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Zuo P, Arefayene M, Pan WJ, Freshwater T, Monteleone J. A Population Pharmacokinetic Assessment of the Effect of Food on Selumetinib in Patients with Neurofibromatosis Type 1-Related Plexiform Neurofibromas and Healthy Volunteers. Clin Pharmacol Drug Dev 2024. [PMID: 38591154 DOI: 10.1002/cpdd.1400] [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: 11/20/2023] [Accepted: 02/27/2024] [Indexed: 04/10/2024]
Abstract
Selumetinib is clinically used for pediatric patients with neurofibromatosis type 1 and symptomatic, inoperable plexiform neurofibromas. Until recently, selumetinib had to be taken twice daily, after 2 hours of fasting and followed by 1 hour of fasting, which could be inconvenient. This population analysis evaluated the effect of low- and high-fat meals on the pharmacokinetic (PK) parameters of selumetinib and its active metabolite N-desmethyl selumetinib. The dataset comprised 511 subjects from 15 clinical trials who received ≥1 dose of selumetinib and provided ≥1 measurable postdose concentration of selumetinib and N-desmethyl selumetinib. A 2-compartment model with sequential 0- and 1st-order delayed absorption and 1st-order elimination adequately described selumetinib PK characteristics. A 1-compartment model reasonably described N-desmethyl selumetinib PK characteristics over time simultaneously with selumetinib. Selumetinib geometric mean area under the concentration-time curve ratio (1-sided 90% confidence interval [CI] lower bound) was 76.9% (73.3%) with a low-fat meal and 79.3% (76.3%) with a high-fat meal versus fasting. The lower bound of the 1-sided 90% CI demonstrated a difference of <30% between fed and fasted states. Considering the flat exposure-response relationship within the dose range (20-30 mg/m2), the observed range of exposure, and the variability in the SPRINT trial, this was not considered clinically relevant.
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Affiliation(s)
- Peiying Zuo
- Clinical Pharmacology and Safety Sciences, Alexion, AstraZeneca Rare Disease, Boston, MA, USA
| | - Million Arefayene
- Clinical Pharmacology and Safety Sciences, Alexion, AstraZeneca Rare Disease, Boston, MA, USA
| | - Wei-Jian Pan
- Clinical Pharmacology and Safety Sciences, Alexion, AstraZeneca Rare Disease, Boston, MA, USA
| | - Tomoko Freshwater
- Quantitative Pharmacology and Pharmacometrics Immune/Oncology (QP2-I/O), Merck & Co., Inc., Rahway, NJ, USA
| | - Jonathan Monteleone
- Clinical Pharmacology and Safety Sciences, Alexion, AstraZeneca Rare Disease, Boston, MA, USA
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2
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Armstrong AJ, Geva R, Chung HC, Lemech C, Miller WH, Hansen AR, Lee JS, Tsai F, Solomon BJ, Kim TM, Rolfo C, Giranda V, Ren Y, Liu F, Kandala B, Freshwater T, Wang JS. CXCR2 antagonist navarixin in combination with pembrolizumab in select advanced solid tumors: a phase 2 randomized trial. Invest New Drugs 2024; 42:145-159. [PMID: 38324085 DOI: 10.1007/s10637-023-01410-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/08/2023] [Indexed: 02/08/2024]
Abstract
C-X-C motif chemokine receptor 2 (CXCR2) has a role in tumor progression, lineage plasticity, and reduction of immune checkpoint inhibitor efficacy. Preclinical evidence suggests potential benefit of CXCR2 inhibition in multiple solid tumors. In this phase 2 study (NCT03473925), adults with previously treated advanced or metastatic castration-resistant prostate cancer (CRPC), microsatellite-stable colorectal cancer (MSS CRC), or non-small-cell lung cancer (NSCLC) were randomized 1:1 to the CXCR2 antagonist navarixin 30 or 100 mg orally once daily plus pembrolizumab 200 mg intravenously every 3 weeks up to 35 cycles. Primary endpoints were investigator-assessed objective response rate (RECIST v1.1) and safety. Of 105 patients (CRPC, n=40; MSS CRC, n=40; NSCLC, n=25), 3 had a partial response (2 CRPC, 1 MSS CRC) for ORRs of 5%, 2.5%, and 0%, respectively. Median progression-free survival was 1.8-2.4 months without evidence of a dose-response relationship, and the study was closed at a prespecified interim analysis for lack of efficacy. Dose-limiting toxicities occurred in 2/48 patients (4%) receiving navarixin 30 mg and 3/48 (6%) receiving navarixin 100 mg; events included grade 4 neutropenia and grade 3 transaminase elevation, hepatitis, and pneumonitis. Treatment-related adverse events occurred in 70/105 patients (67%) and led to treatment discontinuation in 7/105 (7%). Maximal reductions from baseline in absolute neutrophil count were 44.5%-48.2% (cycle 1) and 37.5%-44.2% (cycle 2) and occurred within 6-12 hours postdose in both groups. Navarixin plus pembrolizumab did not demonstrate sufficient efficacy in this study. Safety and tolerability of the combination were manageable. (Trial registration: ClinicalTrials.gov , NCT03473925).
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Affiliation(s)
- Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC, 27710, USA.
| | - Ravit Geva
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hyun Cheol Chung
- Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | | | - Wilson H Miller
- Segal Cancer Center, McGill University, Jewish General Hospital, Montreal, QC, Canada
| | | | - Jong-Seok Lee
- Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | | | | | - Tae Min Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Christian Rolfo
- Center for Thoracic Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | | | | | - Fang Liu
- Merck & Co., Inc, Rahway, NJ, USA
| | | | | | - Judy S Wang
- Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, FL, USA
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3
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Peribañez-Dominguez S, Parra-Guillen ZP, Freshwater T, Troconiz IF. A physiologically based pharmacokinetic model for V937 oncolytic virus in mice. Front Pharmacol 2023; 14:1211452. [PMID: 37771727 PMCID: PMC10524596 DOI: 10.3389/fphar.2023.1211452] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction: Oncolytic viruses (OVs) represent a novel therapeutic strategy in oncology due to their capability to selectively infect and replicate in cancer cells, triggering a direct and/or immune-induced tumor lysis. However, the mechanisms governing OV pharmacokinetics are still poorly understood. This work aims to develop a physiologically based pharmacokinetic model of the novel OV, V937, in non-tumor-bearing mice to get a quantitative understanding of its elimination and tissue uptake processes. Materials and methods: Model development was performed using data obtained from 60 mice. Viral levels were quantified from eight tissues after a single intravenous V937 dose. An external dataset was used for model validation. This test set included multiple-dose experiments with different routes of administration. V937 distribution in each organ was described using a physiological structure based on mouse-specific organ blood flows and volumes. Analyses were performed using the non-linear mixed-effects approach with NONMEM 7.4. Results: Viral levels showed a drop from 108 to 105 copies/µg RNA at day 1 in blood, reflected in a high estimate of total clearance (18.2 mL/h). A well-stirred model provided an adequate description for all organs except the muscle and heart, where a saturable uptake process improved data description. The highest numbers of viral copies were observed in the brain, lymph node, kidney, liver, lung, and spleen on the first day after injection. On the other hand, the maximum amount of viral copies in the heart, muscle, and pancreas occurred 3 days after administration. Conclusion: To the best of our knowledge, this is the first physiologically based pharmacokinetic model developed to characterize OV biodistribution, representing a relevant source of quantitative knowledge regarding the in vivo behavior of OVs. This model can be further expanded by adding a tumor compartment, where OVs could replicate.
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Affiliation(s)
- Sara Peribañez-Dominguez
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Zinnia P. Parra-Guillen
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Tomoko Freshwater
- Quantitative Pharmacology and Pharmacometrics Immune/Oncology (QP2-I/O) Merck & Co., Inc., Rahway, NJ, United States
| | - Iñaki F. Troconiz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Institute of Data Science and Artificial Intelligence (DATAI), University of Navarra, Pamplona, Spain
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Parra-Guillen ZP, Sancho-Araiz A, Mayawala K, Zalba S, Garrido MJ, de Alwis D, Troconiz IF, Freshwater T. Assessment of Clinical Response to V937 Oncolytic Virus After Intravenous or Intratumoral Administration Using Physiologically-Based Modeling. Clin Pharmacol Ther 2023; 114:623-632. [PMID: 37170933 DOI: 10.1002/cpt.2937] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
Oncolytic viruses (OVs) represent a potential therapeutic strategy in cancer treatment. However, there is currently a lack of comprehensive quantitative models characterizing clinical OV kinetics and distribution to the tumor. In this work, we present a mechanistic modeling framework for V937 OV, after intratumoral (i.t.) or intravascular (i.v.) administration in patients with cancer. A minimal physiologically-based pharmacokinetic model was built to characterize biodistribution of OVs in humans. Viral dynamics was incorporated at the i.t. cellular level and linked to tumor response, enabling the characterization of a direct OV killing triggered by the death of infected tumor cells and an indirect killing induced by the immune response. The model provided an adequate description of changes in V937 mRNA levels and tumor size obtained from phase I/II clinical trials after V937 administration. The model showed prominent role of viral clearance from systemic circulation and infectivity in addition to known tumor aggressiveness on clinical response. After i.v. administration, i.t. exposure of V937 was predicted to be several orders of magnitude lower compared with i.t. administration. These differences could be overcome if there is high virus infectivity and/or replication. Unfortunately, the latter process could not be identified at the current clinical setting. This work provides insights on selecting optimal OV considering replication rate and infectivity.
