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A phase I and pharmacokinetic study of ganetespib (STA-9090) in advanced hepatocellular carcinoma

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Summary

Background Ganetespib (STA-9090) is an Hsp90 inhibitor that downregulates VEGFR, c-MET, HER2, IGF-IR, EGFR, and other Hsp90 client proteins involved in hepatocarcinogenesis, thereby making it an attractive therapy for HCC. This Phase I study was performed to establish the safety, tolerability, recommended Phase 2 dose (RP2D), and preliminary clinical activity of ganetespib in previously treated patients with advanced HCC. Methods Patients with advanced HCC, Child-Pugh A cirrhosis, progression on or intolerance to sorafenib, and ECOG PS ≤ 1 were enrolled in a standard 3x3 dose escalation study at doses of 100 mg/m2, 150 mg/m2, and 200 mg/m2 IV given on days 1, 8, and 15 of each 28-day cycle. Objective response by RECIST version 1.1 criteria was evaluated by CT/MRI every 8 weeks. Results Fourteen patients were enrolled in this trial and received at least one dose of the study drug. Of the 14 patients: median age, 57 years old; male 71 %; Asian 36 %; HCC etiology (HBV 36 %, HCV 43 %, Hemachromatosis 7 %, unknown 21 %); Child Pugh Class (A 93 %, B 7 %); median number of prior treatments 2; median baseline AFP 70.1 ng/mL. The RP2D was determined to be 200 mg/m2. The most commonly seen AEs were diarrhea (93 %), fatigue (71 %), AST elevation (64 %), and hyperglycemia (64 %). The most common Gr 3/4 AEs were hyperglycemia (21 %) and lipasemia (21 %). One (7 %) patient had a fatal AE, septic shock, within 30 days of receiving the study drug. One dose-limiting toxicity, grade 3 lipasemia, was observed at the 100 mg/m2 dose. Pharmacokinetics studies showed a t1/2, CL, Tmax, and Vss of 6.45 h, 48.28 L/h (25.56 L/h/m2), 0.76 h, and 191 L (100.4 L/m2), respectively. No objective responses were seen; one patient (7 %) had stable disease at 16 weeks. Median time to progression was 1.8 months, and median overall survival was 7.2 months. Conclusion Ganetespib had a manageable safety profile in patients with advanced HCC who had progressed on at least one line of systemic therapy. The pharmacokinetic profile showed that ganetespib exposure in patients with mild hepatic dysfunction is similar to that seen in patients with normal liver function. Ganetespib showed limited clinical benefit in patients with advanced HCC in this phase I trial.

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Acknowledgments

We received research support for this trial from Synta Pharmaceuticals.

Conflict of interest

AXZ has served consultant/advisory roles for Sanofi-aventis, Eisai, Daiichi Sankyo, and Exelixis. MDK and JC compensated by Synta. The remaining authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Massachusetts General Hospital Cancer Center, 55 Fruit Street, LH/PB 220, Boston, MA, 02114, USA

    Lipika Goyal, Lawrence S. Blaszkowsky, Susan Sheehan, Eamala Sundaram & Andrew X. Zhu

  2. Dana Farber Cancer Institute, Boston, MA, USA

    Brian M. Wolpin, Thomas A. Abrams & Nadine Jackson McCleary

  3. Harvard Medical School, Boston, MA, USA

    Lipika Goyal, Lawrence S. Blaszkowsky, Brian M. Wolpin, Thomas A. Abrams, Nadine Jackson McCleary & Andrew X. Zhu

  4. Virginia Cancer Specialists, Fairfax, VA, USA

    Raymond C. Wadlow

  5. Synta Pharmaceuticals Corp, Lexington, MA, USA

    Michael D. Karol & John Chen

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  1. Lipika Goyal
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Goyal, L., Wadlow, R.C., Blaszkowsky, L.S. et al. A phase I and pharmacokinetic study of ganetespib (STA-9090) in advanced hepatocellular carcinoma. Invest New Drugs 33, 128–137 (2015). https://doi.org/10.1007/s10637-014-0164-8

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