretreated with ≥1 non-crizotinib ALKi. The median duration of follow-up was 11.7 months (range 10.3–16.8), ORRs were comparable between the full analysis set and the 71 patients with brain metastases at 78.7% (95% CI 71.2–84.9) and 74.6% (95% CI 62.9–84.2) respectively. ALKi-naive patients had ORR of 92.3% (95% CI 85.4–96.6), compared to 65.4% (95% CI 44.3–82.8) in the crizotinib-pretreated group. DCR was 98.1% in ALKi-naive and 88.5% in crizotinib-pretreated patients. PFS data are not mature. Conclusions: SAF-189s showed clinical antitumor activity and was well tolerated in patients with advanced, ALK+ NSCLC, including those with brain metastases and pretreated with crizotinib. SAF-189s represents a promising, next-generation, targeted therapy for patients with ALK+ NSCLC. Clinical trial information: NCT04237805. [Table: see text]
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Affiliation(s)
- Jin-Ji Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianying Zhou
- Department of Respiratory Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Cheng
- Department of Medical Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Mingjun Li
- Department of Medical Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiong Zhao
- Department of Thoracic Oncology, Shulan Hospital, Hangzhou, China
| | - Zhiye Zhang
- Department of Oncology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Aimin Zang
- Department of Oncology, North Hospital, Affiliated Hospital of Hebei University, Baoding, China
| | - Yun Fan
- Department of Thoracic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | | | | | - Zhuli Wu
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Beijing, China
| | - Juan Sun
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Shanghai, China
| | - Zhaoyang Pan
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Shanghai, China
| | - Jingjun Qiu
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Shanghai, China
| | - Yi-Long Wu
- Department of Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
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Liu Y, Tan Y, Wei G, Lu Z, Liu Y, Yang B, Hui AM, Li K. Safety and pharmacokinetic profile of pretomanid in healthy Chinese adults: Results of a phase I single dose escalation study. Pulm Pharmacol Ther 2022; 73-74:102132. [PMID: 35595003 DOI: 10.1016/j.pupt.2022.102132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/27/2022] [Accepted: 05/13/2022] [Indexed: 11/20/2022]
Abstract
We investigated the safety, tolerability and pharmacokinetic (PK) profile of pretomanid (formerly PA-824) in healthy Chinese volunteers. This was a single-center, double-blind, placebo-controlled, phase I dose escalation study, in which healthy volunteers were consecutively allocated to increasing pretomanid dose groups (50, 100, 200, 400, 600, 800, or 1000 mg) and randomized to receive pretomanid or matching placebo. The primary objective was to evaluate the safety, tolerability and PK profile of pretomanid. In total, 306 volunteers were screened, and 60 were assigned to treatment (pretomanid: n = 46, placebo: n = 14) of whom 83.3% were male, age ranged from 19 to 39 years and BMI ranged from 19.2 to 25.9 kg/m2. At least one adverse event (AE) was reported by 67.4% of subjects assigned to pretomanid and 50.0% of those who received placebo, there were no serious AEs or AEs leading to withdrawal. Drug-related events that occurred in ≥5% of participants assigned to pretomanid were proteinuria (26.1%), insignificant microscopic hematuria (15.2%), conjugated hyperbilirubinemia (6.5%), hyperbilirubinemia (6.5%) and elevated uric acid (6.5%). No relationship between pretomanid dose and AEs was observed. In the PK analysis (n = 46), maximum pretomanid plasma concentration was reached in a median of 4 h in all dose groups except 800 mg (12 h) and the plasma half-life ranged from 20.2 to 25.2 h. No dose proportionality was observed for maximum plasma concentration, or area under the plasma concentration curve. In conclusion, single pretomanid doses from 50 to 1000 mg were well tolerated in healthy Chinese participants and the PK profile was generally consistent with findings in non-Chinese populations.
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Affiliation(s)
- Yue Liu
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing, China
| | - Yan Tan
- Global R&D Center, Shanghai Fosun Pharmaceutical Development, Co., Ltd, Shanghai, China
| | - Gang Wei
- Global R&D Center, Shanghai Fosun Pharmaceutical Development, Co., Ltd, Shanghai, China
| | - Zhifei Lu
- Global R&D Center, Shanghai Fosun Pharmaceutical Development, Co., Ltd, Shanghai, China
| | - Yazhou Liu
- Shenyang Hongqi Pharmaceutical Co., Ltd, Shenyang, China
| | - Bo Yang
- Shenyang Hongqi Pharmaceutical Co., Ltd, Shenyang, China
| | - Ai-Min Hui
- Global R&D Center, Shanghai Fosun Pharmaceutical Development, Co., Ltd, Shanghai, China.
| | - Kexin Li
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing, China.
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Zhang J, Wang X, Wang X, Li W, Cheng Y, Huang T, Wang Y, Hui AM, Wu Z, Tian L, Zhao H, Yang Y, Zhang W, Zhang Y, Hu X. The CDK4/6 inhibitor FCN-437c plus letrozole for the treatment of HR+/HER2– advanced breast cancer: Updated results from a phase 1b study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13025 Background: FCN-437c is an oral potent and highly selective CDK4/6 inhibitor without the inhibition of CDK1, CDK2, or CDK5. In the phase 1a dose-escalation part of this study (NCT04488107), the safety profile of FCN-437c was acceptable in patients with ABC, and the maximum tolerated dose was determined to be 300 mg QD when used as monotherapy (presented at AACR 2021). Phase 1b aimed to explore the RP2D and to evaluate the tolerability and antitumor activity of FCN-437c combined with letrozole in patients with previously untreated HR+/HER2– ABC. Methods: Adult, post-menopausal female patients diagnosed with treatment-naive ER+/HER2– ABC were eligible for this expansion stage. Patients received FCN-437c once daily at 200 mg or 300 mg on a 21-day-on and 7-day-off schedule in combination with letrozole 2.5 mg once daily in 28-day cycles. The primary endpoints were safety and RP2D. Results: As of November 26, 2021, 29 patients were enrolled and had a median follow-up of 10.4 months. Of these patients, 25 (86.2%) were endocrine-sensitive and 4 (13.8%) were endocrine-resistant. Visceral disease was present in 21 patients (72.4%), and 1 (3.4%) patient had bone-only disease. DLTs of grade 4 neutropenia occurred in 2 patients (40.0%) in 300 mg dose group; they were considered intolerable. One out of the first 6 patients experienced DLTs in 200 mg dose group (grade 4 neutropenia, leukopenia, and thrombocytopenia); these were also considered to be FCN-437c-related SAEs. FCN-437c-related grade ≥3 TEAEs were observed in 26 (89.7%) patients, with neutropenia (n=24, 82.8%) and leukopenia (n=14, 48.3%) being most common. Among the 28 measurable patients, 16 patients had a PR, the ORR was 57.1% (95% CI 37.2–75.5); the CBR was 82.1% (95% CI 63.1–93.9) (Table). Median PFS, DOR, and OS were not reached. At 6 and 12 months, PFS rates were 92.3% and 83.5%, and DOR rates were 100% and 90%, respectively. A RP2D of 200 mg was suggested per safety considerations and preliminary antitumor activity. Conclusions: FCN-437c plus letrozole was well tolerated and demonstrated antitumor activity in patients with previously untreated HR+/HER2– ABC. FCN-437c in combination with NSAI as the first-line treatment for HR+/HER2– ABC will be further investigated in a phase 3 trial. Clinical trial information: NCT04488107. [Table: see text]
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Affiliation(s)
- Jian Zhang
- Department of Medical Oncology, Phase I Clinical Trial Center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaojia Wang
- Department of Breast Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xian Wang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Hangzhou, China
| | - Wei Li
- Cancer center, The First Hospital of Jilin University, Changchun, China
| | - Ying Cheng
- Department of Medical Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Wang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | | | - Zhuli Wu
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Shanghai, China
| | - Ling Tian
- Avanc Pharmaceutical Co., Ltd., Jinzhou, China
| | - Han Zhao
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Shanghai, China
| | - Yuchen Yang
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Shanghai, China
| | - Wenjing Zhang
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Shanghai, China
| | - Yushun Zhang
- Beijing Fosun Pharmaceutical Research and Development Co., Ltd., Shanghai, China
| | - Xichun Hu
- Department of Breast and Urinary Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
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Cong D, Song J, Liu Y, Tan Y, Xue W, Liu X, Qi W, Lu J, Yuan X, Zhou Y, Hui AM, Li K. Pharmacokinetics, Pharmacodynamics, and Tolerability of Opicapone in Healthy Chinese and Caucasian Subjects: An Open-Label, Single-Center, Phase 1 Study. Neurol Ther 2022; 11:283-301. [PMID: 35006479 PMCID: PMC8743745 DOI: 10.1007/s40120-021-00314-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This study evaluated the pharmacokinetics (PK) and pharmacodynamics (PD) of single and multiple doses of opicapone (OPC) in healthy Chinese and Caucasian subjects. METHODS In this open-label, single-center, phase 1 study, eligible Chinese subjects received one of three OPC doses (25, 50, or 100 mg), and Caucasian subjects received either 25 or 50 mg of OPC. All subjects were administered a single dose of OPC, whereas subjects in the 50-mg OPC group continued to receive once-daily doses of 50 mg OPC for 10 days. The primary endpoint was to evaluate and compare the plasma concentrations and PK parameters of OPC and its main metabolite, and erythrocyte-soluble catechol-O-methyltransferase (S-COMT) activity in Chinese subjects with that of Caucasian subjects. The secondary endpoint was to evaluate the safety of OPC in Chinese subjects. The estimated results for geometric mean ratios (GMRs) were evaluated with the standard bioequivalence (BE) limits between 80% and 125% to evaluate the ethnic differences. All statistical analyses were performed using SAS version 9.4. RESULTS In total, 70 subjects (45 Chinese, 25 Caucasian) were enrolled; the majority of them were male (85.7%). The plasma exposure of both OPC and BIA 9-1103 increased in an approximately dose-proportional manner in both populations. Maximum S-COMT inhibition ranged from 79% to 95% after a single dose and was about 94% after a 10-day once-daily regimen in both populations. The point estimates of GMRs (Chinese/Caucasian) and 90% CI, except Cmax in 25-mg and 50-mg OPC groups, for PK and PD parameters were within 80% to 125%. Furthermore, no new risks or safety concerns associated with OPC were identified, indicating a tolerable safety profile in healthy Chinese subjects. CONCLUSION Ethnicity had no significant impact on PK and PD parameters after single or multiple doses of OPC, and OPC was safe and tolerable in healthy Chinese subjects. TRIAL REGISTRATION ChiCTR number, CTR20192230.