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Affiliation(s)
- Zinnia P Parra-Guillen
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Aymara Sancho-Araiz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Kapil Mayawala
- Quantitative Pharmacology and Pharmacometrics Immune/Oncology (QP2-I/O), Merck & Co., Inc., Rahway, New Jersey, USA
| | - Sara Zalba
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Maria J Garrido
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Dinesh de Alwis
- Quantitative Pharmacology and Pharmacometrics Immune/Oncology (QP2-I/O), Merck & Co., Inc., Rahway, New Jersey, USA
| | - Iñaki F Troconiz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Tomoko Freshwater
- Quantitative Pharmacology and Pharmacometrics Immune/Oncology (QP2-I/O), Merck & Co., Inc., Rahway, New Jersey, USA
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Stathis A, Tolcher AW, Wang JS, Renouf DJ, Chen LC, Suttner LH, Freshwater T, Webber AL, Nayak T, Siu LL. Results of an open-label phase 1b study of the ERK inhibitor MK-8353 plus the MEK inhibitor selumetinib in patients with advanced or metastatic solid tumors. Invest New Drugs 2023:10.1007/s10637-022-01326-3. [PMID: 37040046 DOI: 10.1007/s10637-022-01326-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 04/12/2023]
Abstract
AIM We evaluated MK-8353 (small molecule inhibitor of extracellular signal-regulated kinase 1/2) plus selumetinib (mitogen-activated extracellular signal-regulated kinase 1/2 inhibitor) in patients with advanced solid tumors. METHODS This phase 1b, open-label, dose-escalation study (NCT03745989) enrolled adults with histologically/cytologically documented, locally advanced/metastatic solid tumors. MK-8353/selumetinib dose combinations were intended to be investigated in sequence: 50/25, 100/50, 150/75, 200/75, 200/100, and 250/100. Each agent was administered orally BID 4 days on/3 days off in repeating cycles every 21 days. Primary objectives were safety and tolerability and to establish preliminary recommended phase 2 doses for combination therapy. RESULTS Thirty patients were enrolled. Median (range) age was 61.5 (26-78) years and 93% had received previous cancer therapy. Among 28 patients in the dose-limiting toxicities [DLT]-evaluable population, 8 experienced DLTs: 1/11 (9%) in the MK-8353/selumetinib 100/50-mg dose level experienced a grade 3 DLT (urticaria), and 7/14 (50%) in the 150/75-mg dose level experienced grade 2/3 DLTs (n = 2 each of blurred vision, retinal detachment, vomiting; n = 1 each of diarrhea, macular edema, nausea, retinopathy). The DLT rate in the latter dose level exceeded the prespecified target DLT rate (~30%). Twenty-six patients (87%) experienced treatment-related adverse events (grade 3, 30%; no grade 4/5), most commonly diarrhea (67%), nausea (37%), and acneiform dermatitis (33%). Three patients (10%) experienced treatment-related adverse events leading to treatment discontinuation. Best response was stable disease in 14 patients (n = 10 with MK-8353/selumetinib 150/75 mg). CONCLUSION MK-8353/selumetinib 50/25 mg and 100/50 mg had acceptable safety and tolerability, whereas 150/75 mg was not tolerable. No responses were observed.
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Affiliation(s)
- Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, via A. Gallino 12, Bellinzona 6500, Switzerland.
| | | | - Judy S Wang
- Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, FL, USA
| | | | | | | | | | | | | | - Lillian L Siu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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6
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Parra-Guillen ZP, Freshwater T, Cao Y, Mayawala K, Zalba S, Garrido MJ, de Alwis D, Troconiz IF. Mechanistic Modeling of a Novel Oncolytic Virus, V937, to Describe Viral Kinetic and Dynamic Processes Following Intratumoral and Intravenous Administration. Front Pharmacol 2021; 12:705443. [PMID: 34366859 PMCID: PMC8343024 DOI: 10.3389/fphar.2021.705443] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/07/2021] [Indexed: 12/28/2022] Open
Abstract
V937 is an investigational novel oncolytic non-genetically modified Kuykendall strain of Coxsackievirus A21 which is in clinical development for the treatment of advanced solid tumor malignancies. V937 infects and lyses tumor cells expressing the intercellular adhesion molecule I (ICAM-I) receptor. We integrated in vitro and in vivo data from six different preclinical studies to build a mechanistic model that allowed a quantitative analysis of the biological processes of V937 viral kinetics and dynamics, viral distribution to tumor, and anti-tumor response elicited by V937 in human xenograft models in immunodeficient mice following intratumoral and intravenous administration. Estimates of viral infection and replication which were calculated from in vitro experiments were successfully used to describe the tumor response in vivo under various experimental conditions. Despite the predicted high clearance rate of V937 in systemic circulation (t1/2 = 4.3 min), high viral replication was observed in immunodeficient mice which resulted in tumor shrinkage with both intratumoral and intravenous administration. The described framework represents a step towards the quantitative characterization of viral distribution, replication, and oncolytic effect of a novel oncolytic virus following intratumoral and intravenous administrations in the absence of an immune response. This model may further be expanded to integrate the role of the immune system on viral and tumor dynamics to support the clinical development of oncolytic viruses.
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Affiliation(s)
- Zinnia P Parra-Guillen
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | | | - Youfang Cao
- Merck & Co., Inc., Kenilworth, NJ, United States
| | | | - Sara Zalba
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Maria J Garrido
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | | | - Iñaki F Troconiz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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7
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Cohen-Rabbie S, Zhou L, Vishwanathan K, Wild M, Xu S, Freshwater T, Jain L, Schalkwijk S, Tomkinson H, Zhou D. Physiologically Based Pharmacokinetic Modeling for Selumetinib to Evaluate Drug-Drug Interactions and Pediatric Dose Regimens. J Clin Pharmacol 2021; 61:1493-1504. [PMID: 34196005 PMCID: PMC9290801 DOI: 10.1002/jcph.1935] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/29/2021] [Indexed: 12/02/2022]
Abstract
Selumetinib (ARRY‐142886), an oral, potent and highly selective allosteric mitogen‐activated protein kinase kinase 1/2 inhibitor, is approved by the US Food and Drug Administration for the treatment of pediatric patients aged ≥2 years with neurofibromatosis type 1 with symptomatic, inoperable plexiform neurofibromas. A physiologically based pharmacokinetic (PBPK) model was constructed to predict plasma concentration–time profiles of selumetinib, and to evaluate the impact of coadministering moderate cytochrome P450 (CYP) 3A4/2C19 inhibitors/inducers. The model was also used to extrapolate pharmacokinetic exposures from older children with different body surface area to guide dosing in younger children. This model was built based on physiochemical data and clinical in vivo drug‐drug interaction (DDI) studies with itraconazole and fluconazole, and verified against data from an in vivo rifampicin DDI study and an absolute bioavailability study. The pediatric model was updated by changing system‐specific input parameters using the Simcyp pediatric module. The model captured the observed selumetinib pharmacokinetic profiles and the interactions with CYP inhibitors/inducers. The predictions from the PBPK model showed a DDI effect of 30% to 40% increase or decrease in selumetinib exposure when coadministered with moderate CYP inhibitors or inducers, respectively, which was used to inform dose management and adjustments. The pediatric PBPK model was applied to simulate exposures in specific body surface area brackets that matched those achieved with a 25 mg/m2 dose in SPRINT clinical trials. The pediatric PBPK model was used to guide the dose for younger patients in a planned pediatric clinical study.
