Phase I clinical trial of CEP-2563 dihydrochloride, a receptor tyrosine kinase inhibitor, in patients with refractory solid tumors

CEP-2563 dihydrochloride (CEP-2563) is a soluble lysinyl-beta-alanyl ester of CEP-751, a potent inhibitor of the trk family of receptor tyrosine kinases and the platelet-derived growth factor (PDGF) receptor tyrosine kinase. CEP-2563 was developed because of the limited aqueous solubility of CEP-751. Preclinical models have demonstrated that both CEP-751 and CEP-2563 have antitumor activity in a variety of tumors. A Phase I clinical trial involving 18 patients was conducted to determine the toxicity profile, maximum tolerated dose (MTD), toxicity profile, and pharmacokinetics of CEP-2563 in patients with advanced solid tumors refractory to standard therapy. CEP-2563 was administered over 1 hour via a central venous catheter once daily for five consecutive days every three weeks. A rapid dose titration strategy with initial single patient cohorts and 100% dose escalations was used. With the appearance of drug-related toxicity, escalations were decreased to 50% or 25% and cohorts were expanded to 3 or 6 patients until establishment of the MTD. Dose escalation rapidly proceeded to 320 mg/m(2)/d. The dose limiting toxicities (DLTs) observed were grade 3 hypotension and grade 2 allergic reaction. Other toxicities included anemia, thrombocytopenia, anorexia, asthenia, diarrhea, fatigue, headache, nausea, vomiting, and rash. Pharmacokinetic analysis showed that CEP-2563 is reliably converted to CEP-751. This study demonstrated that single agent CEP-2563 therapy is feasible with acceptable toxicities. The recommended phase II dose is 256 mg/m(2)/d. Rapid dose escalation with single patient cohorts was a safe and efficient method of conducting this phase I trial.     

沙尔威辛治疗恶性肿瘤Ⅰ期临床耐受性试验

目的观察沙尔威辛治疗恶性肿瘤的安全性,毒副反应与剂量的关系,确定推荐Ⅱ期临床研究的剂量.方法共入选29例患者,沙尔威辛分为9个剂量组,由初始剂量15 mg·m-2·d-1开始逐渐增加至30,45,60,75,90,105 mg·m-2·d-1,加入生理氯化钠溶液500 mL静脉点滴2 h,连续3 d,其中第7剂量组为90 mg·m-2·d-1连续4 d,第8剂量组为90 mg·m-2·d-1连续5 d,第9剂量组为105 mg·m-2·d-1连续5 d,21 d为一周期,每剂量组3或4例.观察药物对人体各系统的影响及毒性反应.结果沙尔威辛的毒副反应比较轻微,除了血管刺激疼痛外主要还包括Ⅰ/Ⅱ度的骨髓抑制、消化道反应、发热及皮肤潮红等,所有的毒副反应均在停药2周内恢复.没有出现剂量限制性毒性.爬坡最高剂量为105 mg·m-2·d-1连续5 d.结论沙尔威辛对恶性肿瘤患者的耐受性良好,建议Ⅱ期临床研究推荐剂量为90 mg·m-2·d-1连续5 d,21 d为一周期.     

A Bayesian adaptive design for cancer phase I trials using a flexible range of doses

We present a Bayesian adaptive design for dose finding in cancer phase I clinical trials. The goal is to estimate the maximum tolerated dose (MTD) after possible modification of the dose range during the trial. Parametric models are used to describe the relationship between the dose and the probability of dose-limiting toxicity (DLT). We investigate model reparameterization in terms of the probabilities of DLT at the minimum and maximum available doses at the start of the trial. Trial design proceeds using escalation with overdose control (EWOC), where at each stage of the trial we seek the dose of the agent such that the posterior probability of exceeding the MTD of this agent is bounded by a feasibility bound. At any time during the trial, we test whether the MTD is below or above the minimum and maximum doses, respectively. If during the trial there is evidence that the MTD is outside the range of doses, we extend the range of doses and complete the trial with the planned sample size. At the end of the trial, a Bayes estimate of the MTD is proposed. We evaluate design operating characteristics in terms of safety of the trial design and efficiency of the MTD estimate under various scenarios and model misspecification. The methodology is further compared to the original EWOC design. We showed by comprehensive simulation studies that the proposed method is safe and can estimate the MTD more efficiently than the original EWOC design.     

Application of the CFU-GM assay to predict acute drug-induced neutropenia: an international blind trial to validate a prediction model for the maximum tolerated dose (MTD) of myelosuppressive xenobiotics.