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Affiliation(s)
- Duanduan Cong
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, No. 1 Dahua Road, Dongdan Dongcheng District, Beijing, 100005, China
| | - Jie Song
- Clinical Research Department, Shanghai Fosun Pharmaceutical Development, Co., Ltd., Shanghai, 200000, China
| | - Yue Liu
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, No. 1 Dahua Road, Dongdan Dongcheng District, Beijing, 100005, China
| | - Yan Tan
- Clinical Research Department, Shanghai Fosun Pharmaceutical Development, Co., Ltd., Shanghai, 200000, China
| | - Wei Xue
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, No. 1 Dahua Road, Dongdan Dongcheng District, Beijing, 100005, China
| | - Xiaohui Liu
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, No. 1 Dahua Road, Dongdan Dongcheng District, Beijing, 100005, China
| | - Wenyuan Qi
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, No. 1 Dahua Road, Dongdan Dongcheng District, Beijing, 100005, China
| | - Jun Lu
- Clinical Research Department, Shanghai Fosun Pharmaceutical Development, Co., Ltd., Shanghai, 200000, China
| | | | | | - Ai-Min Hui
- Clinical Research Department, Shanghai Fosun Pharmaceutical Development, Co., Ltd., Shanghai, 200000, China.
| | - Kexin Li
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, No. 1 Dahua Road, Dongdan Dongcheng District, Beijing, 100005, China.
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Nitika, Wei J, Hui AM. The Development of mRNA Vaccines for Infectious Diseases: Recent Updates. Infect Drug Resist 2021; 14:5271-5285. [PMID: 34916811 PMCID: PMC8668227 DOI: 10.2147/idr.s341694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/25/2021] [Indexed: 12/27/2022] Open
Abstract
mRNA-based technologies have been of interest for the past few years to be used for therapeutics. Several mRNA vaccines for various diseases have been in preclinical and clinical stages. With the outbreak of the COVID-19 pandemic, the emergence of mRNA vaccines has transformed modern science. Recently, two major mRNA vaccines have been developed and approved by global health authorities for administration on the general population for protection against SARS-CoV-2. They have been proven to be successful in conferring protection against the ongoing SARS-CoV-2 and its emerging variants. This will draw attention to various mRNA vaccines against infectious diseases that are in the early stages of clinical trials. mRNA vaccines offer several advantages ranging from rapid design, generation, manufacturing, and administration and have strong potential to be used against various diseases in the future. Here, we summarize the mRNA-based vaccines in development against various infectious diseases.
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Affiliation(s)
- Nitika
- Fosun Pharma USA Inc., Boston, MA, USA.,Shanghai Fosun Pharmaceutical Industrial Development, Co., Ltd., Shanghai, People's Republic of China
| | - Jiao Wei
- Fosun Pharma USA Inc., Boston, MA, USA.,Shanghai Fosun Pharmaceutical Industrial Development, Co., Ltd., Shanghai, People's Republic of China
| | - Ai-Min Hui
- Fosun Pharma USA Inc., Boston, MA, USA.,Shanghai Fosun Pharmaceutical Industrial Development, Co., Ltd., Shanghai, People's Republic of China
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Richardson GE, Williamson SK, Nagasaka M, Bozon V, Corvez MM, Li C, Li W, Wei J, Hui AM. Abstract CT131: A Phase I safety and tolerance study of FN-1501, a novel FLT3 inhibitor, in patients with advanced solid tumors and acute myeloid leukemia. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: FLT3 mutations are found in approximately 30% of adult patients with Acute Myeloid Leukemia (AML) and to a lesser degree, in certain solid tumors. FN-1501 is a potent inhibitor of FLT3 and other tyrosine kinases such as CDK4/6, KIT, PDGFR, ALK and RET proteins, with demonstrated anti-tumor activity in several leukemia and colon cancer xenograft models. An ongoing, open-label, Phase I study (NCT03690154) is evaluating FN-1501 as monotherapy in patients with various advanced solid tumors and relapsed, refractory (R/R) AML. The objectives of the trial are to assess safety and tolerability, establish a Recommended Phase 2 Dose (RP2D), and evaluate preliminary anti-tumor activity. Methods: Pts received FN-1501 by IV thrice weekly for 2 weeks followed by 1 week off treatment in 21-day cycles. The dose escalation phase follows a standard 3+3 design. Primary objectives include determinations of dose-limiting toxicity (DLT), maximum tolerated dose (MTD), safety, and RP2D. Secondary objectives include pharmacokinetics (PK) and anti-tumor activity. Exploratory objectives include the relationship between pharmacogenetic mutations (e.g. FLT3, TP53, KRAS, NRAS, etc) and safety/efficacy. Expansion cohorts have been added to the ongoing protocol amendment to confirm safety and evaluate preliminary efficacy at RP2D. Results: At the time of data cut-off (Nov 17, 2020), 40 pts (n=1 AML; n=39 solid tumors) were enrolled at doses ranging from 2.5 to 128 mg. Median number of prior lines of treatment was 5 (range 1-12). Thirty-four patients met the minimum exposure criterion for DLT assessment. No DLTs were reported and MTD was not reached. Treatment-related adverse events (TRAEs) were reported in 58% of pts. The most common TRAEs in ≥10% of patients included fatigue (20%), nausea (15%), infusion related reaction (10%), mostly reversible grade 1 or 2. Grade ≥3 TRAEs consisting of anemia, fatigue and serum creatinine increase were observed in 3 pts. TRAEs resulted in dose delay/interruption in 4 pts (10%) but no treatment discontinuations. No serious TRAEs were observed. The exposure of FN-1501 (AUC and Cmax) increased in a dose proportional manner. Mean t1/2 was estimated to be 12-19 hours. Among 25 response-reportable pts, 1 had a best overall response of PR (47% target lesion shrinkage), 10 had stable disease and 14 had progressive disease. The confirmed PR (duration > 4 months) occurred at the 40 mg dose level in a pt with endometrial carcinoma. Conclusion: FN-1501 has demonstrated reasonable safety/tolerability across all doses tested, with promising anti-tumor activity in pts with certain advanced, heavily pre-treated solid tumors. Enrollment of pts into the dose escalation part of the study is continuing and updated safety, PK and molecular biomarker results will be presented at the meeting.
Citation Format: Gary Edward Richardson, Stephen K. Williamson, Misako Nagasaka, Viviana Bozon, Maria Margarita Corvez, Chao Li, Wei Li, Jiao Wei, Ai-Min Hui. A Phase I safety and tolerance study of FN-1501, a novel FLT3 inhibitor, in patients with advanced solid tumors and acute myeloid leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT131.
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Affiliation(s)
| | | | | | - Viviana Bozon
- 4Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | | | - Chao Li
- 4Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | - Wei Li
- 4Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | - Jiao Wei
- 4Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | - Ai-Min Hui
- 4Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
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Gabrail NY, Hamilton EP, Elias AD, Rimawi MF, Li C, Corvez MM, Li W, Feng Y, Wei J, Greene S, Patterson J, Zeng Q, Hui AM. A phase 1/2 trial of ORIN1001, a first-in-class IRE1 inhibitor, in patients with advanced solid tumors. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3080 Background: ORIN1001 is a first-in-class small molecule with a novel, unique enzyme and mode of inhibition that selectively inhibits Inositol Requiring Enzyme 1α (IRE1) RNAse and blocks X-Box Binding Protein 1 (XBP1) activation in the endoplasmic reticulum (ER). IRE1α/XBP1 has been implicated in a host of pathologies, and molecules that modulate it are under intense investigation for the treatment of oncologic, metabolic, neurodegenerative and other diseases. ORIN1001 has demonstrated preclinical anti-tumor activity alone and in combination with standard of care across multiple animal models including breast, prostate, lung, liver, pancreatic, brain, colon, ovarian, esophageal, and hematologic cancers and is now undergoing first-in-human testing. Methods: A phase 1, open label, 3+3 dose escalation trial is testing ORIN1001 administered PO daily to patients (pts) with advanced solid tumors (single agent) or relapsed refractory breast cancer (in combination with Abraxane). The phase 1 dose escalation part of the trial evaluates the safety, tolerability, pharmacokinetics and preliminary efficacy of ORIN1001. After identification of the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) for the single agent, the dose expansion part of the trial will test ORIN1001 in combination with Abraxane. Results: As of Jan 25, 2021, 22 patients with advanced cancer have received ORIN1001 dosed at 100mg, 200mg or 300mg per day in 21-day continuous cycles with a median age of 61 (range 42-77). The pts had received a median of 4 prior line of treatments. Two DLTs were observed at 200 mg with thrombocytopenia and rash. MTD has not been reached. Common (>15%) treatment-emergent adverse events (TEAEs) included nausea, vomiting, rash, fatigue, and hypokalaemia. The vast majority of these events were Grade 1-2 in severity. Seven (32%) pts had at least 1 TRAE grade≥ 3, the most frequent of which were thrombocytopenia (N=3) and rash (N=3). Preliminary pharmacokinetic analysis showed ORIN1001 exposure to increase in a dose proportional manner. Mean t1/2 at steady state was 18 hrs. Thirteen pts were evaluated for preliminary efficacy. Best response, per RECIST 1.1, was stable disease (SD) in 8 pts while 5 pts had progressive disease (PD). For 2 ongoing patients with advanced liver or colorectal cancer, duration of treatment has exceeded 300 days and 570 days, respectively. Conclusions: To date, the phase 1 part of the first-in-human trial has demonstrated a reasonable safety and pharmacokinetic profile for ORIN1001 at 100mg and 200mg dose levels. While efficacy data have yet to mature, chronic dosing achieved in pts with heavily treated advanced solid tumors, suggests clinical potential for in the setting of advanced solid cancers. The phase 2 part of the trial testing ORIN1001 in combination with Abraxane is currently enrolling pts with advanced breast cancer. Clinical trial information: NCT03950570.
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Affiliation(s)
| | - Erika P. Hamilton
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | | | - Mothaffar F. Rimawi
- Lester and Sue Smith Breast Center, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | - Chao Li
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | | | - Wei Li
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | - Ying Feng
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | - Jiao Wei
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
| | | | | | | | - Ai-Min Hui
- Shanghai Fosun Pharmaceutical Development Co., Ltd., Shanghai, China
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Yang JJ, Zhou J, Yang N, Wu Z, Sun J, Hui AM, Wu YL. SAF-189s in previously treated patients with advanced ALK-rearranged non-small cell lung cancer (NSCLC): Results from the dose-finding portion in a single-arm, first-in-human phase I/II study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21689 Background: Patients(pts) with ALK-rearranged non-small cell lung cancer (NSCLC) are sensitive but progress in 8–11 months with treatment of ALK inhibitor crizotinib, with leading progression in brain metastasis. SAF-189s is a novel and selective ALK inhibitor, can penetrate through blood brain barrier, and overcome multiple resistance mutation. This study aimed to explore the safety, efficacy, and pharmacokinetic properties of SAF-189s in patients with advanced ALK-rearranged NSCLC. Methods: In this multicenter I/II study, SAF-189s was orally administered under fasting condition at doses ranging from 20–210 mg once daily in a 21-day cycle to 36 pts with advanced ALK-positive NSCLC who had failed to prior systemic therapy. In this analysis report, anti-tumor activity of SAF-189s was evaluated in 34 pts received 40(n = 6), 80(n = 8), 120(n = 8), 160(n = 9) and 210(n = 3) mg doses daily. Safety was evaluated in all 36 pts who received ≥1 treatment. This study is registered with clinicaltrials.gov, NCT04237805. Results: 36 pts were enrolled in total, 22 pts had CNS metastases at baseline and 26 pts had progressed to prior TKIs therapy. There was no treatment-related SAE among the 36 pts. The most common drug-related events were nausea (14 [38.9%] of 36 pts), vomiting (10[27.8%] of 36 pts), QT prolongation (9 [25.0%] of 36 pts), sinus bradycardia (7 [19.4%] of 36 pts), ALT increase (10 [27.8%] of 36 pts), diarrhea (6 [16.7%] of 36 pts). Only one DLT of grade 3 blood glucose increase occurred at 210 mg out of the first 3 pts, so another 3 pts will be enrolled to determine RP2D/MTD. SAF-189s had shown response in the starting dose of 20mg, with 1of 2 pts achieving partial response (PR) over 43 cycles until clinical data cut off. All 34 pts in efficacy analysis set had achieved tumor shrinkage, with 17 confirmed PR (50%) (95% CI, 32.4–67.6%) and 4 unconfirmed PR (11.7%). 11 (45.8%) pts had confirmed PR among 24 pts who had failed to Crizotinib or Ceritinib and 10 (47.6%) pts had confirmed PR among 21pts who had CNS metastases. PFS data is pre-mature, with only median PFS of the 80 mg cohort being inferred as 19.42 months. Conclusions: In the dose-escalation portion of this study, SAF-189s was safe, very tolerable, and demonstrated both systemic and intracranial activity in pts with advanced ALK-positive NSCLC who had failed to at least 1 prior systemic therapy. Therefore, this study warrants further investigation to prove SAF-189s as an effective therapeutic option for pts who have ALK+ NSCLC. Clinical trial information: NCT04237805.
