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Trippett T, Toledano H, Campbell Hewson Q, Verschuur A, Langevin AM, Aerts I, Howell L, Gallego S, Rossig C, Smith A, Patel D, Pereira LR, Cheeti S, Musib L, Hutchinson KE, Devlin C, Bernardi R, Geoerger B. Cobimetinib in Pediatric and Young Adult Patients with Relapsed or Refractory Solid Tumors (iMATRIX-cobi): A Multicenter, Phase I/II Study. Target Oncol 2022; 17:283-293. [PMID: 35715627 PMCID: PMC9217999 DOI: 10.1007/s11523-022-00888-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
Background The MAPK pathway is an emerging target across a number of adult and pediatric tumors. Targeting the downstream effector of MAPK, MEK1, is a proposed strategy to control the growth of MAPK-dependent tumors. Objective iMATRIX-cobi assessed the safety, pharmacokinetics, and anti-tumor activity of cobimetinib, a highly selective MEK inhibitor, in children and young adults with relapsed/refractory solid tumors. Patients and Methods This multicenter Phase I/II study enrolled patients aged 6 months to < 30 years with solid tumors with known/expected MAPK pathway involvement. Patients received cobimetinib tablet or suspension formulation on Days 1–21 of a 28-day cycle. Dose escalation followed a rolling 6 design. The primary endpoint was safety; secondary endpoints were pharmacokinetics and anti-tumor activity. Results Of 56 enrolled patients (median age 9 years [range 3–29]), 18 received cobimetinib tablets and 38 cobimetinib suspension. Most common diagnoses were low-grade glioma (LGG; n = 32, including n = 12 in the expansion cohort) and plexiform neurofibroma within neurofibromatosis type 1 (n = 12). Six patients (11 %) experienced dose-limiting toxicities (including five ocular toxicity events), which established a pediatric recommended Phase II dose (RP2D) of 0.8 mg/kg tablet and 1.0 mg/kg suspension. Most frequently reported treatment-related adverse events were gastrointestinal and skin disorders. Steady state mean exposure (Cmax, AUC0–24) of cobimetinib at the RP2D (1.0 mg/kg suspension) was ~ 50 % lower than in adults receiving the approved 60 mg/day dose. Overall response rate was 5.4 % (3/56; all partial responses in patients with LGG). Conclusions The safety profile of cobimetinib in pediatrics was similar to that reported in adults. Clinical activity was observed in LGG patients with known/suspected MAPK pathway activation. Cobimetinib combination regimens may be required to improve response rates in this pediatric population. Clinical Trial Registration ClinicalTrials.gov NCT02639546, registered December 24, 2015. Supplementary Information The online version contains supplementary material available at 10.1007/s11523-022-00888-9.
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Affiliation(s)
- Tanya Trippett
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Helen Toledano
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Quentin Campbell Hewson
- Department of Paediatric and Adolescent Oncology, The Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Arnauld Verschuur
- Assistance Publique-Hopitaux de Marseille, Pediatric Oncology, Timone Children's Hospital, Marseille, France
| | | | - Isabelle Aerts
- Oncology Center SIREDO, Institut Curie, PSL Research University, Paris, France
| | - Lisa Howell
- Paediatric Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Soledad Gallego
- Paediatric Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Claudia Rossig
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Amy Smith
- Haley Center for Children's Cancer and Blood Disorders, Orlando-Health Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Darshak Patel