In a previous study of prevalidation, a standard operating procedure (SOP) for two independent in vitro tests (human and mouse) had been developed, to evaluate the potential hematotoxicity of xenobiotics from their direct and the adverse effects on granulocyte-macrophages (CFU-GM). A predictive model to calculate the human maximum tolerated dose (MTD) was set up, by adjusting a mouse-derived MTD for the differential interspecies sensitivity. In this paper, we describe an international blind trial designed to apply this model to the clinical neutropenia, by testing 20 drugs, including 14 antineoplastics (Cytosar-U, 5-Fluorouracil, Myleran, Thioguanine, Fludarabine, Bleomycin, Methotrexate, Gemcitabine, Carmustine, Etoposide, Teniposide, Cytoxan, Taxol, Adriamycin); two antivirals (Retrovir, Zovirax,); three drugs for other therapeutic indications (Cyclosporin, Thorazine, Indocin); and one pesticide (Lindane). The results confirmed that the SOP developed generates reproducible IC90 values with both human and murine GM-CFU. For 10 drugs (Adriamycin, Bleomycin, Etoposide, Fludarabine, 5-Fluorouracil, Myleran, Taxol, Teniposide, Thioguanine, and Thorazine), IC90 values were found within the range of the actual drug doses tested (defined as the actual IC90). For the other 10 drugs (Carmustine, Cyclosporin, Cytosar-U, Cytoxan, Gemcitabine, Indocin, Lindane, Methotrexate, Retrovir, and Zovirax) extrapolation on the regression curve out of the range of the actual doses tested was required to derive IC90 values (extrapolated IC90). The model correctly predicted the human MTD for 10 drugs out of 10 that had "actual IC90 values" and 7 drugs out of 10 for those having only an extrapolated IC90. Two of the incorrect predictions (Gemcitabine and Zovirax) were within 6-fold of the correct MTD, instead of the 4-fold range required by the model, whereas the prediction with Cytosar-U was approximately 10-fold in error. A possible explanation for the failure in the prediction of these three drugs, which are pyrimidine analogs, is discussed. We concluded that our model correctly predicted the human MTD for 20 drugs out of 23, since the other three drugs (Topotecan, PZA, and Flavopiridol) were tested in the prevalidation study. The high percentage of predicitivity (87%), as well as the reproducibility of the SOP testing, confirm that the model can be considered scientifically validated in this study, suggesting promising applications to other areas of research in developing validated hematotoxicological in vitro methods.     

Pharmacokinetic scaling of SJ-8029, a novel anticancer agent possessing microtubule and topoisomerase inhibiting activities,by species-invariant time methods

This study examined the pharmacokinetic disposition of SJ-8029, a novel anticancer agent possessing microtubule and topoisomerase inhibiting activities, in mice, rats, rabbits and dogs after i.v. administration. The serum concentration-time curves of SJ-8029 were best described by tri-exponential equations in all these animal species. The mean Cl, V(ss) and t(1/2) were 0.3 l/h, 0.1 l and 63.2 min in mice, 1.5 l/h, 1.6 l and 247.7 min in rats, 13.8 l/h, 39.6 l and 245.9 min in rabbits, and 29.2 l/h, 44.6 l and 117.4 min in dogs, respectively. Based on animal data, the pharmacokinetics of SJ-8029 were predicted in humans using simple allometry and also by several species-invariant time transformations using kallynochron, apolysichron and dienetichron times. The human pharmacokinetic parameters of Cl, V(ss) and t(1/2) predicted by the simple allometry and various species-invariant time methods were 50.4-145.0 l/h, 369.0-579.8 l and 242.0-1448.3 min, respectively. These preliminary parameter values may be useful in designing early pharmacokinetic studies of SJ-8029 in humans.     

重组人促黄体激素释放激素-绿脓杆菌外毒素A融合蛋白Ⅰ期人体耐受性临床研究

目的:考察人体对冻干重组人促黄体激素释放激素-绿脓杆菌外毒素A融合蛋白(lyophilizedrecombinant human luteinizing hormone releasing hormone-exotoxin of pseudomonas aeruginosa fusion protein,简称LHRH-PE40)的耐受性、最大耐受剂量(MTD)和药代动力学特点,以及人体对LHRH-PE40产生抗体的规律,并初步观察LHRH-PE40的抗肿瘤活性。方法:LHRH-PE40经静脉输注给药。单次给药试验共10例患者接受单剂LHRH-PE40治疗,剂量范围为220～1 110μg.m-2。每日给药试验14例患者接受LHRH-PE40输注每日1次,连用14 d,剂量范围120～600μg.m-2;隔日给药试验共7例患者接受LHRH-PE40输注隔日1次,共14次,剂量为600和700μg.m-2。结果:每日给药方法的MTD为400μg.m-2,剂量限制性毒性为乏力、食欲下降和肾功能损害。肾功能损害为一过性和可逆的。隔日给药方法的MTD为600μg.m-2。在MTD剂量时,LHRH-PE40的一般不良反应...     

On the anticipation of the human dose in first-in-man trials from preclinical and prior clinical information in early drug development

The drug development process is divided into phases with decisions required on compound selection and promotion to each subsequent development phase. In preclinical drug development the main objective is to bring the compound into human trials and there is an inability of many preclinical information packages to predict clinical responses. Since clinical responses are functions of the dose, the human dose anticipation should be a key deliverable of any preclinical package of drug candidate. The human dose should be anticipated by integration of information from multiple sources, in vitro and in vivo, non-human and human, using a variety of methodologies and approaches. Prediction of human safe and active dose relies on the availability of validated animal models for effect. Although there are many exceptions to the rule, the paper defines a four-step approach for the anticipation of human dose for first-in-man trials: 1, characterization of non-human exposure–response relationships; 2, correction for interspecies differences; 3, diagnosing compound absorption, distribution, metabolism and excretion (ADME) properties and prediction of human pharmacokinetics; and 4, prediction of human dose–responses and dose selection for phase I protocols.