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Supplemental Figures S7. Supplemental Figures S7. Effects of JQ1 and OTX015 on BRD4 binding to MYD88 promoter region in DLBCL cell lines.

Purpose: In cancer cells, the epigenome is often deregulated, and inhibition of the bromodomain and extra-terminal (BET) family of bromodomain-containing proteins is a novel epigenetic therapeutic approach. Preliminary results of an ongoing phase I trial have reported promising activity and tolerability with the new BET bromodomain inhibitor OTX015.Experimental Design: We assessed the preclinical activity of OTX015 as single agent and in combination in mature B-cell lymphoma models and performed in vitro and in vivo experiments to identify the mechanism of action and the genetic features associated with sensitivity to the compound.Results: OTX015 showed antiproliferative activity in a large panel of cell lines derived from mature B-cell lymphoid tumors with median IC50 of 240 nmol/L, without significant differences among the different histotypes. In vitro and in vivo experiments showed that OTX015 targeted NFKB/TLR/JAK/STAT signaling pathways, MYC- and E2F1-regulated genes, cell-cycle regulation, and chromatin structure. OTX015 presented in vitro synergism with several anticancer agents, especially with mTOR and BTK inhibitors. Gene expression signatures associated with different degrees of sensitivity to OTX015 were identified. Although OTX015 was mostly cytostatic, the compound induced apoptosis in a genetically defined subgroup of cells, derived from activated B-cell–like diffuse large B-cell lymphoma, bearing wtTP53, mutations in MYD88, and CD79B or CARD11.Conclusions: Together with the data coming from the ongoing phase I study, the in vitro and in vivo data presented here provide the basis for further clinical investigation of OTX015 as single agent and in combination therapies. Clin Cancer Res; 21(7); 1628–38. ©2015 AACR.

Supplemental Figures S1-2. Supplemental Figures S1: effects of OTX015 on cell cycle and cell growth in DLBCL cell lines. Supplemental Figures S2: effects of OTX015 on apoptosis in DLBCL cell lines.

Supplemental Table S4: List of gene-sets associated with the sensitivity to OTX015.

Supplemental Figures S6. Supplemental Figures S6: OTX015 effects on the production of IL-4 and IL-10 in DLBCL cell lines.

Supplemental Figures S3-5. Supplemental Figures S3: the gene expression changes induced by OTX015 in DLBCL cell lines. Supplemental Figures S4: network of genes affected by OTX015. Supplemental Figures S5: similar biologic effects of OTX015 and JQ1.

Supplemental Table S1: Cell lines and growth medium.

Background: OTX015 (OncoEthix SA, Switzerland) is a novel oral bromodomain and extraterminal (BET) protein family inhibitor, with in vitro and in vivo activity in a variety of hematologic and solid tumor cells. A phase Ib study with OTX015 in patients with hematologic malignancies is underway including a pharmacokinetic (PK) investigation. The PK objectives of this study were to determine the PK profile of oral OTX015 using a population approach. Materials and Methods: A multicenter, dose escalation study in cohorts of 3 to 6 patients with acute leukemia or other hematologic malignancies was performed with a dose escalation step followed by expansion cohorts at the recommended dose. Patients received oral OTX015 from 10 to 160 mg different schedules. PK blood samples from 7 time points were collected over 24 h post-administration on Day 1 for leukemia patients (complete PK) and 4 blood samples over 8 h post-administration for patients with other hematologic malignancies (limited PK). OTX015 plasma concentrations were measured using validated ultra-performance liquid chromatography with tandem mass spectrometry detection with a concentration range 1-250ng/mL. Analyses and population PK (PPK) modeling were performed with the nonlinear mixed effect modeling software program Monolix version 4.3. The following parameters were calculated absorption constant (Ka); apparent distribution volume (V/F); apparent clearance (CL/F) and lean body mass (LBM; calculated considering patient sex, weight and height) was considered as covariate. Results: 85 patients enrolled and treated from January 2013 to August 2014, randomized to six dose levels (10, 20, 40, 80, 120 and 160 mg) QD and 40 mg BID were evaluated. Among them, 81 patients with 630 plasma concentrations (607 + 23 BLQ) were evaluable for PK assessment. A 1-compartment open model adequately described the total OTX015 concentration-time curve. The PPK parameters obtained for the structural model were Ka = 0.74 h−1 (12%); V/F = 71.7 L (6.0%) and CL/F = 8.45 L/h (5.0%). The best correlation between OTX015 AUC values and dose was observed from 10 to 120 mg dose levels (R2 = 0.71). The absorption phase was linear and Tmax was between 1 and 4 h. Mean elimination half-life of OTX015 for all patients was 5.8 h (± 1.1). In the PPK study, the best descriptive model was obtained when LBM was considered in the analysis. A correlation between CL/F and V/F was also observed for OTX015. Conclusions: The PK of OTX015 is best described by a one-compartment model. Preliminary PPK analysis considering only the dose escalation cohort of the Phase I trial indicates that LBM is a good predictor of the OTX015 PK profile. This model should be validated in the ongoing expansion cohorts treated at 80mg QD. Citation Format: Elodie Odore, Francois Lokiec, Maria Eugenia Riveiro, Fabrice Bourdel, Carmen Kahatt, Patrice Herait, Esteban Cvitkovic, Keyvan Rezai. Pharmacokinetics of OTX015 in a phase Ib dose-finding study of patients with hematologic malignancies: Preliminary results of a population PK analysis. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4511. doi:10.1158/1538-7445.AM2015-4511