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Affiliation(s)
- Sarit Cohen-Rabbie
- Clinical Pharmacology & Quantitative Pharmacology, Clinical Pharmacology and Safety Science, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Li Zhou
- Clinical Pharmacology & Quantitative Pharmacology, Clinical Pharmacology and Safety Science, BioPharmaceuticals R&D, AstraZeneca, Boston, Massachusetts, USA
| | - Karthick Vishwanathan
- Clinical Pharmacology & Quantitative Pharmacology, Clinical Pharmacology and Safety Science, BioPharmaceuticals R&D, AstraZeneca, Boston, Massachusetts, USA
| | | | - Sherrie Xu
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism (PPDM), Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Tomoko Freshwater
- Quantitative Pharmacology & Pharmacometrics (QP2) Pharmacokinetics, Pharmacodynamics and Drug Metabolism (PPDM), Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Lokesh Jain
- Quantitative Pharmacology & Pharmacometrics (QP2) Pharmacokinetics, Pharmacodynamics and Drug Metabolism (PPDM), Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Stein Schalkwijk
- Clinical Pharmacology & Quantitative Pharmacology, Clinical Pharmacology and Safety Science, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Helen Tomkinson
- Clinical Pharmacology & Quantitative Pharmacology, Clinical Pharmacology and Safety Science, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Diansong Zhou
- Clinical Pharmacology & Quantitative Pharmacology, Clinical Pharmacology and Safety Science, BioPharmaceuticals R&D, AstraZeneca, Boston, Massachusetts, USA
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8
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Li TR, Chatterjee M, Lala M, Abraham AK, Freshwater T, Jain L, Sinha V, de Alwis DP, Mayawala K. Pivotal Dose of Pembrolizumab: A Dose-Finding Strategy for Immuno-Oncology. Clin Pharmacol Ther 2021; 110:200-209. [PMID: 33462831 DOI: 10.1002/cpt.2170] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/20/2020] [Indexed: 12/16/2022]
Abstract
Despite numerous publications emphasizing the value of dose finding, drug development in oncology is dominated by the mindset that higher dose provides higher efficacy. Examples of dose finding implemented by biopharmaceutical firms can change this mindset. The purpose of this article is to outline a pragmatic dose selection strategy for immuno-oncology (IO) and other targeted monoclonal antibodies (mAbs). The approach was implemented for pembrolizumab. Selecting a recommended phase II dose (RP2D) with a novel mechanism of action is often challenging due to uncertain relationships between pharmacodynamics measurements and clinical end points. Additionally, phase I efficacy and safety data are generally inadequate for RP2D selection for IO mAbs. Here, the RP2D was estimated based on phase I (clinical study KN001 A and A2) pharmacokinetics data as the dose required for target saturation, which represents a surrogate for maximal pharmacological effect for antagonist mAbs. Due to limitations associated with collecting and analyzing tumor biopsies, characterizing intratumoral target engagement (TE) is challenging. To overcome this gap, a physiologically-based pharmacokinetic model was implemented to predict intratumoral TE. As tumors are spatially heterogeneous, TE was predicted in well-vascularized and poorly vascularized tumor regions. Additionally, impact of differences in target expression, for example, due to interindividual variability and cancer type, was simulated. Simulations showed that 200 mg every 3 weeks can achieve ≥ 90% TE in clinically relevant scenarios, resulting in the recommendation of 200 mg every 3 weeks as the RP2D. Randomized dose comparison studies (KN001 B2 and D) showing similar efficacy over a fivefold dose/exposure range confirmed the RP2D as the pivotal dose.
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Affiliation(s)
- Tommy R Li
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Manash Chatterjee
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Mallika Lala
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Anson K Abraham
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Tomoko Freshwater
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Lokesh Jain
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Vikram Sinha
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Dinesh P de Alwis
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Kapil Mayawala
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
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9
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Oza AM, Estevez-Diz M, Grischke EM, Hall M, Marmé F, Provencher D, Uyar D, Weberpals JI, Wenham RM, Laing N, Tracy M, Freshwater T, Lee MA, Liu J, Qiu J, Rose S, Rubin EH, Moore K. A Biomarker-enriched, Randomized Phase II Trial of Adavosertib (AZD1775) Plus Paclitaxel and Carboplatin for Women with Platinum-sensitive TP53-mutant Ovarian Cancer. Clin Cancer Res 2020; 26:4767-4776. [DOI: 10.1158/1078-0432.ccr-20-0219] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/21/2020] [Accepted: 06/25/2020] [Indexed: 11/16/2022]
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10
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van Vugt MJH, Stone JA, De Greef RHJMM, Snyder ES, Lipka L, Turner DC, Chain A, Lala M, Li M, Robey SH, Kondic AG, De Alwis D, Mayawala K, Jain L, Freshwater T. Immunogenicity of pembrolizumab in patients with advanced tumors. J Immunother Cancer 2019; 7:212. [PMID: 31395089 PMCID: PMC6686242 DOI: 10.1186/s40425-019-0663-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 02/13/2019] [Accepted: 07/04/2019] [Indexed: 12/25/2022] Open
Abstract
Background Pembrolizumab is a potent, humanized, monoclonal anti–programmed death 1 antibody that has demonstrated effective antitumor activity and acceptable safety in multiple tumor types. Therapeutic biologics can result in the development of antidrug antibodies (ADAs), which may alter drug clearance and neutralize target binding, potentially reducing drug efficacy; such immunogenicity may also result in infusion reactions, anaphylaxis, and immune complex disorders. Pembrolizumab immunogenicity and its impact on exposure, safety, and efficacy was assessed in this study. Patients and methods Pembrolizumab immunogenicity was assessed in 3655 patients with advanced or metastatic cancer treated in 12 clinical studies. Patients with melanoma, non–small cell lung cancer, head and neck squamous cell carcinoma, colorectal cancer, urothelial cancer, and Hodgkin lymphoma were treated with pembrolizumab at 2 mg/kg every 3 weeks, 10 mg/kg every 2 weeks, 10 mg/kg every 3 weeks, or 200 mg every 3 weeks. An additional study involving 496 patients with stage III melanoma treated with 200 mg adjuvant pembrolizumab every 3 weeks after complete resection was analyzed separately. Results Of 3655 patients, 2000 were evaluable for immunogenicity analysis, 36 (1.8%) were treatment-emergent (TE) ADA-positive; 9 (0.5%) of these TE-positive patients had antibodies with neutralizing capacity. The presence of pembrolizumab-specific ADAs did not impact pembrolizumab exposure, nor did pembrolizumab immunogenicity affect the incidence of drug-related adverse events (AEs) or infusion-related reactions. There was no clear relationship between the presence of pembrolizumab-specific ADAs and changes in tumor size across treatment regimens. Of the 496 patients treated with pembrolizumab as adjuvant therapy, 495 were evaluable, 17 (3.4%) were TE ADA–positive; none had neutralizing antibodies. Conclusions The incidence of TE (neutralizing positive) ADAs against pembrolizumab was low in patients with advanced tumors. Furthermore, immunogenicity did not appear to have any clinically relevant effects on the exposure, safety, or efficacy of pembrolizumab. Trial registration ClinicalTrials.gov, NCT01295827 (February 15, 2011), NCT01704287 (October 11, 2012), NCT01866319 (May 31, 2013), NCT01905657 (July 23, 2013), NCT02142738 (May 20, 2014), NCT01848834 (May 8, 2013), NCT02255097 (October 2, 2014), NCT02460198 (June 2, 2015), NCT01953692 (October 1, 2013), NCT02453594 (May 25, 2015), NCT02256436 (October 3, 2014), NCT02335424 (January 9, 2015), NCT02362594 (February 13, 2015). Electronic supplementary material The online version of this article (10.1186/s40425-019-0663-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Julie A Stone
- Quantitative Pharmacology, Merck & Co., Inc, Kenilworth, NJ, USA
| | | | - Ellen S Snyder
- Quantitative Pharmacology, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Leslie Lipka
- Quantitative Pharmacology, Merck & Co., Inc, Kenilworth, NJ, USA
| | - David C Turner
- Quantitative Pharmacology, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Anne Chain
- Quantitative Pharmacology, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Mallika Lala
- Quantitative Pharmacology, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Mengyao Li
- Quantitative Pharmacology, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Seth H Robey
- Quantitative Pharmacology, Merck & Co., Inc, Kenilworth, NJ, USA
| | | | - Dinesh De Alwis
- Quantitative Pharmacology, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Kapil Mayawala
- Quantitative Pharmacology, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Lokesh Jain
- Quantitative Pharmacology, Merck & Co., Inc, Kenilworth, NJ, USA
