1
|
Chabra S, Gill B, Gallo G, Zhu D, Pitou C, Payne C, Accioly A, Puig L. 288 Ixekizumab citrate-free formulation: Results from 2 clinical trials. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
2
|
Chabra S, Gill BJ, Gallo G, Zhu D, Pitou C, Payne CD, Accioly A, Puig L. Ixekizumab Citrate-Free Formulation: Results from Two Clinical Trials. Adv Ther 2022; 39:2862-2872. [PMID: 35449322 PMCID: PMC9022732 DOI: 10.1007/s12325-022-02126-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/11/2022] [Indexed: 02/07/2023]
Abstract
Introduction Subcutaneous (SC) injection is a common route of drug administration; however, injection site pain (ISP) might create a negative patient experience. We evaluated ISP, bioequivalence, and overall safety of the citrate-free (CF) formulation of ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin-17A. Methods Two phase 1, single-blind studies were conducted in healthy participants. The crossover study A (NCT03848403) evaluated pain intensity on injection as measured by visual analog scale of pain (VAS) scores. Subjects (N = 70) were randomized 1:1:1 at the beginning to three possible treatment sequences and received a 1 mL SC injection of the three formulations sequentially in the abdomen on days 1, 8, and 15, respectively. A mixed-effects repeated measures analysis model was used to analyze VAS score by time post-injection. Study B (NCT04259346) evaluated the bioequivalence of a single 80 mg dose of CF formulation compared to the original commercial formulation. Subjects (N = 245) were randomized 1:1 to either commercial or CF formulation and received a single SC injection into the abdomen, arm, or thigh. Results Primary endpoint was achieved in both studies. In study A, least-squares mean (LSM) difference of VAS scores immediately post injection between commercial (n = 61) and CF formulation (n = 63) was − 21.7 (p < 0.0001), indicating a lower degree of pain associated with CF formulation. In study B, bioequivalence of the CF formulation was established as 90% CIs for the ratio of geometric LSM AUC0–tlast, AUC0–∞, and Cmax between treatments were contained within the prespecified limits of 0.8 and 1.25. Except for less ISP in the CF formulation, overall safety profile was comparable. Conclusion Ixekizumab CF formulation proved to be bioequivalent, was associated with less ISP, and had no other notable differences in the safety profile compared to the original commercial formulation. Trail Registration ClinicalTrials.gov identifier NCT03848403, NCT04259346. Video Abstract
Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02126-0.
Collapse
|
3
|
Jackson K, Chua L, Velez de Mendizabal N, Pitou C, Rodriguez Capriles C, Paller AS, Lansang P, Seyger MMB, Papp K. Population pharmacokinetic and exposure-efficacy analysis of ixekizumab in paediatric patients with moderate-to-severe plaque psoriasis (IXORA-PEDS). Br J Clin Pharmacol 2022; 88:1074-1086. [PMID: 34378230 PMCID: PMC9291793 DOI: 10.1111/bcp.15034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/30/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS Ixekizumab is a high-affinity monoclonal antibody that selectively targets interleukin-17A used in the treatment of adult and paediatric patients with moderate-to-severe psoriasis. This analysis evaluated the pharmacokinetics (PK) of ixekizumab and the exposure-efficacy relationship in paediatric patients aged 6 to <18 years with psoriasis. METHODS Population PK and exposure-efficacy models were developed. The models used data from paediatric patients with psoriasis participating in the Phase 3 IXORA-PEDS trial in which patients were dosed according to weight categories. The exposure-efficacy model is a Psoriasis Area and Severity Index (PASI) time course model using data up to Week 12, a co-primary efficacy endpoint. RESULTS A 2-compartment population PK model describes the PK of ixekizumab in paediatric patients with the effect of body weight incorporated on clearance and volume terms using an allometric relationship. The weight category-based dosing ensured that ixekizumab mean trough serum concentrations in paediatric patients with psoriasis (3.20-3.33 μg/mL) were within the range of concentrations observed in adult patients with psoriasis (mean [standard deviation]: 3.48 [2.16] μg/mL) administered an efficacious dosing regimen. The observed PASI response rates at Week 12 in paediatric patients (91.9/81.8/52.5% for PASI75/90/100) are well predicted by the final exposure-efficacy model and response rates are similar or higher than those achieved in adults (86.2/66.6/35.0% for PASI75/90/100). CONCLUSION This analysis is the first to describe the PK and exposure-efficacy relationship of ixekizumab in paediatric patients with psoriasis. The analyses support the selection of the weight category-based ixekizumab dosing regimens approved for use in paediatric patients with psoriasis.