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Affiliation(s)
- Jin-Ji Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianying Zhou
- The First Affiliated Hospital, Zhejiang University, Zhejiang, China
| | - Nong Yang
- Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhuli Wu
- Shanghai Fosun Pharmaceutical Industrial Development, Co.,Ltd, Shanghai, China
| | - Juan Sun
- Shanghai Fosun Pharmaceutical Industrial Development, Co.,Ltd, Shanghai, China
| | - Ai-Min Hui
- Shanghai Fosun Pharmaceutical Industrial Development, Co.,Ltd, Shanghai, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
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Richardson GE, Vaishampayan UN, Bozon V, Hui AM, Williamson SK. FIH phase I dose escalation study of FN1501, an investigational FLT-3 inhibitor with multiple targets in patients with relapsed or refractory solid tumors and acute myeloid leukemia. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e15656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15656 Background: FN1501 inhibits various tyrosine kinases as CDK4/6, KIT, PDGFR, ALK and RET proteins, particularly potent on FLT3 and EGFR2. A Ph1 FIH trial for patients (pts) with solid tumors and Acute Myeloid Leukemia (AML) is on-going1. Preclinical data showed that FN1501 inhibits the phosphorylation of FLT3 and its downstream kinase STAT5 in human acute leukemia cell lines, arrests the cell cycle inducing apoptosis and inhibits growth and proliferation of leukemia cells. It has anti-proliferation activity against other leukemia cell lines bearing FLT3 mutations, and lymphoma cell lines2, 3. Methods: 26 pts with advanced solid tumors or AML enrolled in the escalation phase and received IV FN1501 on days 1, 3, 5, 8, 10 and 12 on 21-day cycles. Primary objectives are safety and MTD, secondary objectives include preliminary activity, PK and PD. Plasma PK were assessed at different timepoints pre and post dose in C1 and C2. Results: As of 6FEB20, 26 pts have been treated in 7 ascending doses of 2.5mg, 5mg, 10mg, 15mg, 22.5mg, 30mg and 40mg. A 54 mg dose cohort is on-going. No DLTs, no SAEs or deaths associated to FN1501 have been reported. 12 pts (46%) had one grade 3 or higher TEAE and 7 pts (27%) had dose interruptions due to a TEAE. Administration of FN1501 to pts with metastatic solid tumors has resulted in anti-tumor activity. 9 pts had durable stable disease across 4 doses in renal, endometrial, ovarian, gastric, appendix and thymic malignancies. One pt with serous endometrial carcinoma achieved a cPR after 2 cycles at 40mg with a 47% tumor size reduction (target lesions). As of 26Oct19 preliminary PK data showed a t1/2 of approximately 12.7-19.0 hours post-dose. Mean Cmax and AUC increased proportionally with dose and Clearance is consistent among all doses. Conclusions: This on-going Ph1trial of FN1501 is providing evidence of dose or exposure effects as a single agent in patients with solid tumors. Since FN1501 targets multiple kinases on addition to FLT3, antitumor activity beyond AML is also being observed, suggesting that the potent inhibitory effects of other tyrosine kinases, including EGFR2 may be playing a role in the regulation of cellular functions, cell growth, differentiation and angiogenesis effects. FN1501 has been well tolerated and AEs are manageable. Genomic alterations investigations are underway to identify candidate biomarkers useful for predicting sensitivity to the multiple FN1501 tyrosine kinases. Further development of FN1501 is warranted. Clinical trial information: NCT03690154.
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Richardson GE, Vaishampayan UN, Lin L, Bozon V, Hui AM, Williamson SK. A phase I clinical study to evaluate the safety, tolerability, pharmacokinetics (PK), and antitumor activity of FN-1501 monotherapy in patients with advanced solid tumors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps3150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3150 Background: Receptor tyrosine kinases (RTK), a group of transmembrane proteins, are responsible for growth factor signaling transduction in normal cellular functions. Abnormal RTK functions are associated with human tumorigenesis. FMS-like tyrosine kinase 3 (FLT3) belongs to the type III receptor tyrosine kinase family and plays a well-established role in normal growth and differentiation of hematopoietic precursor cells. FLT3 mutations have been reported to occur in approximately 30% newly diagnosed AML patients. The internal tandem duplications mutation (FLT3/ITD) is the major mutation and correlated with more aggressive progress and poor prognosis. FN-1501 is an inhibitor of various tyrosine kinases such as cyclin-dependent kinase 4/6(CDK4/6), platelet-derived growth factor receptor (PDGFR), KIT protein, anaplastic lymphoma kinase (ALK) and RET protein, particularly potent on FLT3. The preclinical data generated from biochemical, cell based and animal in vivo studies suggest that FN-1501 as a single agent could offer cancer patients clinical benefit by inhibiting multiple tyrosine kinases including FLT3, PDGFR, KIT, ALK, and RET. Methods: This is a Phase1, open label, multicenter, dose-escalation study that will evaluate the safety, pharmacokinetics (PK), and preliminary efficacy of FN-1501 in up to 33 cancer patients with solid tumors. There is a dose escalation phase that will be followed by an expansion cohort. The dose escalation phase utilizes a standard “3 + 3” design where doses of FN-1501 will be escalated up to the Maximum-Tolerated Dose (MTD) or until the Recommended Phase 2 dose (RP2D) is identified. Once the MTD or RP2D dose is identified, an expansion cohort including patients with hematologic malignancies will be enrolled to further evaluate the safety and efficacy of FN-1501. Key exploratory analyses will include an evaluation of safety and efficacy and levels of expression and/or amplification of FLT3 mutations. As of February 8, 2019, cohorts 1 and 2 have been completed without a dose limiting toxicity (DLT). A total of 11 patients have been treated. Enrollment to cohort 3 is on-going. Clinical trial information: NCT03690154.
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Affiliation(s)
| | | | - Lin Lin
- Shanghai Fosun Pharmaceutical, Shanghai, China
| | | | - Ai-Min Hui
- Shanghai Fosun Pharmaceutical, Billerica, MA
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Richardson PG, Attal M, Campana F, Le-Guennec S, Hui AM, Risse ML, Corzo K, Anderson KC. Isatuximab plus pomalidomide/dexamethasone versus pomalidomide/dexamethasone in relapsed/refractory multiple myeloma: ICARIA Phase III study design. Future Oncol 2017; 14:1035-1047. [PMID: 29268619 DOI: 10.2217/fon-2017-0616] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Treatment for relapsed/refractory multiple myeloma (RRMM) remains an unmet need. Isatuximab, an anti-CD38 monoclonal antibody has shown efficacy and tolerability as a monotherapy and combination therapy in Phase I/II studies in RRMM. Here, we describe the design of the Phase III ICARIA-MM study (NCT02990338) which will evaluate isatuximab in combination with pomalidomide (Pom) and low-dose dexamethasone (dex) (Pom/dex) versus Pom/dex alone in RRMM. Patients will be randomized in a 1:1 ratio. The primary endpoint is progression-free survival. Response will be determined by an independent response review committee using IMWG criteria (2016) and safety will be assessed throughout. Approximately 300 patients (150 in each arm) are expected to enroll. The first patient was recruited in January 2017 and accrual is ongoing.
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Affiliation(s)
- Paul G Richardson
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215-5450, USA
| | - Michel Attal
- Department of Hematology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | | | | | | | | | | | - Kenneth C Anderson
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215-5450, USA
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Richardson PG, Attal M, San Miguel J, Campana F, Le-Guennec S, Hui AM, Risse ML, Anderson KC. A phase III, randomized, open-label study of isatuximab (SAR650984) plus pomalidomide (Pom) and dexamethasone (Dex) versus Pom and Dex in relapsed/refractory multiple myeloma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps8057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS8057 Background: Treatment for refractory or relapsed and refractory multiple myeloma (MM) remains an unmet need. Isatuximab (ISA), an anti-CD38 monoclonal antibody with multiple mechanisms of tumor killing, has shown efficacy and an acceptable tolerability profile in Phase 1/2 studies in patients with refractory or relapsed and refractory MM (RRMM) (Richter et al. ASCO 2016; Vij et al. ASCO 2016). Methods: This Phase III, prospective, multicenter, randomized, open-label study (NCT02990338; ICARIA-MM) is being conducted to evaluate the clinical benefit of ISA in combination with Pom and low-dose Dex (Pom/Dex) versus Pom/Dex for the treatment of adult patients with RRMM and demonstrated disease progression within 60 days of the last therapy, and who have received at least 2 prior lines of therapy, including lenalidomide and a proteasome inhibitor (bortezomib, carfilzomib, or ixazomib) alone or in combination. Patients will be randomly assigned in a 1:1 ratio to either ISA (10 mg/kg IV on Days 1, 8, 15, and 22 in the 1st cycle; Days 1 and 15 in subsequent cycles) plus Pom (4 mg on Days 1–21) and Dex (40 mg for patients < 75 years of age and 20 mg for patients ≥75 years of age, on Days 1, 8, 15, and 22) or Pom and Dex. Treatment cycles will be 28 days each. Patients will continue therapy until disease progression, occurrence of unacceptable adverse events (AEs), or their decision to discontinue the study, whichever comes first. The primary endpoint is progression-free survival (PFS), i.e. time from randomization to progressive disease or death from any cause. Response will be determined by IMWG criteria (2016). Key secondary endpoints include overall response rate and overall survival (OS). Safety evaluations include treatment-emergent AEs/serious AEs (including infusion-associated reactions), laboratory parameters, vital signs and assessment of physical examination. Statistical analyses will be conducted according to a pre-specified plan; approximately 300 patients (150 in each arm) are expected to be enrolled in this study. The first patient was recruited in January 2017. Study funding: Sanofi. Clinical trial information: NCT02990338.
