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Blumenthal GM, Gills JJ, Ballas MS, Bernstein WB, Komiya T, Dechowdhury R, Morrow B, Root H, Chun G, Helsabeck C, Steinberg SM, LoPiccolo J, Kawabata S, Gardner ER, Figg WD, Dennis PA. A phase I trial of the HIV protease inhibitor nelfinavir in adults with solid tumors. Oncotarget 2015; 5:8161-72. [PMID: 25327558 PMCID: PMC4226674 DOI: 10.18632/oncotarget.2415] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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] [Indexed: 01/27/2023] Open
Abstract
Nelfinavir is an HIV protease inhibitor being repurposed as an anti-cancer agent in preclinical models and in small oncology trials, yet the MTD of nelfinavir has not been determined. Therefore, we conducted a Phase Ia study to establish the maximum tolerated dose (MTD) and dose limiting toxicities (DLT) of nelfinavir in subjects with advanced solid tumors. Adults with refractory cancers were given oral nelfinavir twice daily with pharmacokinetic and pharmacodynamic analyses. Twenty-eight subjects were enrolled. Nelfinavir was generally well tolerated. Common adverse events included diarrhea, anemia, and lymphopenia, which were mostly mild. The DLT was rapid-onset neutropenia that was reversible. The MTD was established at 3125 mg twice daily. In an expansion cohort at the MTD, one of 11 (9%) evaluable subjects had a confirmed partial response. This, plus two minor responses, occurred in subjects with neuroendocrine tumors of the midgut or pancreatic origin. Thirty-six percent of subjects had stable disease for more than 6 months. In peripheral blood mononuclear cells, Nelfinavir inhibited AKT and induced markers of ER stress. In summary, nelfinavir is well tolerated in cancer patients at doses 2.5 times the FDA-approved dose for HIV management and showed preliminary activity in tumors of neuroendocrine origin.
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Affiliation(s)
| | - Joell J Gills
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Marc S Ballas
- Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | | | - Takefumi Komiya
- Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | | | - Betsy Morrow
- Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - Hyejeong Root
- Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - Guinevere Chun
- Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | | | - Seth M Steinberg
- Biostatistics and Data Management Section, National Cancer Institute, Bethesda, MD
| | - Jaclyn LoPiccolo
- Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - Shigeru Kawabata
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Erin R Gardner
- Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - William D Figg
- Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - Phillip A Dennis
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Komiya T, Blumenthal GM, Ballas MS, Dechowdhury R, Manu M, Fioravanti S, Hornyak TJ, Wank S, Weinstein D, Morris J, Hewitt SM, Memmott R, Dennis PA, Morrow B. A pilot study of sirolimus (S) in subjects with Cowden syndrome (CS) with germ-line mutations in PTEN. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2532] [Citation(s) in RCA: 8] [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
2532 Background: CS is characterized by germline PTEN mutations. Because tumors from CS patients show increased activation of the PI3K/Akt/mTOR pathway, mTOR inhibitor such as S might have activity in such patients. Methods: Eligibility: subjects with germline PTEN mutation who meet international diagnostic criteria for CS, age 18, ECOG PS 0-2, and adequate organ function. Subjects were treated with a 56-day course of daily oral S (2 mg). Objective: Inhibition of the mTOR pathway in benign skin/GI lesion, as assessed by IHC (P-AKT, Total S6, P-S6, P-4E-BP1, score 0-4), changes in benign or malignant tumor by CT/MRI/PET, digital dermoscopy/endoscopy, and changes in cerebellar testing by modified SARA (Neurology 2006). Protocol was amended to allow up to 20 subjects. Results: A total of 18 pts/16 families were enrolled. Median age 42 (range 19-69). Male/Female: 9/9. Involvement in skin, thyroid, GI polyps, breast, CNS, and all of the five organs was observed in 18, 15, 13, 8, 18, 5 subjects, respectively. 7 had h/o malignancies: 3 renal cell, 4 breast, 3 thyroid, 4 others. 3 cerebellar gangliocytomas and 2 others were measurable by CT or MRI. PTEN mutations: 6 families in Exon 1-2, 1 in Exon 4, 9 in Exon 5-8. All but one (D24H) were truncating mutations. 11 of 16 pts who completed a 56-day course reported subjective improvement in energy, mood, focus or skin lesion. Pts with Ex6-8 mutation (n=4) had a median SUV decrease of 29.4%. Regression of skin and GI lesions was observed by dermoscopy or endoscopy. Cerebellar evaluation showed a significant improvement in a total SARA score at 1 month (n=9, p=0.034). 3 pts were treated for only 28 days due to voluntary withdrawal. IHC analysis in skin and GI benign lesions showed a decrease in average P-S6K, P-S6, Total S6, P-S6/Total S6 in response to S. P-S6K/Total S6 ratios at d14 and d56 were significantly lower than at baseline (p=0.0026, 0.0391, respectively). The most common AEs (all grades >25%) were LFTs/Hb (39%), fatigue/hypercholesterolemia (28%). Grade 3 AEs: 1 pt hypophosphatemia/lymphopenia. Conclusions: A 56-day course of S was well tolerated in subjects with CS and was associated with improvement in symptoms, skin/GI lesions, cerebellar function and decreased mTOR signaling. Clinical trial information: NCT00971789.
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Affiliation(s)
| | | | | | | | | | | | - Thomas J Hornyak
- Dermatology, University of Maryland School of Medicine, Baltimore, MD
| | - Stephen Wank
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Douglas Weinstein
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Jennifer Morris
- Laboraory of Pathology, National Cancer Institute, Gaithersburg, MD
| | - Stephen M. Hewitt
- Tissue Array Research Program, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | - Phillip A. Dennis
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Rajan A, Berman AW, Kelly RJ, Lopez-Chavez A, Dechowdhury R, Chen H, Giaccone G. Phase II study of the insulin-like growth factor-1 receptor (IGF-1R) antibody cixutumumab (C) in patients (pts) with thymoma (T) and thymic carcinoma (TC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e17525] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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