Background: Lymphomas are still incurable in many patients and novel active compounds are actively being sought. We previously reported single agent activity of the BET bromodomain OTX015 in lymphoma cell lines and in vivo (AACR 2012; ICML 2013). Here, we report a study of the mechanism of action of OTX015 and its activity in combination with other anti-cancer compounds. Methods: Cell lines: 22 diffuse large B-cell lymphoma (DLBCL), 4 mantle cell lymphomas, 3 multiple myelomas, 3 splenic marginal zone lymphoma and 1 prolymphocytic leukemia. Anti-proliferative of OTX015 (OncoEthix SA, Switzerland) was assessed by MTT and its cytotoxic activity by Annexin V staining and gene expression profiling (GEP) with Illumina HumanHT-12 Expression BeadChips. Data mining was done with LIMMA, GSEA, Metacore. Synergy was assessed in cells (2-5 cell lines) exposed for 72 h to increasing doses of OTX015 alone or in combination with increasing doses of other agents. MTT assays were performed and Chou-Talalay combination index (CI) calculated. Results: OTX015 (500 nM, 72h) showed cytostatic activity in 29/33 (88%) cell lines and apoptosis in 3/22 (14%). Mutations in genes coding for MYD88 and components of BCR (P=0.027), and ABC signaling phenotypes (P=0.008) were significantly associated with apoptosis induction. We performed GEP on 2 cell lines (SU-DHL-6, SU-DHL-2), treated with DMSO or OTX015 (500 nM) for 1, 2, 4, 8 or 12 hours. Most upregulated genes were histones. MYC target genes were highly significantly enriched among all OTX015 regulated transcripts and MYC was the most frequently downregulated gene. OTX015 also downregulated MYD88, IRAK1, TLR6, IL6, STAT3, and TNFRSF17, members of the NFKB, TLR and JAK/STAT pathways. NFKB target genes (IRF4, TNFAIP3 and BIRC3) were also downregulated (PCR). Immunoblotting and immunohistochemistry showed a reduction of transcriptionally active pSTAT3 in 2 ABC cell lines, and a reduction in nuclear localization of p50 (NFKB1), indicating an inhibitory effect of OTX015 on the canonical NFKB pathway. Finally, IL10 and IL4 production was reduced after 24 hours OTX015 treatment. Synergy was observed with everolimus (median CI=0.1; range 0.1-0.2), ibrutinib in ABC-DLBCL (CI=0.04; 0.02-0.1), idelalisib (CAL101) (CI=0.5; 0.04-2.4), vorinostat (CI=0.5; 0.3-0.6), rituximab (CI=0.5; 0.4-0.5), decitabine (CI=0.6; 0.6-0.7), lenalidomide (CI=0.7; 0.6-0.7), and all-trans retinoic acid (CI=0.4; .1-1.6). Additive effects were observed for combinations with romidepsin (CI=1.08; 1-1.22), bendamustine (CI=0.92; 0.83-1.1), and doxorubicin (CI=0.83; 0.71-0.96). Conclusions: OTX015 is a promising candidate for targeted combination therapies. A phase I study (NCT01713582) in patients with hematological neoplasias is underway and together with our preclinical data, may support further clinical investigations. Citation Format: Eugenio Gaudio, Elena Bernasconi, Ivo Kwee, Michela Boi, Paola Bonetti, Chiara Tarantelli, Andrea Rinaldi, Monica Testoni, Maurilio Ponzoni, Anastasios Stathis, Georg Stüssi, Eugenia Riveiro, Patrice Herait, Emanuele Zucca, Francesco Bertoni. The BET Bromodomain inhibitor OTX015 targets the NFKB, TLR and JAK/STAT pathways and shows pre-clinical activity as single agent and in combination in mature B-cell tumors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5528. doi:10.1158/1538-7445.AM2014-5528