Collapse
Affiliation(s)
| | - Laiyi Chua
- Lilly Centre for Clinical PharmacologySingaporeSingapore
| | | | | | | | - Amy S. Paller
- Department of DermatologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | | | - Marieke M. B. Seyger
- Department of DermatologyRadboud University Medical CentreNijmegenThe Netherlands
| | - Kim Papp
- K Papp Clinical Research and Probity Medical ResearchWaterlooONCanada
| | | |
Collapse
|
4
|
O'Hara MH, Messersmith W, Kindler H, Zhang W, Pitou C, Szpurka AM, Wang D, Peng SB, Vangerow B, Khan AA, Koneru M, Wang-Gillam A. Safety and Pharmacokinetics of CXCR4 Peptide Antagonist, LY2510924, in Combination with Durvalumab in Advanced Refractory Solid Tumors. J Pancreat Cancer 2020; 6:21-31. [PMID: 32219196 PMCID: PMC7097682 DOI: 10.1089/pancan.2019.0018] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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] [Indexed: 01/01/2023] Open
Abstract
Purpose: This was an open-label phase 1a study assessing the maximum tolerated dose (MTD), safety, and tolerability of CXCR4 peptide antagonist, LY2510924, administered in combination with durvalumab in patients with advanced refractory solid tumors. Methods: Patients received LY2510924 at 20, 30, or 40 mg subcutaneous (SC) once daily in combination with durvalumab at 1500 mg intravenously (IV) on day 1 of each 28-day cycle. The primary objective was to assess the MTD and safety of LY2510924 SC daily in combination with durvalumab in patients with advanced (metastatic and/or unresectable) solid tumors. Secondary objectives included pharmacokinetics (PK) and the antitumor activity of LY2510924 in combination with durvalumab. Exploratory objectives were biomarker analysis, including pharmacodynamic markers, relevant to LY2510924 and durvalumab, including immune functioning, drug targets, cancer-related pathways, and the disease state. Results: Nine patients (three each at 20, 30, and 40 mg) were enrolled in the study (eight patients with pancreatic cancer and one patient with rectal cancer). The majority of patients completed one or two cycles (100.0% ≥ 1 cycle; 88.9% ≥ 2 cycles) of LY2510924 and durvalumab. No dose limiting toxicities were reported. Most common (>10%) treatment-emergent adverse events were injection-site reaction (44.4%), fatigue (33.3%), and increased white blood cell count (33.3%). PK parameters for combination were similar to those reported in previous studies when given as monotherapy. Best overall response of stable disease was observed in four (44.4%) patients and one patient had unconfirmed partial response. Conclusion: The recommended phase 2 dose is 40 mg SC once-daily LY2510924 in combination with durvalumab 1500 mg IV and showed acceptable safety and tolerability in patients with advanced refractory tumors.
Collapse
Affiliation(s)
- Mark H O'Hara
- Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wells Messersmith
- Medicine-Medical Oncology, School of Medicine, University of Colorado, Denver, Colorado
| | - Hedy Kindler
- Gastrointestinal Oncology, The University of Chicago Medicine, Chicago, Illinois
| | - Wei Zhang
- Eli Lilly and Company, Indianapolis, Indiana
| | - Celine Pitou
- Eli Lilly and Company, Windlesham, United Kingdom
| | | | - Dan Wang
- Formerly with Eli Lilly and Company, Indianapolis, Indiana
| | | | | | | | - Mythili Koneru
- Formerly with Eli Lilly and Company, Indianapolis, Indiana
| | - Andrea Wang-Gillam
- Department of Medicine, Molecular Oncology, Washington University School of Medicine, Washington University Medical School, St. Louis, Missouri
| |
Collapse
|
5
|
Vergote I, Heitz F, Buderath P, Powell M, Sehouli J, Lee CM, Hamilton A, Fiorica J, Moore KN, Teneriello M, Golden L, Zhang W, Pitou C, Bell R, Campbell R, Farrington DL, Bell-McGuinn K, Wenham RM. A randomized, double-blind, placebo-controlled phase 1b/2 study of ralimetinib, a p38 MAPK inhibitor, plus gemcitabine and carboplatin versus gemcitabine and carboplatin for women with recurrent platinum-sensitive ovarian cancer. Gynecol Oncol 2019; 156:23-31. [PMID: 31791552 DOI: 10.1016/j.ygyno.2019.11.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This phase 1b/2 clinical trial (NCT01663857) evaluated the efficacy of ralimetinib in combination with gemcitabine (G) and carboplatin (C), followed by maintenance ralimetinib, for patients with recurrent platinum-sensitive epithelial ovarian cancer. METHODS Phase 1b was to determine the recommended phase 2 dose (RP2D) of ralimetinib administered Q12H on Days 1-10 (q21d) in combination with G (1000 mg/m2, Days 3 and 10) and C (AUC 4, Day 3) for six cycles. In phase 2, patients were randomized double-blind 1:1 to ralimetinib (R)+GC or placebo (P)+GC, for six cycles, followed by ralimetinib 300 mg Q12H or placebo on Days 1-14, q28d. RESULTS 118 patients received at least one dose of ralimetinib or placebo; eight in phase 1b and 110 in phase 2 (R+GC, N = 58; P+GC, N = 52). The RP2D for R+GC was 200 mg Q12H. The study met its primary objective of a statistically significant difference in PFS (median: R+GC, 10.3 mo vs. P+GC, 7.9 mo; hazard ratio [HR] = 0.773, P = 0.2464, against a two-sided false positive rate of 0.4). Secondary objectives were not statistically significant for median overall survival (R+GC, 29.2 mo vs. P+GC, 25.1 mo; HR = 0.827, P = 0.4686) or overall response rate (R+GC 46.6% vs. P+GC, 46.2%; P = 0.9667). The safety profile of R+GC therapy was mainly consistent with safety of the chemotherapy backbone alone. Grade 3/4 elevated alanine aminotransferase was more common in the ralimetinib arm. CONCLUSIONS Addition of ralimetinib to GC resulted in a modest improvement in PFS.
