A first in human, phase I trial of NP137, a first-in-class antibody targeting netrin-1, in patients with advanced refractory solid tumors

A first in human, phase I trial of NP137, a first-in-class antibody targeting netrin-1, in patients with advanced refractory solid tumors

Annals of Oncology 30 (Supplement 5): v159–v193, 2019 doi:10.1093/annonc/mdz244 DEVELOPMENTAL THERAPEUTICS 438O METEOR-1: A phase I study of GSK3326...

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Annals of Oncology 30 (Supplement 5): v159–v193, 2019 doi:10.1093/annonc/mdz244

DEVELOPMENTAL THERAPEUTICS 438O

METEOR-1: A phase I study of GSK3326595, a first-in-class protein arginine methyltransferase 5 (PRMT5) inhibitor, in advanced solid tumours

Background: PRMT5 is an enzyme that methylates arginines in proteins important for tumor growth and development. GSK3326595 is a potent and selective PRMT5 inhibitor that demonstrates efficacy in multiple tumor models. METEOR-1 is a phase I study to assess the safety, pharmacokinetics (PK), pharmacodynamics (PD), and efficacy of GSK3326595 in adults with solid tumors. Methods: Eligible participants (pts) were >18 years with advanced or metastatic solid tumors. Pts were enrolled in a modified toxicity probability interval design. Safety, tolerability, PK, PD, and efficacy data were used to identify the recommended phase 2 dose (RP2D). Results: Fifty-four pts with a median age of 60 (range 21 – 81) received at least one dose of drug. The most common tumor types were adenoid cystic carcinoma (ACC; n ¼ 14 [26%]), colorectal cancer (n ¼ 9 [17%]), and breast cancer (n ¼ 3 [6%]). Dosing proceeded from 12.5 mg to 600 mg once daily (QD), and from 50 mg to 200 mg twice daily. Median time on treatment was 1.8 months (range 1 day to 18.7 months). Overall, 48 pts (89%) experienced at least one adverse event (AE) that was deemed treatment-related. The most common related AEs were fatigue (n ¼ 21 [39%]), anemia (n ¼ 17 [31%]), nausea (n ¼ 17 [31%]), alopecia (n ¼ 15 [28%]), and dysgeusia (n ¼ 14 [26%]). Grade 3/4 related AEs included anemia (n ¼ 8 [15%]), thrombocytopenia, neutropenia, and fatigue (each n ¼ 4 [7%]). There were no Grade 5 related AEs. Twenty-two pts (41%) had 1 dose reduction. GSK3326595 Cmax and AUC were dose-dependent after single and repeat dosing. PD analyses showed robust target engagement, as measured by dimethylated arginine in plasma and tumor samples. Clinical activity was observed in several tumor types, with partial responses in patients with HPVþ cervical cancer (1 response/1 subject) and ACC (3 responses/14 subjects). Durable stable disease was achieved in bladder cancer and other tumors. 400 mg QD was selected as the RP2D. Conclusions: This is the first study evaluating a PRMT5 inhibitor. Overall, AEs were common but manageable. Patients with multiple tumor types responded to therapy. Part 2 of the study is open for subjects with predefined solid tumors and nonHodgkin’s lymphoma. Clinical trial identification: NCT02783300. Legal entity responsible for the study: GlaxoSmithKline. Funding: GlaxoSmithKline. Disclosure: L.L. Siu: Advisory / Consultancy: Merck (compensated), Pfizer (compensated), Celgene (compensated), AstraZeneca/Medimmune (compensated), Morphosys (compensated), Roche (compensated), GeneSeeq (compensated), Loxo (compensated), Oncorus (compensated), Symphogen (compensated), Seattle Geneti; Research grant / Funding (institution): Novartis, Bristol-Myers Squibb, Pfizer, Boerhinger-Ingelheim, GlaxoSmithKline, Roche/Genentech, Karyopharm, AstraZeneca/Medimmune, Merck, Celgene, Astellas, Bayer, Abbvie, Amgen, Symphogen, Intensity Therapeutics, Mirati, Shattucks; Shareholder / Stockholder / Stock options, Spouse: agios. D.W. Rasco: Research grant / Funding (institution): gsk. S. Postel Vinay: Research grant / Funding (institution): Boehringer Ingelheim, Roche and Merck KGaA; Advisory / Consultancy: Merck KGaA; Travel / Accommodation / Expenses: AstraZeneca; Leadership role, Principal/sub-investigator of clinical trials: Aduro Biotech, Agios Pharmaceuticals, Amgen, Argen-X Bvba, Arno Therapeutics, Astex Pharmaceuticals, AstraZeneca, Aveo, Bayer Healthcare Ag, Bbb Technologies Bv, Beigene, Bioalliance Pharma, Biontech Ag, Blueprint Medicines, Boehringer Ingelheim, Bristol. P. Martin Romano: Research grant / Funding (institution): AstraZeneca, BMS, Boehringer Ingelheim, Janssen Cilag, Merck, Novartis, Pfizer, Roche, Sanofi; Non-remunerated activity/ies, Drug supplied: AstraZeneca, Bayer, BMS, Boringher Ingelheim, Johnson & Johnson, Lilly, Medimmune, Merck, NH TherAGuiX, Pfizer, Roche; Non-remunerated activity/ies, Courses, trainings for: AstraZeneca, Roche. J.L. Egger: Shareholder / Stockholder / Stock options, Full / Part-time employment: GlaxoSmithKline. S.A. Gorman: Shareholder / Stockholder / Stock options, Full / Part-time employment: GlaxoSmithKline. R. Parasrampuria: Full / Part-time employment: GlaxoSmithKline. K. Wang: Shareholder / Stockholder / Stock options, Full / Part-time employment: GlaxoSmithKline. B.E. Kremer: Shareholder / Stockholder / Stock options, Full / Part-time employment: GlaxoSmithKline. M.M. Gounder: Research grant / Funding (institution): GlaxoSmithKline; Honoraria (self): Epizyme, Tracon, Amgen, Daiichi Sankyo, Springwork Therapeutics, Bayer, Karyopharm. All other authors have declared no conflicts of interest.