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Freshwater T, Kondic A, Ahamadi M, Li CH, de Greef R, de Alwis D, Stone JA. Evaluation of dosing strategy for pembrolizumab for oncology indications. J Immunother Cancer 2017; 5:43. [PMID: 28515943 PMCID: PMC5433037 DOI: 10.1186/s40425-017-0242-5] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [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: 09/15/2016] [Accepted: 04/26/2017] [Indexed: 12/13/2022] Open
Abstract
Background Traditionally, most monoclonal antibodies (mAbs) have been dosed based on body weight because of perceived contribution of body size in pharmacokinetic variability. The same approach was used in the initial pembrolizumab studies; however, following availability of PK data, the need for weight-based dosing for pembrolizumab was reassessed. Methods A previously established population PK (popPK) model as well as exposure-response results from patients with advanced melanoma or non–small cell lung cancer (NSCLC) were used to evaluate the potential application of a fixed dosing regimen with the aim of maintaining pembrolizumab exposures within the range demonstrated to provide near maximal efficacy and acceptable safety. Individual PK exposures for the selected fixed dosing regimen from recently completed trials with head and neck cancer, NSCLC, microsatellite instability high (MSI-H) in colorectal cancer (CRC) and urothelial cancer were used to confirm acceptability. To determine whether fixed dosing would maintain exposures within the range of clinical experience, the individual AUC distributions with fixed dosing were compared with the range of exposures from the pembrolizumab doses that were evaluated in early studies (2 mg/kg Q3W, 10 mg/kg Q3W/Q2W). Results Body-weight dependence of clearance was characterized by a power relationship with an exponent of 0.578, a value consistent with fixed- and weight-based dosing providing similar control of PK variability. A fixed dose of 200 mg Q3W was investigated in trials based on predicted exposures maintained within the established exposure range in all patients. Mean (% CV, n) AUCss, 6-weeks was 1.87 (37%, 830), 1.38 (38%, 760) and 7.63 (35%, 1405) mg*day/mL in patients receiving 200 mg, 2 mg/kg and 10 mg/kg Q3W pembrolizumab. High-weight patients had the lowest exposures with 200 mg Q3W; however, exposures in this group (>90 kg) were within the range of prior clinical experience at 2 mg/kg Q3W associated with near maximal efficacy. Conclusions Doses of 200 mg and 2 mg/kg provide similar exposure distributions with no advantage to either dosing approach with respect to controlling PK variability. These findings suggest that weight-based and fixed-dose regimens are appropriate for pembrolizumab. Electronic supplementary material The online version of this article (doi:10.1186/s40425-017-0242-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tomoko Freshwater
- Department of Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ USA
| | - Anna Kondic
- Department of Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ USA
| | - Malidi Ahamadi
- Department of Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ USA
| | - Claire H Li
- Department of Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ USA
| | - Rik de Greef
- Quantitative Solutions, a Certara Company, Kloosterstraat 9, Oss, The Netherlands
| | - Dinesh de Alwis
- Department of Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ USA
| | - Julie A Stone
- Department of Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ USA
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12
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Leijen S, van Geel RM, Pavlick AC, Tibes R, Rosen L, Razak ARA, Lam R, Demuth T, Rose S, Lee MA, Freshwater T, Shumway S, Liang LW, Oza AM, Schellens JH, Shapiro GI. Phase I Study Evaluating WEE1 Inhibitor AZD1775 As Monotherapy and in Combination With Gemcitabine, Cisplatin, or Carboplatin in Patients With Advanced Solid Tumors. J Clin Oncol 2016; 34:4371-4380. [PMID: 27601554 PMCID: PMC7845944 DOI: 10.1200/jco.2016.67.5991] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [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] [Indexed: 01/02/2023] Open
Abstract
Purpose AZD1775 is a WEE1 kinase inhibitor targeting G2 checkpoint control, preferentially sensitizing TP53-deficient tumor cells to DNA damage. This phase I study evaluated safety, tolerability, pharmacokinetics, and pharmacodynamics of oral AZD1775 as monotherapy or in combination with chemotherapy in patients with refractory solid tumors. Patients and Methods In part 1, patients received a single dose of AZD1775 followed by 14 days of observation. In part 2, patients received AZD1775 as a single dose (part 2A) or as five twice per day doses or two once per day doses (part 2B) in combination with one of the following chemotherapy agents: gemcitabine (1,000 mg/m2), cisplatin (75 mg/m2), or carboplatin (area under the curve, 5 mg/mL⋅min). Skin biopsies were collected for pharmacodynamic assessments. TP53 status was determined retrospectively in archival tumor tissue. Results Two hundred two patients were enrolled onto the study, including nine patients in part 1, 43 in part 2A (including eight rollover patients from part 1), and 158 in part 2B. AZD1775 monotherapy given as single dose was well tolerated, and the maximum-tolerated dose was not reached. In the combination regimens, the most common adverse events consisted of fatigue, nausea and vomiting, diarrhea, and hematologic toxicity. The maximum-tolerated doses and biologically effective doses were established for each combination. Target engagement, as a predefined 50% pCDK1 reduction in surrogate tissue, was observed in combination with cisplatin and carboplatin. Of 176 patients evaluable for efficacy, 94 (53%) had stable disease as best response, and 17 (10%) achieved a partial response. The response rate in TP53-mutated patients (n = 19) was 21% compared with 12% in TP53 wild-type patients (n = 33). Conclusion AZD1775 was safe and tolerable as a single agent and in combination with chemotherapy at doses associated with target engagement.
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Affiliation(s)
- Suzanne Leijen
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Robin M.J.M. van Geel
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Anna C. Pavlick
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Raoul Tibes
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Lee Rosen
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Albiruni R. Abdul Razak
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Raymond Lam
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Tim Demuth
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Shelonitda Rose
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Mark A. Lee
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Tomoko Freshwater
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Stuart Shumway
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Li Wen Liang
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Amit M. Oza
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Jan H.M. Schellens
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
| | - Geoffrey I. Shapiro
- Suzanne Leijen, Robin M.J.M. van Geel, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; Anna C. Pavlick, New York University Medical Center, New York, NY; Lee Rosen, University of California Los Angeles, Santa Monica, CA; Raymond Lam, Shelonitda Rose, Mark A. Lee, Tomoko Freshwater, and Stuart Shumway, Merck, Kenilworth, NJ; Geoffrey I. Shapiro, Dana-Farber Cancer Institute, Boston, MA; Albiruni R. Abdul Razak and Amit M. Oza, Princess Margaret Hospital, Toronto, Ontario, Canada; Raoul Tibes, University Hospital of Würzburg, Würzburg; Tim Demuth, Sandoz AG, Holzkirchen, Germany; and Li Wen Liang, Merck Sharp & Dohme R&D, Beijing, China
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Chatterjee MS, Elassaiss-Schaap J, Lindauer A, Turner DC, Sostelly A, Freshwater T, Mayawala K, Ahamadi M, Stone JA, de Greef R, Kondic AG, de Alwis DP. Population Pharmacokinetic/Pharmacodynamic Modeling of Tumor Size Dynamics in Pembrolizumab-Treated Advanced Melanoma. CPT Pharmacometrics Syst Pharmacol 2016; 6:29-39. [PMID: 27896938 PMCID: PMC5270297 DOI: 10.1002/psp4.12140] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/26/2016] [Accepted: 09/15/2016] [Indexed: 12/25/2022]
Abstract
Pembrolizumab is a potent immune‐modulating antibody active in advanced melanoma, as demonstrated in the KEYNOTE‐001, ‐002, and ‐006 studies. Longitudinal tumor size modeling was pursued to quantify exposure‐response relationships for efficacy. A mixture model was first developed based on an initial dataset from KEYNOTE‐001 to describe four patterns of tumor growth and shrinkage. For subsequent analyses, tumor size measurements were adequately described by a single consolidated model structure that captured continuous tumor size with a combination of growth and regression terms, as well as a fraction of tumor responsive to therapy. This revised model structure provided a framework to efficiently evaluate the impact of covariates and pembrolizumab exposure. Both models indicated that exposure to the drug was not a significant predictor of tumor size response, demonstrating that the dose range evaluated (2 and 10 mg/kg every 3 weeks) is likely near or at the plateau of maximal response.
