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Brown NF, Williams M, Arkenau HT, Fleming RA, Tolson J, Yan L, Zhang J, Singh R, Auger KR, Lenox L, Cox D, Lewis Y, Plisson C, Searle G, Saleem A, Blagden S, Mulholland P. A study of the focal adhesion kinase inhibitor GSK2256098 in patients with recurrent glioblastoma with evaluation of tumor penetration of [11C]GSK2256098. Neuro Oncol 2019; 20:1634-1642. [PMID: 29788497 DOI: 10.1093/neuonc/noy078] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background GSK2256098 is a novel oral focal adhesion kinase (FAK) inhibitor. Preclinical studies demonstrate growth inhibition in glioblastoma cell lines. However, rodent studies indicate limited blood-brain barrier (BBB) penetration. In this expansion cohort within a phase I study, the safety, tolerability, pharmacokinetics (PK), and clinical activity of GSK2256098 were evaluated in patients with recurrent glioblastoma. Biodistribution and kinetics of [11C]GSK2256098 were assessed in a substudy using positron-emission tomography (PET). Methods Patients were treated with GSK2256098 until disease progression or withdrawal due to adverse events (AEs). Serial PK samples were collected on day 1. On a single day between days 9 and 20, patients received a microdose of intravenous [11C]GSK2256098 and were scanned with PET over 90 minutes with parallel PK sample collection. Response was assessed by MRI every 6 weeks. Results Thirteen patients were treated in 3 dose cohorts (1000 mg, 750 mg, 500 mg; all dosed twice daily). The maximum tolerated dose was 1000 mg twice daily. Dose-limiting toxicities were related to cerebral edema. Treatment-related AEs (>25%) were diarrhea, fatigue, and nausea. Eight patients participated in the PET substudy, with [11C]GSK2256098 VT (volume of distribution) estimates of 0.9 in tumor tissue, 0.5 in surrounding T2 enhancing areas, and 0.4 in normal brain. Best response of stable disease was observed in 3 patients, including 1 patient on treatment for 11.3 months. Conclusions GSK2256098 was tolerable in patients with relapsed glioblastoma. GSK2256098 crossed the BBB at low levels into normal brain, but at markedly higher levels into tumor, consistent with tumor-associated BBB disruption. Additional clinical trials of GSK2256098 are ongoing.
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Affiliation(s)
- Nicholas F Brown
- NIHR UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Oncology, UCL Cancer Institute, London, UK
| | - Matthew Williams
- Computational Oncology Lab, Institute of Global Health Innovation, South Kensington Campus, Imperial College, London, UK.,Radiotherapy Department, Charing Cross Hospital, London, UK
| | - Hendrik-Tobias Arkenau
- Department of Oncology, UCL Cancer Institute, London, UK.,Sarah Cannon Research Institute UK, London, UK
| | - Ronald A Fleming
- GlaxoSmithKline, Research Triangle Park, Durham, North Carolina, USA
| | - Jerry Tolson
- GlaxoSmithKline, Research Triangle Park, Durham, North Carolina, USA
| | | | | | | | - Kurt R Auger
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Laurie Lenox
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - David Cox
- GlaxoSmithKline Research & Development Ltd, Uxbridge, UK
| | - Yvonne Lewis
- GlaxoSmithKline, Collegeville, Pennsylvania, USA.,Imanova Ltd, Centre for Imaging Sciences, London, UK
| | | | - Graham Searle
- Imanova Ltd, Centre for Imaging Sciences, London, UK
| | - Azeem Saleem
- Imanova Ltd, Centre for Imaging Sciences, London, UK
| | - Sarah Blagden
- NIHR/Wellcome Trust Imperial CRF, Imperial Centre for Translational and Experimental Medicine, Hammersmith Hospital, London, UK
| | - Paul Mulholland
- NIHR UCLH Clinical Research Facility, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Oncology, UCL Cancer Institute, London, UK
