1
|
Bedell C, Zelinsky C, Puglisi M, Fenn L, Harris J, Duffy V. Online Toddler Feeding Survey with Tailored Messages for Parents and to Assist Nutrition Counseling: Pilot Testing in a WIC Waiting Room. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
2
|
Hong DS, Kurzrock R, Wheler JJ, Naing A, Falchook GS, Fu S, Kim KB, Davies MA, Nguyen LM, George GC, Xu L, Shumaker R, Ren M, Mink J, Bedell C, Andresen C, Sachdev P, O'Brien JP, Nemunaitis J. Phase I Dose-Escalation Study of the Multikinase Inhibitor Lenvatinib in Patients with Advanced Solid Tumors and in an Expanded Cohort of Patients with Melanoma. Clin Cancer Res 2015; 21:4801-10. [PMID: 26169970 DOI: 10.1158/1078-0432.ccr-14-3063] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 06/09/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE This "3+3" phase I study evaluated the safety, biologic, and clinical activity of lenvatinib, an oral multikinase inhibitor, in patients with solid tumors. EXPERIMENTAL DESIGN Ascending doses of lenvatinib were administered per os twice daily in 28-day cycles. Safety and response were assessed for all patients. Angiogenic and apoptotic factors were tested as possible biomarkers in an expanded melanoma cohort. RESULTS Seventy-seven patients were treated in 3 cohorts: 18 with intermittent twice-daily dosing (7 days on, 7 days off) of 0.1-3.2 mg; 33 with twice-daily dosing of 3.2-12 mg; and 26 with twice-daily dosing of 10 mg (expanded melanoma cohort). Maximum tolerated dose was established at 10 mg per os twice daily. Prominent drug-related toxicities included hypertension (43%), fatigue (42%), proteinuria (39%), and nausea (25%); dose-limiting toxicities included hypertension, fatigue, and proteinuria. Twelve patients (15.6%) achieved partial response (PR, n = 9) or unconfirmed PR (uPR, n = 3), and 19 (24.7%) achieved stable disease (SD) ≥23 weeks. Total PR/uPR/SD ≥23 weeks was 40.3% (n = 31). Responses (PR/uPR) by disease were as follows: melanoma, 5 of 29 patients (includes 1 patient with NRAS mutation); thyroid, 3 of 6 patients; pancreatic, 1 of 2 patients; lung, 1 of 1 patients; renal, 1 of 1 patients; endometrial, 1 of 4 patients; and ovarian, 1 of 5 patients. AUC(0-24) and C(max) increased dose proportionally. In multivariate Cox proportional hazard model analyses, increased baseline systolic blood pressure and decreased angiopoietin-1 ratio (2 hours:baseline) were associated with longer progression-free survival (PFS) in the expanded melanoma cohort (P = 0.041 and P = 0.03, respectively). CONCLUSIONS The toxicity profile, pharmacokinetics, and antitumor activity of lenvatinib are encouraging. Decreases in the angiopoietin-1 ratio correlated with longer PFS in melanoma patients.
