Mifamurtide in metastatic and recurrent osteosarcoma: a patient access study with pharmacokinetic, pharmacodynamic, and safety assessments

PURPOSE

This non-randomized, patient-access protocol, assessed both safety and efficacy outcomes following liposomal muramyl-tripeptide-phosphatidylethanolamine (L-MTP-PE; mifamurtide) in patients with high-risk, recurrent and/or metastatic osteosarcoma.

METHODS

Patients received mifamurtide 2 mg/m(2) intravenously twice-weekly ×12 weeks, then weekly ×24 weeks with and without chemotherapy. Serum concentration-time profiles were collected. Adverse events within 24 hours of drug administration were classified as infusion-related adverse events (IRAE); other AEs and overall survival (OS) were assessed.

RESULTS

The study began therapy in January 2008; the last patient completed therapy in October 2012. Two hundred five patients were enrolled; median age was 16.0 years and 146/205 (71%) had active disease. Mifamurtide serum concentrations declined rapidly in the first 30 minutes post-infusion, then in a log-linear manner 2-6 hours post-dose; t1/2 was 2 hours. There were no readily apparent relationships between age and BSA-normalized clearance, half-life, or pharmacodynamic effects, supporting the dose of 2 mg/m(2) mifamurtide across the age range. Patients reported 3,679 IRAE after 7,482 mifamurtide infusions. These were very rarely grade 3 or 4 and most commonly included chills + fever or headache + fatigue symptom clusters. One- and 2-year OS was 71.7% and 45.9%. Patients with initial metastatic disease or progression approximated by within 9 months of diagnosis (N = 40) had similar 2-year OS (39.9%) as the entire cohort (45.9%)

CONCLUSIONS

Mifamurtide had a manageable safety profile; PK/PD of mifamurtide in this patient access study was consistent with prior studies. Two-year OS was 45.9%. A randomized clinical trial would be required to definitively determine impact on patient outcomes.

The influence of laser-induced 3-D titania nanofibrous platforms on cell behavior

The current challenge in tissue engineering is to design a platform that can provide appropriate topography and suitable surface chemistry to encourage desired cellular activities and to guide 3-D tissue regeneration. Compared with traditional cell culture materials, 3-D nanofibrous platforms offer a superior environment for promoting cell functions by mimicking the architecture of extracellular matrix (ECM). In this study, we present a technique to engineer freestanding 3-D titania nanofibrous structures on titanium substrates using femtosecond laser processing. The crystallinity, surface adhesion, and surface energy of the synthesized nanostructures are discussed. The effects of synthesized nanoarchitectures on the proliferation, morphology, and viability of MC3T3-E1 mouse osteoblast-like cells and NIH 3T3 mouse embryonic fibroblasts are investigated. The nanofibrous structures show high surface energy and hydrophilicity. The results from in vitro studies reveal that the titania nanofibrous architectures possess excellent biocompatibility and significantly enhances proliferation of both cell lines compared to untreated titanium specimens. Study of the cell morphology shows dynamic cell migration and attachment on the titania nanofibrous architecture. The bioactivity and biocompatibility of the engineered 3-D nanostructures suggest noticeable perspective for developing bio-functionalized scaffolds and implantable materials in regenerative medicine and clinical tissue engineering.

Synthesis of bio-functionalized three-dimensional titania nanofibrous structures using femtosecond laser ablation

The primary objective of current tissue regeneration research is to synthesize nano-based platforms that can induce guided, controlled, and rapid healing. Titanium nanotubes have been extensively considered as a new biomaterial for biosensors, implants, cell growth, tissue engineering, and drug delivery systems. However, due to their one-dimensional structure and chemical inertness, cell adhesion to nanotubes is poor. Therefore, further surface modification is required to enhance nanotube-cell interaction. Although there have been a considerable number of studies on growing titanium nanotubes, synthesizing a three-dimensional (3-D) nano-architecture which can act as a growth support platform for bone and stem cells has not been reported so far. Therefore, we present a novel technique to synthesize and grow 3-D titania interwoven nanofibrous structures on a titanium substrate using femtosecond laser irradiation under ambient conditions. This surface architecture incorporate the functions of 3-D nano-scaled topography and modified chemical properties to improve osseointegration while at the same time leaving space to deliver other functional agents. The results indicate that laser pulse repetition can control the density and pore size of engineered nanofibrous structures. In vitro experiments reveal that the titania nanofibrous architecture possesses excellent bioactivity and can induce rapid, uniform, and controllable bone-like apatite precipitation once immersed in simulated body fluid (SBF). This approach to synthesizing 3-D titania nanofibrous structures suggests considerable promise for the promotion of Ti interfacial properties to develop new functional biomaterials for various biomedical applications.