Background: The human BET family bromodomains, including BRD2-4 and BRDT proteins, has become a druggable target for the development of specific gene transcription inhibitors. Here, we report the preclinical anti-leukemic activity of OTX015 (OncoEthix SA, Switzerland), a novel pan-BET-BRD inhibitor, as single agent and in combination with different drugs. Material and Methods: Eight established human cell lines from acute and chronic myeloid leukemia (AML, i.e. HL-60 and U-937; CML, i.e. K-562 and NALM-1) and acute lymphoblastic leukemia (ALL, i.e. Jurkat, CCRF-CEM, MOLT-3 and -4) were treated by increasing doses of OTX015. The growth inhibition 50% (GI50) values of OTX015 were evaluated by MTT the assay at 72 h. Protein levels were analyzed by Western blot using commercial antibodies. RNA was extracted using the Qiagen RNAEasy and RT-PCR was performed using Fast SYBR Green on a StepOnePlus Real-Time PCR System. Combination effects were evaluated in HL60, U937, Jurkat and K562 cell lines; OTX015 was administered with daunorubicin, azacytidine, dexamethasone, cytarabine or methotrexate. The 48-h combination index (CI) was determined by median effect plot analysis using CalcuSyn software expressed as the median and range of CI values among cell lines (Chou & Talalay analysis). CI1: antagonism. Results: Firstly, the anti-proliferative effect of OTX015 was assessed. In HL60, U937 and Jurkat cells, GI50s values were between 230 and 384 nM, while ≥ 1,000 nM for the remaining cell lines. Both OTX015-sensitive and -resistant cells showed similar basal expression levels of BRD2-4, c-MYC, BCL-2, p21 and Cyclin D1 proteins. In sensitive cell lines, OTX015 caused cell cycle arrest in G1 in a time-dependent manner without induction of apoptosis. Likewise, c-MYC mRNA and protein levels were down-regulated after 6-h and up to 72-h treatments with 500 nM OTX015. In Jurkat cells, OTX015 induced up-regulation of BRD2 and 4 mRNA without modifying protein levels. On the other hand, although the OTX015-resistant cell line K562 showed decreased levels of c-MYC mRNA after 4-h and 24-h exposure, protein levels were constant even after 72 h of treatment. Synergy was observed with daunorubicin in OTX015-sensitive and -resistant cell lines (CI=0.8;0.4-0.9). The combination of OTX015 with azacytine or cytarabine was synergistic (CI=0.6;0.6-0.7 and CI=0.8;0.4-0.9, respectively) despite primary resistance of Jurkat and K562 lines to either of the individual drugs. Methotrexate, dexamethasone and panobinostat exerted synergistic effects with OTX015 in 3 out of 4 cell lines (CI=0.5;0.2-0.9; CI=0.3;0.1-0.7 and CI=0.6;0.5-0.7). Conclusion: Our findings indicate that OTX015 enhances in vitro anti-proliferative effects of standard antileukemic agents supporting combination therapy as an important aspect of the clinical development plan. Citation Format: Lucile Astorgues-Xerri, Ramiro Vázquez, Mohamed Bekradda, Esteban Cvitkovic, Patrice Herait, Eric Raymond, María E. Riveiro. In vitro evaluation of OTX015, a novel pan-BET-bromodomain (BET-BRD) inhibitor, as single agent and in combination with standard chemotherapy drugs in human leukemic cell lines. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5529. doi:10.1158/1538-7445.AM2014-5529

Background: OTX015 is a novel inhibitor of the bromodomain and extra-terminal (BET) protein family. This synthetic oral small molecule targets the BET transcriptional co-activator proteins BRD2/3/4, which are potential cancer targets particularly in hematologic malignancies. A phase Ib study with OTX015 administered to patients with hematologic malignancies was performed including a pharmacokinetic (PK) investigation. The PK objectives of this study were to determine the PK profile and perform a PK/PD modeling of oral OTX015 using a population approach. Materials and Methods: A multicenter, dose escalation study is underway in cohorts of 3 to 6 patients with acute leukemia and other hematologic malignancies. Patients received oral OTX015 at a starting dose of 10 mg once daily (QD). PK blood samples from 7 time points were collected over 24 h post-administration (complete PK) on Day 1 for leukemia patients and 4 blood samples over 8 h post-administration were collected for patients with other malignancies (limited sampling PK). Plasma concentrations of OTX015 were measured using validated Ultra Performance Liquid Chromatography with tandem Mass Spectrometry detection (UPLC-MS/MS) with a concentration range 1 - 250 ng/mL. Analyses and population PK (PPK) modeling were performed with the nonlinear mixed effect modeling software program Monolix version 4.2. Results: From January 2013 to January 2014, 36 patients were treated at four dose levels (10, 20, 40, 80 mg) QD and 40 mg BID. 302 plasma concentrations (289 + 13 BLQ) were analyzed. A 1-compartment open model adequately described the total OTX015 time-concentration curve. The PPK parameters obtained for the structural model were: Ka (absorption constant) = 1.12 h-1; V (distribution volume) = 68.6 L and CL (clearance) = 6.65 L/h with a relative standard error of 27%, 9% and 10% respectively. AUC values for all patients increased dose-proportionally (R²= 0.995). The absorption phase was linear and Tmax was between 1 and 4 hours. Mean elimination half-life of OTX015 for all patients was 7.16 h. The main covariate effects in PPK modeling were body weight (BW) which influenced CL, V. No significant gender influence on PK parameters was observed. Conclusions: The PK of OTX015 is best described by a one-compartment model. BW influenced significantly PK parameters of OTX015. AUC-dose proportionality was observed. Evaluation of glucuronidated metabolite concentrations is ongoing and will contribute to understanding the pathways involved in OTX015 metabolism. PK/PD modeling will be performed to describe toxicity and efficacy (6 experienced clinically meaningful activities) in terms of OTX015 PK. A comparison between QD and BID schemes will be performed in order to verify PK profile of OTX015 for each administration. Citation Format: Elodie Odore, Keyvan Rezai, Eugenia Riveiro, Fabrice Bourdel, Patrice Herait, Esteban Cvitkovic, Herve Dombret, Francois Lokiec. A phase I pharmacokinetic study of OTX015 for the treatment of patients with hematologic malignancies. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr LB-231. doi:10.1158/1538-7445.AM2014-LB-231