Collapse
Affiliation(s)
- David S Hong
- The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Razelle Kurzrock
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Aung Naing
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Siqing Fu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kevin B Kim
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael A Davies
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ly M Nguyen
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Goldy C George
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lucy Xu
- Eisai Inc., Oncology, Woodcliff Lake, New Jersey
| | | | - Min Ren
- Eisai Inc., Oncology, Woodcliff Lake, New Jersey
| | - Jennifer Mink
- Former employees of Eisai Inc., Woodcliff Lake, New Jersey
| | | | | | | | | | | |
Collapse
|
3
|
Barve M, Wang Z, Kumar P, Jay CM, Luo X, Bedell C, Mennel RG, Wallraven G, Brunicardi FC, Senzer N, Nemunaitis J, Rao DD. Phase 1 Trial of Bi-shRNA STMN1 BIV in Refractory Cancer. Mol Ther 2015; 23:1123-1130. [PMID: 25619726 DOI: 10.1038/mt.2015.14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/12/2015] [Indexed: 12/11/2022] Open
Abstract
Stathmin1 (STMN1) is a microtubule modulator that is expressed in multiple cancers and correlates with poor survival. We previously demonstrated in vivo safety of bifunctional (bi) shRNA STMN1 bilamellar invaginated vesicle (BIV) and that systemic delivery correlated with antitumor activity. Patients with superficial advanced refractory cancer with no other standard options were entered into trial. Study design involved dose escalation (four patients/cohort) using a modified Fibonacci schema starting at 0.7 mg DNA administered via single intratumoral injection. Biopsy at baseline, 24/48 hours and resection 8 days after injection provided tissue for determination of cleavage product using next-generation sequencing (NGS) and reverse transcription quantitative polymerase chain reaction (RT-qPCR), 5' RLM rapid amplification of cDNA ends (RACE) assay. Serum pharmacokinetics of circulating plasmid was done. Twelve patients were entered into three dose levels (0.7, 1.4, 7.0 mg DNA). No ≥ grade 3 toxic effects to drug were observed. Maximum circulating plasmid was detected at 30 seconds with less than 10% detectable in all subjects at 24 hours. No toxic effects were observed. Predicted cleavage product was detected by both NGS (n = 7/7 patients analyzed, cohorts 1, 2) and RLM RACE (n = 1/1 patients analyzed cohort 3). In conclusion, bi-shRNA STMN1 BIV is well tolerated and detection of mRNA target sequence-specific cleavage product confirmed bi-shRNA BIV mechanism of action.
Collapse
Affiliation(s)
- Minal Barve
- Mary Crowley Cancer Research Centers, Dallas, Texas, USA; Texas Oncology, P.A., Dallas, Texas, USA
| | | | | | | | | | - Cynthia Bedell
- Mary Crowley Cancer Research Centers, Dallas, Texas, USA
| | - Robert G Mennel
- Texas Oncology, P.A., Dallas, Texas, USA; Baylor University Medical Center, Dallas, Texas, USA
| | | | - Francis Charles Brunicardi
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Neil Senzer
- Mary Crowley Cancer Research Centers, Dallas, Texas, USA; Strike Bio, Inc., Dallas, Texas, USA; Gradalis, Inc., Dallas, Texas, USA
| | - John Nemunaitis
- Mary Crowley Cancer Research Centers, Dallas, Texas, USA; Texas Oncology, P.A., Dallas, Texas, USA; Strike Bio, Inc., Dallas, Texas, USA; Gradalis, Inc., Dallas, Texas, USA; Medical City Dallas Hospital, Dallas, Texas, USA.
| | | |
Collapse
|
4
|
Senzer N, Bedell C, Horvath S, Nemunaitis J. Systemic Benefit of Gm-Csf-Encoding, Oncolytic Herpes Virus (Talimogene Laherparepvec, T-Vec) in Metastatic Melanoma: Phase Ii Assessment. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu342.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
5
|
Nemunaitis J, Barve M, Orr D, Kuhn J, Magee M, Lamont J, Bedell C, Wallraven G, Pappen BO, Roth A, Horvath S, Nemunaitis D, Kumar P, Maples PB, Senzer N. Summary of bi-shRNAfurin/GM-CSF Augmented Autologous Tumor Cell Immunotherapy (FANG) in Advanced Cancer of the Liver. Oncology 2014; 87:21-9. [DOI: 10.1159/000360993] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 12/14/2022]
|
6
|
Shapiro GI, Rodon J, Bedell C, Kwak EL, Baselga J, Braña I, Pandya SS, Scheffold C, Laird AD, Nguyen LT, Xu Y, Egile C, Edelman G. Phase I safety, pharmacokinetic, and pharmacodynamic study of SAR245408 (XL147), an oral pan-class I PI3K inhibitor, in patients with advanced solid tumors. Clin Cancer Res 2013; 20:233-45. [PMID: 24166903 DOI: 10.1158/1078-0432.ccr-13-1777] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [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