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Affiliation(s)
| | - Michel Attal
- Institut Universitaire du Cancer - Oncopole, Toulouse, France
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Moreau P, Masszi T, Grzasko N, Bahlis NJ, Hansson M, Pour L, Sandhu I, Ganly P, Baker BW, Jackson SR, Stoppa AM, Simpson DR, Gimsing P, Palumbo A, Garderet L, Cavo M, Kumar S, Touzeau C, Buadi FK, Laubach JP, Berg DT, Lin J, Di Bacco A, Hui AM, van de Velde H, Richardson PG. Oral Ixazomib, Lenalidomide, and Dexamethasone for Multiple Myeloma. N Engl J Med 2016; 374:1621-34. [PMID: 27119237 DOI: 10.1056/nejmoa1516282] [Citation(s) in RCA: 732] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ixazomib is an oral proteasome inhibitor that is currently being studied for the treatment of multiple myeloma. METHODS In this double-blind, placebo-controlled, phase 3 trial, we randomly assigned 722 patients who had relapsed, refractory, or relapsed and refractory multiple myeloma to receive ixazomib plus lenalidomide-dexamethasone (ixazomib group) or placebo plus lenalidomide-dexamethasone (placebo group). The primary end point was progression-free survival. RESULTS Progression-free survival was significantly longer in the ixazomib group than in the placebo group at a median follow-up of 14.7 months (median progression-free survival, 20.6 months vs. 14.7 months; hazard ratio for disease progression or death in the ixazomib group, 0.74; P=0.01); a benefit with respect to progression-free survival was observed with the ixazomib regimen, as compared with the placebo regimen, in all prespecified patient subgroups, including in patients with high-risk cytogenetic abnormalities. The overall rates of response were 78% in the ixazomib group and 72% in the placebo group, and the corresponding rates of complete response plus very good partial response were 48% and 39%. The median time to response was 1.1 months in the ixazomib group and 1.9 months in the placebo group, and the corresponding median duration of response was 20.5 months and 15.0 months. At a median follow-up of approximately 23 months, the median overall survival has not been reached in either study group, and follow-up is ongoing. The rates of serious adverse events were similar in the two study groups (47% in the ixazomib group and 49% in the placebo group), as were the rates of death during the study period (4% and 6%, respectively); adverse events of at least grade 3 severity occurred in 74% and 69% of the patients, respectively. Thrombocytopenia of grade 3 and grade 4 severity occurred more frequently in the ixazomib group (12% and 7% of the patients, respectively) than in the placebo group (5% and 4% of the patients, respectively). Rash occurred more frequently in the ixazomib group than in the placebo group (36% vs. 23% of the patients), as did gastrointestinal adverse events, which were predominantly low grade. The incidence of peripheral neuropathy was 27% in the ixazomib group and 22% in the placebo group (grade 3 events occurred in 2% of the patients in each study group). Patient-reported quality of life was similar in the two study groups. CONCLUSIONS The addition of ixazomib to a regimen of lenalidomide and dexamethasone was associated with significantly longer progression-free survival; the additional toxic effects with this all-oral regimen were limited. (Funded by Millennium Pharmaceuticals; TOURMALINE-MM1 ClinicalTrials.gov number, NCT01564537.).
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Affiliation(s)
- Philippe Moreau
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Tamás Masszi
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Norbert Grzasko
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Nizar J Bahlis
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Markus Hansson
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Ludek Pour
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Irwindeep Sandhu
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Peter Ganly
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Bartrum W Baker
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Sharon R Jackson
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Anne-Marie Stoppa
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - David R Simpson
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Peter Gimsing
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Antonio Palumbo
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Laurent Garderet
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Michele Cavo
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Shaji Kumar
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Cyrille Touzeau
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Francis K Buadi
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Jacob P Laubach
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Deborah T Berg
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Jianchang Lin
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Alessandra Di Bacco
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Ai-Min Hui
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Helgi van de Velde
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
| | - Paul G Richardson
- From University Hospital Hôtel Dieu, Nantes (P.M., C.T.), the Department of Hematology, Institut Paoli-Calmettes, Marseille (A.-M.S.), and the Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris (L.G.) - all in France; the Department of Haematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (T.M.); the Department of Haemato-oncology and Bone Marrow Transplantation, Medical University of Lublin, and St. John's Cancer Center, Lublin, Poland (N.G.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary (N.J.B.), and the Division of Hematology, Department of Medicine, University of Alberta, Edmonton (I.S.) - both in Canada; the Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden (M.H.); Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (L.P.); the Department of Haematology, Christchurch Hospital, Christchurch (P. Ganly), the Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu (B.W.B.), the Department of Haematology, Middlemore Hospital, Auckland (S.R.J.), and the Department of Haematology, North Shore Hospital, Auckland (D.R.S.) - all in New Zealand; the Department of Hematology, University Hospital Rigshospitalet, Copenhagen (P. Gimsing); Myeloma Unit, Division of Hematology, University of Turin, Turin (A.P.), and Seràgnoli Institute of Haematology, Bologna University School of Medicine, St. Orsola-Malpighi University Hospital, Bologna (M.C.) - both in Italy; the Division of Hematology, Mayo Clinic, Rochester, MN (S.K., F.K.B.); and Dana-Farber Cancer Institute, Boston (J.P.L., P.G.R.), and Millennium Pharmaceuticals, Cambridge (D.T.B., J.L., A.D.B., A.-M.H., H.V.) - both in Massachusetts
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Gupta N, Labotka R, Liu G, Hui AM, Venkatakrishnan K. Exposure-safety-efficacy analysis of single-agent ixazomib, an oral proteasome inhibitor, in relapsed/refractory multiple myeloma: dose selection for a phase 3 maintenance study. Invest New Drugs 2016; 34:338-46. [PMID: 27039387 PMCID: PMC4859859 DOI: 10.1007/s10637-016-0346-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/15/2016] [Indexed: 12/14/2022]
Abstract
Background Ixazomib is the first oral, small molecule proteasome inhibitor to reach phase 3 trials. The current analysis characterized the exposure-safety and exposure-efficacy relationships of ixazomib in patients with relapsed/refractory multiple myeloma (MM) with a purpose of recommending an approach to ixazomib dosing for maintenance therapy. Methods Logistic regression was used to investigate relationships between ixazomib plasma exposure (area under the curve/day; derived from individual apparent clearance values from a published population pharmacokinetic analysis) and safety/efficacy outcomes (hematologic [grade ≥ 3 vs ≤ 2] or non-hematologic [grade ≥ 2 vs ≤ 1] adverse events [AEs], and clinical benefit [≥stable disease vs progressive disease]) using phase 1 data in relapsed/refractory MM (NCT00963820; N = 44). Results Significant relationships to ixazomib exposure were observed for five AEs (neutropenia, thrombocytopenia, rash, fatigue, and diarrhea) and clinical benefit (p < 0.05). Dose–response relationships indicated a favorable benefit/risk ratio at 3 mg and 4 mg weekly, which are below the maximum tolerated dose of 5.5 mg. At 3 mg, the model predicted that: 37 % of patients will achieve clinical benefit; incidence of grade ≥ 3 neutropenia and thrombocytopenia will be 10 % and 23 %, respectively; and incidence of grade ≥ 2 rash, fatigue, and diarrhea will be 8 %, 19 %, and 19 %, respectively. Conclusions Based on the findings, patients in the phase 3 maintenance trial will initiate ixazomib at a once-weekly dose of 3 mg, increasing to 4 mg if acceptable tolerability after 4 cycles, to provide maximum clinical benefit balanced with adequate tolerability.
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Affiliation(s)
- Neeraj Gupta
- Clinical Pharmacology, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, 40 Landsdowne Street, Cambridge, MA, 02139, USA.
| | - Richard Labotka
- Clinical Research, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, 40 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Guohui Liu
- Biostatistics, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, 40 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Ai-Min Hui
- Clinical Research, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, 40 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Karthik Venkatakrishnan
- Clinical Pharmacology, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, 40 Landsdowne Street, Cambridge, MA, 02139, USA
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Gupta N, Hanley MJ, Venkatakrishnan K, Wang B, Sharma S, Bessudo A, Hui AM, Nemunaitis J. The Effect of a High-Fat Meal on the Pharmacokinetics of Ixazomib, an Oral Proteasome Inhibitor, in Patients With Advanced Solid Tumors or Lymphoma. J Clin Pharmacol 2016; 56:1288-95. [PMID: 26872892 PMCID: PMC5069578 DOI: 10.1002/jcph.719] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 11/22/2022]
Abstract
Ixazomib is the first oral proteasome inhibitor to be investigated in the clinic. This clinical study assessed whether the pharmacokinetics of ixazomib would be altered if administered after a high‐calorie, high‐fat meal. In a 2‐period, 2‐sequence, crossover study design, adult patients with advanced solid tumors or lymphoma received a 4‐mg oral dose of ixazomib as immediate‐release capsules on day 1 without food (fasted, administered following an overnight fast) or with food (fed, following consumption of a high‐calorie, high‐fat meal), followed by another dose on day 15 in the alternate food intake condition (fasted to fed or fed to fasted). Twenty‐four patients were enrolled; of these, 15 were included in the pharmacokinetic‐evaluable population. Administration of ixazomib after a high‐fat meal reduced both the rate and extent of absorption of ixazomib. Under fed conditions, the median time to peak plasma concentration (Tmax) of ixazomib was delayed by approximately 3 hours compared with administration in the fasted state (1.02 hours vs 4.0 hours), and there was a 28% reduction in total systemic exposure (area under the curve, AUC) and a 69% reduction in peak plasma concentration (Cmax). Together, the results support the administration of ixazomib on an empty stomach, at least 1 hour before or at least 2 hours after food. These recommendations are reflected in the United States Prescribing Information for ixazomib (clinicaltrials.gov identifier NCT01454076).
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Affiliation(s)
| | | | | | | | - Sunil Sharma
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Alberto Bessudo
- California Cancer Associates for Research and Excellence, San Diego, CA, USA
| | - Ai-Min Hui
- Millennium Pharmaceuticals, Cambridge, MA, USA
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Gupta N, Zhao Y, Hui AM, Esseltine DL, Venkatakrishnan K. Switching from body surface area-based to fixed dosing for the investigational proteasome inhibitor ixazomib: a population pharmacokinetic analysis. Br J Clin Pharmacol 2016; 79:789-800. [PMID: 25377318 DOI: 10.1111/bcp.12542] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/30/2014] [Indexed: 12/19/2022] Open
Abstract
AIMS This population pharmacokinetic analysis of the investigational oral proteasome inhibitor ixazomib assessed the feasibility of switching from body surface area (BSA)-based to fixed dosing, and the impact of baseline covariates on ixazomib pharmacokinetics. METHODS Data were pooled from 226 adult patients with multiple myeloma, lymphoma or solid tumours in four phase 1 studies, in which ixazomib dosing (oral/intravenous, once/twice weekly) was based on BSA. Population pharmacokinetic modelling was undertaken using nonmem version 7.2. RESULTS Ixazomib pharmacokinetics were well described by a three compartment model with first order absorption and linear elimination. Ixazomib was absorbed rapidly (Ka 0.5 h(-1)), with dose- and time-independent pharmacokinetics. Estimated absolute bioavailability and clearance were 60% and 2l h(-1), respectively. Although a small effect of BSA (range 1.3-2.6 m(2)) was observed on the peripheral volume of distribution (V4), reducing the corresponding inter-individual variability by 12.9%, there was no relationship between BSA and ixazomib clearance (the parameter that dictates total systemic exposure following fixed dosing). Consistently, based on simulations (n = 1000), median AUCs (including interquartile range) were similar after BSA-based (2.23 mg m(-2)) and fixed (4 mg) oral dosing with no trend in simulated AUC vs. BSA for fixed dosing (P = 0.42). No other covariates, including creatinine clearance (22-213.7 ml min(-1)) and age (23-86 years), influenced ixazomib pharmacokinetics. CONCLUSIONS This analysis supports a switch from BSA-based to fixed dosing, without dose modification for mild/moderate renal impairment or age, in future adult studies of ixazomib, simplifying dosing guidance and clinical development.