Background: Various inhibitors targeting the activity of BET proteins have been recently developed and have shown potent anti-proliferative effects in several tumors, including NSCLC. The fusion of the echinoderm microtubule-associated protein-like 4 (EML4) and the anaplastic lymphoma kinase (ALK) genes results in the chimeric oncogene EML4-ALK, identified as a distinct entity of NSCLC patients that enables effective ALK-targeted therapy. However, most of these patients invariably acquire resistance within few months. Herein, we report preclinical findings obtained with a novel oral pan-BET-BRD inhibitor, OTX015, in a panel of NSCLC cell lines, some of which bear the fusion protein EML4-ALK. Materials and Methods: Five established NSCLC cell lines (i.e. H2228, H3122, A549, HOP62 and HOP92) were exposed to increasing concentrations of OTX015 (OncoEthix SA, Switzerland). In each case, the effect on cell viability was determined by the MTT assay after 72 h of exposure. GI50 values, representing 50% growth inhibition concentration, were calculated using GraphPad Prism 5.0 software. Protein levels were determined by Western blot using commercial antibodies. RNA was extracted with the Qiagen RNAEasy kit and reverse-transcribed using the Superscript First-Strand Synthesis System for RT-PCR kit following manufacturer's instructions. RT-PCR was performed using Fast SYBR Green Master Mix on a StepOnePlus Real-Time PCR System. Results: OTX015 displayed anti-proliferative activity in EML4-ALK-positive H2228 and H3122 cells after a 72-h treatment, with GI50 values of 629 and 627nM, respectively. The corresponding GI50 values for the benchmark compound, JQ-1, were 2161 and 1265 nM. Interestingly, OTX015 was also active in the EML4-ALK-negative A549 cell line, with a GI50 of 432 nM. BRD4/3/2, c-MYC, BCL-2, p21 and CyclinD1 were detected at protein and mRNA levels in all cell lines. Both OTX015-sensitive and -resistant cells exhibited similar basal expression levels for the aforementioned proteins. EML4-ALK variants 1 and 3 were identified in H3122 and H2228 cells, respectively. Assessment of the signaling pathways involved in the anti-proliferative activity of OTX015 in these cells showed a transient up-regulation of STAT3, followed by a down-regulation after 24 h and up to 72 h of exposure. These results indicate that the key downstream effector of OTX015 is STAT3, frequently found to be overexpressed in crizotinib-resistant cell lines. Interestingly, c-MYC protein and mRNA levels were not altered by OTX015. EML4-ALK-positive H3122 cells showed down-regulation of n-MYC mRNA levels after OTX015 treatment. Conclusion: Our results indicate that NSCLC cell lines with genomic ALK alterations are sensitive to BET-BRD inhibition by OTX015, suggesting its potential clinical use as anticancer agent in EML4-ALK positive NSCLC patients. Citation Format: Ramiro Vázquez, Lucile Astorgues-Xerri, Mohamed Bekradda, Esteban Cvitkovic, Patrice Herait, Michela Boi, Giorgio Inghirami, Maurizio D'Incalci, María E. Riveiro, Eric Raymond. OTX015, a novel pan BET-BRD inhibitor is active in non-small-cell lung cancer (NSCLC) cell lines bearing the fusion protein EML4-ALK. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5530. doi:10.1158/1538-7445.AM2014-5530