- Product Development, Biometrics, Biostatistics, F. Hoffmann-La Roche Ltd, Mississauga, ON, Canada.,Parexel International Ltd, Ottawa, ON, Canada
| | | | - Sravanthi Cheeti
- Clinical Pharmacology, Genentech, Inc., South San Francisco, CA, USA
| | - Luna Musib
- Clinical Pharmacology, Genentech, Inc., South San Francisco, CA, USA.,Arrivent Biopharma, Newtown Square, PA, USA
| | | | - Clare Devlin
- Product Development Oncology, Roche Products Ltd, Welwyn, UK
| | - Ronald Bernardi
- Product Development Oncology, Genentech, Inc., South San Francisco, CA, USA
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, Université Paris-Saclay, INSERM U1015, Villejuif, France
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Casanova M, Bautista F, Campbell Hewson Q, Makin G, Marshall LV, Verschuur A, Canete A, Corradini N, Ploeger B, Mueller U, Zebger-Gong H, Chung JW, Geoerger B. Phase I study of regorafenib in combination with vincristine and irinotecan in pediatric patients with recurrent or refractory solid tumors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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
10507 Background: In pediatric patients with solid tumors, regorafenib demonstrated acceptable tolerability and preliminary anti-tumor activity. This phase 1 study evaluated regorafenib in combination with vincristine/irinotecan in pediatric patients with rhabdomyosarcoma (RMS) and other solid tumors. Methods: Patients with relapsed/refractory tumors received intravenous vincristine (1.5 mg/m2, Days 1 and 8) and irinotecan (50 mg/m2/day, Days 1–5) plus once-daily oral regorafenib (patients 6– < 24 months: 60 mg/m2 escalating to 65 mg/m2; patients 2– < 18 years: 72 mg/m2 escalating to 82 mg/m2) on either Days 1–14 (concomitant dosing) or Days 8–21 (sequential dosing) during each 21-day cycle. As per protocol, at least 50% of patients were required to have RMS. Results: At the time of the cut-off, of 21 treated patients (RMS, n = 12; Ewing sarcoma, n = 5; neuroblastoma, n = 3; Wilms tumor, n = 1), two had concomitant (72 mg/m2) and 19 had sequential (72 mg/m2, n = 6; 82 mg/m2, n = 13) dosing. Median age was 10 years (1.5–17.0). Patients received a median of 3 cycles (1–17); dose reductions of irinotecan occurred in 62% of patients. Grade 3 dose-limiting toxicities were reported in both patients receiving concomitant dosing (peripheral neuropathy and liver injury; pain, vomiting, febrile aplasia) and one patient each in the sequential groups (rash and elevated AST; thrombocytopenia). Concomitant dosing was discontinued. The maximum tolerated dose and recommended phase 2 dose (RP2D) of regorafenib in the sequential combination was 82 mg/m2. The most common grade ≥3 treatment-emergent adverse events were neutropenia (71%), thrombocytopenia (33%), leukopenia (29%), anemia (24%), and ALT increased (24%). The response rate was 38%, including 1 complete (RMS) and 7 partial responders (5 RMS, 2 Ewing sarcoma); 3 of whom had prior irinotecan. Six (4 with alveolar subtype) of 12 patients with RMS had a response. Nine patients (43%) had stable disease (maximum duration 17 cycles). After the cut-off, partial response was reported for two additional patients (1 RMS, 1 Ewing sarcoma). Conclusions: Regorafenib can be combined at its single agent RP2D of 82 mg/m2 with standard-dose vincristine/irinotecan (with appropriate dose modifications) in pediatric patients with refractory/relapsed solid tumors in a sequential dosing schedule. Clinical activity was observed in patients with sarcoma. Clinical trial information: NCT02085148.
