A Phase II Trial of Prexasertib (LY2606368) in Patients With Extensive-Stage Small-Cell Lung Cancer

BACKGROUND

This study assessed the checkpoint kinase 1 inhibitor prexasertib in patients with extensive-stage small-cell lung cancer (ED-SCLC).

PATIENTS AND METHODS

This was a parallel-cohort phase II study of 105 mg/m² prexasertib once every 14 days for patients who progressed after no more than two prior therapies and had platinum-sensitive (Cohort 1) or platinum-resistant/platinum-refractory (Cohort 2) disease. The primary endpoint was objective response rate (ORR). Secondary endpoints included disease control rate (DCR), progression-free survival (PFS), overall survival (OS), safety, and pharmacokinetics. Exploratory endpoints included biomarker identification and assessment of an alternative regimen (Cohort 3: 40 mg/m² days 1-3, 14-day cycle).

RESULTS

In Cohort 1 (n = 58), ORR was 5.2%; DCR, 31%; median PFS, 1.41 months (95% confidence interval [CI], 1.31-1.64); and median OS, 5.42 months (95% CI, 3.75-8.51). In Cohort 2 (n = 60), ORR was 0%; DCR, 20%; median PFS, 1.36 months (95% CI, 1.25-1.45); and median OS, 3.15 months (95% CI, 2.27-5.52). The most frequent all-grade, related, treatment-emergent adverse events were decreased neutrophil count (Cohort 1, 69.6%; Cohort 2, 73.3%), decreased platelet count (Cohort 1, 51.8%; Cohort 2, 50.0%), decreased white blood cell count (Cohort 1, 28.6%; Cohort 2, 40.0%), and anemia (Cohort 1, 39.3%; Cohort 2, 28.3%). Eleven patients (19.6%) in Cohort 1 and one patient (1.7%) in Cohort 2 experienced grade ≥3 febrile neutropenia. Prexasertib pharmacokinetics were consistent with prior studies. Cohort 3 outcomes were similar to those of Cohorts 1 and 2. No actionable biomarkers were identified.

CONCLUSION

Prexasertib did not demonstrate activity to warrant future development as monotherapy in ED-SCLC.

A phase Ib study of prexasertib, a checkpoint kinase (CHK1) inhibitor, and LY3023414, a dual inhibitor of class I phosphatidylinositol 3-kinase (PI3K) and the mammalian target of rapamycin (mTOR) in patients with advanced solid tumors

3091

Background: Prexasertib inhibits CHK1, a kinase involved in DNA repair and replication. LY3023414 inhibits PI3K/mTOR signaling, implicated in the development of malignant disease. Prexasertib + LY3023414 has resulted in enhanced antitumor activity in triple negative breast cancer (TNBC) in vitro models. Methods: This Phase 1b study in patients (pts) with solid tumors assessed escalating doses of prexasertib (60-105 mg/m2 IV every 14 days [q14d]) and LY3023414 (100-200 mg orally twice daily [BID]). Dose escalation ceased once the maximum tolerated dose of each monotherapy was reached. An initial expansion cohort (Arm E) explored prexasertib 105 mg/m2 q14d + LY3023414 200 mg BID. Subsequent expansion cohorts evaluated prexasertib 105 mg/m2 q14d + LY3023414 150 mg BID in pts with solid tumors with PIK3CA mutations (Arm E2) or TNBC (Arm E3). Results: Fifty pts were enrolled (escalation: n = 13; Arm E: n = 9; Arm E2: n = 15; Arm E3: n = 13). No dose-limiting toxicities (DLTs) were observed during escalation however DLT-equivalent toxicities were observed in 2 pts in Arm E (anemia, neutropenia, thrombocytopenia, oral mucositis, abdominal pain, fatigue). Due to toxicity, a reduced dose of LY3023414 (150 mg BID) was assessed in Arm E2/E3. In the 28 patients treated in Arms E2/E3, common treatment-related adverse events (any grade; grade ≥3) were: leukopenia/neutropenia (82%; 79%), thrombocytopenia (46%; 36%), nausea (46%; 0%), stomatitis (39%, 4%), vomiting (36%; 0%), and anemia (29%; 18%). Febrile neutropenia was reported in 25% of pts. Dose reductions in Arm E2/E3 were common. In escalation, 2 pts achieved a partial response (PR) and 3 pts achieved stable disease (SD). In Arm E, 78% of pts achieved SD. Of the pts evaluable at the time of data transfer, PRs were achieved in 1 pt with an unknown primary (Arm E2) and 2 pts with TNBC (Arm E3). Each agent’s pharmacokinetic profile was consistent with prior monotherapy data. Conclusions: Prexasertib + LY3023414 showed preliminary efficacy in heavily pretreated pts with solid tumors but was associated with toxicity, suggesting supportive care may be required. Clinical trial information: NCT02124148.

