A phase I study to assess the safety, pharmacokinetics (PK), pharmacodynamics (PD) and antitumor activities of BAL101553, a novel tumor checkpoint controller (TCC), administered as 48-hour infusion in adult patients with advanced solid tumors

TPS2602

Background: BAL101553 (prodrug of BAL27862), is a novel TCC that promotes tumor cell death by modulating the spindle assembly checkpoint. BAL27862 has shown potent antitumor activity in diverse preclinical tumor models, including models refractory to standard therapies. In a completed Phase 1 study using 2-h IV infusions (Days 1, 8, 15, q28d, NCT01397929 , CDI-CS-001, Lopez et al. JCO 34, 2016 suppl; 2525) dose-limiting vascular effects were observed and appeared Cmax related. The recommended Phase 2 dose for 2-h IV BAL101553 is 30 mg/m2. Vascular toxicity was not observed in an ongoing study with oral BAL101553 (NCT02490800, CDI-CS-002) at daily doses up to 30 mg (QD). Preclinical data suggest that antiproliferative effects of BAL101553/27862 are driven by exposure (AUC); thus vascular toxicity and antitumor activity are mediated by different PK drivers. BAL27862 has a half-life of ~15 h. Based on PK-modeling, extending the infusion from 2 h to 48 h was expected to result in ~4-fold higher AUC at a given Cmaxlevel and thereby improve the therapeutic window. Methods: This is an ongoing multicenter, open-label, Phase 1 dose-escalation study (NCT02895360, CDI-CS-003/SAKK67/15) using a 3+3 design to determine the MTD, characterize dose-limiting toxicities and assess the PK, PD and antitumor activities of 48-h infusions of BAL101553 in consecutive 28-day cycles at a starting dose of 30 mg/m2 administered on Day 1, 8 and 15 (q28d). The dose escalation scheme foresees up to ~ 50% dose increments depending on observed toxicities. During cycle 2, patients receive 7 days oral (QD) BAL101553 (Day 15–21) instead of the weekly IV infusion to assess absolute oral bioavailability. Patients with histologically-confirmed advanced or recurrent solid tumors are eligible for enrollment. Adverse events are assessed using CTCAEv4; tumor response by RECIST 1.1 (every 2 cycles). PD assessments include optional tumor biopsies and circulating tumor cells. PK profiles are assessed during the first 2 cycles. Two dose cohorts (30 and 45 mg/m2) have completed without DLTs or signs of vascular toxicity. Clinical trial information: NCT02895360.

Effect of placebo on office and on 24 hour noninvasive ambulatory blood pressure measurements

Elevated BP in the clinical but not during daily activities (white coat hypertension) is a well recognised problem encountered in the diagnosis of mild hypertension. The aim of this study is to evaluate this phenomenon with a study population of 90 mild hypertensive patients subjected to 24h BP measurement, and to assess the effect of placebo on both the office and the daytime continual BP monitored values. For this purpose, 90 patients were evaluated after four weeks of single-blind placebo (Phase I) and, of these, 27 patients were evaluated after a further four weeks of double-blind placebo administration (Phase II). During Phase I treatment the mean office SBP (163.9 mmHg) and the mean office DBP (104.5 mmHg) were significantly higher than the average of the six readings obtained during the first two hours of automatic continual BP monitoring (158.6 and 98 mmHg respectively, P < 0.001) (white coat effect). These differences were much more pronounced when the comparison was made between office measurements and the average daytime values (SBP 152.8 mmHg, DBP 93.1 mmHg). At the end of Phase II, the average values of BP measurements obtained both in the office and from continual monitoring were significantly lower (placebo effect). However, the difference between the office and the daytime values persisted. Thus, notwithstanding the reduction in the BP measurements following placebo administration, the white coat effect persists.

Atrial natriuretic peptide in diabetic patients before and after control of blood sugar level

Atrial natriuretic peptide (ANP) was examined in 20 diabetic patients: 10 patients referred from the emergency room with severe hyperglycemia, (Group A), and 10 patients with uncontrolled diabetes referred by the outpatient clinic (Group B). Seven patients from Group A reached the nadir of less than 10 pg/ml, and three reached 12-16 pg/ml; following equilibration of sugar level, mean ANP level rose to 51.4 pg/ml (SD +/- 5.6). In Group B mean ANP level before treatment was 19.2 pg/ml +/- 11.4, and after diabetes control reached 40.4 pg/ml (SD +/- 10.04). Findings demonstrate a significant decrease in ANP in the acute hypoglycemic state, and a return to normal levels when sugar is controlled and hypovolemia corrected. Patients with chronic hyperglycemia exhibit compensation of intravascular volume. It seems that the equilibration system functioning via ANP is highly sensitive as a result of acute changes in total body fluid, and becomes desensitized during chronic disequilibrium.