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Affiliation(s)
- Michela Casanova
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francisco Bautista
- Department of Paediatric Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Guy Makin
- Division of Cancer Sciences, School of Medical Sciences, University of Manchester and Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Lynley V. Marshall
- Paediatric and Adolescent Drug Development Team, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Arnauld Verschuur
- Department of Pediatric Oncology, La Timone Children's Hospital, Marseille, France
| | - Adela Canete
- Unidad de Oncología Pediátrica, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - Nadège Corradini
- Hematology and Oncology Pediatric Institute, Leon Berard Center, Lyon, France
| | - Bart Ploeger
- Clinical Pharmacometrics, Bayer AG, Berlin, Germany
| | - Udo Mueller
- Department of Statistics, ClinStat GmbH, Cologne, Germany
| | | | - John Woojune Chung
- Clinical Development Oncology, Bayer HealthCare Pharmaceuticals, Whippany, NJ
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, Université Paris-Saclay, Villejuif, France
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Carceller F, Bautista F, Castañeda A, Surun A, Wasti A, Revon-Riviere G, Cortes M, Bergamaschi L, Juan Ribelles A, Millen G, Campbell Hewson Q, Amoroso L, Van der Lugt J, Fagioli F, Zwaan M, Marshall LV, Vassal G, Pearson ADJ, Geoerger B, Moreno L. Mortality and survival rates in children and adolescents enrolled in early phase trials with a dose-finding/dose-confirmation component: An innovative therapies for children with cancer (ITCC) study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e21509] [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
e21509 Background: Participation of children with advanced solid cancers in phase I trials raises ethical and logistic dilemmas. Life-expectancy beyond 8-12 weeks is a common inclusion criterion, but it can be difficult to gauge. This multicentric European study assessed the mortality and survival rates in pediatric phase I trials. Methods: Retrospective study of patients aged < 18 years with solid tumors enrolled in phase I trials in ITCC centres between 2015-2017. Outcome variables were described and prognostic factors analysed. Results: 256 patients across 12 centres in 5 countries were eligible. Median age 11.8 years (range, 0.5-17.9). Female:Male ratio 1:1.9. Tumor location: central nervous system (CNS) 66% vs extra-CNS 34%. Main diagnoses: 22% soft tissue sarcomas, 13% high grade gliomas, 11% osteosarcomas. Most frequent therapy: single targeted agent (63%). Ten cases (4%) were not evaluable for response and 128 (50%) had progressive disease at first evaluation. Best responses were complete in 12 cases (5%), partial in 29 (11%) and stable disease in 77 (30%). Median follow-up 7 months (range, 0.5-42.4). Median Time On Study (TOS) 2.1 months (range, 0.2-38.1). The 30 and 90-day mortality on trial were 3% (8/256) and 21% (54/256), respectively. The 90-day survival (95%CI) for patients with CNS vs extra-CNS tumors was 88% (78-93) vs 76% (68-82), respectively. One-year Overall Survival (95%CI) for the whole sample was 40% (33-46). No toxic deaths on trial were reported. Twenty-five cases (10%) survived ≥365 days on trial. Median TOS 21.5 months (range, 12.3-38.1). Compared to patients who died within 365 days from Cycle1-Day1, those on trial ≥365 days had lower rates of metastatic disease (74% vs 28%, respectively, p < 0.001), higher objective response rates (13% vs 44%, respectively, p < 0.001) and higher disease stabilization (27% vs 56%, respectively, p < 0.001). Conclusions: Currently few patients die within the first cycle of treatment. However a fifth of all patients died within 3 months from trial initiation. Patients with CNS tumors have comparable survival rates to those with extra-CNS and should not be excluded from phase I trials solely because of their diagnosis. The survival rates beyond one year remain modest.
