Nintedanib plus letrozole in early breast cancer: a phase 0/I pharmacodynamic, pharmacokinetic, and safety clinical trial of combined FGFR1 and aromatase inhibition
Abstract Background The combined use of a FGFR1 blocker and aromatase inhibitors is appealing for treating breast cancer patients with FGFR1 amplification. However, no pharmacodynamic studies have addressed the effects of this combined target modulation. We conducted a phase 0/I clinical trial in an...
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| Format: | Article |
| Language: | English |
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BMC
2019-05-01
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| Series: | Breast Cancer Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13058-019-1152-x |
| _version_ | 1818429995093065728 |
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| author | Miguel Quintela-Fandino Juan V. Apala Diego Malon Silvana Mouron Javier Hornedo Lucia Gonzalez-Cortijo Ramon Colomer Juan Guerra |
| author_facet | Miguel Quintela-Fandino Juan V. Apala Diego Malon Silvana Mouron Javier Hornedo Lucia Gonzalez-Cortijo Ramon Colomer Juan Guerra |
| author_sort | Miguel Quintela-Fandino |
| collection | DOAJ |
| description | Abstract Background The combined use of a FGFR1 blocker and aromatase inhibitors is appealing for treating breast cancer patients with FGFR1 amplification. However, no pharmacodynamic studies have addressed the effects of this combined target modulation. We conducted a phase 0/I clinical trial in an adjuvant setting, with the goal of obtaining pharmacodynamic proof of the effects of combined aromatase and FGFR1 inhibition and to establish the RP2D for nintedanib combined with letrozole. Patients and methods Women with early-stage luminal breast cancer were eligible for enrollment in the study. Dose level 1 was nintedanib (150 mg/bid) plus letrozole (2.5 mg/day) administered for a single 28-day cycle (DLT assessment period), followed by a classic 3 + 3 schedule. FGF23 and 17-B-estradiol levels were determined on days 0 and 15; pharmacokinetic parameters were assessed on days 1 and 28. Patients were allowed to continue treatment for 6 cycles. The primary study endpoint was a demonstration of FGFR1 modulation (defined as a 25% increase in the plasma FGF23 level). Results A total of 19 patients were enrolled in the study (10 in the expansion cohort following dose escalation). At the RP2D (nintedanib 200 mg/bid plus letrozole 2.5 mg/day), we observed a 55% mean increase in the plasma FGF23 level, and 81.2% of the patients had no detectable level of 17-B-estradiol in their plasma (87.5% of the patients treated with letrozole alone). Nintedanib and letrozole displayed a pharmacokinetic interaction that led to three- and twofold increases in their respective plasma concentrations. Most G3 toxic events (5 out of 6: 2 diarrhea and 3 hypertransaminasemia) occurred subsequent to the DLT assessment period. Conclusion Combined treatment with nintedanib (200 mg/bid) plus letrozole (2.5 mg/day) effectively suppressed FGFR1 and aromatase activity, and these respective doses can be used as starting doses in any subsequent trials. However, drug-drug interactions may produce tolerability issues when these drugs are co-administered for an extended time period (e.g., 6 months). Patients enrolled in future trials with these drugs should be carefully monitored for their FGF23 levels and signs of toxicity, and those findings should guide individualized treatment decisions. Trial registration This trial was registered at www.clinicaltrials.gov under reg. # NCT02619162, on December 2, 2015. |
| first_indexed | 2024-12-14T15:26:22Z |
| format | Article |
| id | doaj.art-1917c626fbb948caba36756bcb86cc27 |
| institution | Directory Open Access Journal |
| issn | 1465-542X |
| language | English |
| last_indexed | 2024-12-14T15:26:22Z |
| publishDate | 2019-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Breast Cancer Research |