PURPOSE SAR245408 is a pan-class I phosphoinositide 3-kinase (PI3K) inhibitor. This phase I study determined the maximum tolerated dose (MTD) of two dosing schedules [first 21 days of a 28-day period (21/7) and continuous once-daily dosing (CDD)], pharmacokinetic and pharmacodynamic profiles, and preliminary efficacy. EXPERIMENTAL DESIGN Patients with refractory advanced solid malignancies were treated with SAR245408 using a 3 + 3 design. Pharmacokinetic parameters were determined after single and repeated doses. Pharmacodynamic effects were evaluated in plasma, hair sheath cells, and skin and tumor biopsies. RESULTS Sixty-nine patients were enrolled. The MTD of both schedules was 600 mg; dose-limiting toxicities were maculopapular rash and hypersensitivity reaction. The most frequent drug-related adverse events included dermatologic toxicities, diarrhea, nausea, and decreased appetite. Plasma pharmacokinetics showed a median time to maximum concentration of 8 to 22 hours, mean terminal elimination half-life of 70 to 88 hours, and 5- to 13-fold accumulation after daily dosing (first cycle). Steady-state concentration was reached between days 15 and 21, and exposure was dose-proportional with doses up to 400 mg. SAR245408 inhibited the PI3K pathway (∼40%-80% reduction in phosphorylation of AKT, PRAS40, 4EBP1, and S6 in tumor and surrogate tissues) and, unexpectedly, also inhibited the MEK/ERK pathway. A partial response was seen in one patient with advanced non-small cell lung cancer. Eight patients were progression-free at 6 months. Pharmacodynamic and clinical activity were observed irrespective of tumor PI3K pathway molecular alterations. CONCLUSIONS SAR245408 was tolerable at doses associated with PI3K pathway inhibition. The recommended phase II dose of the capsule formulation is 600 mg administered orally with CDD.
Collapse
Affiliation(s)
- Geoffrey I Shapiro
- Authors' Affiliations: Dana-Farber Cancer Institute; Massachusetts General Hospital; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Mary Crowley Cancer Research Centers, Dallas, Texas; Exelixis Inc., South San Francisco, California; and Sanofi, Cambridge, Massachusetts, and Vitry-sur-Seine, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Olivares J, Kumar P, Yu Y, Maples PB, Senzer N, Bedell C, Barve M, Tong A, Pappen BO, Kuhn J, Magee M, Wallraven G, Nemunaitis J. Phase I trial of TGF-beta 2 antisense GM-CSF gene-modified autologous tumor cell (TAG) vaccine. Clin Cancer Res 2011; 17:183-92. [PMID: 21208907 DOI: 10.1158/1078-0432.ccr-10-2195] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE On the basis of the hypothesis that the combined expression of immunostimulatory granulocyte macrophage colony stimulating factor (GM-CSF) and antitumor suppressor TGF-β2 antisense (AS) transgenes can break tolerance and stimulate immune responses to cancer-associated antigens, we constructed an expression plasmid [the tumor-associated glycoprotein (TAG) plasmid] that coexpresses GM-CSF and TGF-β2 AS nucleotide sequences and which was incorporated into an autologous whole-cell vaccine. EXPERIMENTAL DESIGN Patients undergoing resection were enrolled. Freshly harvested autologous tumor cells were mechanically and enzymatically disaggregated, then electroporated with the TAG vector. The resulting vaccine was irradiated, then aliquoted and cryopreserved until the time of injection. Patients received a minimum of 5 to a maximum of 12 monthly intradermal injections. Immune function was monitored at baseline and at months 3 and 6. RESULTS Vaccine manufacturing efficiency was 84% (32/38). Twenty-three patients received at least 1 vaccination. There were no grade 3 or 4 toxicities, and grade 1 and 2 events were local in nature. Seventeen of 21 patients had stable disease (SD) at month 2 or later as their best response, and 1 patient with stage IVa malignant melanoma achieved a complete response (CR) following 11 vaccinations and remains without evidence of disease 2 years following initiation of therapy. Six of 13 patients displayed a positive enzyme-linked immunospot (ELISPOT) response to autologous TAG vaccine at week 12 including 3 patients with prolonged SD or CR. The 3 other patients survived through week 24, as compared with none of the 7 ELISPOT-negative patients. CONCLUSIONS On the basis of safety and clinical and immunologic results, further evaluation of bifunctional vaccines is warranted.