Aim: The bromodomain and extraterminal (BET) subfamily of human bromodomain (BRD) proteins associates with acetylated chromatin and plays a key role in the epigenetic control of transcriptional activation, notably of genes with super-enhancers, such as the MYC oncogene. OTX015, a potent small molecule inhibitor of BRD2/3/4 (Noel et al, EORTC-NCI-AACR 2013), inhibits proliferation of a wide range of hematologic malignancies (HMs) in vitro (Bonetti et al, EORTC-NCI-AACR 2012; Boi et al, EORTC-NCI-AACR 2013; Braun et al, ASH 2013). This phase I study, designed to determine the recommended dose and pharmacokinetics of oral OTX015 as a single agent, is the first reported clinical study evaluating the effects of BRD inhibition in patients (pts) with HMs. Methods: Two independent cohorts of pts having failed all standard therapies were given ascending oral doses of OTX015 in a conventional 3+3 design, with acute leukemias (AL) treated 14 days on/7 days off and other HMs (OHM) treated continuously in 21-day cycles. OTX015 was given once daily (QD), then twice daily (BID). Results: From Jan to Dec 2013, 16 pts with AL (14 AML, 2 ALL) and 17 with OHM (6 DLBCL, 5 other lymphomas, 6 multiple myelomas) were enrolled over 4 dose levels, 10, 20, 40 and 80 mg QD. Exposure increased dose-proportionally. Plasma trough concentrations at 80 mg QD and 12h concentrations at 40 mg QD were ≥ IC50 values in vitro (250 nM), justifying the shift to a BID schedule. The 40 mg BID cohort is ongoing. Pts have a median age of 70 years (range 32-83) and median of 2 (1-8) prior therapies; 10 of 16 AL pts had AML secondary to pre-existing conditions or chemotherapy. No dose limiting toxicity was observed up to 80 mg QD/40 mg BID. Adverse events (AEs) were mainly grade (G) 1-2 hematologic and gastrointestinal events and diabetes aggravation. G 3-4 AEs were reversible thrombocytopenia in 3 pts with OHM (40 and 80 mg), and neutropenia, diarrhea, and elevated transaminases in 1 pt each. No cumulative toxicity was observed. Nine pts received >3 (range 4-7) cycles without or with minor interruptions. Among 28 pts evaluable for response, 6 had clinically meaningful activity, with 4 of 6 treated at 80 mg. Four pts with refractory/relapsed secondary or post-treatment AML achieved significant peripheral and bone marrow blast decrease or clearance, including 1 complete remission (CR) and 1 CR with incomplete recovery. Among OHM, 1 DLBCL had a partial response (PR) and 1 lymphoplasmacytic lymphoma had metabolic PR on cycle 2 PET-scan. Treatment of 5 of 6 responding pts is ongoing. Responses occurred in pts with various clinical, cytogenetic and molecular profiles. Conclusion: OTX015 is the first BRD inhibitor demonstrating clinical activity. Maximum tolerated dose was not reached at 80 mg QD or 40 mg BID; dose escalation is ongoing with the BID schedule and further schedule optimization. Updated results will be presented. Citation Format: Patrice E. Herait, Celine Berthon, Catherine Thieblemont, Emmanuel Raffoux, Valeria Magarotto, Anastasios Stathis, Xavier Thomas, Xavier Leleu, Carlos Gomez-Roca, Elodie Odore, Christophe Roumier, Fabrice Bourdel, Bruno Quesnel, Emanuele Zucca, Mauricette Michallet, Christian Recher, Esteban Cvitkovic, Keyvan Rezai, Claude Preudhomme, Thierry Facon, Antonio Palumbo, Herve Dombret. BET-bromodomain inhibitor OTX015 shows clinically meaningful activity at nontoxic doses: interim results of an ongoing phase I trial in hematologic malignancies. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr CT231. doi:10.1158/1538-7445.AM2014-CT231