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Affiliation(s)
- Neeraj Gupta
- Clinical Pharmacology, Takeda Pharmaceuticals International Co, Cambridge, MA, USA
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Gupta N, Hanley MJ, Venkatakrishnan K, Bessudo A, Sharma S, O'Neil B, Wang B, Hui AM, Nemunaitis J. Abstract B147: A phase 1 drug-drug interaction study between ixazomib, an oral proteasome inhibitor, and rifampin in patients (pts) with advanced solid tumors. Mol Cancer Ther 2015. [DOI: 10.1158/1535-7163.targ-15-b147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Ixazomib is an oral proteasome inhibitor under phase 3 investigation in pts with multiple myeloma and AL amyloidosis. Ixazomib citrate, a prodrug, rapidly hydrolyzes to the active moiety, ixazomib, in plasma. Metabolism appears to be the major route of elimination for ixazomib. This phase 1, open-label, multicenter, parallel-group study (NCT01454076) investigated the effect of rifampin, an established strong CYP3A inducer, on the pharmacokinetics (PK) of ixazomib.
Methods
Adult pts with advanced solid tumors (Eastern Cooperative Oncology Group Performance Status 0 or 1), for which no effective standard treatment was available, were enrolled. Pts in the ixazomib + rifampin arm received a single 4 mg dose of ixazomib on day 8, plus rifampin 600 mg PO on days 1-14 of a 21-day PK cycle. On day 8, ixazomib and rifampin were administered concomitantly and PK samples were collected over 168 hours post-dose. Pts in the reference arm received a single 4 mg dose of ixazomib on day 1 with PK samples collected over 168 hours post-dose. After completion of the 21-day PK cycle, pts could continue in the study and receive ixazomib on days 1, 8, and 15 of 28-day cycles. Plasma PK parameters were estimated by non-compartmental methods. Geometric mean ratios and 90% confidence intervals (CIs) of PK parameters in the ixazomib + rifampin versus ixazomib alone arms were calculated using an ANOVA model. Treatment-emergent adverse events (TEAEs) were assessed using NCI CTCAE version 4.03.
Results
Eighteen and 20 pts were enrolled to the ixazomib + rifampin and ixazomib alone arms, respectively. To assess the impact of rifampin on ixazomib PK, data from 16 PK-evaluable pts who received ixazomib + rifampin were compared with data from 14 PK-evaluable pts who received ixazomib alone. Demographics and PK parameters are shown in the Table. At data cut-off (4 August 2014), 15 pts (83%) in the ixazomib + rifampin arm had ≥1 TEAE related to study medication. The most common (≥20%) drug-related TEAEs, regardless of grade, were nausea (39%) and fatigue (28%). Three pts (17%) in the ixazomib + rifampin arm experienced ≥1 grade 3 TEAE.
Conclusions
The strong CYP3A inducer rifampin produced a 74% decrease in ixazomib total systemic exposure. Systemic treatment with strong CYP3A inducers should be avoided in pts receiving ixazomib.
ParameterIxazomib + rifampin (test)Ixazomib alone (reference)LS geometric mean ratio (90% CI) (test / reference)N (PK evaluable)18 (16)20 (14)-Age, yearsa62 (39-81)61 (29-76)-Male,%5645-Weight, kga80.2 (58.9-109.3)69.8 (46.9-93.5)-Tmax, hoursb1.45 (0.5-4.12)1.49 (0.5-7.5)-Cmax, ng/mLc25.7 (50)55.8 (57)0.46 (0.29, 0.73)AUC0-last, ng•hr/mLc232 (50)907 (44)0.26 (0.18, 0.37)aMean (range); bmedian (range); cgeometric mean (% coefficient of variation). AUC, area under the plasma concentration-time curve from time 0 to the time of the last quantifiable concentration; CI, confidence interval; Cmax, maximum plasma concentration; LS, least square; PK, pharmacokinetic; Tmax, time to first maximum plasma concentration.
Citation Format: Neeraj Gupta, Michael J. Hanley, Karthik Venkatakrishnan, Alberto Bessudo, Sunil Sharma, Bert O'Neil, Bingxia Wang, Ai-Min Hui, John Nemunaitis. A phase 1 drug-drug interaction study between ixazomib, an oral proteasome inhibitor, and rifampin in patients (pts) with advanced solid tumors. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr B147.
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Affiliation(s)
- Neeraj Gupta
- 1Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Michael J. Hanley
- 1Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Karthik Venkatakrishnan
- 1Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Alberto Bessudo
- 2California Cancer Associates for Research and Excellence, San Diego, CA
| | - Sunil Sharma
- 3Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Bert O'Neil
- 4Indiana University Simon Cancer Center, Indianapolis, IN
| | - Bingxia Wang
- 1Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Ai-Min Hui
- 1Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
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Smith DC, Kalebic T, Infante JR, Siu LL, Sullivan D, Vlahovic G, Kauh JS, Gao F, Berger AJ, Tirrell S, Gupta N, Di Bacco A, Berg D, Liu G, Lin J, Hui AM, Thompson JA. Phase 1 study of ixazomib, an investigational proteasome inhibitor, in advanced non-hematologic malignancies. Invest New Drugs 2015; 33:652-63. [PMID: 25777468 PMCID: PMC4435632 DOI: 10.1007/s10637-015-0230-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/06/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE Ixazomib is an investigational proteasome inhibitor with demonstrated antitumor activity in xenograft models of multiple myeloma (MM), lymphoma, and solid tumors. This open-label, phase 1 study investigated intravenous (IV) ixazomib, in adult patients with advanced non-hematologic malignancies. METHODS Patients received IV ixazomib twice-weekly for up to twelve 21-day cycles. The 0.125 mg/m(2) starting dose was doubled (one patient/dose) until 1.0 mg/m(2) based on dose-limiting toxicities (DLTs) in cycle 1. This was followed by 3 + 3 dose-escalation and expansion at the maximum tolerated dose (MTD). Primary objectives included safety and MTD assessment. Secondary objectives included assessment of pharmacokinetics, pharmacodynamics, and disease response. RESULTS Ixazomib was escalated from 0.125 to 2.34 mg/m(2) to determine the MTD (n = 23); patients were then enrolled to MTD expansion (n = 73) and pharmacodynamic (n = 20) cohorts. Five patients experienced DLTs (1.0 and 1.76 mg/m(2): grade 3 pruritic rash; 2.34 mg/m(2): grade 3 and 4 thrombocytopenia, and grade 3 acute renal failure); thus, the MTD was 1.76 mg/m(2). Drug-related grade ≥3 adverse events (AEs) included thrombocytopenia (23 %), skin and subcutaneous (SC) tissue disorders (16 %), and fatigue (9 %). Among 92 evaluable patients, one (head and neck cancer) had a partial response and 30 had stable disease. Ixazomib terminal half-life was 3.8-7.2 days; plasma exposures increased dose-proportionally and drug was distributed to tumors. Inhibition of whole-blood 20S proteasome activity and upregulation of ATF-3 in tumor biopsies demonstrated target engagement. CONCLUSIONS In patients with solid tumors, ixazomib was associated with a manageable safety profile, limited antitumor activity, and evidence of downstream proteasome inhibition effects.
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Affiliation(s)
- David C Smith
- University of Michigan Comprehensive Cancer Center, 7302 CC SPC 5948, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5948, USA,
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Richardson PG, Moreau P, Laubach JP, Gupta N, Hui AM, Anderson KC, San Miguel JF, Kumar S. The investigational proteasome inhibitor ixazomib for the treatment of multiple myeloma. Future Oncol 2015; 11:1153-68. [DOI: 10.2217/fon.15.9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
ABSTRACT Ixazomib is an investigational, reversible 20S proteasome inhibitor. It is the first oral proteasome inhibitor under clinical investigation in multiple myeloma (MM). Under physiological conditions, the stable citrate ester drug substance, ixazomib citrate (MLN9708), rapidly hydrolyzes to the biologically active boronic acid, ixazomib (MLN2238). Preclinical studies have demonstrated antitumor activity in MM cell lines and xenograft models. In Phase I/II clinical studies ixazomib has had generally manageable toxicities, with limited peripheral neuropathy observed to date. Preliminary data from these studies indicate ixazomib is active as a single agent in relapsed/refractory MM and as part of combination regimens in newly diagnosed patients. Phase III studies in combination with lenalidomide–dexamethasone are ongoing.
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Affiliation(s)
- Paul G Richardson
- Division of Hematologic Malignancy, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Philippe Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | - Jacob P Laubach
- Division of Hematologic Malignancy, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Neeraj Gupta
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Ai-Min Hui
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Kenneth C Anderson
- Division of Hematologic Malignancy, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Jesús F San Miguel
- Clinica Universidad de Navarra, Centro Investigación Medica Aplicada (CIMA), Pamplona, Spain
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Abstract
INTRODUCTION This study aimed to understand the symptomatic impact of amyloid light-chain (AL) amyloidosis from the patient's perspective. METHODS Four data sources were included: a literature review, review of online patient blogs, expert clinician interviews and patient interviews. Patients were recruited through the Amyloidosis Foundation and physician referral. Phone interviews were conducted and included open-ended concept elicitation questions. Thematic analysis was performed to identify symptoms and impacts. Descriptive statistics were used to characterize the sample. A conceptual model was developed depicting the impact of disease and treatment. RESULTS Two hundred seventy abstracts were identified; 10 articles were deemed relevant. No qualitative studies were identified, and only three studies included patient-reported measures. Ten patients completed interviews (mean age 61 [±8]; 7 male). Over 25 signs/symptoms were identified, including fatigue, weakness, dyspnea, neuropathy, edema, dizziness/lightheadedness, anorexia, diarrhea and constipation. Impacts included reduced physical and social functioning, and emotional impacts, including frustration, anxiety and depression. Findings from the blogs and expert interviews were consistent with patient reports. CONCLUSION Symptoms can vary widely, but a core set of symptoms were common across patients. The conceptual model derived from this study can be used to ensure a patient-centered approach to drug development.