Collapse
Affiliation(s)
- Jairo Olivares
- Mary Crowley Cancer Research Centers, Dallas, Texas, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Nemunaitis G, Jay CM, Maples PB, Gahl WA, Huizing M, Yardeni T, Tong AW, Phadke AP, Pappen BO, Bedell C, Allen H, Hernandez C, Templeton NS, Kuhn J, Senzer N, Nemunaitis J. Hereditary inclusion body myopathy: single patient response to intravenous dosing of GNE gene lipoplex. Hum Gene Ther 2011; 22:1331-41. [PMID: 21517694 DOI: 10.1089/hum.2010.192] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Hereditary inclusion body myopathy (HIBM) is an autosomal recessive adult-onset myopathy due to mutations in the GNE (UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase) gene. Affected patients have no therapeutic options. We have previously demonstrated in preclinical testing the ability to safely correct GNE gene function through liposomal delivery of the wild-type GNE gene. Results were verified in a single patient treated by intravenous infusion of GNE gene lipoplex. A single patient (patient 001) with severe HIBM treated with a compassionate investigational new drug received seven doses of GNE gene lipoplex via intravenous infusion at the following doses: 0.4, 0.4, 1.0, 4.0, 5.0, 6.0, and 7.0 mg of DNA. GNE transgene expression, downstream induction of sialic acid, safety, and muscle function were evaluated. Transient low-grade fever, myalgia, tachycardia, transaminase elevation, hyponatremia, and hypotension were observed after infusion of each dose of GNE gene lipoplex. Quadriceps muscle expression of the delivered GNE, plasmid, and RNA was observed 24 hr after the 5.0-mg dose and at significantly greater levels 72 hr after the 7.0-mg infusion in comparison with expression in quadriceps muscle immediately before infusion. Sialic acid-related proteins were increased and stabilization in the decline of muscle strength was observed. We conclude that clinical safety and activity have been demonstrated with intravenous infusion of GNE gene lipoplex. Further assessment will involve a phase I trial of intravenous administration of GNE gene lipoplex in individuals with less advanced HIBM with more muscle function.
Collapse
|
9
|
Nemunaitis G, Maples PB, Jay C, Gahl WA, Huizing M, Poling J, Tong AW, Phadke AP, Pappen BO, Bedell C, Templeton NS, Kuhn J, Senzer N, Nemunaitis J. Hereditary inclusion body myopathy: single patient response to GNE gene Lipoplex therapy. J Gene Med 2011; 12:403-12. [PMID: 20440751 DOI: 10.1002/jgm.1450] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hereditary inclusion body myopathy (HIBM) is an autosomal recessive adult onset myopathy. It is characterized by mutations of the GNE (UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase) gene. Afflicted patients have no therapeutic options. In preclinical testing, we have previously demonstrated the ability to correct GNE gene function and the safety of delivery of wild type GNE gene using a liposomal delivery vehicle. METHODS A single patient (subject #001) with severe HIBM treated by compassionate investigational new drug received four doses of GNE gene Lipoplex via intramuscular injection. GNE transgene expression, downstream induction of sialic acid, safety and muscle function were evaluated. RESULTS Significant durable improvement in locoregional skeletal muscle function was observed in the injected left extensor carpi radialis longus of #001 in correlation with GNE transgene upregulation and local induction of sialic acid. Other than transient low grade fever and pain at the injection site, no significant toxicity was observed. CONCLUSIONS Proof of principle for manufacturing of 'clinical grade' GNE gene Lipoplex, clinical safety and activity are demonstrated with GNE gene Lipoplex. Further assessment will involve intravenous administration and subsequent phase I trial involving additional but less severely afflicted HIBM patients.
Collapse
Affiliation(s)
- Gregory Nemunaitis
- Mary Crowley Cancer Research Centers, 1700 Pacific, Dallas, TX 75201, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
Background In Phase I evaluation of CT-2103 (paclitaxel poliglumex), prolongation of prothrombin time (PT) and activated thromboplastin time (aPTT) was observed, without clinical consequence, with doses 1.3–1.5 times higher than the current clinical dose of 175 mg/m2. This Phase I, open-label, nonrandomized pilot study was performed to study the effect of the standard dose regimen on blood coagulation. Methods Seven previously treated solid tumor patients received CT-2103 175 mg/m2 intravenously on day 1 of 21-day cycles for a mean of 5.4 cycles (median 4, range 2–14). Plasma samples were collected for cycle 1 predose and at hours 1, 24, 48, and 72 after the end of administration for drug levels, and for PT and aPTT assays. Results No coagulopathy-related adverse events were documented. Bleeding time remained normal in the six patients tested, with transient increases in PT and aPTT noted but resolving within 72 hours. Titration studies at 100 μg/mL of CT-2103 (corresponding to the standard clinical dose) prolonged PT and aPTT clotting times, produced a modest dose-dependent reduction of thrombin and factor Xa, and no significant changes in factors IXa, XIa, or XIIa. Two patients achieved stable disease for ≥10 cycles. Conclusion CT-2103 is associated with transient prolongation of PT and aPTT without clinical sequelae.