Background: Gal-1 is a lectin with multiple biological functions including tumor progression, migration, and angiogenesis. OTX008, a small molecule downregulating gal-1 protein level, displays direct antiproliferative and anti-invasive effects in human cancer cells. Objectives: Determine the maximum tolerated dose (MTD) of single agent OTX008 using a subcutaneous (SC) daily dosing based on dose-limiting toxicities (DLTs). Secondary objectives were safety, pharmacokinetics (PK), pharmacodynamics (PD), and antitumor activity. Patients and Methods: Patients (pts) with solid tumors having failed standard therapies, and given a written consent were enrolled. OTX008 was delivered as daily SC injection. In case of DLT, treatment was interrupted until recovery and resumed at the dose level (DL) below. Dose was escalated according to a 3+3 design. The MTD was defined as the highest DL, in which ≤1/6 pt experiences a DLT. Results: 22 pts (50% with colorectal carcinoma) were treated from March 2012 to March 2013. Six were enrolled at DL1 (65mg-flat dose) without DLT. Among the 7 pts enrolled at DL2 (120-130mg), 2 experienced DLT. DL2 was therefore deemed to exceed the MTD and 9 additional pts were enrolled at DL1. No DLT was observed among the 15 patients treated at DL1. The most frequent related adverse event (AE) was G1-2 injection site reaction in 20 patients. Two pts experienced skin ulcerations, resulting in subcutaneous abscess and treatment discontinuation in one and consent withdrawal in another. Transient and fully reversible neurological AEs were observed in 12 pts (55%), and were more frequent (100% vs 33%) and more severe (G3 in 29% vs 0%) at DL2 compared to DL1 respectively. G 1-2 tremor was observed in 8 pts, perioral paresthesia in 5, dizziness in 4 and myoclonia in 2. Two patients experienced G3 ataxia (DLT), and one patient with past history of post-traumatic epilepsy experienced G3 seizure. Gastrointestinal (GI) AEs were reported by 12 pts (55%); G3 vomiting/abdominal pain and G3 diarrhea were reported in 1 pt each; 12 patients developed asymptomatic abnormal lab values (10 hypomagnesemia and 8 transient elevation of CPK without rhabdomyolysis or cardiac ischemia). OTX008 plasma concentrations were >1µM over 12h after administration. PK of OTX008 is best described by a two compartment open model and showed less than proportional exposure increase, possibly due to wide inter-patient variability. The main covariate effect was related to body weight. Plasma gal-1 levels decreased proportionally with increasing OTX008 plasma concentrations. Serial tumor biopsies in 6 patients did not conclude on a PD effect. No objective response was reported. Conclusions: OTX008 recommended flat daily sc dose is 65mg, which achieves significant systemic plasma concentrations based on in vitro models. Weight adapted dosing may optimize systemic exposure. Local tolerance of SC injection is poor.Reversible ataxia was a dose-limiting toxicity. Citation Information: Mol Cancer Ther 2013;12(11 Suppl):A72. Citation Format: Jean-Pierre Delord, Ahmad Awada, Eric Raymond, François Lokiec, Patrice Herait, Keyvan Rezai, Nicolas Lachaux, Gabriel A. Rabinovich, Carlos Gomez-Roca, Philippe Aftimos, Sandrine Faivre, Juan Carlos Stupirski. A first-in-man Phase I study of the galectin-1 (gal-1) inhibitor OTX008 given subcutaneously as a single agent to patients with advanced solid tumors. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr A72.

Background: Galectin-1, a multifunctional lectin, modulates cancer cell proliferation and tumor angiogenesis. OTX-008, a synthetic calixarene molecule, binds directly to galectin-1 and induces a conformation change in reduces galectin-1 binding to carbohydrates. In vitro pharmacodynamic studies showed that OTX008, at micromolar concentrations, inhibited agglutination, proliferation, and invasion of cultured cancer cells. Objectives of the ongoing OTX008 phase I study are: determine the recommended dose, pharmacokinetics (PK), pharmacodynamics (PD) and a PK/PD modeling of OTX008 given subcutaneously (SC) in humans. Materials and Methods: This is a multicenter, dose escalation, open label, phase I study in successive cohorts of 3 to 6 evaluable patients treated with OTX008. Nine time point blood samples were collected on D1 of cycle 1 and two blood samples, just before and 1 hour after OTX008 administration (Cmin/Cmax) were collected on D2 and D22. Urine samples were collected during the first 24 hours after D1 administration. At the first DL (65 mg OTX008 sq qd), tumor samples also were obtained from a patient with advanced, heavily pre-treated cutaneous angiosarcoma of the scalp at baseline and at D22. Plasma, urine and tumor concentrations of OTX008 were measured using a validated Ultra Performance Liquid Chromatography with tandem Mass Spectrometry detection (UPLC-MS/MS) with range of 5 - 250 ng/mL. Pharmacokinetic analyses were carried out using the nonlinear mixed effect modeling software program Monolix version 4.1. Results: PK profiles of 7 patients treated at DL1 (65 mg) are reported. A 2-compartment open model adequately described the total OTX008 time-concentration curve with linear elimination. Following D1 administration, mean + SD Cmax was 4666 + 2012 ng/ml; and Tmax ranged from 0.5 h to 2 h; mean + SD AUC was 48.9 + 36.8 mg.h/l and mean + SD T1/2 was T1/2=5.5 + 0.9 h. Prior to D2 dosing, all patients had OTX008 plasma concentrations ≥1 μM. No accumulation was observed, steady state was reached around D22 after drug administration; 8-10 % of dose was recovered in urine during the first 24 hours. In one patient assessed, the intra-tumor concentration of OTX008 at D22 was 0.002 nM/mg of tumor. DL2 130mg sq qd ongoing (ongoing) and 65 mg bid schedule (planned) will be assessed and also presented. Conclusions: Our DL1 results show that OTX008 is rapidly absorbed and distributed after single SC administration. The PK of OTX008 is best described by a two compartment open model. The influence of BMI will be studied with further DL cohorts and larger number of patients. Urinary excretion seems to be the major route of unchanged drug elimination. High plasma concentrations, close to the active dose in vitro were achieved from DL1. Citation Format: Keyvan Rezai, Sylvere Durand, Nicolas Lachaux, Eric Raymond, Patrice Herait, Francois Lokiec. OTX008 pharmacokinetics (PK) during the first-in-man phase I study in patients with advanced solid tumors . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 33. doi:10.1158/1538-7445.AM2013-33