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Affiliation(s)
| | | | | | - Aurore Surun
- SIREDO Oncology Center, Institut Curie, Paris, France
| | - Ajla Wasti
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Gabriel Revon-Riviere
- Paediatric Hematology-Oncology Unit, Hôpital d’Enfants de la Timone, Marseille, France
| | | | | | | | - Gerard Millen
- Department of Paediatric Oncology, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Quentin Campbell Hewson
- The Great North Children's Hospital, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
| | | | | | | | | | | | | | - Andrew DJ Pearson
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | | | - Lucas Moreno
- Hospital Universitario Niño Jesús, Madrid, Spain
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Gaspar N, Gallego Melcon MS, Venkatramani R, Bielack SS, Casanova M, Locatelli F, Thebaud E, Rigaud C, Abbou S, Gambart M, Morland B, Aerts I, Kraljevic S, Li D, Maniar H, Hayato S, Dutcus CE, Campbell Hewson Q. Single-agent dose-finding cohort of a phase 1/2 study of lenvatinib (LEN) in children and adolescents with refractory or relapsed solid tumors. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10544] [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
10544 Background: LEN is an inhibitor of vascular endothelial growth factor (VEGF) receptors 1‒3, fibroblast growth factor receptors 1‒4, platelet-derived growth factor receptor α, RET, and KIT. LEN is approved in adults for radioiodine-refractory differentiated thyroid cancer (DTC) and in combination with everolimus in patients (pts) with advanced renal cell carcinoma. We show results from the single-agent LEN dose-finding part of a phase 1/2 study in children and adolescents with solid tumors. Methods: Pts had any relapsed or refractory solid tumor, evaluable or measurable disease, were aged 2 to ≤18 years, had < 2 prior VEGF-targeted therapies, and adequate organ function. A starting dose of LEN 11 mg/m2was escalated with a time-to-event continual reassessment method. The primary endpoint was to determine the LEN recommended dose (RD). Secondary objectives included best overall response (BOR), objective response rate, safety, and pharmacokinetics (PK). Results: 23 pts enrolled (11 mg/m2: n = 5, 14 mg/m2: n = 11, 17 mg/m2: n = 7). The most common tumors were rhabdomyosarcoma (n = 5), Ewing sarcoma (n = 4), and neuroblastoma (n = 3). 3 Dose-limiting toxicities occurred in cycle 1 at 14 mg/m2 (increased alanine aminotransferase: 1; hypertension: 2). All pts had any-grade treatment-emergent adverse events (TEAEs; grade 3/4: 65%). Most common any-grade TEAEs were vomiting (52%), abdominal pain (48%), decreased appetite (48%), diarrhea (44%), and hypothyroidism (44%). 1 Pt discontinued LEN due to a LEN-related TEAE (hypertension). BOR was stable disease (n = 10). Effect of age on oral clearance and central volume of distribution was not significant. Exposure was similar to that in adults. LEN 14 mg/m2/day was therefore identified as the RD. Updated cohort 1 data will be shown. Conclusions: The LEN RD in children and adolescents was similar to the adult dose and showed a reasonable safety profile. PK in these pts did not differ significantly from that in adults. The phase 1b dose-finding study of LEN in combination with chemotherapy in osteosarcoma (OS) and phase 2 LEN monotherapy (RD 14 mg/m2) parts in DTC and OS are ongoing. Clinical trial information: NCT02432274.
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Affiliation(s)
| | | | | | - Stefan S. Bielack
- Klinikum Stuttgart Olgahospital, Stuttgart Cancer Center, Stuttgart, Germany
| | | | - Franco Locatelli
- Bambino Gesù Children’s Hospital, Rome; University of Pavia, Pavia, Italy
| | | | | | | | | | - Bruce Morland
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | | | | | - Di Li
- Eisai Co., Ltd., Woodcliff Lake, NJ
| | | | | | | | - Quentin Campbell Hewson
- North of England Principal Treatment Centre for Cancer in Children and Young People, Great North Children’s Hospital, Newcastle-upon-Tyne, United Kingdom
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Hewson QC, Lovat PE, Pearson ADJ, Redfern CPF. Retinoid signalling and gene expression in neuroblastoma cells: RXR agonist and antagonist effects on CRABP-II and RARbeta expression. J Cell Biochem 2003; 87:284-91. [PMID: 12397610 DOI: 10.1002/jcb.10310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/12/2022]
Abstract
9-cis Retinoic acid (RA) induces gene expression in neuroblastoma cells more effectively and with different kinetics than other RA isomers, and could be acting in part through Retinoid X Receptors (RXRs). The aim of this study was to characterise the effects of an RXR agonist and RXR homodimer antagonist on the induction of cellular RA binding protein II (CRABP-II) and RA receptor-beta (RARbeta) in neuroblastoma cells in response to different retinoids. The RXR agonist, LDG1069, was as effective as all-trans RA in inducing gene expression, but less effective than 9-cis RA. The RXR-homodimer antagonist, LG100754, inhibited the induction of CRABP-II mRNA in SH-SY5Y neuroblastoma cells by 9-cis RA or the RXR-specific agonist LGD1069, but had no effect when used with all-trans RA. Conversely, LG100754 did not inhibit induction of RARbeta mRNA by 9-cis or all-trans RA, or by LGD1069. RAR- and RXR-specific ligands used together induced CRABP-II and RARbeta as effectively as 9-cis RA. These results demonstrate the value of combining RXR- and RAR-specific ligands to regulate RA-inducible gene expression. The possibility that RXR-homodimers mediate, in part, the induction of CRABP-II by 9-cis RA and RXR-specific ligands is discussed.