Collapse
|
11
|
Vergote I, Sella A, Bedell C, Ramondetta L, Shapiro G, Balic K, Prokopczuk E, Sauer L, Tseng L, Berger R. 407 Phase 2 study of XL184 in a cohort of ovarian cancer patients (pts) with measurable soft tissue disease. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)72114-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
12
|
Edelman G, Bedell C, Shapiro G, Pandya SS, Kwak EL, Scheffold C, Nguyen LT, Laird A, Baselga J, Rodon J. A phase I dose-escalation study of XL147 (SAR245408), a PI3K inhibitor administered orally to patients (pts) with advanced malignancies. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
13
|
Senzer N, Bedell C, Nemunaitis J. OncoVEX(GM-CSF). DRUG FUTURE 2010. [DOI: 10.1358/dof.2010.035.06.1500437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
14
|
Nemunaitis J, Tong AW, Nemunaitis M, Senzer N, Phadke AP, Bedell C, Adams N, Zhang YA, Maples PB, Chen S, Pappen B, Burke J, Ichimaru D, Urata Y, Fujiwara T. A phase I study of telomerase-specific replication competent oncolytic adenovirus (telomelysin) for various solid tumors. Mol Ther 2009; 18:429-34. [PMID: 19935775 DOI: 10.1038/mt.2009.262] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A phase I clinical trial was conducted to determine the clinical safety of Telomelysin, a human telomerase reverse transcriptase (hTERT) promoter driven modified oncolytic adenovirus, in patients with advanced solid tumors. A single intratumoral injection (IT) of Telomelysin was administered to three cohorts of patients (1 x 10(10), 1 x 10(11), 1 x 10(12) viral particles). Safety, response and pharmacodynamics were evaluated. Sixteen patients with a variety of solid tumors were enrolled. IT of Telomelysin was well tolerated at all dose levels. Common grade 1 and 2 toxicities included injection site reactions (pain, induration) and systemic reactions (fever, chills). hTERT expression was demonstrated at biopsy in 9 of 12 patients. Viral DNA was transiently detected in plasma in 13 of 16 patients. Viral DNA was detectable in four patients in plasma or sputum at day 7 and 14 post-treatment despite below detectable levels at 24 h, suggesting viral replication. One patient had a partial response of the injected malignant lesion. Seven patients fulfilled Response Evaluation Criteria in Solid Tumors (RECIST) definition for stable disease at day 56 after treatment. Telomelysin was well tolerated. Evidence of antitumor activity was suggested.
