1. Phase I trial of vandetanib and bevacizumab evaluating the VEGF and EGF signal transduction pathways in adults with solid tumours and lymphomas
- Author
-
Ismail B. Turkbey, Yvonne Horneffer, Yeong Sang Kim, Helen Chen, James H. Doroshow, Martin Gutierrez, Peter L. Choyke, Alice P. Chen, Liang Cao, Lamin Juwara, Yunkai Yu, Shivaani Kummar, Jane B. Trepel, Anthony J. Murgo, Deborah Allen, Giovanni Melillo, and Jerry M. Collins
- Subjects
Adult ,Male ,Vascular Endothelial Growth Factor A ,Oncology ,Cancer Research ,medicine.medical_specialty ,Time Factors ,Lymphoma ,Bevacizumab ,medicine.drug_class ,Contrast Media ,Antineoplastic Agents ,Antibodies, Monoclonal, Humanized ,Vandetanib ,Article ,Tyrosine-kinase inhibitor ,chemistry.chemical_compound ,Piperidines ,Pharmacokinetics ,Epidermal growth factor ,Neoplasms ,Internal medicine ,Biomarkers, Tumor ,medicine ,Humans ,Aged ,Epidermal Growth Factor ,business.industry ,Antibodies, Monoclonal ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Vascular Endothelial Growth Factor Receptor-2 ,Vascular endothelial growth factor ,chemistry ,Monoclonal ,Quinazolines ,Cancer research ,Female ,business ,Signal Transduction ,medicine.drug - Abstract
Purpose Inhibition of epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) pathways may result in synergistic antitumour activity. We designed a phase I study to evaluate the combination of vandetanib, an investigational agent with activity against EGF receptor and VEGF receptor 2, and bevacizumab, a monoclonal antibody against VEGF. Experimental design Patients with advanced solid tumours and lymphomas were enrolled. Objectives were to determine the safety and maximum tolerated dose of the combination, characterise pharmacokinetics, measure angiogenic marker changes in blood, and assess tumour blood flow using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Vandetanib was given orally once daily and bevacizumab intravenously once in every 3 weeks in 21-day cycles utilising a standard dose-escalation design. Results Fifteen patients were enrolled, and a total of 94 cycles of therapy were administered. No protocol-defined dose-limiting toxicities were observed; due to toxicities associated with chronic dosing, hypertension, proteinuria, diarrhoea and anorexia, dose escalation was stopped at the second dose level. We observed one partial response and one minor response; 9 patients experienced stable disease. There were significant changes in plasma VEGF and placental-derived growth factor levels, and decreases in K trans and k ep were observed by DCE-MRI. Conclusion In this trial, we safely combined two targeted agents that cause dual blockade of the VEGF pathway, demonstrated preliminary evidence of clinical activity, and conducted correlative studies demonstrating anti-angiogenic effect. The recommended phase II dose was established as vandetanib 200 mg daily and bevacizumab 7.5 mg/kg every 3 weeks.
- Published
- 2011