A phase II study to evaluate LY2603618 in combination with gemcitabine in pancreatic cancer patients

Background

The aim of this study was to determine whether checkpoint kinase 1 inihibitor (CHK1), LY2603618, and gemcitabine prolong overall survival (OS) compared to gemcitabine alone in patients with unresectable pancreatic cancer.

Methods

Patients with Stage II-IV locally advanced or metastatic pancreatic cancer were randomized (2:1) to either 230 mg of LY2603618/1000 mg/m² gemcitabine combined or 1000 mg/m² gemcitabine alone. OS was assessed using both a Bayesian augment control model and traditional frequentist analysis for inference. Progression-free survival (PFS), overall response rate (ORR), duration of response, pharmacokinetics (PK), and safety (Common Terminology Criteria for Adverse Events [AEs] v 3.0) were also evaluated.

Results

Ninety-nine patients (n = 65, LY2603618/gemcitabine; n = 34, gemcitabine) were randomized (intent-to-treat population). The median OS (months) was 7.8 (range, 0.3–18.9) with LY2603618/gemcitabine and 8.3 (range, 0.8-19.1+) with gemcitabine. Similarly, in a Bayesian analysis, the study was not positive since the posterior probability that LY2603618/gemcitabine was superior to gemcitabine in improving OS was 0.3, which did not exceed the prespecified threshold of 0.8. No significant improvements in PFS, ORR, or duration of response were observed. Drug-related treatment-emergent AEs in both arms included nausea, thrombocytopenia, fatigue, and neutropenia. The severity of AEs with LY2603618/gemcitabine was comparable to gemcitabine. The LY2603618 exposure targets (AUC_(0-∞) ≥21,000 ng∙hr/mL and C_max ≥2000 ng/mL) predicted for maximum pharmacodynamic response were achieved after 230 mg of LY2603618.

Conclusions

LY2603618/gemcitabine was not superior to gemcitabine for the treatment of patients with pancreatic cancer.

Trial Registration

NCT00839332. Clinicaltrials.gov. Date of registration: 6 February 2009

Management of landfill leachate: The legacy of European Union Directives

Landfill leachate is the product of water that has percolated through waste deposits and contains various pollutants, which necessitate effective treatment before it can be released into the environment. In the last 30years, there have been significant changes in landfill management practices in response to European Union (EU) Directives, which have led to changes in leachate composition, volumes produced and treatability. In this study, historic landfill data, combined with leachate characterisation data, were used to determine the impacts of EU Directives on landfill leachate management, composition and treatability. Inhibitory compounds including ammonium (NH4-N), cyanide, chromium, nickel and zinc, were present in young leachate at levels that may inhibit ammonium oxidising bacteria, while arsenic, copper and silver were present in young and intermediate age leachate at concentrations above inhibitory thresholds. In addition, the results of this study show that while young landfills produce less than 50% of total leachate by volume in the Republic of Ireland, they account for 70% of total annual leachate chemical oxygen demand (COD) load and approximately 80% of total 5-day biochemical oxygen demand (BOD5) and NH4-N loads. These results show that there has been a decrease in the volume of leachate produced per tonne of waste landfilled since enactment of the Landfill Directive, with a trend towards increased leachate strength (particularly COD and BOD5) during the initial five years of landfill operation. These changes may be attributed to changes in landfill management practices following the implementation of the Landfill Directive. However, this study did not demonstrate the impact of decreasing inputs of biodegradable municipal waste on leachate composition. Increasingly stringent wastewater treatment plant (WWTP) emission limit values represent a significant threat to the sustainability of co-treatment of leachate with municipal wastewater. In addition, the seasonal variation in leachate production poses a risk to effective co-treatment in municipal WWTPs, as periods of high leachate production coincide with periods of maximum hydraulic loading in WWTPs.

