Safety and tolerability of increasing doses of CB-839, a first-in-class, orally administered small molecule inhibitor of glutaminase, in solid tumors.

Authors

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James J. Harding

Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY

James J. Harding , Melinda L. Telli , Pamela N. Munster , Mai H. Le , Christopher Molineaux , Mark K. Bennett , Erik Mittra , Howard A. Burris III, Amy Sanders Clark , Mark Dunphy , Funda Meric-Bernstam , Manish R. Patel , Angela DeMichele , Jeffrey R. Infante

Organizations

Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, Stanford University School of Medicine, Stanford, CA, University of California, San Francisco, San Francisco, CA, Calithera Biosciences, Inc., South San Francisco, CA, Calithera Biosciences Inc, South San Francisco, CA, Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN, Hosp of the Univ of Penn, Philadelphia, PA, Memorial Sloan Kettering Cancer Center, New York, NY, The University of Texas MD Anderson Cancer Center, Houston, TX, Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN

Research Funding

Pharmaceutical/Biotech Company

Background: Glutamine is required for the growth and survival of multiple tumor types. CB-839 is a highly selective, reversible, allosteric inhibitor of glutaminase, a choke point in the utilization of glutamine. CB-839 has broad in vitro and in vivo anti-tumor activity in solid and heme malignancies. Methods: CX-839-001 is an ongoing Phase 1 study of escalating doses of CB-839 in advanced and/or treatment-refractory solid tumor patients (pts) to evaluate safety and tolerability, and to identify the recommended Phase 2 dose (R2PD). CB-839 was administered orally continuously in 21-day cycles. Pharmacokinetics (PK) was monitored on Days 1, 15, and 22; pharmacodynamic (PD) assessment of glutaminase activity was measured ex vivoin platelets and tumor biopsies. Additional pts will be enrolled at the RP2D with triple negative breast cancer (TNBC), non-small cell lung adenocarcinoma (NSCLC), renal cell carcinoma (RCC), mesothelioma, and tumors with mutations in enzymes of the TCA cycle. Results: 35 pts were enrolled in dose escalation receiving CB-839 doses from 100 to 800 mg TID and 600 mg BID. Exposure increased less than dose proportionally but there was a clear PK/PD relationship with > 90% glutaminase inhibition in platelets when CB-839 exceeded 450 nM; target inhibition was confirmed in tumors. Radiographic stable disease (SD) was observed in 7 (28%) of 25 efficacy-evaluable pts (average duration 107 days; range 59-209) across all diseases and dose levels including TNBC (2/9 evaluable pts), NSCLC (2/4), mesothelioma (2/4) and RCC (1/3). Grade ≥ 3 treatment-related AEs occurred in 7 (20%) of pts, including ALT/AST (4 pts), creatinine, alkaline phosphatase, and GGT increases, lymphopenia, and hypoglycemia (1 pt each). A Grade 3 increase in creatinine considered unlikely related to CB-839 was a DLT at 250 mg TID. CB-839 was absorbed rapidly (Tmax 1-2 hr fasted and 2-4 hr fed) and cleared with a half-life of about 4 hr. Plasma Cminwas > 450 nM at steady state at the RP2D of 600 mg BID. Conclusions: Continuous CB-839 administration showed an acceptable safety profile, significant glutaminase inhibition and preliminary signs of clinical activity in multiple tumor types. Clinical trial information: NCT02071862

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Abstract Details

Meeting

2015 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Developmental Therapeutics—Clinical Pharmacology and Experimental Therapeutics

Track

Developmental Therapeutics and Translational Research

Sub Track

Cytotoxic and Other Novel Agents

Clinical Trial Registration Number

NCT02071862

Citation

J Clin Oncol 33, 2015 (suppl; abstr 2512)

DOI

10.1200/jco.2015.33.15_suppl.2512

Abstract #

2512

Poster Bd #

228

Abstract Disclosures

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