Collapse
Affiliation(s)
- Ignace Vergote
- University Hospital Leuven, Leuven Cancer Institute, Gynaecological Oncology, Leuven, Belgium.
| | - Florian Heitz
- Kliniken Essen-Mitte, Evangelische Huyssenstiftung, Essen, Germany; Charité Campus Virchow Klinikum / Department of Gynecology and Oncological Surgery, Berlin, Germany
| | | | | | - Jalid Sehouli
- Charité Campus Virchow Klinikum / Department of Gynecology and Oncological Surgery, Berlin, Germany
| | | | - Anne Hamilton
- Royal Women's Hospital/ Peter MacCallum Cancer Centre, Parkville, Melbourne, Victoria, Australia
| | | | - Kathleen N Moore
- Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA/Sarah Cannon Research Institute, Nashville, TN, USA
| | | | - Lisa Golden
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Wei Zhang
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Celine Pitou
- Eli Lilly and Company, Erl Wood, Windlesham, Surrey, UK
| | - Robert Bell
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | | |
Collapse
|
6
|
Vergote I, Heitz F, Buderath P, Powell MA, Sehouli J, Lee CM, Hamilton AL, Fiorica J, Moore KN, Teneriello M, Golden L, Zhang W, Pitou C, Farrington DL, Bell-McGuinn KM, Wenham RM. A randomized, double-blind, placebo-controlled phase Ib/II study of ralimetinib, a p38 MAPK inhibitor, plus gemcitabine (G) and carboplatin (C) versus GC for women with recurrent platinum-sensitive ovarian cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5537 Background: p38 mitogen-activated protein kinase (MAPK) regulates cytokine production in the tumor microenvironment and enables therapeutic resistance of cancer cells. Ralimetinib (R) is a selective small-molecule inhibitor of p38α and p38β MAPKs. Methods: Main inclusion criteria: ≥18 y; recurrent platinum-sensitive epithelial ovarian, fallopian tube, or primary peritoneal, cancer after first-line treatment. Phase (Ph)1b was to determine the recommended Ph2 dose (RP2D) of R administered 12-hourly (Q12H) on Days 1-10 (21-day cycle [Q21D]) in combination with gemcitabine (G: 1000 mg/m2 on Days 3 and 10) and carboplatin (C: AUC 4 on Day 3) for 6 cycles. In Ph2, patients (pts) were randomized double-blind, 1:1 to RP2D R+GC or placebo (P)+GC, for 6 cycles, followed by R 300 mg Q12H or P on Days 1-14, Q28D until disease progression. The stratified log-rank test compared progression-free survival (PFS; primary endpoint) between treatment groups in Ph2, at a 1-sided α level of 0.2. ClinicalTrials.gov, NCT01663857. Results: 118 pts received ≥1 dose of R or P (safety population); 8 in Ph1b and 110 in Ph2 (R+GC N = 58; P+GC N = 52). The RP2D for R in combination with GC was 200 mg Q12H. The study met its primary objective (median PFS: R+GC 10.3 mo vs P+GC 7.9 mo; HR = 0.773, 2-sided p = 0.246). The secondary objectives of median overall survival (R+GC 29.2 mo vs P+GC 25.1 mo; HR = 0.827, p = 0.469) or overall response rate (R+GC 46.6% vs P+GC 46.2%; p = 0.967) were not statistically significant, and 32.4% vs 25.0% of pts had normalized CA125 at the end of cycle 6. Most pts (safety population) experienced ≥1 Grade 3/4 treatment-emergent adverse event (TEAE: R+GC 63/66 [95.5%]; P+GC 48/52 [92.3%]). Decreased neutrophil count (60.6% vs 76.9%), platelet count (43.9% vs 38.5%), and white blood cell count, (30.3% vs 26.9%), anemia (22.7% vs 25.0%), and increased alanine aminotransferase (ALT) (19.7% vs 3.8%) were the Grade 3/4 TEAEs in ≥10% of pts in the R+GC and P+GC arms, respectively. Conclusions: Addition of ralimetinib to GC resulted in modest improvements in PFS. Grade 3/4 elevated ALT was more common in the ralimetinib arm. Clinical trial information: NCT01663857.
Collapse
Affiliation(s)
- Ignace Vergote
- BGOG and University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Florian Heitz
- AGO study group & Kliniken Essen-Mitte, Department for Gynecology and Gynecologic Oncology Essen, Germany, Essen, Germany
| | - Paul Buderath
- University Hospital of Essen, Department of Gynecology, Essen, Germany
| | - Matthew A. Powell
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Jalid Sehouli
- AGO and Charité Campus Virchow-Klinikum, Berlin, Germany
| | | | | | | | - Kathleen N. Moore
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK
| | | | | | - Wei Zhang
- Eli Lilly and Company, Indianapolis, IN
| | | | | | | | | |
Collapse
|
7
|
Garcia-Cremades M, Pitou C, Iversen PW, Troconiz IF. Translational Framework Predicting Tumour Response in Gemcitabine-Treated Patients with Advanced Pancreatic and Ovarian Cancer from Xenograft Studies. AAPS J 2019; 21:23. [DOI: 10.1208/s12248-018-0291-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/17/2018] [Indexed: 12/28/2022]
|
8
|
Berdeja J, Palandri F, Baer M, Quick D, Kiladjian J, Martinelli G, Verma A, Hamid O, Walgren R, Pitou C, Li P, Gerds A. Phase 2 study of gandotinib (LY2784544) in patients with myeloproliferative neoplasms. Leuk Res 2018; 71:82-88. [DOI: 10.1016/j.leukres.2018.06.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 12/22/2022]
|
9
|
Parra-Guillen ZP, Mangas-Sanjuan V, Garcia-Cremades M, Troconiz IF, Mo G, Pitou C, Iversen PW, Wallin JE. Systematic Modeling and Design Evaluation of Unperturbed Tumor Dynamics in Xenografts. J Pharmacol Exp Ther 2018; 366:96-104. [PMID: 29691287 DOI: 10.1124/jpet.118.248286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/16/2018] [Indexed: 12/21/2022] Open
Abstract
Xenograft mice are largely used to evaluate the efficacy of oncological drugs during preclinical phases of drug discovery and development. Mathematical models provide a useful tool to quantitatively characterize tumor growth dynamics and also optimize upcoming experiments. To the best of our knowledge, this is the first report where unperturbed growth of a large set of tumor cell lines (n = 28) has been systematically analyzed using a previously proposed model of nonlinear mixed effects (NLME). Exponential growth was identified as the governing mechanism in the majority of the cell lines, with constant rate values ranging from 0.0204 to 0.203 day-1 No common patterns could be observed across tumor types, highlighting the importance of combining information from different cell lines when evaluating drug activity. Overall, typical model parameters were precisely estimated using designs in which tumor size measurements were taken every 2 days. Moreover, reducing the number of measurements to twice per week, or even once per week for cell lines with low growth rates, showed little impact on parameter precision. However, a sample size of at least 50 mice is needed to accurately characterize parameter variability (i.e., relative S.E. values below 50%). This work illustrates the feasibility of systematically applying NLME models to characterize tumor growth in drug discovery and development, and constitutes a valuable source of data to optimize experimental designs by providing an a priori sampling window and minimizing the number of samples required.