Abstract P3-14-20: Phase 1 Dose-Escalation Study of the Investigational HER2/EGFR Inhibitor TAK-285 in Patients with Advanced Cancer

Background and Objectives: TAK-285 is a novel, orally active, dual HER2/EGFR inhibitor. Nonclinical data show that TAK-285 has high selectivity and specificity for binding to HER family kinases, and has demonstrated anti-tumor activity in a BT-474 mouse xenograft model of breast cancer. Nonclinical data also indicate that TAK-285 is not a substrate for the efflux transporters P-gp and BCRP and penetrates an intact blood-brain barrier in rats. This phase 1 dose-escalation study in patients with advanced cancer aimed to determine the safety and pharmacokinetic (PK) profile.

Methods: Adults had advanced histologically confirmed non-hematologic malignancies, life expectancy >12 weeks, adequate bone marrow, liver and renal function, ECOG PS 0-2, and were refractory to other treatments. Oral TAK-285 was escalated from 50 to 500 mg QD or BID for 21 or 28 consecutive days of a 28-day cycle until disease progression or unacceptable toxicity was observed.

Results: At the data cut-off of 04/23/10, the dose-escalation portion was complete, and the RP2D expansion cohort is ongoing. Preliminary data from the dose-escalation cohorts are reported. 43 patients (median age 60 years [43-76]) were enrolled: 30% ≥65 years, 51% female, and 86% white. Dose levels were 50 mg QD (N=4), 50 mg BID (N=7), and 75 mg BID (N=6) on d 1-21; and 150 mg (N=6), 225 mg (N=4), 325 mg (N=3), 400 mg (N=6), and 500 mg (N=7) BID on d 1-28. Median duration of exposure across all cohorts was 52 days (3-267). Four patients experienced a DLT in Cycle 1: 1 patient (50 mg BID) had Grade 3 pancreatitis; 1 patient (150 mg BID) had Grade 3 chest pain and Grade 3 hypoxia; 1 patient (500 mg BID) had Grade 3 increased ALT; and 1 patient (500 mg BID) had Grade 3 diarrhoea and Grade 3 hypokalaemia. The MTD was 400 mg BID d 1-28. 30 patients (70%) discontinued TAK-285, primarily due to disease progression (n=19, 44%) or an AE (n=9, 21%). Most frequent AEs were fatigue (37%), diarrhoea (35%), nausea (26%), anorexia (21%), vomiting (16%), and elevated AST (16%). 58% of patients had a drug-related AE; the most frequent were diarrhoea (21%), fatigue (19%), and rash (includes rash, rash maculo-papular and rash macular; 12%). 35% of patients had a grade 3/4 AE; the most common were hypokalaemia (7%), ileus, abdominal pain, and hypoxia (5% each). Grade 3/4 AEs related to TAK-285 were the DLTs in Cycle 1 and Grade 4 rhabdomyolysis in 1 patient (400 mg BID, d 1-28) in Cycle 3. 42% of patients experienced a serious AE (SAE); the only SAE seen in >1 patient was ileus (n=2). 4 (9%) patients had fatal AEs; none were considered related to TAK-285. Absorption was fast: plasma concentrations peaked 2-3 hours post-dose. Steady-state plasma exposures increased with dose in a greater than dose-proportional manner, with PK steady-state achieved by Day 8. Accumulation was noted with BID dosing (mean accumulation ratio, 2.4 at MTD); there was moderate fluctuation in plasma concentrations over the steady-state dosing interval (mean Cmax:Cmin ratio, 2.4 at MTD).