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Affiliation(s)
| | - J Elassaiss-Schaap
- Merck & Co., Inc, Kenilworth, New Jersey, USA.,Former employee of Merck, currently employed at PD-Value, Houten, The Netherlands
| | - A Lindauer
- Merck & Co., Inc, Kenilworth, New Jersey, USA.,Former employee of Merck, currently employed at SGS Exprimo NV, Mechelen, Belgium
| | - D C Turner
- Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - A Sostelly
- Merck Serono, Darmstadt, Germany.,Former employee of Merck, currently employed at Roche, Basel, Switzerland
| | | | - K Mayawala
- Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - M Ahamadi
- Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - J A Stone
- Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - R de Greef
- Merck & Co., Inc, Kenilworth, New Jersey, USA.,Former employee of Merck, currently employed at Quantitative Solutions, a Certara company, Oss, The Netherlands
| | - A G Kondic
- Merck & Co., Inc, Kenilworth, New Jersey, USA
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14
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Ahamadi M, Freshwater T, Prohn M, Li CH, de Alwis DP, de Greef R, Elassaiss-Schaap J, Kondic A, Stone JA. Model-Based Characterization of the Pharmacokinetics of Pembrolizumab: A Humanized Anti-PD-1 Monoclonal Antibody in Advanced Solid Tumors. CPT Pharmacometrics Syst Pharmacol 2016; 6:49-57. [PMID: 27863186 PMCID: PMC5270291 DOI: 10.1002/psp4.12139] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/26/2016] [Accepted: 09/15/2016] [Indexed: 12/17/2022]
Abstract
Pembrolizumab, a potent antibody against programmed death 1 (PD-1) receptor, has shown robust antitumor activity and manageable safety in patients with advanced solid tumors. Its pharmacokinetic (PK) properties were analyzed with population PK modeling using pooled data from the KEYNOTE-001, -002, and -006 studies of patients with advanced melanoma, non-small cell lung cancer (NSCLC), and other solid tumor types. Pembrolizumab clearance was low and the volume of distribution small, as is typical for therapeutic antibodies. Identified effects of sex, baseline Eastern Cooperative Oncology Group performance status, measures of renal and hepatic function, tumor type and burden, and prior ipilimumab treatment on pembrolizumab exposure were modest and lacked clinical significance. Furthermore, simulations demonstrated the model has robust power to detect clinically relevant covariate effects on clearance. These results support the use of the approved pembrolizumab dose of 2 mg/kg every 3 weeks without dose adjustment in a variety of patient subpopulations.
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Affiliation(s)
- M Ahamadi
- Merck & Co., Inc, Kenilworth, New Jersey, USA
| | | | - M Prohn
- Former employee of Merck, currently employed at qPharmetra, Nijmegen, The Netherlands
| | - C H Li
- Merck & Co., Inc, Kenilworth, New Jersey, USA
| | | | - R de Greef
- Former employee of Merck, currently employed at Quantitative Solutions, a Certara company, Oss, The Netherlands
| | - J Elassaiss-Schaap
- Former employee of Merck, currently employed at PD-Value, Houton, The Netherlands
| | - A Kondic
- Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - J A Stone
- Merck & Co., Inc, Kenilworth, New Jersey, USA
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Leijen S, van Geel RMJM, Sonke GS, de Jong D, Rosenberg EH, Marchetti S, Pluim D, van Werkhoven E, Rose S, Lee MA, Freshwater T, Beijnen JH, Schellens JHM. Phase II Study of WEE1 Inhibitor AZD1775 Plus Carboplatin in Patients With TP53-Mutated Ovarian Cancer Refractory or Resistant to First-Line Therapy Within 3 Months. J Clin Oncol 2016; 34:4354-4361. [PMID: 27998224 DOI: 10.1200/jco.2016.67.5942] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose AZD1775 is a first-in-class, potent, and selective inhibitor of WEE1 with proof of chemopotentiation in p53-deficient tumors in preclinical models. In a phase I study, the maximum tolerated dose of AZD1775 in combination with carboplatin demonstrated target engagement. We conducted a proof-of-principle phase II study in patients with p53 tumor suppressor gene ( TP53)-mutated ovarian cancer refractory or resistant (< 3 months) to first-line platinum-based therapy to determine overall response rate, progression-free and overall survival, pharmacokinetics, and modulation of phosphorylated cyclin-dependent kinase (CDK1) in skin biopsies. Patients and Methods Patients were treated with carboplatin (area under the curve, 5 mg/mL⋅min) combined with AZD1775 225 mg orally twice daily over 2.5 days every 21-day cycle until disease progression. Results AZD1775 plus carboplatin demonstrated manageable toxicity; fatigue (87%), nausea (78%), thrombocytopenia (70%), diarrhea (70%), and vomiting (48%) were the most common adverse events. The most frequent grade 3 or 4 adverse events were thrombocytopenia (48%) and neutropenia (37%). Of 24 patients enrolled, 21 patients were evaluable for efficacy end points. The overall response rate was 43% (95% CI, 22% to 66%), including one patient (5%) with a prolonged complete response. Median progression-free and overall survival times were 5.3 months (95% CI, 2.3 to 9.0 months) and 12.6 months (95% CI, 4.9 to 19.7), respectively, with two patients with ongoing response for more than 31 and 42 months at data cutoff. Conclusion To our knowledge, this is the first report providing clinical proof that AZD1775 enhances carboplatin efficacy in TP53-mutated tumors. The encouraging antitumor activity observed in patients with TP53-mutated ovarian cancer who were refractory or resistant (< 3 months) to first-line therapy warrants further development.
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Affiliation(s)
- Suzanne Leijen
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Robin M J M van Geel
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Gabe S Sonke
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Daphne de Jong
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Efraim H Rosenberg
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Serena Marchetti
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Dick Pluim
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Erik van Werkhoven
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Shelonitda Rose
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Mark A Lee
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Tomoko Freshwater
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Jos H Beijnen
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
| | - Jan H M Schellens
- Suzanne Leijen, Robin M.J.M. van Geel, Gabe S. Sonke, Daphne de Jong, Efraim H. Rosenberg, Serena Marchetti, Dick Pluim, Erik van Werkhoven, Jos H. Beijnen, and Jan H.M. Schellens, The Netherlands Cancer Institute, Amsterdam; Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands; and Shelonitda Rose, Mark A. Lee, and Tomoko Freshwater, Merck, Kenilworth, NJ
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Chatterjee MS, Turner DC, Ahamadi M, de Greef R, Freshwater T, Mayawala K, Dong D, Stone J, de Alwis D, Kondic A. Abstract CT112: Exposure-response analysis of pembrolizumab in patients with advanced melanoma and non-small cell lung cancer enrolled in KEYNOTE-001, -002, and -006. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-ct112] [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: The anti-PD-1 monoclonal antibody pembrolizumab has demonstrated durable antitumor activity against several advanced malignancies and is generally well tolerated. In the KEYNOTE-001, -002, and -006 trials, patients with advanced/metastatic melanoma and non-small cell lung cancer (NSCLC) were given pembrolizumab doses ranging from 2 mg/kg Q3W to 10 mg/kg Q2W. The objective of this current analysis was to explore the relationship between exposure to pembrolizumab and safety/efficacy in patients with advanced melanoma or NSCLC to help select an appropriate therapeutic dose.
Methods: Exposure-response analyses (using graphical exploration and nonlinear mixed effects modeling) of tumor size data were used to characterize the relationship between pembrolizumab exposure and tumor size reduction. Data for these analyses were derived from 1366 patients with melanoma and 496 with NSCLC; exposure-response analyses were performed separately for each indication. Tumor size, defined as the sum of longest dimensions (SLD) of target lesions, was the response readout and individual steady-state area under the curve (AUC) estimates from a population PK model were used as an integrated exposure measure across all concentration data for each patient. Additionally, exposure-adverse event (AE) logistic regression was performed on the integrated dataset, focusing on AEs of special interest (AEOSIs), defined as a broad category of potentially immune-related AEs.
Results: The graphical analysis for both melanoma (stratified by IPI pretreatment status) and NSCLC (stratified by PD-L1 expression status) identified an almost flat relationship between exposure and change in tumor size from baseline at 24 wk (melanoma) or 18 wk (NSCLC), with substantial overlap in confidence intervals. In agreement with the exploratory graphical analyses, individual pembrolizumab exposures showed a small and statistically insignificant influence on the final model estimated tumor decay parameter for both melanoma (slope = 0.131, P = 0.20 for IPI-naive; and slope = 0.1, P = 0.25 for IPI-experienced), and NSCLC (slope = 0.196, P = 0.54) patients. Clinical trial simulations, using the tumor size model to normalize for covariates, predicted little variation and considerable overlap in the confidence intervals for response across the dose regimens studied for both populations, confirming lack of clinically meaningful differences between 2 mg/kg and 10 mg/kg. The exposure-AEOSI analysis did not identify exposure to pembrolizumab as a significant predictor of the occurrence of AEOSIs.
Conclusions: The exposure range associated with 2 mg/kg Q3W dose provides near maximal efficacy with acceptable tolerability, and thus there is no clear benefit to higher dosing. The findings of this analysis support a common regimen of 2 mg/kg Q3W for pembrolizumab in melanoma and NSCLC.
Citation Format: Manash S. Chatterjee, David C. Turner, Malidi Ahamadi, Rik de Greef, Tomoko Freshwater, Kapil Mayawala, David Dong, Julie Stone, Dinesh de Alwis, Anna Kondic. Exposure-response analysis of pembrolizumab in patients with advanced melanoma and non-small cell lung cancer enrolled in KEYNOTE-001, -002, and -006. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr CT112.