Collapse
Affiliation(s)
- Zinnia P Parra-Guillen
- Pharmacometrics and Systems Pharmacology Research Unit, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Navarra Institute for Health Research, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Global PK/PD & Pharmacometrics (G.M., C.P., J.E.W.) and Lilly Research Laboratories (P.W.I.), Eli Lilly and Company, Indianapolis, USA Solna, Sweden
| | - Victor Mangas-Sanjuan
- Pharmacometrics and Systems Pharmacology Research Unit, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Navarra Institute for Health Research, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Global PK/PD & Pharmacometrics (G.M., C.P., J.E.W.) and Lilly Research Laboratories (P.W.I.), Eli Lilly and Company, Indianapolis, USA Solna, Sweden
| | - Maria Garcia-Cremades
- Pharmacometrics and Systems Pharmacology Research Unit, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Navarra Institute for Health Research, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Global PK/PD & Pharmacometrics (G.M., C.P., J.E.W.) and Lilly Research Laboratories (P.W.I.), Eli Lilly and Company, Indianapolis, USA Solna, Sweden
| | - Iñaki F Troconiz
- Pharmacometrics and Systems Pharmacology Research Unit, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Navarra Institute for Health Research, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Global PK/PD & Pharmacometrics (G.M., C.P., J.E.W.) and Lilly Research Laboratories (P.W.I.), Eli Lilly and Company, Indianapolis, USA Solna, Sweden
| | - Gary Mo
- Pharmacometrics and Systems Pharmacology Research Unit, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Navarra Institute for Health Research, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Global PK/PD & Pharmacometrics (G.M., C.P., J.E.W.) and Lilly Research Laboratories (P.W.I.), Eli Lilly and Company, Indianapolis, USA Solna, Sweden
| | - Celine Pitou
- Pharmacometrics and Systems Pharmacology Research Unit, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Navarra Institute for Health Research, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Global PK/PD & Pharmacometrics (G.M., C.P., J.E.W.) and Lilly Research Laboratories (P.W.I.), Eli Lilly and Company, Indianapolis, USA Solna, Sweden
| | - Philip W Iversen
- Pharmacometrics and Systems Pharmacology Research Unit, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Navarra Institute for Health Research, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Global PK/PD & Pharmacometrics (G.M., C.P., J.E.W.) and Lilly Research Laboratories (P.W.I.), Eli Lilly and Company, Indianapolis, USA Solna, Sweden
| | - Johan E Wallin
- Pharmacometrics and Systems Pharmacology Research Unit, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Navarra Institute for Health Research, Pamplona, Spain (Z.P.P.-G.,V.M.-S.,M.G.-C., I.F.T.); Global PK/PD & Pharmacometrics (G.M., C.P., J.E.W.) and Lilly Research Laboratories (P.W.I.), Eli Lilly and Company, Indianapolis, USA Solna, Sweden
| |
Collapse
|
10
|
Bendell J, Andre V, Ho A, Kudchadkar R, Migden M, Infante J, Tiu RV, Pitou C, Tucker T, Brail L, Von Hoff D. Phase I Study of LY2940680, a Smo Antagonist, in Patients with Advanced Cancer Including Treatment-Naïve and Previously Treated Basal Cell Carcinoma. Clin Cancer Res 2018; 24:2082-2091. [PMID: 29483143 DOI: 10.1158/1078-0432.ccr-17-0723] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/29/2017] [Accepted: 02/20/2018] [Indexed: 11/16/2022]
Abstract
Purpose: The purpose of this study was to determine a recommended phase II dose and schedule of LY2940680 (taladegib) for safe administration to patients with locally advanced/metastatic cancer.Experimental Design: This was a phase I, multicenter, open-label study of oral LY2940680. The maximum tolerable dose (MTD) was determined using a 3+3 design, the dose was confirmed, and then treatment-naïve and previously hedgehog (Hh)-inhibitor-treated patients with basal cell carcinoma (BCC) were enrolled.Results: Eighty-four patients were treated (dose escalation, n = 25; dose confirmation, n = 19; and BCC dose expansion, n = 40). Common treatment-emergent adverse events were dysgeusia [41 (48.8%)], fatigue [40 (47.6%)], nausea [38 (45.2%)], and muscle spasms [34 (40.5%)]. Four patients experienced events (3 were grade 3; 1 was grade 2) that were considered dose-limiting toxicities (DLT). The MTD was determined to be 400 mg because of DLTs and dose reductions. Pharmacokinetic analyses showed no clear relationship between exposure and toxicity. Analysis of Gli1 mRNA from skin biopsies from unaffected areas suggested that all doses were biologically active [inhibition median of 92.3% (80.9% to 95.7%)]. All clinical responses (per RECIST 1.1) were in patients with BCC (n = 47); the overall and estimated response rate was 46.8% (95% confidence interval, 32.1%-61.9%). Responses were observed in patients previously treated with Hh therapy (11/31) and in Hh treatment-naïve (11/16) patients.Conclusions: LY2940680 treatment resulted in an acceptable safety profile in patients with advanced/metastatic cancer. Clinical responses were observed in patients with locally advanced/metastatic BCC who were previously treated with Hh therapy and in Hh treatment-naïve patients. Clin Cancer Res; 24(9); 2082-91. ©2018 AACR.
