MEDI4276 is a HER2-bispecific antibody targeting two different epitopes on HER2, with site-specific conjugation via maleimidocaproyl linker to a potent tubulysin-based microtubule inhibitor. MEDI4276 demonstrates enhanced cellular internalization and cytolysis of HER2+ tumor cells in vitro, including T-DM1 resistant cells.
This was a phase 1 dose escalation trial in patients with advanced HER2+ breast or gastric cancer that was relapsed or refractory to standard therapy. MEDI4276 was infused intravenously over 60-90 minutes at 0.05, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.75, or 0.9 mg/kg every 3 weeks. Primary endpoints were safety and tolerability; secondary endpoints included antitumor activity (RECIST 1.1; ORR, PFS, and OS), pharmacokinetics (PK), and immunogenicity.
As of 13 November 2017, 43 patients (median age 60 years [range: 36-76]; 69.8% female] were enrolled and treated: n = 3 in all groups except 0.4 (n = 6), 0.6 (n = 11), and 0.75 (n = 8) mg/kg. Maximum tolerated dose was exceeded at 0.9 mg/kg; dose-limiting toxicities (DLTs) were grade 3 liver function test (LFT) increases (n = 2; reversible) and grade 3 diarrhea (n = 1). Two other DLTs of grade 3 or 4 LFT increases were reported (0.4 and 0.6 mg/kg). Thirty-eight patients (88%) had drug-related adverse events (AE) of any grade; most common were nausea (58%), fatigue (42%), elevated AST (37%), vomiting (37%), and elevated ALT (35%). Twelve patients (28%) had drug-related AEs of grade 3-4 severity; most common were grade 3 elevated AST (19%) and grade 3 elevated ALT (12%). Drug-related grade 3 peripheral neuropathy was observed in 1 patient (2%) at 0.6 mg/kg and in 2 patients (5%) at 0.75 mg/kg. Four patients (9%) had ≥1 drug-related AE leading to treatment discontinuation. In the as-treated population, there was 1 CR (0.5 mg/kg; breast), 1 PR (0.6 mg/kg; breast), and 12 (28%) patients with SD. MEDI4276 exhibited non-linear PK, rapid clearance and negligible deconjugation.
MEDI4276 has clinical activity, but with increased toxicity at higher doses. Updated results will be presented.
NCT02576548
MedImmune, LLC
MedImmune
M. Pegram: Consulting work for AstraZeneca, parent company of study sponsor (MedImmune), for non-branded educational sessions, within the past year. A.R. Tan: The author\'s institution has received research funding from MedImmune. A.M. Storniolo: Stock in Gilead, Celgene, Amgen - immediate family member Honoraria from Pfizer – author. N. Elgeioushi, S. Marshall, S. Abdullah: MedImmune employment and stock interests or options in its parent company, AstraZeneca. All other authors have declared no conflicts of interest.
Patients (pts) with NHL experiencing early relapse (ER) within two years of initial diagnosis and those double refractory (DR) to both rituximab and chemotherapy have particularly poor outcomes (Casulo et al
CC-122 was given orally (5/7 d) for 28-d cycles in escalating doses plus a fixed dose of intravenous G 1000 mg on d2, 8, 15 of cycle 1 (c1) and d1 of c2–8. CC–122 active ingredient in capsule formulation (AIC) 1, 2, 3, and 4 mg and CC-122 formulated capsules (F6) 3 and 4 mg were evaluated in separate cohorts. Primary end points included safety and tolerability, NTD, and MTD. Response was assessed using the Cheson 2007 criteria every 2 cycles to c6, every 3 cycles to c12, and every 6 cycles thereafter.
As of September 1, 2017, 44 pts with R/R B-cell NHL were enrolled in the dose-escalation phase. Tumor types included 19 pts with DLBCL, 24 with FL, and 1 with MZL. Median age was 60 y (range, 26–81 y), 29 (66%) were men, and 33 (75%) had stage III/IV disease. Median number of prior anticancer therapies was 3 (range, 1–11), and 18 pts (41%) had 1 prior ASCT; 2 pts had a dose-limiting toxicity (grade 4 neutropenia, n = 1 [CC-122 AIC 3 mg]; grade 5 tumor flare, n = 1 [CC-122 F6 4 mg]). The most common (≥15%) grade 3/4 TEAEs were neutropenia (52%) and thrombocytopenia (25%). ORR/CR rate in the total population was 68%/27% (DLBCL, 47%/11%; FL, 84%/42%). The mDOR was 19.4 mo (95% CI:7.9, NR). Subgroup analysis showed comparable mPFS and DOR for high-risk (ER+DR) and standard-risk FL pts (mPFS, 21.1 mo [2.9, NR] vs 16.2 mo [1.7, 16.2]; DOR, 19.3 mo [1.9, NR] vs NR).
CC-122+G is well-tolerated, with promising response rates and durable remissions in R/R B-cell NHL. Subgroup analysis showed CC-122+G has similar efficacy in the high-risk and standard-risk FL population.
