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Abou-Alfa GK, Capanu M, O'Reilly EM, Ma J, Chou JF, Gansukh B, Shia J, Kalin M, Katz S, Abad L, Reidy-Lagunes DL, Kelsen DP, Chen HX, Saltz LB. A phase II study of cixutumumab (IMC-A12, NSC742460) in advanced hepatocellular carcinoma. J Hepatol 2014; 60:319-24. [PMID: 24045151 PMCID: PMC3901953 DOI: 10.1016/j.jhep.2013.09.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/29/2013] [Accepted: 09/06/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS IGF-IR is implicated in hepatic carcinogenesis. This and preliminary evidence of biological activity of anti-IGF-1R monoclonal antibody cixutumumab in phase I trials prompted this phase II study. METHODS Patients with advanced HCC, Child-Pugh A-B8, received cixutumumab 6mg/kg weekly, in a Simon two-stage design study, with the primary endpoints being 4-month PFS and RECIST-defined response rate. Tissue and circulating markers plus different HCC scoring systems were evaluated for correlation with PFS and OS. RESULTS As a result of pre-specified futility criteria, only stage 1 was accrued: N=24: median age 67.5 years (range 49-83), KPS 80% (70-90%), 20 males (83%), 9 stage III (37%)/15 stage IV (63%), 18 Child-Pugh A (75%), 11 HBV (46%)/10 HCV (42%)/11 alcoholic cirrhosis (46%)/2 NASH (8%), 11 (46%) diabetic. Median number of doses: 7 (range 1-140). Grade 3/4 toxicities >10% included: diabetes, elevated liver function tests, hyponatremia, and lymphopenia. Four-month PFS was 30% (95% CI 13-48), and there were no objective responses. Median overall survival was 8 months (95% CI 5.8-14). IGF-R1 staining did not correlate with outcome. Elevated IGFBP-1 correlated with improved PFS (1.2 [95% CI 1-1.4]; p 0.009) and OS (1.2 [95% CI 1.1-1.4]; p 0.003). CONCLUSIONS Cixutumumab monotherapy did not have clinically meaningful activity in this unselected HCC population. Grade 3-4 hyperglycemia occurred in 46% of patients. Elevated IGFBP-1 correlated with improved PFS and OS.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/metabolism
- Carcinoma, Hepatocellular/blood
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/therapy
- Female
- Humans
- Insulin-Like Growth Factor Binding Protein 1/blood
- Insulin-Like Growth Factor Binding Protein 3/blood
- Insulin-Like Growth Factor I/metabolism
- Insulin-Like Growth Factor II/metabolism
- Kaplan-Meier Estimate
- Liver Neoplasms/blood
- Liver Neoplasms/pathology
- Liver Neoplasms/therapy
- Male
- Middle Aged
- Receptor, IGF Type 1/metabolism
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Affiliation(s)
- Ghassan K Abou-Alfa
- Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Department of Internal Medicine, Weill Medical College at Cornell University, New York, NY, United States.
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Eileen M O'Reilly
- Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Department of Internal Medicine, Weill Medical College at Cornell University, New York, NY, United States
| | - Jennifer Ma
- Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Joanne F Chou
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Bolorsukh Gansukh
- Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Jinru Shia
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Marcia Kalin
- Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Seth Katz
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Leslie Abad
- Research Department, ImClone Systems, a wholly-owned subsidiary of Eli Lilly & Company, New York, NY, United States
| | - Diane L Reidy-Lagunes
- Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Department of Internal Medicine, Weill Medical College at Cornell University, New York, NY, United States
| | - David P Kelsen
- Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Department of Internal Medicine, Weill Medical College at Cornell University, New York, NY, United States
| | - Helen X Chen
- Cancer Therapy Evaluation Program (CTEP), National Cancer Institute, Bethesda, MD, United States
| | - Leonard B Saltz
- Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Department of Internal Medicine, Weill Medical College at Cornell University, New York, NY, United States
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