Collapse
Affiliation(s)
- Johanna Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee.
| | | | - Alan Ho
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Michael Migden
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey Infante
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee
| | - Ramon V Tiu
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | - Les Brail
- Infinity Pharmaceuticals, Cambridge, Massachusetts
| | - Daniel Von Hoff
- Translational Genomics Research Institute, Phoenix, Arizona.,Honorhealth Research Institute, Scottsdale, Arizona
| |
Collapse
|
11
|
Garcia-Cremades M, Pitou C, Iversen PW, Troconiz IF. Predicting tumour growth and its impact on survival in gemcitabine-treated patients with advanced pancreatic cancer. Eur J Pharm Sci 2018; 115:296-303. [PMID: 29366960 DOI: 10.1016/j.ejps.2018.01.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 10/10/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/17/2022]
Abstract
The aim of this evaluation was to characterize the impact of the tumour size (TS) effects driven by the anticancer drug gemcitabine on overall survival (OS) in patients with advanced pancreatic cancer by building and validating a predictive semi-mechanistic joint TS-OS model. TS and OS data were obtained from one phase II and one phase III study where gemcitabine was administered (1000-1250 mg/kg over 30-60 min i.v infusion) as single agent to patients (n = 285) with advanced pancreatic cancer. Drug exposure, TS and OS were linked using the population approach with NONMEM 7.3. Pancreatic tumour progression was characterized by exponential growth (doubling time = 67 weeks), and tumour response to treatment was described as a function of the weekly area under the gemcitabine triphosphate concentration vs time curve (AUC), including treatment-related resistance development. The typical predicted percentage of tumour growth inhibition with respect to no treatment was 22.3% at the end of 6 chemotherapy cycles. Emerging resistance elicited a 57% decrease in drug effects during the 6th chemotherapy cycle. Predicted TS profile was identified as main prognostic factor of OS, with tumours responders' profiles improving median OS by 30 weeks compared to stable-disease TS profiles. Results of NCT00574275 trial were predicted using this modelling framework, thereby validating the approach as a prediction tool in clinical development. Our analyses show that despite the advanced stage of the disease in this patient population, the modelling framework herein can be used to predict the likelihood of treatment success using early clinical data.
Collapse
Affiliation(s)
- Maria Garcia-Cremades
- Pharmacometrics and Systems Pharmacology, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), University of Navarra, Pamplona, Spain.
| | - Celine Pitou
- Global Pharmacokinetic/Pharmacodynamics and Pharmacometrics, Eli Lilly and Company Windlesham, Surrey, United Kingdom.
| | - Philip W Iversen
- Lilly Research laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA.
| | - Iñaki F Troconiz
- Pharmacometrics and Systems Pharmacology, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), University of Navarra, Pamplona, Spain.
| |
Collapse
|
12
|
Verstovsek S, Mesa RA, Salama ME, Li L, Pitou C, Nunes FP, Price GL, Giles JL, D'Souza DN, Walgren RA, Prchal JT. A phase 1 study of the Janus kinase 2 (JAK2) V617F inhibitor, gandotinib (LY2784544), in patients with primary myelofibrosis, polycythemia vera, and essential thrombocythemia. Leuk Res 2017; 61:89-95. [PMID: 28934680 DOI: 10.1016/j.leukres.2017.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 04/26/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 02/02/2023]
Abstract
Mutations in Janus kinase 2 (JAK2) are implicated in the pathogenesis of Philadelphia-chromosome negative myeloproliferative neoplasms, including primary myelofibrosis, polycythemia vera, and essential thrombocythemia. Gandotinib (LY2784544), a potent inhibitor of JAK2 activity, shows increased potency for the JAK2V617F mutation. The study had a standard 3+3 dose-escalation design to define the maximum-tolerated dose. Primary objectives were to determine safety, tolerability, and recommended oral daily dose of gandotinib for patients with JAK2V617F-positive myelofibrosis, essential thrombocythemia, or polycythemia vera. Secondary objectives included estimating pharmacokinetic parameters and documenting evidence of efficacy by measuring clinical improvement. Thirty-eight patients were enrolled and treated (31 myelofibrosis, 6 polycythemia vera, 1 essential thrombocythemia). The maximum-tolerated dose of gandotinib was 120mg daily, based on dose-limiting toxicities of blood creatinine increase or hyperuricemia at higher doses. Maximum plasma concentration was reached 4h after single and multiple doses, and mean half-life on day 1 was approximately 6h. Most common treatment-emergent adverse events were diarrhea (55.3%) and nausea (42.1%), a majority of which were of grade 1 severity. Best response of clinical improvement was achieved by 29% of myelofibrosis patients. A ≥50% palpable spleen length reduction was observed at any time during therapy in 20/32 evaluable patients. Additionally, ≥50% reduction in the Total Symptom Myeloproliferative Neoplasm Symptom Assessment Form Score was seen in 11/21 (52%) and 6/14 patients (43%) receiving ≥120mg at 12 and 24 weeks respectively. Gandotinib demonstrated an acceptable safety and tolerability profile, and findings at the maximum-tolerated dose of 120mg supported further clinical testing. Clinicaltrials.gov identifier: NCT01134120.