Phase I Study of LY2606368, a Checkpoint Kinase 1 Inhibitor, in Patients With Advanced Cancer

PURPOSE

The primary objective was to determine safety, toxicity, and a recommended phase II dose regimen of LY2606368, an inhibitor of checkpoint kinase 1, as monotherapy.

PATIENTS AND METHODS

This phase I, nonrandomized, open-label, dose-escalation trial used a 3 + 3 dose-escalation scheme and included patients with advanced solid tumors. Intravenous LY2606368 was dose escalated from 10 to 50 mg/m(2) on schedule 1 (days 1 to 3 every 14 days) or from 40 to 130 mg/m(2) on schedule 2 (day 1 every 14 days). Safety measures and pharmacokinetics were assessed, and pharmacodynamics were measured in blood, hair follicles, and circulating tumor cells.

RESULTS

Forty-five patients were treated; seven experienced dose-limiting toxicities (all hematologic). The maximum-tolerated doses (MTDs) were 40 mg/m(2) (schedule 1) and 105 mg/m(2) (schedule 2). The most common related grade 3 or 4 treatment-emergent adverse events were neutropenia, leukopenia, anemia, thrombocytopenia, and fatigue. Grade 4 neutropenia occurred in 73.3% of patients and was transient (typically < 5 days). Febrile neutropenia incidence was low (7%). The LY2606368 exposure over the first 72 hours (area under the curve from 0 to 72 hours) at the MTD for each schedule coincided with the exposure in mouse xenografts that resulted in maximal tumor responses. Minor intra- and intercycle accumulation of LY2606368 was observed at the MTDs for both schedules. Two patients (4.4%) had a partial response; one had squamous cell carcinoma (SCC) of the anus and one had SCC of the head and neck. Fifteen patients (33.3%) had a best overall response of stable disease (range, 1.2 to 6.7 months), six of whom had SCC.

CONCLUSION

An LY2606368 dose of 105 mg/m(2) once every 14 days is being evaluated as the recommended phase II dose in dose-expansion cohorts for patients with SCC.

The potential of algae blooms to produce renewable gaseous fuel

Ulva lactuca (commonly known as sea letuce) is a green sea weed which dominates Green Tides or algae blooms. Green Tides are caused by excess nitrogen from agriculture and sewage outfalls resulting in eutrophication in shallow estuaries. Samples of U. lactuca were taken from the Argideen estuary in West Cork on two consecutive years. In year 1 a combination of three different processes/pretreatments were carried out on the Ulva. These include washing, wilting and drying. Biomethane potential (BMP) assays were carried out on the samples. Fresh Ulva has a biomethane yield of 183LCH4/kgVS. For dried, washed and macerated Ulva a BMP of 250LCH4/kgVS was achieved. The resource from the estuary in West Cork was shown to be sufficient to provide fuel to 264 cars on a year round basis. Mono-digestion of Ulva may be problematic; the C:N ratio is low and the sulphur content is high. In year 2 co-digestion trials with dairy slurry were carried out. These indicate a potential increase in biomethane output by 17% as compared to mono-digestion of Ulva and slurry.

Abstract A94: Dose determination of LY2603618, a Chk1 inhibitor, administered in combination with gemcitabine in patients with advanced cancer

Background: LY2603618 is a selective inhibitor of Chk1, a protein kinase that plays a key role in the DNA damage checkpoint. Inhibition of Chk1 is predicted to enhance the effects of antimetabolites, such as gemcitabine.