Conclusions: The MTD for TAK-285 was 400 mg BID d 1-28. The RP2D cohort is ongoing and includes CSF collection to assess the CNS distribution of TAK-285. Updated safety as well as efficacy data for the dose escalation cohorts will be presented.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-14-20.

Nanofiber Plasmon Enhancement of Two-Photon Polymerization Induced by Femtosecond Laser

The nanofiber plasmon effect on the two-photon polymerization (2PP) induced by a femtosecond laser is reported for the first time in this paper. The nanofibers were generated using a femtosecond laser, which was also used to construct microfeatures through two-photon polymerization of a nanofiber dispersed polymer resin. Nanofiber plasmon resonant effect greatly enhances local field intensities, resulting in increased particle scattering cross sections. This leads to a drastic enhancement of two-photon-like absorption processes, allowing much lower incident radiation intensities to be used. The huge enhancements in local field intensity due to nanofiber plasmon resonances have been shown to lower the required intensity for 2PP by factors of 10 or more.

Mechanical Property Enhancement of Nanocomposite Microstructures Generated by Two Photon Polymerization

The mechanical properties of nanofiber reinforced polymer microstructures were investigated in this work by means of nanoindentation. The femtosecond laser was used to generate nanofibers on selected area on the surface of the substrate and to generate microstructures. These microstructures were formed via two photon polymerization using femtosecond laser material processing by incorporation of silicon nanofibers into Ormocer matrix. Results show that the hardness and elastic modulus of the nanocomposites have improved by 25% and 75%, respectively, with the incorporation of nanofibers using the described method, which has the potential of direct fabrication of reinforced micro-/nanostructures. The volume fraction of the generated nanofibers in the nanocomposite was calculated by using nanoindentation analysis.

Single step self-enclosed fluidic channels via Two Photon Absorption (TPA) polymerization

In this paper, we demonstrate a simple, fast and single-step method for fabricating self-enclosed fluidic channels via TPA. Pairs of parallel, polymerized ribs are linked by the subsequent polymerization with correctly predetermined offset between the ribs. The region, where the radicals are initiated but its concentration is below the threshold, we called it a sub-activated region. The subsequent polymerization is triggered by the overlap of the sub-activated regions of the two adjacent ribs. The dimensions of the self-enclosed channels depends on the offset between ribs, the scan speed as well as the laser parameters such as pulse energy, pulse width and repetition rate.

Synthesis of Nanoscale Tips Using Femtosecond Laser Radiation under Ambient Condition

We report a unique growth of platelet-shaped nanoscale tips of transparent dielectric using femtosecond laser radiation at MHz pulse repetition rate with nitrogen background gas flow under ambient condition. The tips grew with sharp nanoscale apex while their base and lengths are of the order of few hundred nanometers. In the absence of nitrogen, the irradiation leads to nanofibrous structure formation. The collision between the nitrogen gas atoms and the vapor species slows down plume expansion and lead to an increase of nanoparticles size. This prevents the fibrous structure formation and provides appropriate condition for nanoscale tips growth.

Synthesis of Glass Nanofibers Using Femtosecond Laser Radiation Under Ambient Condition

We report the unique growth of nanofibers in silica and borosilicate glass using femtosecond laser radiation at 8 MHz repetition rate and a pulse width of 214 fs in air at atmospheric pressure. The nanofibers are grown perpendicular to the substrate surface from the molten material in laser-drilled microvias where they intertwine and bundle up above the surface. The fibers are few tens of nanometers in thickness and up to several millimeters in length. Further, it is found that at some places nanoparticles are attached to the fiber surface along its length. Nanofiber growth is explained by the process of nanojets formed in the molten liquid due to pressure gradient induced from the laser pulses and subsequently drawn into fibers by the intense plasma pressure. The attachment of nanoparticles is due to the condensation of vapor in the plasma.