Collapse
Affiliation(s)
- Srdan Verstovsek
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Ruben A Mesa
- Mayo Clinic Cancer Center, 5881 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | - Mohamed E Salama
- University of Utah School of Medicine, ARUP Reference Laboratories, 500 Chipeta Way, MS 115-G-4, Salt Lake City, UT 84108, USA.
| | - Li Li
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - Celine Pitou
- Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH, UK.
| | - Fabio P Nunes
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - Gregory L Price
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - Jennifer L Giles
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - Deborah N D'Souza
- inVentiv Health Clinical, 225 S. East Street, Indianapolis, IN 46202, USA.
| | - Richard A Walgren
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - Josef T Prchal
- University of Utah School of Medicine, Division of Hematology, 30 North 1900 East, Salt Lake City, UT 84132, USA.
| |
Collapse
|
13
|
Garcia-Cremades M, Pitou C, Iversen PW, Troconiz IF. Characterizing Gemcitabine Effects Administered as Single Agent or Combined with Carboplatin in Mice Pancreatic and Ovarian Cancer Xenografts: A Semimechanistic Pharmacokinetic/Pharmacodynamics Tumor Growth-Response Model. J Pharmacol Exp Ther 2016; 360:445-456. [DOI: 10.1124/jpet.116.237610] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/22/2016] [Indexed: 12/15/2022] Open
|
14
|
Schaefer E, Braiteh F, Forster M, Talbot D, Chandler J, Richards D, Andre V, Estrem S, Pitou C, Tiu R, Brail L, Nikolinakos P. Phase 1b/2 trial of taladegib (LY2940680), a Hh/Smo inhibitor, in combination with carboplatin and etoposide followed by taladegib maintenance in extensive-stage small-cell lung cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32990-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
15
|
Patnaik A, Haluska P, Tolcher AW, Erlichman C, Papadopoulos KP, Lensing JL, Beeram M, Molina JR, Rasco DW, Arcos RR, Kelly CS, Wijayawardana SR, Zhang X, Stancato LF, Bell R, Shi P, Kulanthaivel P, Pitou C, Mulle LB, Farrington DL, Chan EM, Goetz MP. A First-in-Human Phase I Study of the Oral p38 MAPK Inhibitor, Ralimetinib (LY2228820 Dimesylate), in Patients with Advanced Cancer. Clin Cancer Res 2015; 22:1095-102. [PMID: 26581242 DOI: 10.1158/1078-0432.ccr-15-1718] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/02/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE p38 MAPK regulates the production of cytokines in the tumor microenvironment and enables cancer cells to survive despite oncogenic stress, radiotherapy, chemotherapy, and targeted therapies. Ralimetinib (LY2228820 dimesylate) is a selective small-molecule inhibitor of p38 MAPK. This phase I study aimed to evaluate the safety and tolerability of ralimetinib, as a single agent and in combination with tamoxifen, when administered orally to patients with advanced cancer. EXPERIMENTAL DESIGN The study design consisted of a dose-escalation phase performed in a 3+3 design (Part A; n = 54), two dose-confirmation phases [Part B at 420 mg (n = 18) and Part C at 300 mg (n = 8)], and a tumor-specific expansion phase in combination with tamoxifen for women with hormone receptor-positive metastatic breast cancer refractory to aromatase inhibitors (Part D; n = 9). Ralimetinib was administered orally every 12 hours on days 1 to 14 of a 28-day cycle. RESULTS Eighty-nine patients received ralimetinib at 11 dose levels (10, 20, 40, 65, 90, 120, 160, 200, 300, 420, and 560 mg). Plasma exposure of ralimetinib (Cmax and AUC) increased in a dose-dependent manner. After a single dose, ralimetinib inhibited p38 MAPK-induced phosphorylation of MAPKAP-K2 in peripheral blood mononuclear cells. The most common adverse events, possibly drug-related, included rash, fatigue, nausea, constipation, pruritus, and vomiting. The recommended phase II dose was 300 mg every 12 hours as monotherapy or in combination with tamoxifen. Although no patients achieved a complete response or partial response,19 patients (21.3%) achieved stable disease with a median duration of 3.7 months, with 9 of these patients on study for ≥ 6 cycles. CONCLUSIONS Ralimetinib demonstrated acceptable safety, tolerability, and pharmacokinetics for patients with advanced cancer.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Robert Bell
- Eli Lilly and Company, Indianapolis, Indiana
| | - Peipei Shi
- Eli Lilly and Company, Indianapolis, Indiana
| | | | - Celine Pitou
- Eli Lilly and Company, Guildford, United Kingdom
| | | | | | | | | |
Collapse
|
16
|
Coutant DE, Kulanthaivel P, Turner PK, Bell RL, Baldwin J, Wijayawardana SR, Pitou C, Hall SD. Understanding Disease-Drug Interactions in Cancer Patients: Implications for Dosing Within the Therapeutic Window. Clin Pharmacol Ther 2015; 98:76-86. [PMID: 25808023 DOI: 10.1002/cpt.128] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/19/2015] [Indexed: 12/17/2022]
Abstract
The human inflammatory response can result in the alteration of drug clearance through effects on metabolizing enzymes or transporters. In this article we briefly review the theory of how cancer can lead to indirect changes in drug metabolism, review acute phase proteins and cytokines as markers of changes in cytochrome P450 (CYP) activity in cancer patients, and provide clinical case examples of how the inflammation in advanced cancer patients can lead to altered CYP-mediated drug clearance.