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Affiliation(s)
| | | | | | - Rik de Greef
- 2Quantitative Solutions, a Certara Company, Oss, Netherlands
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van Vugt M, de Greef R, Freshwater T, Mangin E, van Aarle F, Kondic A. Immunogenicity of pembrolizumab (pembro) in patients (pts) with advanced melanoma (MEL) and non-small cell lung cancer (NSCLC): Pooled results from KEYNOTE-001, 002, 006, and 010. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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
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Chatterjee M, Turner DC, Felip E, Lena H, Cappuzzo F, Horn L, Garon EB, Hui R, Arkenau HT, Gubens MA, Hellmann MD, Dong D, Li C, Mayawala K, Freshwater T, Ahamadi M, Stone J, Lubiniecki GM, Zhang J, Im E, De Alwis DP, Kondic AG, Fløtten Ø. Systematic evaluation of pembrolizumab dosing in patients with advanced non-small-cell lung cancer. Ann Oncol 2016; 27:1291-8. [PMID: 27117531 DOI: 10.1093/annonc/mdw174] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/04/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In the phase I KEYNOTE-001 study, pembrolizumab demonstrated durable antitumor activity in patients with advanced non-small-cell lung cancer (NSCLC). We sought to characterize the relationship between pembrolizumab dose, exposure, and response to define an effective dose for these patients. PATIENTS AND METHODS Patients received pembrolizumab 2 mg/kg every 3 weeks (Q3W) (n = 55), 10 mg/kg Q3W (n = 238), or 10 mg/kg Q2W (n = 156). Response (RECIST v1.1) was assessed every 9 weeks. The relationship between the estimated pembrolizumab area under the concentration-time curve at steady state over 6 weeks (AUCss-6weeks) and the longitudinal change in tumor size (sum of longest diameters) was analyzed by regression and non-linear mixed effects modeling. This model was simultaneously fit to all tumor size data, then used to simulate response rates, normalizing the trial data across dose for prognostic covariates (tumor PD-L1 expression and EGFR mutation status). The exposure-safety relationship was assessed by logistic regression of pembrolizumab AUCss-6weeks versus occurrence of adverse events (AEs) of interest based on their immune etiology. RESULTS Overall response rates were 15% [95% confidence interval (CI) 7%-28%] at 2 mg/kg Q3W, 25% (18%-33%) at 10 mg/kg Q3W, and 21% (95% CI 14%-30%) at 10 mg/kg Q2W. Regression analyses of percentage change from baseline in tumor size versus AUCss-6weeks indicated a flat relationship (regression slope P > 0.05). Simulations showed the exposure-response relationship to be similarly flat, thus indicating that the lowest evaluated dose of 2 mg/kg Q3W to likely be at or near the efficacy plateau. Exposure-safety analysis showed the AE incidence to be similar among the clinically tested doses. CONCLUSIONS No significant exposure dependency on efficacy or safety was identified for pembrolizumab across doses of 2-10 mg/kg. These results support the use of a 2 mg/kg Q3W dosage in patients with previously treated, advanced NSCLC. CLINICALTRIALSGOV REGISTRY NCT01295827.
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Affiliation(s)
- M Chatterjee
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc., Kenilworth, USA
| | - D C Turner
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc., Kenilworth, USA
| | - E Felip
- Thoracic Tumors Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - H Lena
- Pneumonology Service, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - F Cappuzzo
- Department of Medical Oncology, Istituto Toscano Tumori, Ospedale Civile, Livorno, Italy
| | - L Horn
- Department of Medicine, Vanderbilt Ingram Cancer Center, Nashville, USA
| | - E B Garon
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, USA
| | - R Hui
- Department of Medical Oncology, Westmead Hospital and the University of Sydney, Sydney, Australia
| | - H-T Arkenau
- Department of Medical Oncology, Sarah Cannon Research Institute UK and University College London, London, UK
| | - M A Gubens
- Department of Medicine, University of California, San Francisco, San Francisco
| | - M D Hellmann
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York
| | - D Dong
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc., Kenilworth, USA
| | - C Li
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc., Kenilworth, USA
| | - K Mayawala
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc., Kenilworth, USA
| | - T Freshwater
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc., Kenilworth, USA
| | - M Ahamadi
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc., Kenilworth, USA
| | - J Stone
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc., Kenilworth, USA
| | - G M Lubiniecki
- Oncology Clinical Research, Merck & Co., Inc., Kenilworth
| | - J Zhang
- Biostatistics and Research Design Sciences, Merck & Co., Inc., Kenilworth, USA
| | - E Im
- Oncology Clinical Research, Merck & Co., Inc., Kenilworth
| | - D P De Alwis
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc., Kenilworth, USA
| | - A G Kondic
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc., Kenilworth, USA
| | - Ø Fløtten
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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Gangadhar TC, Mehnert J, Patnaik A, Hamid O, Carlino MS, Hodi FS, Blank CU, Ribas A, Robert C, Kondic AG, Ahamadi M, Freshwater T, de Greef R, van Vugt M, Lubiniecki G, Ebbinghaus S, Kang SP, Daud A. Population pharmacokinetic (popPK) model of pembrolizumab (pembro; MK-3475) in patients (pts) treated in KEYNOTE-001 and KEYNOTE-002. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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)
- Tara C. Gangadhar
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | - Janice Mehnert
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Omid Hamid
- The Angeles Clinic and Research Institute, Los Angeles, CA
| | | | | | | | - Antoni Ribas
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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Do K, Wilsker D, Ji J, Zlott J, Freshwater T, Kinders RJ, Collins J, Chen AP, Doroshow JH, Kummar S. Phase I Study of Single-Agent AZD1775 (MK-1775), a Wee1 Kinase Inhibitor, in Patients With Refractory Solid Tumors. J Clin Oncol 2015; 33:3409-15. [PMID: 25964244 DOI: 10.1200/jco.2014.60.4009] [Citation(s) in RCA: 241] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Wee1 tyrosine kinase phosphorylates and inactivates cyclin-dependent kinase (Cdk) 1/2 in response to DNA damage. AZD1775 is a first-in-class inhibitor of Wee1 kinase with single-agent antitumor activity in preclinical models. We conducted a phase I study of single-agent AZD1775 in adult patients with refractory solid tumors to determine its maximum-tolerated dose (MTD), pharmacokinetics, and modulation of phosphorylated Tyr15-Cdk (pY15-Cdk) and phosphorylated histone H2AX (γH2AX) levels in paired tumor biopsies. PATIENTS AND METHODS AZD1775 was administered orally twice per day over 2.5 days per week for up to 2 weeks per 21-day cycle (3 + 3 design). At the MTD, paired tumor biopsies were obtained at baseline and after the fifth dose to determine pY15-Cdk and γH2AX levels. Six patients with BRCA-mutant solid tumors were also enrolled at the MTD. RESULTS Twenty-five patients were enrolled. The MTD was established as 225 mg twice per day orally over 2.5 days per week for 2 weeks per 21-day cycle. Confirmed partial responses were observed in two patients carrying BRCA mutations: one with head and neck cancer and one with ovarian cancer. Common toxicities were myelosuppression and diarrhea. Dose-limiting toxicities were supraventricular tachyarrhythmia and myelosuppression. Accumulation of drug (t1/2 approximately 11 hours) was observed. Reduction in pY15-Cdk levels (two of five paired biopsies) and increases in γH2AX levels (three of five paired biopsies) were demonstrated. CONCLUSION This is the first report of AZD1775 single-agent activity in patients carrying BRCA mutations. Proof-of-mechanism was demonstrated by target modulation and DNA damage response in paired tumor biopsies.