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Affiliation(s)
- Huamao Mark Lin
- a Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - David Seldin
- b Boston Medical Center , Boston , MA , USA , and
| | - Ai-Min Hui
- a Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Deborah Berg
- a Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
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Kumar SK, Berdeja JG, Niesvizky R, Lonial S, Laubach JP, Hamadani M, Stewart AK, Hari P, Roy V, Vescio R, Kaufman JL, Berg D, Liao E, Di Bacco A, Estevam J, Gupta N, Hui AM, Rajkumar V, Richardson PG. Safety and tolerability of ixazomib, an oral proteasome inhibitor, in combination with lenalidomide and dexamethasone in patients with previously untreated multiple myeloma: an open-label phase 1/2 study. Lancet Oncol 2014; 15:1503-1512. [PMID: 25456369 DOI: 10.1016/s1470-2045(14)71125-8] [Citation(s) in RCA: 207] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The combination of bortezomib, lenalidomide, and dexamethasone is a highly effective therapy for newly diagnosed multiple myeloma. Ixazomib is an investigational, oral, proteasome inhibitor with promising anti-myeloma effects and low rates of peripheral neuropathy. In a phase 1/2 trial we aimed to assess the safety, tolerability, and activity of ixazomib in combination with lenalidomide and dexamethasone in newly diagnosed multiple myeloma. METHODS We enrolled patients newly diagnosed with multiple myeloma aged 18 years or older with measurable disease, Eastern Cooperative Oncology Group performance status 0-2, and no grade 2 or higher peripheral neuropathy, and treated them with oral ixazomib (days 1, 8, 15) plus lenalidomide 25 mg (days 1-21) and dexamethasone 40 mg (days 1, 8, 15, 22) for up to 12 28-day cycles, followed by maintenance therapy with ixazomib alone. In phase 1, we gave patients escalating doses of ixazomib (1·68-3·95 mg/m(2)) to establish the recommended dose for phase 2. The primary endpoints were maximum tolerated dose for phase 1, and the rate of very good partial response or better for phase 2. Safety analyses were done in all patients who received at least one dose of study drug; efficacy analyses were done in all patients who received at least one dose of study drug at the phase 2 dose, had measurable disease at baseline, and had at least one post-baseline response assessment. This study is registered at ClinicalTrials.gov, number NCT01217957. FINDINGS Between Nov 22, 2010, and Feb 28, 2012, we enrolled 65 patients (15 to phase 1 and 50 to phase 2). Four dose-limiting toxic events were noted in phase 1: one at a dose of ixazomib of 2·97 mg/m(2) and three at 3·95 mg/m(2). The maximum tolerated dose of ixazomib was established as 2·97 mg/m(2) and the recommended phase 2 dose was 2·23 mg/m(2), which was converted to a 4·0 mg fixed dose based on population pharmacokinetic results. Grade 3 or higher adverse events related to any drug were reported in 41 (63%) patients, including skin and subcutaneous tissue disorders (11 patients, 17%), neutropenia (eight patients, 12%), and thrombocytopenia (five patients, 8%); drug-related peripheral neuropathy of grade 3 or higher occurred in four (6%) patients. Five patients discontinued because of adverse events. In 64 response-evaluable patients, 37 (58%, 95% CI 45-70) had a very good partial response or better. INTERPRETATION The all-oral combination of weekly ixazomib plus lenalidomide and dexamethasone was generally well tolerated and appeared active in newly diagnosed multiple myeloma. These results support the phase 3 trial development of this combination for multiple myeloma. FUNDING Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceutical International Company.
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Affiliation(s)
- Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
| | | | - Ruben Niesvizky
- Myeloma Center, Weill Cornell Medical College, New York Presbyterian Hospital, NY, USA
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | - Mehdi Hamadani
- West Virginia University, Mary Babb Randolph Cancer Center, Morgantown, WV, USA
| | | | - Parameswaran Hari
- Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Robert Vescio
- Cedars-Sinai Outpatient Cancer Center at the Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | - Jonathan L Kaufman
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Deborah Berg
- Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceutical International Company, Cambridge, MA, USA
| | - Eileen Liao
- Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceutical International Company, Cambridge, MA, USA
| | - Alessandra Di Bacco
- Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceutical International Company, Cambridge, MA, USA
| | - Jose Estevam
- Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceutical International Company, Cambridge, MA, USA
| | - Neeraj Gupta
- Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceutical International Company, Cambridge, MA, USA
| | - Ai-Min Hui
- Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceutical International Company, Cambridge, MA, USA
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Gupta N, Huh Y, Hutmacher MM, Ottinger S, Hui AM, Venkatakrishnan K. Integrated nonclinical and clinical risk assessment to obviate the need for a dedicated QTc study of ixazomib citrate (MLN9708) in cancer patients (pts). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.2553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Neeraj Gupta
- Takeda Pharmaceuticals International Co., Cambridge, MA
| | - Yeamin Huh
- Ann Arbor Pharmacometrics Group, Ann Arbor, MI
| | | | - Sean Ottinger
- Takeda Pharmaceuticals International Co., Cambridge, MA
| | - Ai-Min Hui
- Takeda Pharmaceuticals International Co., Cambridge, MA
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Kumar S, Bensinger W, Zimmerman TM, Reeder CB, Berenson JR, Berg D, Hui AM, Gupta N, Di Bacco A, Yu J, Shou Y, Niesvizky R. Weekly MLN9708, an investigational oral proteasome inhibitor (PI), in relapsed/refractory multiple myeloma (MM): Results from a phase I study after full enrollment. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.8514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8514 Background: MLN9708 is an investigational, orally bioavailable, potent, reversible, specific inhibitor of the 20S proteasome that has demonstrated antitumor activity in in vivo models of MM. We report safety, activity and pharmacokinetics (PK) of weekly oral MLN9708 in a phase 1 trial in patients (pts) with relapsed and/or refractory MM after full enrollment (NCT00963820). Methods: Pts received MLN9708 (days 1, 8, 15; 28-day cycles) at 0.24–3.95 mg/m2 (dose-escalation phase) and at the MTD, 2.97 mg/m2, in relapsed and refractory (RR), bortezomib (btz)-relapsed, PI-naïve, and prior carfilzomib (CZ) expansion cohorts. Adverse events (AEs) were graded by NCI-CTCAE v3.0. Response was assessed by IMWG uniform criteria. Results: 60 pts (33 male, median age 64 yrs [40–79]) were enrolled, 32 in the dose-escalation phase and 31 to the expansion cohorts (11 RR, 10 btz-relapsed, 6 PI-naïve, 4 CZ; 2 RR and 1 btz-relapsed pts included from MTD dose-escalation cohort). Median time from MM diagnosis was 4.9 yrs (1.5–18.8). Median number of prior regimens was 6 (2–18), including btz, lenalidomide, thalidomide, and CZ in 83%, 95%, 52%, and 13%, respectively; 76% were refractory to last therapy (17% btz-refractory). At data cut-off (Nov 29, 2012) pts had received a median of 2 cycles (1–11); 5 pts remained on treatment. All-grade/grade ≥3 drug-related AEs were seen in 83%/52% of pts; common drug-related grade ≥3 AEs were thrombocytopenia (33%), diarrhea, neutropenia (17%), decreased appetite, fatigue, and lymphopenia (8%). 6 pts (10%) had drug-related PN (no grade ≥3). 5 pts discontinued due to drug-related AEs; 1 pt died on study due to an unrelated AE. By investigator assessment in 41 evaluable pts, responses included1 VGPR, 5 PR, 1 MR, and 15 with SD. MLN9708 was rapidly absorbed, with a terminal half-life of 4–12 days (supporting weekly dosing) and a proportional increase in plasma AUC with dose (0.8–3.95 mg/m2). PK data were similar across expansion cohorts. Conclusions: Current data suggest weekly oral MLN9708 is generally well tolerated with infrequent PN, and shows activity in this heavily pretreated population with prior exposure to immunomodulatory drugs and btz. Clinical trial information: NCT00963820.
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Affiliation(s)
| | - William Bensinger
- Clinical Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Craig B. Reeder
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ
| | | | | | - Ai-Min Hui
- Millennium Pharmaceuticals, Inc., Cambridge, MA
| | | | | | - Jiang Yu
- Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - Yaping Shou
- Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - Ruben Niesvizky
- Center of Excellence for Lymphoma and Myeloma, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY
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Kumar S, Bensinger W, Reeder CB, Zimmerman TM, Berenson JR, Liu G, Berg D, Gupta N, Di Bacco A, Hui AM, Niesvizky R. Weekly dosing of the investigational oral proteasome inhibitor MLN9708 in patients (pts) with relapsed/refractory multiple myeloma (MM): A phase I study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8034 Background: Phase 1 studies are evaluating IV and oral dosing of the reversible proteasome inhibitor MLN9708 in multiple tumor types. We report the safety, MTD, pharmacokinetics (PK), pharmacodynamics, and preliminary responses with weekly oral MLN9708 in pts with relapsed/refractory MM (NCT00963820). Methods: Pts aged ≥18 yrs received MLN9708 on d 1, 8, and 15 of 28-d cycles. In the dose-escalation phase, pts required ≥2 prior therapies (including bortezomib, thalidomide/lenalidomide, and corticosteroids). At the MTD, pts were to be enrolled to relapsed and refractory (RR), bortezomib-relapsed (VR), proteasome inhibitor (PI) naïve, and carfilzomib (CZ) expansion cohorts. Results: 36 pts have been enrolled to date (data cut-off: Dec 1, 2011), 32 in the dose-escalation phase (0.24–3.95 mg/m2) and 8 to expansion cohorts (2 RR, 5 VR, 1 PI naïve; RR and VR cohorts each include 2 pts from MTD dose-escalation cohort). Median age was 64.5 yrs (range 40–79), 53% were male, and median number of prior lines of therapy was 3.5 (range 1-13), including 92%, 92%, 56%, and 8% who had prior bortezomib, lenalidomide, thalidomide, and carfilzomib, respectively. Pts have received a median of 2 cycles (range 1–11); 5 pts remain on treatment. Among 24 DLT-evaluable pts, 3 DLTs were seen: 2 at 3.95 mg/m2 (1 grade 3 rash, 1 grade 3 GI AEs) and 1 at 2.97 mg/m2 (grade 3 GI AEs). The MTD was determined as 2.97 mg/m2. Overall, 69% of pts had drug-related AEs, and 28% had related grade ≥3 AEs, including thrombocytopenia (17%), diarrhea (11%), nausea, neutropenia, and fatigue (each 8%). Only 3 (8%) pts had drug-related peripheral neuropathy (PN; no grade ≥3). 2 pts discontinued due to AEs. In 18 response-evaluable pts, 1 had a VGPR at 3.95 mg/m2, 1 had a PR at 2.97 mg/m2, and 8 have achieved SD durable for up to 9.5 mos. PK analyses showed linear plasma PK (0.8–3.95 mg/m2), Tmax of 0.5-2 hr, and terminal half-life of 7 d for MLN2238 (biologically active hydrolysis product). There was a trend for a dose-dependent increase in whole blood 20S proteasome inhibition. Conclusions: Current data suggest weekly oral MLN9708 is generally well tolerated with infrequent PN, and shows early signs of antitumor activity.