Collapse
Affiliation(s)
- D E Coutant
- Department of Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - P Kulanthaivel
- Department of Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - P K Turner
- Pharmacokinetics and Pharmacodynamics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - R L Bell
- Pharmacokinetics and Pharmacodynamics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - J Baldwin
- Pharmacokinetics and Pharmacodynamics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - S R Wijayawardana
- Department of Statistics-Oncology, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - C Pitou
- Pharmacokinetics and Pharmacodynamics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - S D Hall
- Department of Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana, USA
| |
Collapse
|
17
|
Ma L, Clayton JR, Walgren RA, Zhao B, Evans RJ, Smith MC, Heinz-Taheny KM, Kreklau EL, Bloem L, Pitou C, Shen W, Strelow JM, Halstead C, Rempala ME, Parthasarathy S, Gillig JR, Heinz LJ, Pei H, Wang Y, Stancato LF, Dowless MS, Iversen PW, Burkholder TP. Discovery and characterization of LY2784544, a small-molecule tyrosine kinase inhibitor of JAK2V617F. Blood Cancer J 2013; 3:e109. [PMID: 23584399 PMCID: PMC3641321 DOI: 10.1038/bcj.2013.6] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Owing to the prevalence of the JAK2V617F mutation in myeloproliferative neoplasms (MPNs), its constitutive activity, and ability to recapitulate the MPN phenotype in mouse models, JAK2V617F kinase is an attractive therapeutic target. We report the discovery and initial characterization of the orally bioavailable imidazopyridazine, LY2784544, a potent, selective and ATP-competitive inhibitor of janus kinase 2 (JAK2) tyrosine kinase. LY2784544 was discovered and characterized using a JAK2-inhibition screening assay in tandem with biochemical and cell-based assays. LY2784544 in vitro selectivity for JAK2 was found to be equal or superior to known JAK2 inhibitors. Further studies showed that LY2784544 effectively inhibited JAK2V617F-driven signaling and cell proliferation in Ba/F3 cells (IC50=20 and 55 nM, respectively). In comparison, LY2784544 was much less potent at inhibiting interleukin-3-stimulated wild-type JAK2-mediated signaling and cell proliferation (IC50=1183 and 1309 nM, respectively). In vivo, LY2784544 effectively inhibited STAT5 phosphorylation in Ba/F3-JAK2V617F-GFP (green fluorescent protein) ascitic tumor cells (TED50=12.7 mg/kg) and significantly reduced (P<0.05) Ba/F3-JAK2V617F-GFP tumor burden in the JAK2V617F-induced MPN model (TED50=13.7 mg/kg, twice daily). In contrast, LY2784544 showed no effect on erythroid progenitors, reticulocytes or platelets. These data suggest that LY2784544 has potential for development as a targeted agent against JAK2V617F and may have properties that allow suppression of JAK2V617F-induced MPN pathogenesis while minimizing effects on hematopoietic progenitor cells.
Collapse
Affiliation(s)
- L Ma
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Ma L, Clayton JR, Walgren RA, Zhao B, Evans RJ, Smith MC, Heinz-Taheny KM, Kreklau EL, Bloem L, Pitou C, Shen W, Strelow JM, Halstead C, Rempala ME, Parthasarathy S, Gillig JR, Heinz LJ, Pei H, Wang Y, Stancato LF, Dowless MS, Iversen PW, Burkholder TP. Discovery and characterization of LY2784544, a small-molecule tyrosine kinase inhibitor of JAK2V617F. Blood Cancer J 2013. [PMID: 23584399 DOI: 10.1038/bcj] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Owing to the prevalence of the JAK2V617F mutation in myeloproliferative neoplasms (MPNs), its constitutive activity, and ability to recapitulate the MPN phenotype in mouse models, JAK2V617F kinase is an attractive therapeutic target. We report the discovery and initial characterization of the orally bioavailable imidazopyridazine, LY2784544, a potent, selective and ATP-competitive inhibitor of janus kinase 2 (JAK2) tyrosine kinase. LY2784544 was discovered and characterized using a JAK2-inhibition screening assay in tandem with biochemical and cell-based assays. LY2784544 in vitro selectivity for JAK2 was found to be equal or superior to known JAK2 inhibitors. Further studies showed that LY2784544 effectively inhibited JAK2V617F-driven signaling and cell proliferation in Ba/F3 cells (IC50=20 and 55 nM, respectively). In comparison, LY2784544 was much less potent at inhibiting interleukin-3-stimulated wild-type JAK2-mediated signaling and cell proliferation (IC50=1183 and 1309 nM, respectively). In vivo, LY2784544 effectively inhibited STAT5 phosphorylation in Ba/F3-JAK2V617F-GFP (green fluorescent protein) ascitic tumor cells (TED50=12.7 mg/kg) and significantly reduced (P<0.05) Ba/F3-JAK2V617F-GFP tumor burden in the JAK2V617F-induced MPN model (TED50=13.7 mg/kg, twice daily). In contrast, LY2784544 showed no effect on erythroid progenitors, reticulocytes or platelets. These data suggest that LY2784544 has potential for development as a targeted agent against JAK2V617F and may have properties that allow suppression of JAK2V617F-induced MPN pathogenesis while minimizing effects on hematopoietic progenitor cells.