Collapse
|
15
|
Shapiro G, Kwak E, Baselga J, Rodon J, Scheffold C, Laird AD, Bedell C, Edelman G. Phase I dose-escalation study of XL147, a PI3K inhibitor administered orally to patients with solid tumors. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.3500] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [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
3500 Background: XL147 is a selective inhibitor of Class I PI3K isoforms. In preclinical cancer models XL147 is cytostatic or cytoreductive as monotherapy and enhances the efficacy of targeted agents and chemotherapeutics. This open label, Phase 1 dose escalation study assesses the safety, pharmacokinetics, pharmacodynamics, and efficacy of XL147 in advanced solid tumors. Methods: For each 28 day cycle, patients (pts) receive XL147 on Days 1–21 (21/7) or as a continuous daily dose (CDD). Cycle 1 safety data determine dose-limiting toxicities (DLTs). Tumor response is assessed every 8 weeks. Results: As of December 2008, 39 pts have been treated: 36 on 21/7 across 7 dose levels (30–900 mg) and 3 on CDD at 100 mg. At 900 mg, 2 of 3 pts experienced a DLT of reversible grade 3 rash, and the MTD was established as 600 mg based on 15 pts. Drug-related toxicities included grade 3 skin rash (3 pts), grade 3 arterial thrombosis (1 pt), grade 2 transaminase elevation (1 pt), and grade 1 hyperglycemia (4 pts). XL147 exposure increased with dose from 30–400 mg and was similar from 400–900 mg. XL147 reached steady-state plasma concentrations by Day 15–20. Mean t1/2, z at steady-state ranged from 3.7–6.3 days. Doses ≥400 mg yielded exposures that exceeded the EC90 in xenograft models. A trend suggesting augmented food-induced changes in insulin was evident; however, glucose was minimally affected. XL147 reduced levels of phosphorylated PI3K pathway components in PBMCs, hair, skin, and tumor tissues in an exposure-dependent manner. In 2 pts dosed at the MTD, reductions of ≥70% in PI3K pathway signaling were observed in tumor tissue without compensatory upregulation of MEK/ERK phosphorylation. As of December 2008, 6 pts (3 NSCLC, 1 BCC, 1 NHL, 1 PC) continued on study >6 months including 3 >10 months (NHL, NSCLC, BCC). One pt with hormone refractory PC has sustained a normalization of PSA levels through 5 months. Conclusions: XL147 was generally well tolerated with the MTD for the 21/7 schedule defined as 600 mg. The most common drug-related toxicity was skin rash. Inhibition of PI3K pathway signaling has been demonstrated in tumor and surrogate tissues. Prolonged stable disease has been observed. [Table: see text]
Collapse
Affiliation(s)
- G. Shapiro
- Dana-Farber Cancer Institute, Boston, MA; Vall D'Hebron University Hospital, Barcelona, Spain; Exelixis, Inc., South San Francisco, CA; Texas Oncology, Irving, TX
| | - E. Kwak
- Dana-Farber Cancer Institute, Boston, MA; Vall D'Hebron University Hospital, Barcelona, Spain; Exelixis, Inc., South San Francisco, CA; Texas Oncology, Irving, TX
| | - J. Baselga
- Dana-Farber Cancer Institute, Boston, MA; Vall D'Hebron University Hospital, Barcelona, Spain; Exelixis, Inc., South San Francisco, CA; Texas Oncology, Irving, TX
| | - J. Rodon
- Dana-Farber Cancer Institute, Boston, MA; Vall D'Hebron University Hospital, Barcelona, Spain; Exelixis, Inc., South San Francisco, CA; Texas Oncology, Irving, TX
| | - C. Scheffold
- Dana-Farber Cancer Institute, Boston, MA; Vall D'Hebron University Hospital, Barcelona, Spain; Exelixis, Inc., South San Francisco, CA; Texas Oncology, Irving, TX
| | - A. D. Laird
- Dana-Farber Cancer Institute, Boston, MA; Vall D'Hebron University Hospital, Barcelona, Spain; Exelixis, Inc., South San Francisco, CA; Texas Oncology, Irving, TX
| | - C. Bedell
- Dana-Farber Cancer Institute, Boston, MA; Vall D'Hebron University Hospital, Barcelona, Spain; Exelixis, Inc., South San Francisco, CA; Texas Oncology, Irving, TX
| | - G. Edelman
- Dana-Farber Cancer Institute, Boston, MA; Vall D'Hebron University Hospital, Barcelona, Spain; Exelixis, Inc., South San Francisco, CA; Texas Oncology, Irving, TX
| |
Collapse
|
16
|
