An Innovative Phase I Clinical Study Demonstrates Inhibition of FLT3 Phosphorylation by SU11248 in Acute Myeloid Leukemia Patients

Anne Marie O'Farrell, James M. Foran, Walter Fiedler, Hubert Serve, Ron L. Paquette, Maureen A. Cooper, Helene A. Yuen, Sharianne G. Louie, Heidi Kim, Susan Nicholas, Michael Heinrich, Wolfgang E. Berdel, Carlo Bello, Mark Jacobs, Paul Scigalla, William C. Manning, Stephen Kelsey, Julie M. Cherrington

    Research output: Contribution to journalArticle

    266 Citations (Scopus)

    Abstract

    Purpose: Obtaining direct and rapid proof of molecular activity in early clinical trials is critical for optimal clinical development of novel targeted therapies. SU11248 is an oral multitargeted kinase inhibitor with selectivity for fms-related tyrosine kinase 3/Flk2 (FLT3), platelet-derived growth factor receptor α/β, vascular endothelial growth factor receptor 1/2, and KIT receptor tyrosine kinases. FLT3 is a promising candidate for targeted therapy in acute myeloid leukemia (AML), because activating mutations occur in up to 30% of patients. We conducted an innovative single-dose clinical study with a primary objective to demonstrate inhibition of FLT3 phosphorylation by SU11248 in AML. Experimental Design: Twenty-nine AML patients each received a single dose of SU11248, escalated from 50 to 350 mg, in increments of 50 mg and cohorts of three to six patients. FLT3 phosphorylation and plasma pharmacokinetics were evaluated at seven time points over 48 h after SU11248 administration, and FLT3 genotype was determined. Study drug-related adverse events occurred in 31% of patients, mainly grade 1 or 2 diarrhea and nausea, at higher dose levels. Results: Inhibition of FLT3 phosphorylation was apparent in 50% of FLT3-wild-type (WT) patients and in 100% of FLT3-mutant patients. FLT3 internal tandem duplication (ITD) mutants showed increased sensitivity relative to FLT3-WT, consistent with preclinical predictions. The primary end point, strong inhibition of FLT3 phosphorylation in >50% patients, was reached in 200 mg and higher dose cohorts. Downstream signaling pathways were also inhibited; signal transducer and activator of transcription 5 (STAT5) was reduced primarily in internal tandem duplication patients and at late time points in FLT3-WT patients, whereas extracellular signal-regulated kinase (ERK) activity was reduced in the majority of patients, independent of FLT3 inhibition. Conclusions: This novel translational study bridges preclinical models to the patient setting and provides the first evidence of anti-FLT3 activity in patients. Proof of target inhibition accomplishes a crucial milestone in the development of novel oncology therapeutics.

    Original languageEnglish (US)
    Pages (from-to)5465-5476
    Number of pages12
    JournalClinical Cancer Research
    Volume9
    Issue number15
    StatePublished - Nov 15 2003

    Fingerprint

    Acute Myeloid Leukemia
    Phosphorylation
    sunitinib
    Clinical Studies
    STAT5 Transcription Factor
    Vascular Endothelial Growth Factor Receptor-1
    Platelet-Derived Growth Factor Receptors
    Vascular Endothelial Growth Factor Receptor-2
    Extracellular Signal-Regulated MAP Kinases
    Receptor Protein-Tyrosine Kinases
    Drug-Related Side Effects and Adverse Reactions
    Protein-Tyrosine Kinases
    Nausea
    Diarrhea
    Research Design
    Phosphotransferases
    Therapeutics
    Pharmacokinetics
    Genotype
    Clinical Trials

    ASJC Scopus subject areas

    • Cancer Research
    • Oncology

    Cite this

    O'Farrell, A. M., Foran, J. M., Fiedler, W., Serve, H., Paquette, R. L., Cooper, M. A., ... Cherrington, J. M. (2003). An Innovative Phase I Clinical Study Demonstrates Inhibition of FLT3 Phosphorylation by SU11248 in Acute Myeloid Leukemia Patients. Clinical Cancer Research, 9(15), 5465-5476.