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Affiliation(s)
| | | | | | | | | | - Guohui Liu
- Millennium Pharmaceuticals, Cambridge, MA
| | | | | | | | - Ai-Min Hui
- Millennium Pharmaceuticals, Cambridge, MA
| | - Ruben Niesvizky
- Center of Excellence for Lymphoma and Myeloma, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY
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Richardson PGG, Berdeja JG, Niesvizky R, Lonial S, Roy V, Hari P, Berg D, Liu G, Gupta N, Di Bacco A, Hui AM, Kumar S. Oral weekly MLN9708, an investigational proteasome inhibitor, in combination with lenalidomide and dexamethasone in patients (pts) with previously untreated multiple myeloma (MM): A phase I/II study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8033 Background: MLN9708 is an oral, reversible 20S proteasome inhibitor. The feasibility of combining a proteasome inhibitor with an immunomodulatory drug and a steroid in previously untreated MM has been demonstrated with the RVD regimen. This is the first study of MLN9708 in combination with lenalidomide and dexamethasone (NCT01217957). Here we report the phase (Ph) 1 MTD and preliminary Ph 2 results. Methods: Pts with previously untreated MM, aged ≥18 yrs with measurable disease received oral MLN9708 (phase 1: 1.68–3.95 mg/m2) days 1, 8, and 15, lenalidomide 25 mg days 1–21, and dexamethasone 40 mg days 1, 8, 15, and 22, for up to twelve 28-day cycles. Primary objectives were determination of safety, MTD, and recommended phase 2 dose (RP2D) (Ph 1), and CR+VGPR rate (Ph 2). Results: At data cut-off (Dec 1, 2011), 29 pts had been enrolled (15 Ph 1, 14 Ph 2). Median age was 64 yrs (range 40–82); 69% ISS stage II/III. In Ph 1, the MLN9708 MTD was determined as 2.97 mg/m2 and the RP2D as 2.23 mg/m2; for Ph 2, the RP2D was converted to a 4.0 mg fixed dose based on population PK results. Ph 1 pts have received a median of 6 treatment cycles (range 1–11), 8 received ≥6 cycles; 6 stopped to receive ASCT, 7 are ongoing. Ph 2 pts received a median of 1 (range 1–2), all are ongoing. Grade ≥3 hematologic toxicity was reversible and included anemia (n=2) and thrombocytopenia (n=1). Grade ≥3 nonhematologic toxicity included erythematous rash, syncope, and vomiting (2 pts each). All-grade drug-related peripheral neuropathy was seen in 6 pts (21%), including grade 2 with pain in 2 (both Ph 1 at doses above the MTD). Two pts discontinued due to AE; there were 5 pts who had serious drug-related AE (all Ph 1). Of 19 response-evaluable pts (Ph 1 + Ph 2), all achieved ≥PR, including 5 CR (1 sCR), 4 VGPR, and 10 PR; all remain in response with duration of confirmed response of up to 9.5 months. Of 4 response-evaluable Ph 2 pts, 1 has achieved VGPR and 3 PR to date. Conclusions: Oral MLN9708 plus lenalidomide and dexamethasone appears well tolerated with manageable toxicity. These data show antitumor activity at the RP2D in pts with previously untreated MM, with ≥PR in all pts to date.
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Affiliation(s)
| | | | - Ruben Niesvizky
- Center of Excellence for Lymphoma and Myeloma, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY
| | - Sagar Lonial
- Winship Cancer Institute, Emory University, Atlanta, GA
| | | | - Parameswaran Hari
- Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Guohui Liu
- Millennium Pharmaceuticals, Cambridge, MA
| | | | | | - Ai-Min Hui
- Millennium Pharmaceuticals, Cambridge, MA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN
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Martin P, Chang JE, Rifkin RM, Hui AM, Berg D, Gupta N, Liu G, Di Bacco A, Assouline SE. MLN9708, an investigational proteasome inhibitor, in patients (pts) with relapsed/refractory lymphoma: Emerging data from a phase I dose-escalation study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8064 Background: MLN9708 is a reversible, orally bioavailable, specific 20S proteasome inhibitor. This study (NCT00893464) studied the safety and determined the MTD of IV MLN9708 in pts with relapsed/refractory lymphoma, and characterized pharmacokinetics (PK) and pharmacodynamics (PD). Methods: Pts aged ≥18 yrs who had failed ≥2 chemotherapeutic regimens received IV MLN9708 on days 1, 8, and 15 of 28-day cycles until disease progression or unacceptable toxicity. One pt was enrolled at the 0.125 mg/m2 starting dose; dose doubling proceeded with 1 pt at each dose up to 1.0 mg/m2. Dose escalation occurred in ≤40% increments using a standard 3+3 scheme based on DLT occurrence in cycle 1. Blood samples were collected at multiple time points after dosing on days 1 and 15 of cycle 1 for PK/PD analyses. Results: At data cut-off (Dec 1 2011), 21 pts had been enrolled and treated: 1 each at 0.125, 0.25, 0.5 and 1 mg/m2, 4 at 1.4 mg/m2, 7 at 1.76 mg/m2, and 6 at 2.34 mg/m2. Median age was 57 yrs (range 23–78); 57% were male. Median number of prior therapies was 5; 29% had prior radiation, 24% prior stem cell transplant. Histologies included T-cell lymphoma (n=5), Hodgkin lymphoma (n=3), follicular lymphoma (n=2), DLBCL (n=1) and other indolent B-cell lymphoma (n=7). Pts had received a median of 2 cycles (range 1–22); 2 DLTs were seen (neutropenia at 1.76 and 2.34 mg/m2). All pts experienced drug-related AEs, including fatigue (48%), nausea (29%), diarrhea (29%), pyrexia, thrombocytopenia, and vomiting (each 24%). 43% had drug-related grade ≥3 AEs, 1 pt discontinued due to drug-related grade 3 neutropenia (2.34 mg/m2). Three pts had drug-related peripheral neuropathy (1 grade 1, 2 grade 2). There were no on-study deaths. Of 18 response-evaluable pts, 3 achieved PR (including 2 who remain in response and on-study for >1 yr) and 4 SD. PK analyses showed linear PK (0.5–2.34 mg/m2) and a terminal half-life of ~6–9 days. There was a dose-dependent increase in maximal whole blood 20S proteasome inhibition. Conclusions: These data suggest IV MLN9708 is generally well tolerated, with infrequent PN, and is clinically active in pretreated lymphoma pts. The trial is ongoing and updated data will be presented.
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Affiliation(s)
| | - Julie E. Chang
- University of Wisconsin, Carbone Comprehensive Cancer Center, Madison, WI
| | | | - Ai-Min Hui
- Millennium Pharmaceuticals, Cambridge, MA
| | | | | | - Guohui Liu
- Millennium Pharmaceuticals, Cambridge, MA
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Lonial S, Baz RC, Wang M, Talpaz M, Liu G, Berg D, Gupta N, Di Bacco A, Hui AM, Richardson PGG. Phase I study of twice-weekly dosing of the investigational oral proteasome inhibitor MLN9708 in patients (pts) with relapsed and/or refractory multiple myeloma (MM). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8017 Background: MLN9708 is the first oral proteasome inhibitor to enter clinical investigation in MM. This study (NCT00932698) assessed safety, MTD, and response rate with twice-weekly oral MLN9708 in pts with relapsed and/or refractory MM, and characterized plasma pharmacokinetics (PK) and blood pharmacodynamics. Methods: Pts aged ≥18 yrs with measurable MM received MLN9708 on d 1, 4, 8, and 11 of 21-d cycles. In the dose-escalation phase, pts required ≥2 prior therapies (including bortezomib, thalidomide/lenalidomide, and corticosteroids). At the MTD (2.0 mg/m2), pts were enrolled to relapsed and refractory [RR], bortezomib-relapsed [VR], proteasome-inhibitor [PI] naïve, and carfilzomib [CZ] expansion cohorts. Results: 57 pts (53% M) were enrolled, 37 to the expansion cohorts (16 RR, 14 VR, 6 PI naïve, 1 CZ). Median age was 65 yrs (range 50-86). Median number of prior lines of therapy was 4 (range 1-28); 88%, 84%, 61%, and 5% had prior bortezomib, lenalidomide, thalidomide, and carfilzomib, respectively. Pts have received a median of 3 cycles (range 1-24) to date (data cut-off Dec 1, 2011); 7 (12%) have received ≥13 cycles. Drug-related AEs were seen in 89% of pts, including fatigue (46%), thrombocytopenia (40%), and nausea (30%); 63% had drug-related grade ≥3 AEs, including thrombocytopenia (33%), neutropenia (14%), fatigue (9%), and rash (7%). Only 6 (11%) pts had drug-related peripheral neuropathy (PN; no grade ≥3). 7 pts discontinued due to AEs. 2 pts died on study, due to PD and an unrelated cardiac disorder. Of 46 response-evaluable pts, 6 have achieved ≥PR, with 1 sCR (PI naïve cohort) and 5 PRs (2 in dose-escalation, 1 in RR, 2 in VR cohorts), and 1 VR pt has achieved MR, with duration of disease control of up to 18.6 mo. PK analyses showed MLN2238 (biologically active hydrolysis product) has linear plasma PK (0.8-2.23 mg/m2), Tmax of 0.5-1.25 hr, and terminal half-life of 4-6 d. A dose-dependent increase in whole blood 20S proteasome inhibition was observed. Conclusions: Current data suggest MLN9708 has clinical activity in heavily pretreated MM pts, with durable responses/disease control, and is generally well tolerated with infrequent low-grade PN.
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Affiliation(s)
- Sagar Lonial
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Rachid C. Baz
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Michael Wang
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Moshe Talpaz
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Guohui Liu
- Millennium Pharmaceuticals, Cambridge, MA
| | | | | | | | - Ai-Min Hui
- Millennium Pharmaceuticals, Cambridge, MA
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Ruggeri B, Miknyoczki S, Dorsey B, Hui AM. The development and pharmacology of proteasome inhibitors for the management and treatment of cancer. Adv Pharmacol 2009; 57:91-135. [PMID: 20230760 DOI: 10.1016/s1054-3589(08)57003-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The ubiquitin-proteasome complex is an important molecular target for the design of novel chemotherapeutics. This complex plays a critical role in signal transduction pathways important for tumor cell growth and survival, cell-cycle control, transcriptional regulation, and the modulation of cellular stress responses to endogenous and exogenous stimuli. The sensitivity of transformed cells to proteasome inhibitors and the successful design of treatment protocols with tolerable, albeit narrow, therapeutic indices have made proteasome inhibition a viable strategy for cancer treatment. Clinical validation of the proteasome as a molecular target was achieved with the approval of bortezomib, a boronic acid proteasome inhibitor, for the treatment of multiple myeloma and mantle cell lymphoma. Several "next-generation" proteasome inhibitors (carfilzomib and PR-047, NPI-0052, and CEP-18770) representing distinct structural classes (peptidyl epoxyketones, beta-lactones, and peptidyl boronic acids, respectively), mechanisms of action, pharmacological and pharmacodynamic activity profiles, and therapeutic indices have now entered clinical development. These agents may expand the clinical utility of proteasome inhibitors for the treatment of solid tumors and for specific non-oncological, i.e., inflammatory disease, indications as well. This chapter addresses the biology of the proteasome, the medicinal chemistry and mechanisms of action of proteasome inhibitors currently in clinical development, the preclinical and clinical pharmacological and safety profiles of bortezomib and the newer compounds against hematological and solid tumors. Future directions for research and other applications for this novel class of therapeutics agents are considered in this chapter.