Vukelja S, Richards D, Campos LT, Bedell C, Hagenstad C, Hyman W, Letzer J, Gardner L, Sportelli P, Nemunaitis J. Randomized phase II study of perifosine in combination with capecitabine versus capecitabine alone in patients with second- or third-line metastatic colon cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4081] [Citation(s) in RCA: 4] [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
4081 Background: Perifosine (Peri), a synthetic alkylphospholipid, inhibits or modifies a number of different signal transduction pathways (AKT, MAPK and JNK). Peri as a single agent or in combination with other cytotoxic agents, has shown clinical benefit with a manageable safety profile. In a phase I solid tumor trial, Peri was safely combined with capecitabine (Cap) and demonstrated interesting activity in patients (pts) with metastatic colorectal cancer (mCRC), with one patient progression-free for 49 weeks (wks). To assess the true effect of Peri, a phase II was initiated as an exploratory randomized double-blind, placebo controlled study where mCRC pts received Cap in combination with Peri or placebo. Methods: Pts with 2nd or 3rd line mCRC, not previously treated with single agent Cap. ECOG PS 0–1, normal organ/marrow function required. Dose for Cap was 825 mg/m2 BID d 1–14 q 3 weeks. Dose for Peri or placebo was 50 mg qd. Primary outcome analyses included median time to progression (TTP) and response rate (CR+PR). Results: 37 pts have been randomized. Median age 68 (range 32–83) and 57% were male. Median prior Rx was 2 (range 1 - 5). For the analyses, 25 pts were unblinded (12 too early) with 22/25 pts evaluable for response (2 pts off for toxicity at d 14, 46 and 1 patient off at d 4 for other disease; all 3 pts were on Cap + placebo). Results in table below. The log-rank p-value comparing active to placebo for TTP is 0.01. As of 12/08, all unblinded pts are off treatment and 11/12 that were too early remain on treatment with enrollment ongoing. Most frequent (>5%) grade 3 /4 adverse events for Cap + Peri was hand/foot syndrome (16%) and anemia (8%); for Cap + placebo was fatigue (8%). Conclusions: Perifosine in combination with capecitabine was well tolerated, clinically active and more than doubled median TTP over capecitabine alone in pts with advanced, metastatic CRC. [Table: see text] [Table: see text]
Collapse
Affiliation(s)
- S. Vukelja
- Tyler Cancer Center, Tyler, TX; Oncology Consultants, Houston, TX; Mary Crowley Cancer Research Center, Dallas, TX; Suburban Hematology Oncology, Lawrenceville, GA; Kalamazoo Hematology/Oncology, Kalamazoo, MI; Keryx Biopharmaceuticals, New York, NY
| | - D. Richards
- Tyler Cancer Center, Tyler, TX; Oncology Consultants, Houston, TX; Mary Crowley Cancer Research Center, Dallas, TX; Suburban Hematology Oncology, Lawrenceville, GA; Kalamazoo Hematology/Oncology, Kalamazoo, MI; Keryx Biopharmaceuticals, New York, NY
| | - L. T. Campos
- Tyler Cancer Center, Tyler, TX; Oncology Consultants, Houston, TX; Mary Crowley Cancer Research Center, Dallas, TX; Suburban Hematology Oncology, Lawrenceville, GA; Kalamazoo Hematology/Oncology, Kalamazoo, MI; Keryx Biopharmaceuticals, New York, NY
| | - C. Bedell
- Tyler Cancer Center, Tyler, TX; Oncology Consultants, Houston, TX; Mary Crowley Cancer Research Center, Dallas, TX; Suburban Hematology Oncology, Lawrenceville, GA; Kalamazoo Hematology/Oncology, Kalamazoo, MI; Keryx Biopharmaceuticals, New York, NY
| | - C. Hagenstad
- Tyler Cancer Center, Tyler, TX; Oncology Consultants, Houston, TX; Mary Crowley Cancer Research Center, Dallas, TX; Suburban Hematology Oncology, Lawrenceville, GA; Kalamazoo Hematology/Oncology, Kalamazoo, MI; Keryx Biopharmaceuticals, New York, NY
| | - W. Hyman
- Tyler Cancer Center, Tyler, TX; Oncology Consultants, Houston, TX; Mary Crowley Cancer Research Center, Dallas, TX; Suburban Hematology Oncology, Lawrenceville, GA; Kalamazoo Hematology/Oncology, Kalamazoo, MI; Keryx Biopharmaceuticals, New York, NY
| | - J. Letzer
- Tyler Cancer Center, Tyler, TX; Oncology Consultants, Houston, TX; Mary Crowley Cancer Research Center, Dallas, TX; Suburban Hematology Oncology, Lawrenceville, GA; Kalamazoo Hematology/Oncology, Kalamazoo, MI; Keryx Biopharmaceuticals, New York, NY