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Affiliation(s)
- Khanh Do
- Khanh Do, Jennifer Zlott, Jerry Collins, Alice P. Chen, James H. Doroshow, and Shivaani Kummar, National Cancer Institute, Bethesda, MD; Deborah Wilsker, Jiuping Ji, and Robert J. Kinders, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; and Tomoko Freshwater, Merck Research Laboratories-Oncology, Boston, MA
| | - Deborah Wilsker
- Khanh Do, Jennifer Zlott, Jerry Collins, Alice P. Chen, James H. Doroshow, and Shivaani Kummar, National Cancer Institute, Bethesda, MD; Deborah Wilsker, Jiuping Ji, and Robert J. Kinders, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; and Tomoko Freshwater, Merck Research Laboratories-Oncology, Boston, MA
| | - Jiuping Ji
- Khanh Do, Jennifer Zlott, Jerry Collins, Alice P. Chen, James H. Doroshow, and Shivaani Kummar, National Cancer Institute, Bethesda, MD; Deborah Wilsker, Jiuping Ji, and Robert J. Kinders, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; and Tomoko Freshwater, Merck Research Laboratories-Oncology, Boston, MA
| | - Jennifer Zlott
- Khanh Do, Jennifer Zlott, Jerry Collins, Alice P. Chen, James H. Doroshow, and Shivaani Kummar, National Cancer Institute, Bethesda, MD; Deborah Wilsker, Jiuping Ji, and Robert J. Kinders, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; and Tomoko Freshwater, Merck Research Laboratories-Oncology, Boston, MA
| | - Tomoko Freshwater
- Khanh Do, Jennifer Zlott, Jerry Collins, Alice P. Chen, James H. Doroshow, and Shivaani Kummar, National Cancer Institute, Bethesda, MD; Deborah Wilsker, Jiuping Ji, and Robert J. Kinders, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; and Tomoko Freshwater, Merck Research Laboratories-Oncology, Boston, MA
| | - Robert J Kinders
- Khanh Do, Jennifer Zlott, Jerry Collins, Alice P. Chen, James H. Doroshow, and Shivaani Kummar, National Cancer Institute, Bethesda, MD; Deborah Wilsker, Jiuping Ji, and Robert J. Kinders, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; and Tomoko Freshwater, Merck Research Laboratories-Oncology, Boston, MA
| | - Jerry Collins
- Khanh Do, Jennifer Zlott, Jerry Collins, Alice P. Chen, James H. Doroshow, and Shivaani Kummar, National Cancer Institute, Bethesda, MD; Deborah Wilsker, Jiuping Ji, and Robert J. Kinders, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; and Tomoko Freshwater, Merck Research Laboratories-Oncology, Boston, MA
| | - Alice P Chen
- Khanh Do, Jennifer Zlott, Jerry Collins, Alice P. Chen, James H. Doroshow, and Shivaani Kummar, National Cancer Institute, Bethesda, MD; Deborah Wilsker, Jiuping Ji, and Robert J. Kinders, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; and Tomoko Freshwater, Merck Research Laboratories-Oncology, Boston, MA
| | - James H Doroshow
- Khanh Do, Jennifer Zlott, Jerry Collins, Alice P. Chen, James H. Doroshow, and Shivaani Kummar, National Cancer Institute, Bethesda, MD; Deborah Wilsker, Jiuping Ji, and Robert J. Kinders, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; and Tomoko Freshwater, Merck Research Laboratories-Oncology, Boston, MA
| | - Shivaani Kummar
- Khanh Do, Jennifer Zlott, Jerry Collins, Alice P. Chen, James H. Doroshow, and Shivaani Kummar, National Cancer Institute, Bethesda, MD; Deborah Wilsker, Jiuping Ji, and Robert J. Kinders, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD; and Tomoko Freshwater, Merck Research Laboratories-Oncology, Boston, MA.
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Daud AI, Ashworth MT, Strosberg J, Goldman JW, Mendelson D, Springett G, Venook AP, Loechner S, Rosen LS, Shanahan F, Parry D, Shumway S, Grabowsky JA, Freshwater T, Sorge C, Kang SP, Isaacs R, Munster PN. Phase I dose-escalation trial of checkpoint kinase 1 inhibitor MK-8776 as monotherapy and in combination with gemcitabine in patients with advanced solid tumors. J Clin Oncol 2015; 33:1060-6. [PMID: 25605849 DOI: 10.1200/jco.2014.57.5027] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We determined the safety, pharmacokinetics, pharmacodynamics, and recommended phase II dose of MK-8776 (SCH 900776), a potent, selective checkpoint kinase 1 (Chk1) inhibitor, as monotherapy and in combination with gemcitabine in a first-in-human phase I clinical trial in patients with advanced solid tumor malignancies. PATIENTS AND METHODS Forty-three patients were treated by intravenous infusion with MK-8776 at seven dose levels ranging from 10 to 150 mg/m(2) as monotherapy and then in combination with gemcitabine 800 mg/m(2) (part A, n = 26) or gemcitabine 1,000 mg/m(2) (part B, n = 17). Forty percent of patients had three or more prior treatment regimens, and one third of patients had previously received gemcitabine. RESULTS As monotherapy, MK-8776 was well tolerated, with QTc prolongation (19%), nausea (16%), fatigue (14%), and constipation (14%) as the most frequent adverse effects. Combination therapy demonstrated a higher frequency of adverse effects, predominantly fatigue (63%), nausea (44%), decreased appetite (37%), thrombocytopenia (32%), and neutropenia (24%), as well as dose-related, transient QTc prolongation (17%). The median number of doses of MK-8776 administered was five doses, with relative dose-intensity of 0.96. Bioactivity was assessed by γ-H2AX ex vivo assay. Of 30 patients evaluable for response, two showed partial response, and 13 exhibited stable disease. CONCLUSION MK-8776 was well tolerated as monotherapy and in combination with gemcitabine. Early evidence of clinical efficacy was observed. The recommended phase II dose is MK-8776 200 mg plus gemcitabine 1,000 mg/m(2) on days 1 and 8 of a 21-day cycle.
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Affiliation(s)
- Adil I Daud
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ.
| | - Michelle T Ashworth
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Jonathan Strosberg
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Jonathan W Goldman
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - David Mendelson
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Gregory Springett
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Alan P Venook
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Sabine Loechner
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Lee S Rosen
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Frances Shanahan
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - David Parry
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Stuart Shumway
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Jennifer A Grabowsky
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Tomoko Freshwater
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Christopher Sorge
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Soonmo Peter Kang
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Randi Isaacs
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
| | - Pamela N Munster
- Adil I. Daud, Michelle T. Ashworth, Alan P. Venook, Jennifer A. Grabowsky, and Pamela N. Munster, University of California, San Francisco, San Francisco; Jonathan W. Goldman and Lee S. Rosen, University of California, Los Angeles, Santa Monica, CA; Jonathan Strosberg and Gregory Springett, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Mendelson, Pinnacle Oncology Hematology, Scottsdale, AZ; and Sabine Loechner, Frances Shanahan, David Parry, Stuart Shumway, Tomoko Freshwater, Christopher Sorge, Soonmo Peter Kang, and Randi Isaacs, Merck, Whitehouse Station, NJ
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Brana I, Moore K, Welch S, Shapira-Frommer R, Gibbon D, Hirte H, Rivkin S, Coleman R, Prendergast G, Moxley KM, Jou YM, Marinucci M, Freshwater T, McCarthy S, Anthony ML, Rose S, Oza AM. Abstract B181: TP53 mutation screening in patients with recurrent platinum-sensitive ovarian cancer. Mol Cancer Ther 2013. [DOI: 10.1158/1535-7163.targ-13-b181] [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: TP53 is commonly mutated in ovarian cancer. As potential agents targeting TP53 mutant or wt are under development, the efficiency and accuracy for determination of TP53 mutations in a clinical trial was evaluated.
Methods: Eligible patients, including relapsed, platinum-sensitive ovarian, fallopian tube, or primary peritoneal cancer, underwent pre-screening for a clinical trial with MK1775, eligibility for which was determined by the presence of functional TP53 mutations (Brana I et al, ASCO 2013). Single base substitution and single base deletion mutations in exons 2 - 11 and the flanking splice junction in the TP53 gene were analyzed using AmpliChip p53 Assay (Roche Molecular Diagnostics, California) on archival tumor specimens.
Results: Seventy-five women were screened for eligibility based on TP53; 43 had TP53 mutations, 27 were TP53 wild-type (wt), and 5 undetermined (Table 1). No clustering of mutations to define hot spots was evident. The most commonly mutated region was exon 5 (11 mutations). Missense mutations were the most common mutation type (69.7%); although, nonsense (14 %), splice (14 %), and frame shift mutations (2.3%) were also observed (Table 1). Most of the missense mutations were in exons 5 to 8 (90%). The mean turnaround time from sample reception to final TP53 status report was 3 days (range 1:14).
Conclusions: The TP53 mutational status has been successfully determined in 93.3% of patients with a short turnaround time, supporting the feasibility of TP53 determination in the clinical setting. In our patient population, 57.3% had a TP53 mutation. Potential geographic differences in the incidence TP53 mutations cannot be evaluated due to the limited sample size; this hypothesis should be further evaluated in a larger patient population
Citation Information: Mol Cancer Ther 2013;12(11 Suppl):B181.
