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Purpose: Vanucizumab is an investigational antiangiogenic, first-in-class, bispecific mAb targeting VEGF-A and angiopoietin-2 (Ang-2). This first-in-human study evaluated the safety, pharmacokinetics, pharmacodynamics, and antitumor activity of vanucizumab in adults with advanced solid tumors refractory to standard therapies.Experimental Design: Patients received escalating biweekly (3–30 mg/kg) or weekly (10–30 mg/kg) intravenous doses guided by a Bayesian logistic regression model with overdose control.Results: Forty-two patients were treated. One dose-limiting toxicity, a fatal pulmonary hemorrhage from a large centrally located mediastinal mass judged possibly related to vanucizumab, occurred with the 19 mg/kg biweekly dose. Arterial hypertension (59.5%), asthenia (42.9%), and headache (31%) were the most common toxicities. Seventeen (41%) patients experienced treatment-related grade ≥3 toxicities. Toxicity was generally higher with weekly than biweekly dosing. A MTD of vanucizumab was not reached in either schedule. Pharmacokinetics were dose-linear with an elimination half-life of 6–9 days. All patients had reduced plasma levels of free VEGF-A and Ang-2; most had reductions in KTRANS (measured by dynamic contrast-enhanced MRI). Two patients (renal cell and colon cancer) treated with 30 mg/kg achieved confirmed partial responses. Ten patients were without disease progression for ≥6 months. A flat-fixed 2,000 mg biweekly dose (phamacokinetically equivalent to 30 mg/kg biweekly) was recommended for further investigation.Conclusions: Biweekly vanucizumab had an acceptable safety and tolerability profile consistent with single-agent use of selective inhibitors of the VEGF-A and Ang/Tie2 pathway. Vanucizumab modulated its angiogenic targets, impacted tumor vascularity, and demonstrated encouraging antitumor activity in this heterogeneous population. Clin Cancer Res; 24(7); 1536–45. ©2017 AACR.

Supplementary Table S1. Criteria for defining dose-limiting toxicities; Supplementary Table S2. Plasma pharmacokinetic parameters of vanucizumab on Cycles 1 and 4 following bi-weekly administration of ascending doses of vanucizumab; Supplementary Table S3. Plasma pharmacokinetic parameters of vanucizumab on Cycles 1 and 4 following weekly administration of ascending doses of vanucizumab.

Background: S 49076 is a novel ATP-competitive tyrosine kinase inhibitor which displays a unique profile targeting MET, AXL and FGFR-1/2/3 (IC50 for inhibition of pathway activation was Methods: Pts are enrolled on dose-escalation cohorts, using a “3+3” design. Two dosing regimens of S 49076 administration (once a day, QD, or twice a day, BID) are tested in this study, in which pts receive oral capsule(s) of S 49076 during a continuous 21-day cycle. The PK measurements are performed at D1 and at steady state. Tumor biopsies for genomic and proteomic analyses are taken predose and on treatment. Tumor response is measured once every 2 cycles. Results: To date 49 pts have been treated at doses ranging from 15 to 270 mg QD or 7.5 to 225 mg BID. Median age is 59 years, and the most common tumor types are colorectal, NSCLC and uveal melanoma. The most frequent adverse events reported as treatment-related by the investigator have been hypomagnesemia, peripheral edema and hypoalbuminemia mostly grade (G) 1-2. Three DLTs were observed, including failure to restart S 49076 within 1 week due to G2 asymptomatic ejection fraction decrease in 30 mg QD and 225 mg BID cohorts and G3 hypotension in the 180 mg BID cohort. MTD has not been reached and the dose escalation is ongoing. Among 37 evaluable pts, 20 pts had stable disease (SD) ranging from 6 to 36 weeks of whom 3 pts with uveal melanoma had prolonged SD from 12 to 24 weeks. Preliminary PK analyses showed that the maximal plasma concentration (Cmax) occurred between 2h and 6h after oral administration. The bioavailability was estimated to be around 30% and the effective half-life around 15h. There was no evidence of non-linearity since Cmax and AUC24h increased proportionally over the range of doses tested and no evidence of time dependent PK. Based on PK data, the plasma concentrations reached in human at the higher doses are consistent with inhibition of the S 49076 targets MET, AXL and FGFR. Conclusions: The general safety profile of oral treatment with S 49076 is good at the doses tested. PK data suggest dose proportionality in exposure without marked drug accumulation. S 49076 has demonstrated preliminary anti-tumor activity, especially in uveal melanoma. Citation Information: Mol Cancer Ther 2013;12(11 Suppl):C65. Citation Format: Antoine Hollebecque, Jean-Charles Soria, Ratislav Bahleda, Natividad Lopez-Busto, Anne Jacquet-Bescond, Mike F. Burbridge, Cattan Valérie, Jeanne Pauly, Maria Herranz, Analia Azaro, Stéphane Depil, Jordi Rodon. First-in-human Phase I dose-escalation study of a MET/AXL/FGFR inhibitor, S 49076, in 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 C65.