A first in human, phase I trial of NP137, a first-in-class antibody targeting netrin-1, in patients with advanced refractory solid tumors

P. Cassier1, L. Eberst1, G. Garin2, Y. Courbebaisse3, C. Terret1, M. Robert4, J.-S. Frenel5, S. Depil1, J.-P. Delord6, D. Perol7, I.L. Ray-Coquard1, A.-S. Bidaux8, S. Tabone-Eglinger9, L. Gilles-Afchain1, I. Treilleux10, Q. Wang11, B. Ducarouge12, P. Mehlen13, J.-Y. Blay14, C.A. Gomez-Roca15 1 Medical Oncology, Centre Le´on Be´rard, Lyon, France, 2Direction de la Recherche Clinique et de l’Innovation, Centre Le´on Be´rard, Lyon, France, 3Socie´te´ Courbebaisse Yann, Lyon, France, 4Medical Oncology, Centre Rene Gauducheau, Nantes, France, 5 Medical Oncology, ICO Institut de Cancerologie de l’Ouest Rene´ Gauducheau, SaintHerblain, France, 6Medical Oncology, Institut Universitaire du Cancer -ToulouseOncopole, Toulouse, Haute-Garonne, France, 7Clinical Research, Centre Le´on Be´rard, Lyon, France, 8DRCI promotion, Centre Le´on Be´rard, Lyon, France, 9Cance´rologie, Centre Le´on-Be´rard, Lyon, France, 10Pathology, Centre Le´on Be´rard, Lyon, France, 11 Recherche Translationnelle, Centre Le´on Be´rard, Lyon, France, 12Preclinical Science, Netris Pharma, Lyon, France, 13Netris Pharma, Lyon, France, 14Medicine, Centre Le´on Be´rard, Lyon, France, 15Medical Oncology & Clinical Research, Institut Universitaire du Cancer -Toulouse- Oncopole, Toulouse, Haute-Garonne, France Background: Netrin-1, a dependence receptor ligand, is overexpressed in many cancers and leads to resistance to cell death. In preclinical studies, targeting netrin-1 with the humanized anti-netrin-1 antibody NP137 inhibits tumor growth and metastasis. Methods: Adults with advanced, refractory solid tumors received NP137 IV Q2W, starting at 1 mg/kg. Dose was escalated using a rapid titration design followed by a model-based design with 3-6 pts per cohort; Additional patients (pts) were enrolled in 4 biomarker cohorts, at dose levels that had been declared safe, starting at 6 mg/kg, and underwent paired biopsies for pharmacodynamics (PD) purposes. Results: Nineteen pts were enrolled in 7 dose levels (1 to 20 mg/kg). No DLTs were observed but 11 (58%) had infusion related reactions (IRR) of grade 1-2 severity, all at doses of 4 mg/kg and above. Twenty-three pts were enrolled in the biomarker cohorts (up to 6 pts per cohort), and 18 (78%) experienced IRR. To date, 9 of 42 pts (21%) experienced at least one grade  3 drug related AE and 9 pts had at least one related SAEs (total of 14 SAEs including 10 IRRs and ischemic stroke, back pain, hyponatremia, pneumonia, n ¼ 1 each). Among 36 pts with at least one follow-up RECIST 1.1 assessment, 1 pt with endometrial carcinoma had a confirmed PR (> 6 months to date, >50%, 14mg/kg) and 6 pts had SD at 3 months including one long-lasting SD over 1 year (cervical carcinoma, 6mg/kg) with a shrinkage > 30% in an irradiated lesion. To date, 3 pts are still on treatment (median duration: 43.0 days [7.0; 476.0]). Serum NP137 concentrations had biphasic disposition characteristic of both target and nontarget-mediated clearances. PK data up to 5 consecutive cycles showed no evidence of NP137 accumulation. No ADAs were noted. RNAseq data on paired biopsies suggests that NP137 triggers a shift toward a more epithelial phenotype. Based on available data, 14mg/kg Q2W was selected as the RP2D. Recruitment in the extension