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Phase I trial of DNA methyltransferase inhibitor guadecitabine combined with cisplatin and gemcitabine for solid malignancies including urothelial carcinoma (SPIRE)

Phase I trial of DNA methyltransferase inhibitor guadecitabine combined with cisplatin and gemcitabine for solid malignancies including urothelial carcinoma (SPIRE)
Phase I trial of DNA methyltransferase inhibitor guadecitabine combined with cisplatin and gemcitabine for solid malignancies including urothelial carcinoma (SPIRE)

PURPOSE: Preclinical data indicate that DNA methyltransferase inhibition will circumvent cisplatin resistance in various cancers.

PATIENT AND METHODS: SPIRE comprised a dose-escalation phase for incurable metastatic solid cancers, followed by a randomized dose expansion phase for neoadjuvant treatment of T2-4a N0 M0 bladder urothelial carcinoma. The primary objective was a recommended phase II dose (RP2D) for guadecitabine combined with gemcitabine and cisplatin. Treatment comprised 21-day gemcitabine and cisplatin cycles (cisplatin 70 mg/m 2, i.v., day 8 and gemcitabine 1,000 mg/m 2, i.v., days 8 + 15). Guadecitabine was injected subcutaneously on days 1-5, within escalation phase cohorts, and to half of 20 patients in the expansion phase. Registration ID: ISRCTN 16332228.

RESULTS: Within the escalation phase, dose-limiting toxicities related predominantly to myelosuppression requiring G-CSF prophylaxis from cohort 2 (guadecitabine 20 mg/m 2, days 1-5). The most common grade ≥3 adverse events in 17 patients in the dose-escalation phase were neutropenia (76.5%), thrombocytopenia (64.7%), leukopenia (29.4%), and anemia (29.4%). Addition of guadecitabine to gemcitabine and cisplatin in the expansion phase resulted in similar rates of severe hematologic adverse events, similar cisplatin dose intensity, but modestly reduced gemcitabine dose intensity. Radical treatment options after chemotherapy were not compromised. Pharmacodynamics evaluations indicated guadecitabine maximal target effect at the point of cisplatin administration. Pharmacokinetics were consistent with prior data. No treatment-related deaths occurred.

CONCLUSIONS: The guadecitabine RP2D was 20 mg/m 2, days 1-5, in combination with gemcitabine and cisplatin and required GCSF prophylaxis. Gene promoter methylation pharmacodynamics are optimal with this schedule. Addition of guadecitabine to gemcitabine and cisplatin was tolerable, despite some additional myelosuppression, and warrants further investigation to assess efficacy.

1078-0432
1882-1892
Crabb, Simon J
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Danson, Sarah
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Catto, James W F
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Hussain, Syed
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Chan, Danna
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Dunkley, Denise
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Downs, Nichola
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Marwood, Ellice
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Day, Laura
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Saunders, Geoff N.
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Light, Michelle
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Whitehead, Amy
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Ellis, Deborah
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Sarwar, Naveed
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Enting, Deborah
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Birtle, Alison Jane
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Johnson, Bernadette
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Huddart, Robert
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Griffiths, Gareth
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Crabb, Simon J
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Danson, Sarah
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Catto, James W F
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Hussain, Syed
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Chan, Danna
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Dunkley, Denise
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Downs, Nichola
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Marwood, Ellice
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Day, Laura
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Saunders, Geoff N.
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Light, Michelle
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Whitehead, Amy
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Ellis, Deborah
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Sarwar, Naveed
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Enting, Deborah
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Birtle, Alison Jane
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Johnson, Bernadette
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Huddart, Robert
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Griffiths, Gareth
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Crabb, Simon J, Danson, Sarah, Catto, James W F, Hussain, Syed, Chan, Danna, Dunkley, Denise, Downs, Nichola, Marwood, Ellice, Day, Laura, Saunders, Geoff N., Light, Michelle, Whitehead, Amy, Ellis, Deborah, Sarwar, Naveed, Enting, Deborah, Birtle, Alison Jane, Johnson, Bernadette, Huddart, Robert and Griffiths, Gareth (2021) Phase I trial of DNA methyltransferase inhibitor guadecitabine combined with cisplatin and gemcitabine for solid malignancies including urothelial carcinoma (SPIRE). Clinical Cancer Research, 27 (7), 1882-1892. (doi:10.1158/1078-0432.CCR-20-3946).

Record type: Article

Abstract

PURPOSE: Preclinical data indicate that DNA methyltransferase inhibition will circumvent cisplatin resistance in various cancers.

PATIENT AND METHODS: SPIRE comprised a dose-escalation phase for incurable metastatic solid cancers, followed by a randomized dose expansion phase for neoadjuvant treatment of T2-4a N0 M0 bladder urothelial carcinoma. The primary objective was a recommended phase II dose (RP2D) for guadecitabine combined with gemcitabine and cisplatin. Treatment comprised 21-day gemcitabine and cisplatin cycles (cisplatin 70 mg/m 2, i.v., day 8 and gemcitabine 1,000 mg/m 2, i.v., days 8 + 15). Guadecitabine was injected subcutaneously on days 1-5, within escalation phase cohorts, and to half of 20 patients in the expansion phase. Registration ID: ISRCTN 16332228.