| spelling | doaj.art-1917c626fbb948caba36756bcb86cc272022-12-21T22:56:00ZengBMCBreast Cancer Research1465-542X2019-05-0121111410.1186/s13058-019-1152-xNintedanib plus letrozole in early breast cancer: a phase 0/I pharmacodynamic, pharmacokinetic, and safety clinical trial of combined FGFR1 and aromatase inhibitionMiguel Quintela-Fandino0Juan V. Apala1Diego Malon2Silvana Mouron3Javier Hornedo4Lucia Gonzalez-Cortijo5Ramon Colomer6Juan Guerra7Breast Cancer Clinical Research Unit, CNIO–Spanish National Cancer Research CenterBreast Cancer Clinical Research Unit, CNIO–Spanish National Cancer Research CenterMedical Oncology, Hospital Universitario de FuenlabradaBreast Cancer Clinical Research Unit, CNIO–Spanish National Cancer Research CenterMedical Oncology, Hospital Universitario QuironMedical Oncology, Hospital Universitario QuironMedical Oncology, Hospital Universitario La PrincesaMedical Oncology, Hospital Universitario de FuenlabradaAbstract Background The combined use of a FGFR1 blocker and aromatase inhibitors is appealing for treating breast cancer patients with FGFR1 amplification. However, no pharmacodynamic studies have addressed the effects of this combined target modulation. We conducted a phase 0/I clinical trial in an adjuvant setting, with the goal of obtaining pharmacodynamic proof of the effects of combined aromatase and FGFR1 inhibition and to establish the RP2D for nintedanib combined with letrozole. Patients and methods Women with early-stage luminal breast cancer were eligible for enrollment in the study. Dose level 1 was nintedanib (150 mg/bid) plus letrozole (2.5 mg/day) administered for a single 28-day cycle (DLT assessment period), followed by a classic 3 + 3 schedule. FGF23 and 17-B-estradiol levels were determined on days 0 and 15; pharmacokinetic parameters were assessed on days 1 and 28. Patients were allowed to continue treatment for 6 cycles. The primary study endpoint was a demonstration of FGFR1 modulation (defined as a 25% increase in the plasma FGF23 level). Results A total of 19 patients were enrolled in the study (10 in the expansion cohort following dose escalation). At the RP2D (nintedanib 200 mg/bid plus letrozole 2.5 mg/day), we observed a 55% mean increase in the plasma FGF23 level, and 81.2% of the patients had no detectable level of 17-B-estradiol in their plasma (87.5% of the patients treated with letrozole alone). Nintedanib and letrozole displayed a pharmacokinetic interaction that led to three- and twofold increases in their respective plasma concentrations. Most G3 toxic events (5 out of 6: 2 diarrhea and 3 hypertransaminasemia) occurred subsequent to the DLT assessment period. Conclusion Combined treatment with nintedanib (200 mg/bid) plus letrozole (2.5 mg/day) effectively suppressed FGFR1 and aromatase activity, and these respective doses can be used as starting doses in any subsequent trials. However, drug-drug interactions may produce tolerability issues when these drugs are co-administered for an extended time period (e.g., 6 months). Patients enrolled in future trials with these drugs should be carefully monitored for their FGF23 levels and signs of toxicity, and those findings should guide individualized treatment decisions. Trial registration This trial was registered at www.clinicaltrials.gov under reg. # NCT02619162, on December 2, 2015.http://link.springer.com/article/10.1186/s13058-019-1152-xPhase 0 clinical trialPhase I clinical trialPharmacodynamicsFGFR1FGF23Letrozole |
| spellingShingle | Miguel Quintela-Fandino Juan V. Apala Diego Malon Silvana Mouron Javier Hornedo Lucia Gonzalez-Cortijo Ramon Colomer Juan Guerra Nintedanib plus letrozole in early breast cancer: a phase 0/I pharmacodynamic, pharmacokinetic, and safety clinical trial of combined FGFR1 and aromatase inhibition Breast Cancer Research Phase 0 clinical trial Phase I clinical trial Pharmacodynamics FGFR1 FGF23 Letrozole |
| title | Nintedanib plus letrozole in early breast cancer: a phase 0/I pharmacodynamic, pharmacokinetic, and safety clinical trial of combined FGFR1 and aromatase inhibition |
| title_full | Nintedanib plus letrozole in early breast cancer: a phase 0/I pharmacodynamic, pharmacokinetic, and safety clinical trial of combined FGFR1 and aromatase inhibition |
| title_fullStr | Nintedanib plus letrozole in early breast cancer: a phase 0/I pharmacodynamic, pharmacokinetic, and safety clinical trial of combined FGFR1 and aromatase inhibition |
| title_full_unstemmed | Nintedanib plus letrozole in early breast cancer: a phase 0/I pharmacodynamic, pharmacokinetic, and safety clinical trial of combined FGFR1 and aromatase inhibition |
| title_short | Nintedanib plus letrozole in early breast cancer: a phase 0/I pharmacodynamic, pharmacokinetic, and safety clinical trial of combined FGFR1 and aromatase inhibition |
| title_sort | nintedanib plus letrozole in early breast cancer a phase 0 i pharmacodynamic pharmacokinetic and safety clinical trial of combined fgfr1 and aromatase inhibition |
| topic | Phase 0 clinical trial Phase I clinical trial Pharmacodynamics FGFR1 FGF23 Letrozole |
| url | http://link.springer.com/article/10.1186/s13058-019-1152-x |
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