Collapse
Affiliation(s)
- L Ma
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Goetz MP, Tolcher AW, Haluska P, Papadopoulos KP, Erlichman C, Beeram M, Lensing J, Rasco DW, Molina JR, Arcos R, SHI P, Kulanthaivel P, Pitou C, Mulle L, Chan EM, Patnaik A. A first-in-human phase I study of the oral p38 MAPK inhibitor LY2228820 dimesylate in patients with advanced cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3001 Background: p38 MAPK regulates production of cytokines by the tumor microenvironment and its activation enables cancer cells to survive in the presence of oncogenic stress, radiation, chemotherapy, and targeted therapies. LY2228820 is a selective small-molecule inhibitor of p38 MAPK and preclinical studies demonstrate antitumor activity as a single agent and in combination with standard agents. We performed a phase I study to determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of LY2228820 and to characterize its pharmacokinetics and pharmacodynamics. Methods: Dose escalation was performed in a 3+3 design. LY2228820 was taken orally every 12 hours on days 1-14 of a 28-day cycle. Results: 54 patients received either capsules at 8 dose levels (10, 20, 40, 65, 90, 120, 160, and 200mg) or tablets at 5 dose levels (160, 200, 300, 420, and 560mg). For both formulations, Cmax and AUC increased in a dose-dependent manner. LY2228820 inhibited p38 MAPK induced phosphorylation of MAPKAP-K2 in peripheral blood with dose-dependent maximum inhibition from 10 to 70% across the dose range 10-200mg. The most common drug-related adverse events included fatigue, nausea, rash, constipation, vomiting, and pruritus. 1 patient (200mg) had DLT of erythema multiforme (Gr3) and 2 patients (560mg) had DLT of ataxia (Gr3) and dizziness (Gr2), respectively. Although the MTD was 420mg, the frequency of Gr1/2 adverse events (mainly rash, dizziness, and tremor) and observation of clinical activity at lower dose levels led to a recommended dose of 300mg (mean AUC0-24 = 11.7ug-hr/ml at steady state). Early clinical activity has been observed in ovary, breast, and kidney cancers. One patient with metastatic clear cell carcinoma of the kidney refractory to sorafenib, sunitinib, and temsirolimus had confirmed near partial response (29% decrease) after 8 cycles and remains on therapy. 15 patients (28%) achieved best overall response of stable disease, which in 12 patients (22%) was prolonged (≥4 cycles). Conclusions: LY2228820 demonstrates acceptable pharmacokinetics, safety, and early clinical activity as a single agent in advanced cancer. A phase II study for patients with ovary cancer is planned.
Collapse
Affiliation(s)
| | - Anthony W. Tolcher
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio, TX
| | | | | | | | - Muralidhar Beeram
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio, TX
| | | | - Drew Warren Rasco
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio, TX
| | | | - Rebecca Arcos
- South Texas Accelerated Research Therapeutics, LLC, San Antonio, TX
| | | | | | | | | | | | - Amita Patnaik
- South Texas Accelerated Research Therapeutics, LLC, San Antonio, TX
| |
Collapse
|
20
|
Bueno L, de Alwis DP, Pitou C, Yingling J, Lahn M, Glatt S, Trocóniz IF. Semi-mechanistic modelling of the tumour growth inhibitory effects of LY2157299, a new type I receptor TGF-beta kinase antagonist, in mice. Eur J Cancer 2007; 44:142-50. [PMID: 18039567 DOI: 10.1016/j.ejca.2007.10.008] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 09/14/2007] [Accepted: 10/09/2007] [Indexed: 11/18/2022]
Abstract
Human xenografts Calu6 (non-small cell lung cancer) and MX1 (breast cancer) were implanted subcutaneously in nude mice and LY2157299, a new type I receptor TGF-beta kinase antagonist, was administered orally. Plasma levels of LY2157299, percentage of phosphorylated Smad2,3 (pSmad) in tumour, and tumour size were used to establish a semi-mechanistic pharmacokinetic/pharmacodynamic model. An indirect response model was used to relate plasma concentrations with pSmad. The model predicts complete inhibition of pSmad and rapid turnover rates [t(1/2) (min)=18.6 (Calu6) and 32.0 (MX1)]. Tumour growth inhibition was linked to pSmad using two signal transduction compartments characterised by a mean signal propagation time with estimated values of 6.17 and 28.7 days for Calu6 and MX1, respectively. The model provides a tool to generate experimental hypothesis to gain insights into the mechanisms of signal transduction associated to the TGF-beta membrane receptor type I.
Collapse
Affiliation(s)
- Lorea Bueno
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, Pamplona, Spain
| | | | | | | | | | | | | |
Collapse
|