Methods: This study is a Phase 1–2 study in patients with solid tumors (Phase 1) and advanced pancreatic adenocarcinoma (Phase 2). In Phase 1, gemcitabine (1000 mg/m2) was administered on Days 1, 8, and 15 of a 28-day cycle. LY2603618 was administered on Days 2, 9, and 16. Patients were assessed for safety, tolerability, and dose-limiting toxicity (DLT). A recommended Phase 2 dose (RP2D) was determined based on safety, dose intensity, and pharmacokinetics (PK).

Results: A total of 50 patients were enrolled. Patients were treated at 70 (n =3), 105 (n=3), 150 (n=7), 200 (n=11), 250 (n=6) mg/m2and at 2 additional flat-fixed dose cohorts of 200 (n=10) and 230 (n=10) mg. The most frequent AEs reported included fatigue, thrombocytopenia, anemia, nausea, neutropenia, and constipation, which are consistent with those reported with gemcitabine monotherapy. During escalation, DLTs included neutropenia, infusion-related reaction and thrombocytopenia, with thrombocytopenia being dose limiting. The maximum tolerated dose (MTD) was determined to be 200 mg/m2. The systemic exposure of LY2603618 increased in a dose-dependent manner and the LY2603618 systemic clearance was dose-independent across all doses on average. The mean LY2603618 half-life varied across doses but was consistent with a half-life (i.e., &gt;10 hr and &lt;24 hr) suitable for maintaining required human exposures while minimizing intra and intercycle accumulation. The administration of gemcitabine approximately 24 hours before LY2603618 administration did not alter LY2603618 PK. Following dose escalation, identification of the MTD and results from a population PK analysis, 2 additional flat-fixed dose cohorts of 200 and 230 mg (n=10 in each cohort) were added in an effort to minimize dose reduction/omissions of gemcitabine and reduce PK variability. At a dose of 230 mg, the plasma exposures that correlate with the maximal pharmacodynamic (PD) effect in nonclinical models (i.e., AUC(0−∞) &gt;21,000 ng hr/mL and Cmax &gt; 2000 ng/mL) were achieved by all but one patient. Based on safety/tolerability, the ability to maintain dose intensity, and PK, a RP2D of 230 mg was selected. A total of 17 of 30 patients received more than 2 cycles of therapy.

Conclusions: LY2603618 administered in combination with gemcitabine demonstrated an acceptable safety profile; the MTD for this regimen was defined at 200 mg/m2 in the originally designed study. However at a fixed dose of 230 mg, LY2603618 in combination with gemcitabine had an acceptable safety profile and the observed exposures exceed those required for biological effect in nonclinical models. This dose is being evaluated in the Phase 2 component of the study.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2011 Nov 12-16; San Francisco, CA. Philadelphia (PA): AACR; Mol Cancer Ther 2011;10(11 Suppl):Abstract nr A94.

Demographics, nature and treatment of orthopaedic trauma injuries occurring in an agricultural context in the West of Ireland

BACKGROUND

Farming is a major industry in the West of Ireland. This prospective study examined the age profile, nature and treatment of orthopaedic injuries occurring in agricultural surroundings presenting at the Orthopaedic Unit of Merlin Park Hospital, Galway.

METHODS

The cohort consisted of 70 direct or indirect farm employees presenting with orthopaedic injuries caused in an accident occurring on a farm.

RESULTS

There were significantly (P < 0.01) more male than female farmers (73 vs. 27%) with a mean age of 63 years (ranging from 13 to 87 years). Average number of out-patient visits related to the injury was 3.6. Injuries involving livestock resulted in the majority of accidents (P < 0.05) with a significant rise in the number of visits with increasing age (P < 0.01) with older patients having more severe injuries. Soft tissue injuries and fractures were commonly encountered. Complex fractures were the slowest injury to heal requiring eight subsequent out-patient visits.