| | - L. Gardner
- Tyler Cancer Center, Tyler, TX; Oncology Consultants, Houston, TX; Mary Crowley Cancer Research Center, Dallas, TX; Suburban Hematology Oncology, Lawrenceville, GA; Kalamazoo Hematology/Oncology, Kalamazoo, MI; Keryx Biopharmaceuticals, New York, NY
| | - P. Sportelli
- Tyler Cancer Center, Tyler, TX; Oncology Consultants, Houston, TX; Mary Crowley Cancer Research Center, Dallas, TX; Suburban Hematology Oncology, Lawrenceville, GA; Kalamazoo Hematology/Oncology, Kalamazoo, MI; Keryx Biopharmaceuticals, New York, NY
| | - J. Nemunaitis
- Tyler Cancer Center, Tyler, TX; Oncology Consultants, Houston, TX; Mary Crowley Cancer Research Center, Dallas, TX; Suburban Hematology Oncology, Lawrenceville, GA; Kalamazoo Hematology/Oncology, Kalamazoo, MI; Keryx Biopharmaceuticals, New York, NY
| |
Collapse
|
17
|
Duey WJ, Williford HN, Bassett DR, Sharff-Olson M, Bedell C, Lloyd G, Rogers E. Hemodynamic responses to cold stress in blacks: effect of application site. Ethn Dis 2001; 6:272-8. [PMID: 9086317] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Black Americans have been shown to exhibit increased blood pressure responses to a variety of physical stressors. However, few investigators have examined hemodynamic responses to cold stress. Additionally, no studies have compared blood pressure responses to forehead and foot stress in blacks. Therefore, in this study, hemodynamic responses to cold pressor tests were compared in 30 blacks (15 males, 15 females) utilizing two application sites. Baseline comparisons of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), forearm blood flow (FBF) and forearm vascular resistance (FVR) were not different prior to forehead and foot cold stress. Following baseline measurements, ice was applied separately to the forehead and foot for 90 seconds with hemodynamic measurements being recorded at 45 and 90 seconds. During application of ice to the forehead, FVR-90 was significantly higher (P < .002, 97.0 units vs. 66.4 units) compared to the foot. The application of ice to the foot resulted in significantly greater SBP-45 responses (P < .0001, 147 mmHg vs. 139 mmHg), HR-45 responses (P < .0043, 80, b.min-1 vs. 69 b.min-1). HR-90 responses (P < .0001, 78 b.min-1 vs. 64 b.min-1), and FBF-45 responses (P < .05, 2.74 ml.min-1.100ml-1 vs. 1.98 ml.min-1.100ml-1). These findings suggest that blacks exhibit disparate patterns of reactivity in response to cold stress as a function of application site. Therefore, investigators should consider the application site when interpreting studies examining a biracial cohort.
Collapse
Affiliation(s)
- W J Duey
- Alabama State University, Montgomery 36101-0271, USA.
| | | | | | | | | | | | | |
Collapse
|
18
|
Savage RE, Nofzinger K, Bedell C, DeAngelo AB, Pereira MA. Chloroform-induced multiple forms of ornithine decarboxylase: differential sensitivity of forms to enhancement by diethyl maleate and inhibition by ODC-antizyme. J Toxicol Environ Health 1989; 27:57-64. [PMID: 2724368 DOI: 10.1080/15287398909531278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The role of glutathione (GSH) and ornithine decarboxylase-antizyme (ODC-AZ) in the regulation of the chloroform-mediated stimulation of rat hepatic ornithine decarboxylase (ODC) was investigated. We have previously implicated roles for each while examining the chloroform effect on crude cytosolic enzyme preparations. In this study we examined the effect of pretreatment with diethyl maleate (DEM), a GSH-depleting agent, on the chloroform stimulation of the two forms of the rat hepatic ODC enzyme and the sensitivity of these two forms to inhibition by the ODC-AZ. While the pretreatment with DEM provided a greater amount of the two forms of the ODC enzyme, it also resulted in a differential stimulation of each form when compared to chloroform alone. Additionally, Peak II was 20-25% more sensitive to the same amount of ODC-AZ then Peak I ODC activity.
Collapse
Affiliation(s)
- R E Savage
- Bioassay Branch, U.S. Environmental Protection Agency, Cincinnati, Ohio
| | | | | | | | | |
Collapse
|