RESULTS: Within the escalation phase, dose-limiting toxicities related predominantly to myelosuppression requiring G-CSF prophylaxis from cohort 2 (guadecitabine 20 mg/m 2, days 1-5). The most common grade ≥3 adverse events in 17 patients in the dose-escalation phase were neutropenia (76.5%), thrombocytopenia (64.7%), leukopenia (29.4%), and anemia (29.4%). Addition of guadecitabine to gemcitabine and cisplatin in the expansion phase resulted in similar rates of severe hematologic adverse events, similar cisplatin dose intensity, but modestly reduced gemcitabine dose intensity. Radical treatment options after chemotherapy were not compromised. Pharmacodynamics evaluations indicated guadecitabine maximal target effect at the point of cisplatin administration. Pharmacokinetics were consistent with prior data. No treatment-related deaths occurred.

CONCLUSIONS: The guadecitabine RP2D was 20 mg/m 2, days 1-5, in combination with gemcitabine and cisplatin and required GCSF prophylaxis. Gene promoter methylation pharmacodynamics are optimal with this schedule. Addition of guadecitabine to gemcitabine and cisplatin was tolerable, despite some additional myelosuppression, and warrants further investigation to assess efficacy.

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Accepted/In Press date: 15 January 2021
e-pub ahead of print date: 20 January 2021
Published date: 1 April 2021
Additional Information: Funding Information: S.J. Crabb reported grants and nonfinancial support from Astex Pharmaceuticals during the conduct of the study, personal fees and nonfinancial support from MSD, Bayer, Roche, and Janssen Cilag, personal fees from Astellas, Pfizer, and BeiGene, grants and personal fees from AstraZeneca, and grants from Clovis Oncology outside the submitted work. S. Danson reported grants from Cancer Research UK & the Department of Health and NIHR during the conduct of the study. J.W.F. Catto reported personal fees from AstraZeneca, Roche, Janssen, BMS, Ferring, Nucleix, and MAD during the conduct of the study. S. Hussain reported personal fees from AstraZeneca, Roche, Merck, Janssen, BMS, GlaxoSmithKline, Pfizer, Eisai, and Pierre Fabre outside the submitted work. D. Dunkley reported grants from Astex Pharmaceuticals during the conduct of the study. N. Downs reported grants from Astex Pharmaceuticals during the conduct of the study. E. Marwood reported grants and nonfinancial support from Astex Pharmaceuticals during the conduct of the study. L. Day reported grants from Astex Pharmaceuticals during the conduct of the study. D. Ellis reported grants from Astex Pharmaceuticals during the conduct of the study. A. Birtle reported other from Janssen, Roche, and MSD outside the submitted work. R. Huddart reported grants from Astex Pharmaceuticals during the conduct of the study, grants, personal fees, and nonfinancial support from MSD and Roche, personal fees and nonfinancial support from Janssen and Nektar Pharmaceuticals, and personal fees from Bayer and Astellas outside the submitted work, and is a partner in Cancer Centre London. G. Griffiths reported grants from AstraZeneca and personal fees from AstraZeneca during the conduct of the study, grants from Janssen Cilag, AstraZeneca, Novartis, Astex Pharmaceuticals, Roche, Heartflow, BMS, and BioNTech and personal fees from Celldex outside the submitted work. No disclosures were reported by the other authors. Funding Information: We thank the patients and their families for participating in this study, along with all investigators and site personnel. We thank Cancer Research UK and Astex Pharmaceuticals for provision of research funding to undertake this trial. The authors also wish to acknowledge Prof. John Staffurth, Dr. Anthony Kong, and Jacqueline Birks as members of the independent data monitoring and ethicscommittee. R.Huddart and B. Johnson acknowledge the support of the Institute of Cancer Research/Royal Marsden FT NIHR Biomedical Research Centre. This work was supported by Cancer Research UK (grant No. C9317/A19903) and Astex Pharmaceuticals. Publisher Copyright: © 2021 American Association for Cancer Research.

Identifiers

Local EPrints ID: 447027
URI: http://eprints.soton.ac.uk/id/eprint/447027
ISSN: 1078-0432
PURE UUID: b887f25d-18e8-42ef-a160-eb9fd00dccca
ORCID for Simon J Crabb: ORCID iD orcid.org/0000-0003-3521-9064
ORCID for Gareth Griffiths: ORCID iD orcid.org/0000-0002-9579-8021

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Date deposited: 02 Mar 2021 17:30
Last modified: 17 Mar 2024 06:20

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Contributors

Author: Simon J Crabb ORCID iD
Author: Sarah Danson
Author: James W F Catto
Author: Syed Hussain
Author: Danna Chan
Author: Denise Dunkley
Author: Nichola Downs
Author: Ellice Marwood
Author: Laura Day
Author: Geoff N. Saunders
Author: Michelle Light
Author: Amy Whitehead
Author: Deborah Ellis
Author: Naveed Sarwar
Author: Deborah Enting
Author: Alison Jane Birtle
Author: Bernadette Johnson
Author: Robert Huddart

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