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Affiliation(s)
- Quentin Campbell Hewson
- Department of Child Health, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom
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Hewson QC, Lova PE, Malcolm AJ, Pearson AD, Redfern CP. Receptor mechanisms mediating differentiation and proliferation effects of retinoids on neuroblastoma cells. Neurosci Lett 2000; 279:113-6. [PMID: 10674634 DOI: 10.1016/s0304-3940(99)00956-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 11/22/2022]
Abstract
The aim of this study was to clarify retinoid receptor mechanisms mediating the effects of 9-cis retinoic acid (RA) and investigate the ability of RAR- and RXR-specific analogues to induce differentiation and inhibit proliferation in neuroblastoma cells. Differentiation and the inhibition of proliferation by 9-cis RA, but not all-trans RA, were inhibited by the RXR-homodimer antagonist LG745. The RXR-specific agonist LGD1069 was ineffective at inducing differentiation or inhibiting proliferation, but showed marked synergism with RAR-specific agonists with respect to inhibiting proliferation. These data suggest that the effects of 9-cis RA are mediated via both RXR-homodimers and heterodimers. However, combinations of RAR- and RXR-selective analogues were not as effective at promoting differentiation. This study indicates that different receptor mechanisms are involved in retinoid-induced differentiation and inhibition of proliferation in neuroblastoma cells.
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Affiliation(s)
- Q C Hewson
- Department of Child Health, University of Newcastle upon Tyne, UK
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Affiliation(s)
- D A Tweddle
- Department of Paediatric Oncology, Institute of Child Health, Royal Victoria Infirmary NHS Trust and University of Newcastle, Newcastle upon Tyne NE1 4LP
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Irving H, Lovat PE, Hewson QC, Malcolm AJ, Pearson AD, Redfern CP. Retinoid-induced differentiation of neuroblastoma: comparison between LG69, an RXR-selective analogue and 9-cis retinoic acid. Eur J Cancer 1998; 34:111-7. [PMID: 9624247 DOI: 10.1016/s0959-8049(97)10027-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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: 02/07/2023]
Abstract
The aim of this study was to investigate in vitro the effects of all-trans retinoic acid (RA), 9-cis RA and the RXR-selective analogue, LG69, on the morphological differentiation, proliferation and gene expression of neuroblastoma cells. Three different cell lines were cultured with the retinoid for either 9 continuous days or for 5 days followed by 4 days without the retinoid and morphological differentiation was assessed both qualitatively and quantitatively. SH SY 5Y cell proliferation was examined by measuring cell numbers after exposure to the retinoids and RAR-beta gene expression was examined by Northern blot analysis. Morphological differentiation was more effectively induced by all-trans and 9-cis RA than by LG69. SH SY 5Y cells, when treated with 9-cis RA for only 5 of the 9 days of culture, underwent apoptosis, but this was not seen with 9 days continuous exposure nor with LG69. Inhibition of SH SY 5Y cell proliferation by all-trans or 9-cis RA was dose-dependent, but LG69 had little effect. Conversely, LG69 induced higher expression of RAR-beta than all-trans RA, but less than that produced by 9-cis RA. These data suggest that 9-cis RA as a single agent is the most effective modulator of neuroblastoma behaviour and may be the most appropriate therapeutic agent.
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Affiliation(s)
- H Irving
- Department of Child Health, University of Newcastle upon Tyne, U.K
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