phase is ongoing in gynecological tumors. Conclusions: NP137 was well-tolerated, with mild to moderate IRR as the most frequent treatment-related AEs and showed encouraging signs of clinical activity. Updated data will be presented at the meeting. Clinical trial identification: NCT02977195. Legal entity responsible for the study: Centre Le´on Be´rard. Funding: Netris Pharma. Disclosure: P. Cassier: Honoraria (self), Research grant / Funding (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: AstraZeneca; Research grant / Funding (institution), Travel / Accommodation / Expenses: BMS; Research grant / Funding (institution), Travel / Accommodation / Expenses: Lilly; Honoraria (self), Research grant / Funding (institution): Amgen; Research grant / Funding (institution): Abbvie; Honoraria (self), Research grant / Funding (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Novartis; Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche. Y. Courbebaisse: Full / Part-time employment: Netris Pharma. S. Depil: Advisory / Consultancy: Cellectis; Advisory / Consultancy: Netris Pharma; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: PDCLine Pharma; Advisory / Consultancy: Erytech; Advisory / Consultancy: Servier. J. Delord: Honoraria (self), Advisory / Consultancy, Research grant / Funding (self): BMS; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self): MSD; Honoraria (self), Advisory / Consultancy, Research grant / Funding (self): Novartis; Honoraria (self), Research grant / Funding (self): Roche/ Genentech; Advisory / Consultancy: EMD Serono; Research grant / Funding (self): AstraZeneca. I.L. Ray-Coquard: Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: AstrZeneca; Honoraria (self), Advisory / Consultancy: Clovis; Honoraria (self), Advisory / Consultancy: Tesaro; Honoraria (self), Advisory / Consultancy: PharmaMar; Advisory / Consultancy, Travel / Accommodation / Expenses: Roche; Advisory / Consultancy, Research grant / Funding (self): MSD; Advisory / Consultancy: Pfizer; Advisory / Consultancy: GenMab. B. Ducarouge: Full / Part-time employment: Netris Pharma. P. Mehlen: Shareholder / Stockholder / Stock options, Full / Part-time employment: Netris Pharma. J. Blay: Non-remunerated activity/ies, uncompensated scientific advice: Netris Pharma. All other authors have declared no conflicts of interest.

C European Society for Medical Oncology 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. V

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L.L. Siu1, D.W. Rasco2, S. Postel Vinay3, P. Martin Romano3, J. Menis4, F.L. Opdam5, K.M. Heinhuis5, J.L. Egger6, S.A. Gorman7, R. Parasrampuria8, K. Wang9, B.E. Kremer7, M.M. Gounder10 1 Medical Oncology and Hematology Department, Princess Margaret Cancer Centre, Toronto, ON, Canada, 2Clinical Research, The START Center for Cancer Care, San Antonio, TX, USA, 3Drug Development Department, Institut Gustave Roussy, Villejuif, France, 4Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy, 5Clinical Pharmacology, NKI-AVL, Amsterdam, Netherlands, 6Global Clinical Sciences and Delivery, GlaxoSmithKline, Uxbridge, UK, 7Oncology, GlaxoSmithKline USA, Collegeville, PA, USA, 8CPMC, GlaxoSmithKline, Collegeville, PA, USA, 9Biostatistics, GlaxoSmithKline, Collegeville, PA, USA, 10Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

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