Citation Format: Irene Brana, Kathleen Moore, Stephen Welch, Ronnie Shapira-Frommer, Darlene Gibbon, Hal Hirte, Saul Rivkin, Robert Coleman, Gerry Prendergast, Katherine M. Moxley, Ying-Ming Jou, Michelle Marinucci, Tomoko Freshwater, Sharon McCarthy, Mark Lee Anthony, Shelonitda Rose, Amit M. Oza. TP53 mutation screening in patients with recurrent platinum-sensitive ovarian cancer. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr B181.
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Affiliation(s)
- Irene Brana
- 1Drug Development Program - Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kathleen Moore
- 2Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK
| | - Stephen Welch
- 3London Regional Cancer Program, London, Ontario, Canada
| | - Ronnie Shapira-Frommer
- 4Sheba Medical Center, Affiliated to Sackler Faculty of Medicine Tel Aviv University, Tel Hashomer, Israel
| | | | - Hal Hirte
- 6Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | | | | | - Gerry Prendergast
- 1Drug Development Program - Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | - Amit M. Oza
- 1Drug Development Program - Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Brana I, Moore KN, Shapira-Frommer R, Welch S, Jou YM, Marinucci M, Freshwater T, Rose S, Oza AM. Targeting p53 mutant ovarian cancer: Phase I results of the WEE1 inhibitor MK-1775 with carboplatin plus paclitaxel in patients (pts) with platinum-sensitive, p53-mutant ovarian cancer (OC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.5518] [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
5518 Background: MK-1775 is a highly selective, investigational oral tyrosine kinase inhibitor of WEE1, which regulates G2 cell cycle checkpoint. Functional p53 mutation impairs G1 checkpoint; hence, targeting G2 checkpoint with MK-1775 in p53 mutants should induce synthetic lethality. Methods: Pts with platinum-sensitive disease-recurrent OC who had measurable disease (RECIST 1.1) with loss of function (LOF) p53 mutations by Roche AmpliChip were eligible. All pts received MK-1775 225mg twice daily (BID) D1-D3 (5 doses) plus carboplatin AUC5 + paclitaxel 175mg/m2 every 21 days (CP) for 6 cycles. The objective for the phase I run-in portion of the study was to determine the recommended phase II dose based on safety data. A Toxicity Probability Interval method [Ji et al, Clin Trials 2010; 7(6):653-63] would determine if additional lower doses should be explored. A randomized phase II portion, assessing the efficacy of the combination vs placebo, would start if ≥5 radiological responses and <5 dose-limiting toxicities (DLTs) were observed among the first 13 pts. Results: Of 76 pts screened (26 wt, 43 mutant [24 nonfunctional], 7 undetermined), 19 women had LOF p53 mutations and were eligible. Fifteen consented and were enrolled in the Phase I: median age was 57 (range 38-77); ECOG 0:1 ratio 9:6 pts. Three DLTs were observed: G3 febrile neutropenia, G4 neutropenia, and G4 thrombocytopenia. Diarrhea (84.6%), nausea (76.9%), and fatigue (76.9%) were the most common adverse events (AEs). Seven of 13 pts completed treatment (2 ongoing). Three pts discontinued due to AEs and 3 patients withdrew consent prior to completing treatment. Of 14 evaluable pts by RECIST 1.1 there were 11 partial responses (PRs; 6 confirmed, 5 unconfirmed) and 3 had stable disease; 7 pts were evaluable by CA125 with 3 complete responses and 4 PRs. MK-1775 PK results were similar to those reported for monotherapy studies. Conclusions: The combination of MK-1775 225mg BID x 5 doses with CP is well tolerated, with a preliminary radiological response rate of 78.6%, and has met the safety and efficacy bar for randomized phase II assessment in part 2 of the study. Clinical trial information: NCT01357161.
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Affiliation(s)
- Irene Brana
- Princess Margaret Cancer Center, University Health Network, Division of Medical Oncology & Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Ronnie Shapira-Frommer
- Ella Institute for Research and Treatment of Melanoma, Sheba Medical Center, Affiliated to Sackler Faculty of Medicine Tel Aviv University, Tel Hashomer, Israel
| | | | | | | | | | | | - Amit M. Oza
- Princess Margaret Cancer Center, University Health Network, Division of Medical Oncology & Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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24
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Karp JE, Thomas BM, Greer JM, Sorge C, Gore SD, Pratz KW, Smith BD, Flatten KS, Peterson K, Schneider P, Mackey K, Freshwater T, Levis MJ, McDevitt MA, Carraway HE, Gladstone DE, Showel MM, Loechner S, Parry DA, Horowitz JA, Isaacs R, Kaufmann SH. Phase I and pharmacologic trial of cytosine arabinoside with the selective checkpoint 1 inhibitor Sch 900776 in refractory acute leukemias. Clin Cancer Res 2012; 18:6723-31. [PMID: 23092873 DOI: 10.1158/1078-0432.ccr-12-2442] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE Incorporation of cytarabine into DNA activates checkpoint kinase 1 (Chk1), which stabilizes stalled replication forks, induces S-phase slowing, and diminishes cytarabine cytotoxicity. The selective Chk1 inhibitor SCH 900776 abrogates cytarabine-induced S-phase arrest and enhances cytarabine cytotoxicity in acute leukemia cell lines and leukemic blasts in vitro. To extend these findings to the clinical setting, we have conducted a phase I study of cytarabine and SCH 900776. EXPERIMENTAL DESIGN Twenty-four adults with relapsed and refractory acute leukemias received timed sequential, continuous infusion cytarabine 2 g/m(2) over 72 hours (667 mg/m(2)/24 hours) beginning on day 1 and again on day 10. SCH 900776 was administered as a 15- to 30-minute infusion on days 2, 3, 11, and 12. The starting dose of SCH 900776 was 10 mg/m(2)/dose. RESULTS Dose-limiting toxicities consisting of corrected QT interval prolongation and grade 3 palmar-plantar erythrodysesthesia occurred at 140 mg flat dosing (dose level 5, equivalent to 80 mg/m(2)). Complete remissions occurred in 8 of 24 (33%) patients, with 7 of 8 at 40 mg/m(2) or higher. SCH 900776 did not accumulate at any dose level. Marrow blasts obtained pretreatment and during therapy showed increased phosphorylation of H2Ax after SCH 900776 beginning at 40 mg/m(2), consistent with unrepaired DNA damage. CONCLUSIONS These data support a randomized phase II trial of cytarabine +/- SCH 900776 at a recommended flat dose of 100 mg (equivalent to 56 mg/m(2)) for adults with poor-risk leukemias. The trial (SP P05247) was registered at www.clinicaltrials.gov as NCT00907517.
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Affiliation(s)
- Judith E Karp
- Division of Hematologic Malignancies, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
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Priestap HA, Torres MC, Rieger RA, Dickman KG, Freshwater T, Taft DR, Barbieri MA, Iden CR. Aristolochic acid I metabolism in the isolated perfused rat kidney. Chem Res Toxicol 2011; 25:130-9. [PMID: 22118289 DOI: 10.1021/tx200333g] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [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]
Abstract
Aristolochic acids are natural nitro-compounds found globally in the plant genus Aristolochia that have been implicated in the severe illness in humans termed aristolochic acid nephropathy (AAN). Aristolochic acids undergo nitroreduction, among other metabolic reactions, and active intermediates arise that are carcinogenic. Previous experiments with rats showed that aristolochic acid I (AA-I), after oral administration or injection, is subjected to detoxication reactions to give aristolochic acid Ia, aristolactam Ia, aristolactam I, and their glucuronide and sulfate conjugates that can be found in urine and feces. Results obtained with whole rats do not clearly define the role of liver and kidney in such metabolic transformation. In this study, in order to determine the specific role of the kidney on the renal disposition of AA-I and to study the biotransformations suffered by AA-I in this organ, isolated kidneys of rats were perfused with AA-I. AA-I and metabolite concentrations were determined in perfusates and urine using HPLC procedures. The isolated perfused rat kidney model showed that AA-I distributes rapidly and extensively in kidney tissues by uptake from the peritubular capillaries and the tubules. It was also established that the kidney is able to metabolize AA-I into aristolochic acid Ia, aristolochic acid Ia O-sulfate, aristolactam Ia, aristolactam I, and aristolactam Ia O-glucuronide. Rapid demethylation and sulfation of AA-I in the kidney generate aristolochic acid Ia and its sulfate conjugate that are voided to the urine. Reduction reactions to give the aristolactam metabolites occur to a slower rate. Renal clearances showed that filtered AA-I is reabsorbed at the tubules, whereas the metabolites are secreted. The unconjugated metabolites produced in the renal tissues are transported to both urine and perfusate, whereas the conjugated metabolites are almost exclusively secreted to the urine.
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Affiliation(s)
- Horacio A Priestap
- Department of Biological Sciences, Florida International University , Miami, Florida 33199, United States.
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