Background: Aflibercept (AF) is a recombinant fusion protein of the human vascular endothelial growth factor (VEGF) receptor combining the Fc portion of human IgG1 with the extracellular ligand-binding domains of human VEGFR1 and VEGFR2. AF binds and neutralizes all VEGF-A isoforms plus placental growth factor. This study was designed to assess the safety, dose-limiting toxicities (DLTs)/ recommended dose (RD), and PK of AF + DCF. Methods: This phase I combination trial explored escalating IV doses of AF given on day 1 followed by DCF (fixed dose of D 75mg/m2, C 75mg/m2 both on day 1 and F 750 mg/m2/day from day 1 to 5), every 3 weeks. G-CSF and fluoroquinolone were given as primary prophylaxis. Patient characteristics: 44 pts (M/F 29/15, median age 53 [range: 33–74], baseline ECOG-PS 0/1/2: 16/27/1) were enrolled in 3 AF dose cohorts: 2 (n = 9), 4 (n = 14) and 6 (n = 21) mg/kg. Primary tumors were mostly gastro-intestinal (28, including 22 gastro-esophageal, 3 pancreas, 2 liver, 1 cholangiocarcinoma), 4 breast, 3 lung, 3 utero-vaginal, 2 thyroid, and 4 others. Sixteen (36%) pts received prior chemotherapy, median number of lines 2 (range 1–6). Preliminary Results: Pts received a median number of 6, 4, and 7 cycles respectively for each dose group of 2, 4, and 6 mg/kg (range 1–19). One AF-related DLT of pulmonary embolism was observed at the 6 mg/kg AF dose level. Most common Gr ≥ 3 adverse events included: fatigue/asthenia (46%), mucosal inflammation/stomatitis (41%), anorexia (18%), and febrile neutropenia (16%). Mild to moderate arterial hypertension and proteinuria were reported. Grade 1 or 2 epistaxis (61%) and dysphonia (41%) also were reported. Two fatal events were observed: gastrointestinal haemorrhage after C2 (cholangiocarcinoma, AF 6 mg/kg), pulmonary haemorrhage with bronchial necrosis after C12 (NSCL cancer, AF 6 mg/kg). Thirteen (35%) partial responses (PR) in various tumor types, and 20 stable disease (SD) including 14 pts with SD≥2 months were noted. PK analysis will be presented once available. Conclusions: AF 6 mg/kg combined with DCF q3wks was selected for further investigation, based on DLTs and overall safety profile. This dose is consistent with results from other aflibercept phase 1 studies. Encouraging signs of anti-tumor activity and disease control have been seen. Citation Information: Mol Cancer Ther 2009;8(12 Suppl):B10.

Background: The PI3K pathway is frequently dysregulated in cancer cells and has been implicated as a mediator of resistance to EGFR inhibitors. In preclinical xenograft models, the oral selective Class I PI3K inhibitor XL147 augments the anti-tumor efficacy of EGFR inhibitors, including erlotinib. Methods: Patients (pts) with advanced solid tumors are enrolled in successive cohorts of 3 to receive escalating doses of XL147 in combination with erlotinib. Erlotinib is dosed qd, and XL147 is dosed once daily on Days 1–21 of each 28-day cycle. Dose limiting toxicities (DLTs) are determined using Cycle 1 safety data. Tumor response is evaluated every 8 weeks. Results: As of 01 Aug2009, 18 pts with advanced solid tumors have been enrolled: NSCLC (7), CRC (5), HCC, HNSCC, biliary tract, carcinoid, ethmoid, and esophageal cancer (1 each). Pts have been treated at 6 dose levels up to 400 mg XL147/150 mg erlotinib. No DLTs or study treatment-related SAEs have been reported. The MTD has not yet been established. The most frequently reported related AEs were rash (40%), fatigue (30%), diarrhea, nausea, and vomiting (each 20%). Two events of Grade 3 thrombosis (both unrelated) were reported. Based on preliminary data, the PK of XL147 in combination with erlotinib is consistent with that observed for XL147 given alone (Exelixis Study XL147-001). Likewise, XL147 does not appear to alter the PK of erlotinib as the PK parameters of erlotinib are similar to published single agent values. Modulation of PI3K pathway and EGFR signaling by XL147/erlotinib has been demonstrated in PBMCs by reductions in phosphorylation of AKT, the AKT substrates PRAS40 and GSK3 , and ERK. In skin and tumor biopsies, robust post-dose reductions were evident in phosphorylation of AKT, the mTOR substrate 4EBP1, ERK, and EGFR. For example, in tumor biopsies from a subject with an ethmoid tumor (400 mg XL147/150 mg erlotinib), reductions in pAKT-T308 (43%), p4EBP1 (44%), pERK (43%), and pEGFR (40%) were evident at Day 15 post-dose, with a corresponding reduction in Ki67 (47%) and induction of apoptosis (2.7-fold). One EGFR inhibitor-naïve NSCLC pt (no EGFR mutations detected in archival tumor sample, 200 mg XL147/150 mg erlotinib) had a confirmed PR with a 59% reduction in the sum of target lesions. Nine pts continued on study ≥ 12 weeks, including 2 pts who remained on study ≥ 24 weeks. Conclusions: The combination of XL147 and erlotinib is generally well tolerated at doses up to 400 mg XL147/150 mg erlotinib, with no apparent drug-drug PK interaction or emergent toxicities, and results in robust simultaneous inhibition of PI3K and EGFR signaling. Citation Information: Mol Cancer Ther 2009;8(12 Suppl):C197.