Background. Galectin-1 is a multifunctional protein involved in various aspects of tumorigenesis and has been described as a promising cancer target. It has been previously shown that galectin-1 has high sensitivity to oxidative inactivation. During oxidation, galectin-1 may forms disulfide bridges resulting in profound conformational changes, which prevent galectin-1 dimerization and ligand recognition. OTX-008 is a non-peptide chemical antagonist designed to bind galectin-1. We previously showed that OTX-008 displays direct antiproliferative effects and inhibits galectin-1 expression in cancer cell lines (AACR 2011, Abstract n°685). The aim of the present study was to further the understanding on the molecular mechanism implicated on galectin-1 downregulation mediated by OTX-008 in cancer cells. Material and Methods. Proliferative SQ20B cancer cells were exposed to 3µM OTX-008 during 48h with or without i) 10µM N-acetylcysteine (an antioxidant agent), ii) 1mM Tempol (an antioxidant agent), iii) 10µM co-enzyme Q10 (a naturally occurring antioxidant agent), iv) 55µM α-mercaptoethanol (a strong reducing agent), or v) 10nM bortezomib (a proteasome inhibitor). Effects on galectin-1 protein levels were assessed by western blot analysis. Results. The head and neck SQ20B human cancer cell line is sensitive to OTX-008 (GI50 = 3µM). In this cell line, 48h-exposure to OTX-008 inhibits galectin-1 protein level (40% inhibition respect to control cells) without effect on galectin-1 mRNA levels. It has been described that galectin-1 oxidation represents a mechanism by which galectin-1 activity is regulated. SQ20B cells were exposed to OTX-008 for 48h with or without co-treatment with well-known antioxidant or reducing agents. Interestingly, these agents counteract the effects of OTX-008 on galectin-1 expression (galectin-1 protein levels by densitometry analysis: control SQ20B 100%, OTX-008 60%, N-acetylcystein+OTX-008 110%, Tempol+OTX-008 120%, co-enzyme Q10 +OTX-008 140% and α-mercaptoethanol+OTX-008 120%), suggesting that oxidation plays a key role in galectin-1 down-expression by OTX-008 in SQ20B cells. We further observed that pre-treatment with bortezomib abrogated the decrease in galectin-1 protein levels by OTX-008, pointing out that oxidized galectin-1 is recognized and degradated by the proteasome system. Conclusion. Our findings show that OTX-008 mechanism of action involves galectin-1 oxidation followed by proteosomal degradation in SQ20B cells. The mechanism by which OTX-008 can enhance the oxidation of galectin-1 will require further investigations. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2836. doi:1538-7445.AM2012-2836

Background. Galectin-1 binds neuropilin-1, enhances VEGFR2 signalling, and contributes to membrane anchorage of H-RAS in cancer cells. Those effects may modulate cancer cell proliferation, apoptosis, and tumor angiogenesis. OTX-008 is a non-peptide chemical antagonist designed to bind galectin-1. We previously showed that OTX-008 displays direct antiproliferative effects and inhibits galectin-1 expression in cancer cell lines (AACR 2011, Abstract n°685). In this study we focused on the antitumor and antiangiogenic effects of galectin-1 inhibition by OTX-008 or shRNA in xenograft models. Material and Methods. A2780-1A9 (1A9) ovarian cells, head and neck SQ20B and SQ-shGAL-1 (SQ20B transfected with shGalectin-1 RNA) cells were injected s.c. into female nu/nu athymic mice. When tumors became palpable, 1A9- and SQ20B- mice were treated with vehicle (PBS) or 5-10 mg/kg OTX008 i.p. q.d for 3 weeks. At the end of treatment, mice were sacrificed and tumors collected. Immunohistochemistry was performed on OCT-embedded tumor stained with H&E, galectin-1, MIB1 (Ki67), VEGFR2 or CD31. Image quantification was done with Histolab software (Microvision, France) subtracting the background. Results. OTX-008 inhibited tumor growth in both 1A9 and SQ20B xenografts after 21 days of treatment. A major decrease in the number of secondary tumors development was observed in SQ20B xenografts. A decrease in galectin-1 expression was seen in treated tumors respect to control tumors (1A9: 11.103 +/− 2.103 µm2 vs 26.103 +/− 6.103 µm2, p Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1926. doi:1538-7445.AM2012-1926