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Brown N, McBain C, Nash S, Hopkins K, Sanghera P, Saran F, Phillips M, Dungey F, Clifton-Hadley L, Wanek K, Krell D, Jeffries S, Khan I, Smith P, Mulholland P. Multi-Center Randomized Phase II Study Comparing Cediranib plus Gefitinib with Cediranib plus Placebo in Subjects with Recurrent/Progressive Glioblastoma. PLoS One 2016; 11:e0156369. [PMID: 27232884 PMCID: PMC4883746 DOI: 10.1371/journal.pone.0156369] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 05/12/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cediranib, an oral pan-vascular endothelial growth factor (VEGF) receptor tyrosine kinase inhibitor, failed to show benefit over lomustine in relapsed glioblastoma. One resistance mechanism for cediranib is up-regulation of epidermal growth factor receptor (EGFR). This study aimed to determine if dual therapy with cediranib and the oral EGFR inhibitor gefitinib improved outcome in recurrent glioblastoma. METHODS AND FINDINGS This was a multi-center randomized, two-armed, double-blinded phase II study comparing cediranib plus gefitinib versus cediranib plus placebo in subjects with first relapse/first progression of glioblastoma following surgery and chemoradiotherapy. The primary outcome measure was progression free survival (PFS). Secondary outcome measures included overall survival (OS) and radiologic response rate. Recruitment was terminated early following suspension of the cediranib program. 38 subjects (112 planned) were enrolled with 19 subjects in each treatment arm. Median PFS with cediranib plus gefitinib was 3.6 months compared to 2.8 months for cediranib plus placebo (HR; 0.72, 90% CI; 0.41 to 1.26). Median OS was 7.2 months with cediranib plus gefitinib and 5.5 months with cediranib plus placebo (HR; 0.68, 90% CI; 0.39 to 1.19). Eight subjects (42%) had a partial response in the cediranib plus gefitinib arm versus five patients (26%) in the cediranib plus placebo arm. CONCLUSIONS Cediranib and gefitinib in combination is tolerated in patients with glioblastoma. Incomplete recruitment led to the study being underpowered. However, a trend towards improved survival and response rates with the addition of gefitinib to cediranib was observed. Further studies of the combination incorporating EGFR and VEGF inhibition are warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT01310855.
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Affiliation(s)
- Nicholas Brown
- University College London Hospitals, London, United Kingdom
| | | | - Stephen Nash
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Kirsten Hopkins
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - Paul Sanghera
- Hall Edwards Radiotherapy Research Group, University Hospital Birmingham, Birmingham, United Kingdom
| | - Frank Saran
- Department of Radiotherapy and Paediatric Oncology, Royal Marsden NHS Trust, Sutton, United Kingdom
| | - Mark Phillips
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Fiona Dungey
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Katharina Wanek
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Daniel Krell
- Department of Academic Oncology, Royal Free Hospital, London, United Kingdom
| | - Sarah Jeffries
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Iftekhar Khan
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Paul Smith
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Paul Mulholland
- UCL Cancer Institute, University College London, London, United Kingdom
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Abstract
Despite an improved understanding of the molecular aberrations that occur in glioblastoma, the use of molecularly targeted therapies have so far been disappointing. We present a patient with three different brain tumours: astrocytoma, glioblastoma and gliosarcoma. Genetic analysis showed that the three different brain tumours were derived from a common origin but had each developed unique genetic aberrations. Included in these, the glioblastoma had PDGFRA amplification, whereas the gliosarcoma had MYC amplification. We propose that genetic heterogeneity contributes to treatment failure and requires comprehensive assessment in the era of personalised medicine.
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de Oliveira MS, Cechim G, Braganhol E, Santos DG, Meurer L, de Castro CG, Brunetto AL, Schwarstmann G, Battastini AMO, Lenz G, Roesler R. Anti-proliferative effect of the gastrin-release peptide receptor antagonist RC-3095 plus temozolomide in experimental glioblastoma models. J Neurooncol 2009; 93:191-201. [DOI: 10.1007/s11060-008-9775-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 12/22/2008] [Indexed: 10/21/2022]
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