Pharmacodynamic effects of MLN4924, a novel NAE inhibitor, on blood and skin

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Background: MLN4924 is a first-in-class, small molecule inhibitor of NEDD8 Activating Enzyme (NAE) with potent antitumor activity in animal models. Inhibition of NAE by MLN4924 leads to decreased neddylation and inhibition of cullin-RING ubiquitin ligase (CRL) activity. CRLs are enzyme complexes that control the ubiquitination and degradation of proteins with important roles in cell cycle and survival. Potent antitumor activity in animal models correlates with accumulation of substrates of the CRLs associated with DNA replication (e.g.Cdt-1), stress response (e.g.Nrf-2), and signal transduction (e.g. pIκB). Methods: A primary objective of this phase I trial in patients (pts) with advanced non-hematologic malignancies was to evaluate the pharmacodynamic (PD) effects of MLN4924 as measured by accumulation of pIκB in peripheral blood mononuclear cells (PBMCs) and Cdt-1 and Nrf-2 in skin. Pts were treated with a daily infusion of MLN4924 for 5 days of a 21-day cycle. PBMCs were isolated for analysis of pIκB levels at screening, baseline, and at selected time points following its administration. Skin biopsies for assay of Cdt-1 and Nrf-2 were performed at baseline and following the second dose of MLN4924. Results: 10 pts have been treated at 3 dose levels. Treatment emergent adverse events include elevations in transaminases, bilirubin and alkaline phosphatase. PK analysis indicated approximately dose-proportional increases in MLN4924 exposure with an estimated half life of 5 to 15 hours and no readily apparent drug accumulation. Analysis of pIκB levels in PBMCs demonstrated accumulation from baseline levels following administration of MLN4924. Cdt-1 and Nrf-2 levels in skin rose above baseline following the second dose of MLN4924. Conclusions: Treatment of pts with MLN4924 results in accumulation of substrates associated with inhibition of NAE in both peripheral blood and skin. Inhibition occurs at exposure levels that are comparable to those resulting in pharmacodynamic activity and in vivo tumor activity in xenograft models. Evidence of PD modulation of NAE activity through the accumulation of CRL substrates has been established in this early analysis, and dose escalation is ongoing to establish the MTD of this agent.

[Table: see text]

Maskless fabrication of nano-fluidic channels by two-photon absorption (TPA) polymerization of SU-8 on glass substrate

We present a simple, fast, and repeatable method for fabricating nano-fluidic channels based on two-photon absorption (TPA) polymerization. Since our method does not require any mask, it is relatively cheaper and faster than other conventional lithography techniques. We illustrate that SU-8 has pronounced photoinitiation threshold behavior, which linearly decreases as the repetition rate increases. If the pulse energy and the repetition rate are controlled, channel width can be easily controlled. We report fluidic channels up to 110 nm in width, between polymerized parallel ribs, utilizing TPA and the photoinitiation threshold properties of SU-8. Finally, we also show that high repetition rate laser presents greater controllability in size of the polymerized region by varying fluence.

Mechanism-based inactivation of human cytochrome P450 enzymes: strategies for diagnosis and drug-drug interaction risk assessment

Among drugs that cause pharmacokinetic drug-drug interactions, mechanism-based inactivators of cytochrome P450 represent several of those agents that cause interactions of the greatest magnitude. In vitro inactivation kinetic data can be used to predict the potential for new drugs to cause drug interactions in the clinic. However, several factors exist, each with its own uncertainty, that must be taken into account in order to predict the magnitude of interactions reliably. These include aspects of in vitro experimental design, an understanding of relevant in vivo concentrations of the inactivator, and the extent to which the inactivated enzyme is involved in the clearance of the affected drug. Additionally, the rate of enzyme degradation in vivo is also an important factor that needs to be considered in the prediction of the drug interaction magnitudes. To address mechanism-based inactivation for new drugs, various in vitro experimental approaches have been employed. The selection of approaches for in vitro kinetic characterization of inactivation as well as in vitro-in vivo extrapolation should be guided by the purpose of the exercise and the stage of drug discovery and development, with an increase in the level of sophistication throughout the research and development process.