NCT02417285/EUDRACT 2014-003333-26
Celgene Corporation
Celgene Corporation
J.K. Doorduijn: Received honoraria from Roche and Celgene. U. Vitolo: Received honoraria from Roche, Celgene, Janssen, Takeda, Mundipharma, Gilead and is an advisory member of Roche, Celgene and Janssen. M.J. Kersten: Research funding from Celgene, Roche and Millennium/Takeda and honoraria from Celgene, Roche, Millennium/Takeda, Novartis, Kite Pharma, Gilead. A. Chiappella: Speakers bureau from Amgen, Celgene, Janssen, Nanostring, Pfizer, Roche, and Teva. P.L. Zinzani: Advisory board member for Roche, Celgene, Gilead, J&J, BMS, Karyopharma, Takeda, Bayer, Verastem, Merck and Servier. M. Pourdehnad: Employee of and stock ownership from Celgene Corporation. Z. Nikolova: Employee of and stock ownership from Celgene International Sarl. V. Ribrag: Research funding from ArgenX and honoraria from Roche, Servier, BMS, MSD, Infinity, Gilead, Nanostring, and Epizyme. All other authors have declared no conflicts of interest.
The mutation in BRAF kinase at V600 has been frequently reported in nearly 50% of melanoma patients resulting in the hyper-activation of MAPK pathway. As such, various inhibitors which target mutant BRAF have been developed including vemurafenib and dabrafenib both of which have demonstrated significant clinical outcomes. Nevertheless, both primary and acquired resistance reduce the overall response of patients to the therapy. So, the search of efficient biomarkers to stratify melanoma patients has become an imperative subject of research to enhance the efficacy of RAF inhibitor treatments and to decrease the rate of side effects due to the therapy. The mechanism of ubiquitination in controlling various functions such as stabilization of a protein cannot be neglected. A number of ubiquitin regulatory enzymes have been already shown to act on and regulate various component of MAPK pathway.
In order to investigate the role of deubiquitinating enzymes (DUBs) in MAPK signaling, we performed a RNAi screen using a shRNA library targeting all known human DUBs and phosphorylated ERK level was assessed by western blotting. Biochemical analysis of significant hits and their potential role in response of melanoma patients to RAF inhibitors were investigated.
We identified 9 DUBs which significantly regulate MAPK pathway activity including USP28. Interestingly, USP28 has been reported to be mutated in 10% of melanoma patients. Our analysis demonstrated that the loss of USP28 functionality confers poorer overall survival to melanoma patients. The correlation analysis of expression of USP28 in BRAF600E mutated melanoma patients confirmed the tumor suppressor role of USP28 in melanoma. Our results revealed that cells depleted for USP28 show BRAF stabilization resulting in high MAPK activity. Moreover, tissue microarray analysis of 98 melanoma patients showed the inverse correlation of USP28 and BRAF protein expression. Critically we demonstrated that stabilization of BRAF due to the loss of USP28 results in vemurafenib resistance in melanoma.
Overall, our results demonstrate that the loss of USP28 could be used as a novel and promising biomarker for resistance to RAF inhibitors in melanoma patients.
National University of Singapore
National University of Singapore
All authors have declared no conflicts of interest.
A key metabolic alteration in tumour cells is increased dependency on glycolysis, resulting in the production of lactate which is transported out of cells by MCTs. Inhibition of MCT-1 can constrain cancer cell growth in preclinical models. We report results on the phase I study of AZD3965, a FIC inhibitor of MCT-1.
Patients with advanced solid tumours were treated with oral (po) AZD3965 at total daily doses of 5-30mg given once (od) and twice daily (bd). Exclusion criteria included a history of retinal or cardiac disease due to preclinical toxicology findings in the eye and heart (which express MCT-1). The primary objectives were to determine the safety, dose limiting toxicities (DLT) and maximum tolerated dose (MTD) of AZD3965. Intensive pharmacokinetic (PK) profiling was performed with subsequent modelling for receptor occupancy. Pharmacodynamic profiling included imaging to detect pH changes and tumour glucose uptake, and plasma/urine metabolomics.
40 patients (24M:16F; median age 64.5 were treated at dose levels of 5, 10, 20, and 30mg od and 10 and 15mg bd. AZD3965 was well tolerated with nausea and fatigue (CTCAE Gr1-2) the most commonly reported side effects. A single DLT of cardiac troponin rise was observed at 20mg od. Asymptomatic, reversible retinal ERG changes were first observed at 20mg od, with DLTs observed at doses above 20mg od. PK data indicate exposures in the preclinical efficacy range. Metabolomic changes in urinary lactate and ketones correlate with on-target activity. A patient with undiagnosed tumour-associated lactic acidosis experienced a DLT with exacerbation of this following a single 10mg dose of AZD3965, again indicating target engagement.
The MCT1 inhibitor AZD3965 can be administered to patients at doses which engage the drug target, with a RP2D of 10mg bd po. Observed DLTs were primarily dose dependent, asymptomatic, reversible changes in retinal function, an expected on-target effect. Part 2 of the study is open to recruitment in patients with diffuse large B cell lymphoma, a tumour that predominantly expresses MCT1.
Cancer Research UK
Cancer Research UK
All authors have declared no conflicts of interest.