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Affiliation(s)
- Bruce Ruggeri
- Discovery Research, Cephalon, Inc., West Chester, Pennsylvania 19380, USA
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McParland BJ, Miller MP, Spinks TJ, Kenny LM, Osman S, Khela MK, Aboagye E, Coombes RC, Hui AM, Cohen PS. The biodistribution and radiation dosimetry of the Arg-Gly-Asp peptide 18F-AH111585 in healthy volunteers. J Nucl Med 2008; 49:1664-7. [PMID: 18794263 DOI: 10.2967/jnumed.108.052126] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED We report the safety, biodistribution, and internal radiation dosimetry of a new PET tracer, (18)F-AH111585, a peptide with a high affinity for the alpha(v)beta(3) integrin receptor involved in angiogenesis. METHODS PET scans of 8 healthy volunteers were acquired at time points up to 4 h after a bolus injection of (18)F-AH111585. (18)F activity in whole blood and plasma and excreted urine were measured up to 4 h after injection. In vivo (18)F activities in up to 12 source regions were determined from quantitative analysis of the images. The cumulated activities subsequently calculated were then used to determine the internal radiation dosimetry, including the effective dose. RESULTS Injection of (18)F-AH111585 was well tolerated in all subjects, with no serious or drug-related adverse events reported. The main route of (18)F excretion was renal (37%), and the 3 highest initial uptakes were by liver (15%); combined walls of the small, upper large, and lower large intestines (11%); and kidneys (9%). The 3 highest absorbed doses were received by the urinary bladder wall (124 microGy/MBq), kidneys (102 microGy/MBq), and cardiac wall (59 microGy/MBq). The effective dose was 26 microGy/MBq. CONCLUSION (18)F-AH111585 is a safe PET tracer with a dosimetry profile comparable to other common (18)F PET tracers.
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Affiliation(s)
- Brian J McParland
- Medical Diagnostics, GE Healthcare Ltd., Amersham, Buckinghamshire, England.
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Kenny LM, Coombes RC, Oulie I, Contractor KB, Miller M, Spinks TJ, McParland B, Cohen PS, Hui AM, Palmieri C, Osman S, Glaser M, Turton D, Al-Nahhas A, Aboagye EO. Phase I trial of the positron-emitting Arg-Gly-Asp (RGD) peptide radioligand 18F-AH111585 in breast cancer patients. J Nucl Med 2008; 49:879-86. [PMID: 18483090 DOI: 10.2967/jnumed.107.049452] [Citation(s) in RCA: 226] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
UNLABELLED The integrin alpha v beta3 receptor is upregulated on tumor cells and endothelium and plays important roles in angiogenesis and metastasis. Arg-Gly-Asp (RGD) peptide ligands have high affinity for these integrins and can be radiolabeled for PET imaging of angiogenesis or tumor development. We have assessed the safety, stability, and tumor distribution kinetics of a novel radiolabeled RGD-based integrin peptide-polymer conjugate, 18F-AH111585, and its feasibility to detect tumors in metastatic breast cancer patients using PET. METHODS The biodistribution of 18F-AH111585 was assessed in 18 tumor lesions from 7 patients with metastatic breast cancer by PET, and the PET data were compared with CT results. The metabolic stability of 18F-AH111585 was assessed by chromatography of plasma samples. Regions of interest (ROIs) defined over tumor and normal tissues of the PET images were used to determine the kinetics of radioligand binding in tissues. RESULTS The radiopharmaceutical and PET procedures were well tolerated in all patients. All 18 tumors detected by CT were visible on the 18F-AH111585 PET images, either as distinct increases in uptake compared with the surrounding normal tissue or, in the case of liver metastases, as regions of deficit uptake because of the high background activity in normal liver tissue. 18F-AH111585 was either homogeneously distributed in the tumors or appeared within the tumor rim, consistent with the pattern of viable peripheral tumor and central necrosis often seen in association with angiogenesis. Increased uptake compared with background (P = 0.002) was demonstrated in metastases in lung, pleura, bone, lymph node, and primary tumor. CONCLUSION 18F-AH111585 designed to bind the alpha v beta3 integrin is safe, metabolically stable, and retained in tumor tissues and detects breast cancer lesions by PET in most anatomic sites.
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Affiliation(s)
- Laura M Kenny
- Department of Oncology, Imperial College Faculty of Medicine, Hammersmith Hospital, London, United Kingdom
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Sun L, Hui AM, Su Q, Vortmeyer A, Kotliarov Y, Pastorino S, Passaniti A, Menon J, Walling J, Bailey R, Rosenblum M, Mikkelsen T, Fine HA. Neuronal and glioma-derived stem cell factor induces angiogenesis within the brain. Cancer Cell 2006; 9:287-300. [PMID: 16616334 DOI: 10.1016/j.ccr.2006.03.003] [Citation(s) in RCA: 640] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 01/26/2006] [Accepted: 03/03/2006] [Indexed: 11/28/2022]
Abstract
Stem cell factor (SCF) is overexpressed by neurons following brain injury as well as by glioma cells; however, its role in gliomagenesis remains unclear. Here, we demonstrate that SCF directly activates brain microvascular endothelial cells (ECs) in vitro and induces a potent angiogenic response in vivo. Primary human gliomas express SCF in a grade-dependent manner and induce normal neurons to express SCF in brain regions infiltrated by glioma cells, areas that colocalize with prominent angiogenesis. Downregulation of SCF inhibits tumor-mediated angiogenesis and glioma growth in vivo, whereas overexpression of SCF is associated with shorter survival in patients with malignant gliomas. Thus, the SCF/c-Kit pathway plays an important role in tumor- and normal host cell-induced angiogenesis within the brain.
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Affiliation(s)
- Lixin Sun
- Neuro-Oncology Branch, National Cancer Institute/National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
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Li X, Hui AM, Sun L, Hasegawa K, Torzilli G, Minagawa M, Takayama T, Makuuchi M. p16INK4A hypermethylation is associated with hepatitis virus infection, age, and gender in hepatocellular carcinoma. Clin Cancer Res 2005. [PMID: 15569978 DOI: 10.1158/1078-432.ccr-04-1715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The tumor suppressor gene p16INK4A is mainly inactivated by an epigenetic change involving promoter hypermethylation in hepatocarcinogenesis. The possible clinical impact of p16INK4A methylation and the potential risk factors for this epigenetic alteration have not been thoroughly investigated. EXPERIMENTAL DESIGN We studied the methylation status and mRNA and protein expression of p16INK4A in 50 hepatocellular carcinomas and corresponding nonneoplastic liver lesions using methylation-specific PCR, reverse transcription-PCR, and immunohistochemical techniques. RESULTS p16INK4A hypermethylation was observed in 58% (29 of 50) of the hepatocellular carcinomas and 16% (6 of 38) of the corresponding chronic hepatitis and cirrhosis tissue samples. p16INK4A methylation was significantly associated with mRNA and protein expression (P <0.001 and P=0.003, respectively). All of the p16INK4A-methylated tumors were positive for hepatitis B virus or hepatitis C virus markers, but none of the virus-negative tumors exhibited p16INK4A methylation (P=0.006). The frequency of p16INK4A hypermethylation tended to be higher in hepatitis C virus-related tumors (23 of 32, 72%) than in hepatitis B virus-related tumors (6 of 13, 46%; P=0.1). Aberrant methylation of p16INK4A was also related significantly to increasing age, female gender, and normal levels of serum PIVKA-II (P=0.02, 0.04, and 0.04, respectively). No statistically significant difference in survival was observed between patients with p16INK4A hypermethylation and those without. CONCLUSIONS Our observations suggest that p16INK4A hypermethylation may contribute to hepatocarcinogenesis from an early stage and that multiple risk factors, such as viral infections, age, and gender, may be associated with p16INK4A hypermethylation in hepatocarcinogenesis.
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Affiliation(s)
- Xin Li
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
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Okada H, Kimura M, Tan D, Fujiwara K, Igarashi J, Makuuchi M, Hui AM, Tsurumaru M, Nagase H. Frequent trefoil factor 3 (TFF3) overexpression and promoter hypomethylation in mouse and human hepatocellular carcinomas. Int J Oncol 2005. [DOI: 10.3892/ijo.26.2.369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Okada H, Kimura MT, Tan D, Fujiwara K, Igarashi J, Makuuchi M, Hui AM, Tsurumaru M, Nagase H. Frequent trefoil factor 3 (TFF3) overexpression and promoter hypomethylation in mouse and human hepatocellular carcinomas. Int J Oncol 2005; 26:369-77. [PMID: 15645121 PMCID: PMC2292801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Expression profiling analysis revealed ectopic high expression of mouse TFF3 in non-tumor liver tissues from the hepatocellular carcinoma (HCC) susceptible PWK/Rbrc strain. TFF3 is a member of the trefoil factor family peptides, which are small secreted proteins regulating mucosal regeneration and repair, and which are overexpressed during inflammatory processes and cancer progression. We, therefore, analyzed the TFF3 expression extensively in mouse and human HCCs. Expression of the mouse TFF3 gene was significantly increased in 6 out of 7 HCCs from a PWK spontaneous tumor model and in all 7 HCCs from an SV40T antigen-induced transgenic MT-D2C57BL/6 model. In humans, 8 of 20 HCCs (40%) had overexpression of TFF3 in both mRNA level and protein level. We then analyzed DNA methylation patterns of the TFF3 promoter region to evaluate expression regulation of promoter methylation. In mouse HCCs, we demonstrated that two CpGs, at positions -992 and +109, were hypomethylated in 13 of 14 mouse HCCs. In human HCCs, hypomethylation at CpG -260 was associated with TFF3 overexpression (p=0.04). These results indicate that TFF3 overexpression may be a critical process in mouse and human hepatocellular carcinogenesis, and the specific promoter CpG hypomethylation may be one of the regulation mechanisms of TFF3 overexpression in HCCs.
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Affiliation(s)
- Haruhiko Okada
- Department of Cancer Genetics, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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Hui AM, Zhang W, Chen W, Xi D, Purow B, Friedman GC, Fine HA. Agents with Selective Estrogen Receptor (ER) Modulator Activity Induce ApoptosisIn vitroandIn vivoin ER-Negative Glioma Cells. Cancer Res 2004; 64:9115-23. [PMID: 15604281 DOI: 10.1158/0008-5472.can-04-2740] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tamoxifen, a member of the selective estrogen receptor modulator (SERM) family, is widely used in the treatment of estrogen receptor (ER)-expressing breast cancer. It has previously been shown that high-dose tamoxifen has cytotoxic activity against glioma cells, but whether this effect is drug specific or represents a general property of SERMs is unknown. In this study, we demonstrate that tamoxifen and CC-8490, a novel benzopyranone with SERM activity, induce glioma cell apoptosis in a dose- and time-dependent manner. Moreover, administration of tamoxifen and CC-8490 suppresses tumor growth in vivo and extends animal survival in glioma xenograft models. None of the eight glioma cell lines examined express either ER-alpha or -beta, suggesting the mechanism for tamoxifen- and CC-8490-induced glioma cell apoptosis is independent of the ER signaling pathway. Complementary DNA microarray expression profiling allowed us to identify a subset of genes specifically regulated by tamoxifen and CC-8490, and not by other apoptotic stimuli, including nuclear factor (NF)-kappaB with its target genes IEX-3, SOD2, IL6, and IL8. We demonstrate that suppression of NF-kappaB activation markedly enhances SERM-induced apoptosis, suggesting a role for NF-kappaB in protecting glioma cells from SERM-induced cytotoxicity. These findings demonstrate for the first time that a SERM other than tamoxifen can induce glioma cell apoptosis in vitro and in vivo and that the clinical efficacy of SERMs for the treatment of malignant gliomas could potentially be enhanced by simultaneous inhibition of the NF-kappaB pathway.
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Affiliation(s)
- Ai-Min Hui
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, and Celgene, San Diego, California, USA
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