Background: Galectin-1 binds neuropilin-1, enhances VEGFR2 signalling, and contributes to membrane anchorage of H-RAS in cancer cells. Those effects may modulate cancer cell proliferation, apoptosis, cell cycle, and tumor angiogenesis. OTX008 is a non-peptide chemical antagonist designed to bind the amphipathic -sheet conformation of galectin-1. We previously showed that OTX008 displays direct antiproliferative effects in cancer cell lines (AACR 2011, Abstract n°685). In this study we focused on the antiproliferative and antiangiogenic effects of OTX008 in xenograft models. Material and Methods: A2780–1A9 (1A9) ovarian cells and SQ20B head and neck cells, selected for intermediate/high in vitro sensitivity to OTX008, were injected s.c. into female nu/nu athymic mice. When tumors became palpable, treatment was initiated with vehicle (PBS) or 5–10 mg/kg OTX008 i.p. q.d for 3 weeks. At the end of treatment, mice were sacrificed and tumors collected. mRNA expression was evaluated with qRT-PCR. Immunohistochemistry (IHC) was performed on OCT-embedded tumor stained with H&E, MIB1 (Ki67), VEGFR2, CD31, or galectin-1. Image quantification was done with Histolab software (Microvision, France) subtracting the background. Results: OTX008 inhibited tumor growth in both 1A9 and SQ20B xenografts. OTX008 also decreased the number of secondary tumors (subcutaneous metastases distant from the injection site) in SQ20B xenografts. 1A9 and SQ20B tumors treated with OTX008 expressed significantly lower galectin-1 protein as compared to control tumors (1A9: 11.103 +/− 2.103 μm2 vs 26.103 +/− 6.103 μm2, p Conclusion: Antiproliferative activity of OTX008 in xenograft models seems to be associated with galectin-1 expression inhibition. In addition to this direct effect, qualitative and quantitative normalization of microvessels may also play a role in the antitumor activity of OTX008. Galectin-1 and VEGFR2 expression as well as quantitative assessment of microvessels are candidate biomarkers for further clinical studies. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2011 Nov 12-16; San Francisco, CA. Philadelphia (PA): AACR; Mol Cancer Ther 2011;10(11 Suppl):Abstract nr C76.

Background. Sensitivity to targeted agents inhibiting VEGFR/PDGFR signaling, including sunitinib, may be dependent of the concomitant modulation of alternative survival pathways. The lectin galectin-1 (gal1) is overexpressed in several tumors, selectively binds neuropilin-1 and enhances VEGFR2 signaling thereby activating the MAPK and/or AKT pathways in cancer cells. Those effects may result in modulation of cancer cell proliferation, apoptosis, cell cycle, and tumour angiogenesis. Optimizing the inhibition of gal1/neuropilin-1/VEGFR-dependent signaling may be a useful approach to improve the activity of multitargeted drugs in cancer cells. The aim of the present study was to evaluate the effects of PTX-008, a novel drug that targets gal1, alone or in combination with sunitinib on several human cancer cell lines. Material and Methods. Antiproliferative effects were evaluated in human colon, breast, ovarian, head & neck, lung, prostate and HCC cancer cell lines by MTT assay. Effects of PTX-sunitinib combinations were determined by median effect plot analysis (Chou & Talalay). Results. Antiproliferative effects of sunitinib as single agent were evaluated on a panel of 20 human cancer cell lines including SQ20B, COLO205 and HT29 with IC50=2; 3 and 8µM, respectively. Antiproliferative effects of single agent PTX-008 were detected in several cell lines including head & neck SQ20B, colon HT29 and COLO205, lung HOP62 and ovarian cancer cells OVCAR3 and IGROV1 with GI50 of 3; 9; 9; 27; 3 and 27µM respectively. In contrast, head & neck HEP2, prostate DU145, breast MCF7 and SKBR3, renal CAKI1, hepatocarcinoma SK-HEP1 and colon HCC2998 lines appear to be resistant to PTX-008 (GI50>27µM). Effects of PTX-008 were slowing cell proliferation and G2/M accumulation, along with blockage of ERK and AKT survival pathways. In order to evaluate the effects of PTX-008 in combination with other multitargeted inhibitors, we used sequential and simultaneous exposure to PTX-008 with sunitinib. Combinations of PTX-008 with sunitinib in two colon cancer cell lines COLO205 and HT29 (which express low gal1, VEGFR and PDGFR mRNA), result in additive (CI=1) and synergistic (CI Conclusion. Combination of PTX-008 with sunitinib appears to be synergistic both in PTX-008-sensitive and -resistant cells, suggesting that modulation of gal1 signaling may be used to enhance the activity of sunitinib. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1548.