    An Innovative Phase I Clinical Study Demonstrates Inhibition of FLT3 Phosphorylation by SU11248 in Acute Myeloid Leukemia Patients. / O'Farrell, Anne Marie; Foran, James M.; Fiedler, Walter; Serve, Hubert; Paquette, Ron L.; Cooper, Maureen A.; Yuen, Helene A.; Louie, Sharianne G.; Kim, Heidi; Nicholas, Susan; Heinrich, Michael; Berdel, Wolfgang E.; Bello, Carlo; Jacobs, Mark; Scigalla, Paul; Manning, William C.; Kelsey, Stephen; Cherrington, Julie M.

    In: Clinical Cancer Research, Vol. 9, No. 15, 15.11.2003, p. 5465-5476.

    Research output: Contribution to journalArticle

    O'Farrell, AM, Foran, JM, Fiedler, W, Serve, H, Paquette, RL, Cooper, MA, Yuen, HA, Louie, SG, Kim, H, Nicholas, S, Heinrich, M, Berdel, WE, Bello, C, Jacobs, M, Scigalla, P, Manning, WC, Kelsey, S & Cherrington, JM 2003, 'An Innovative Phase I Clinical Study Demonstrates Inhibition of FLT3 Phosphorylation by SU11248 in Acute Myeloid Leukemia Patients', Clinical Cancer Research, vol. 9, no. 15, pp. 5465-5476.
    O'Farrell AM, Foran JM, Fiedler W, Serve H, Paquette RL, Cooper MA et al. An Innovative Phase I Clinical Study Demonstrates Inhibition of FLT3 Phosphorylation by SU11248 in Acute Myeloid Leukemia Patients. Clinical Cancer Research. 2003 Nov 15;9(15):5465-5476.
    O'Farrell, Anne Marie ; Foran, James M. ; Fiedler, Walter ; Serve, Hubert ; Paquette, Ron L. ; Cooper, Maureen A. ; Yuen, Helene A. ; Louie, Sharianne G. ; Kim, Heidi ; Nicholas, Susan ; Heinrich, Michael ; Berdel, Wolfgang E. ; Bello, Carlo ; Jacobs, Mark ; Scigalla, Paul ; Manning, William C. ; Kelsey, Stephen ; Cherrington, Julie M. / An Innovative Phase I Clinical Study Demonstrates Inhibition of FLT3 Phosphorylation by SU11248 in Acute Myeloid Leukemia Patients. In: Clinical Cancer Research. 2003 ; Vol. 9, No. 15. pp. 5465-5476.
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    abstract = "Purpose: Obtaining direct and rapid proof of molecular activity in early clinical trials is critical for optimal clinical development of novel targeted therapies. SU11248 is an oral multitargeted kinase inhibitor with selectivity for fms-related tyrosine kinase 3/Flk2 (FLT3), platelet-derived growth factor receptor α/β, vascular endothelial growth factor receptor 1/2, and KIT receptor tyrosine kinases. FLT3 is a promising candidate for targeted therapy in acute myeloid leukemia (AML), because activating mutations occur in up to 30{\%} of patients. We conducted an innovative single-dose clinical study with a primary objective to demonstrate inhibition of FLT3 phosphorylation by SU11248 in AML. Experimental Design: Twenty-nine AML patients each received a single dose of SU11248, escalated from 50 to 350 mg, in increments of 50 mg and cohorts of three to six patients. FLT3 phosphorylation and plasma pharmacokinetics were evaluated at seven time points over 48 h after SU11248 administration, and FLT3 genotype was determined. Study drug-related adverse events occurred in 31{\%} of patients, mainly grade 1 or 2 diarrhea and nausea, at higher dose levels. Results: Inhibition of FLT3 phosphorylation was apparent in 50{\%} of FLT3-wild-type (WT) patients and in 100{\%} of FLT3-mutant patients. FLT3 internal tandem duplication (ITD) mutants showed increased sensitivity relative to FLT3-WT, consistent with preclinical predictions. The primary end point, strong inhibition of FLT3 phosphorylation in >50{\%} patients, was reached in 200 mg and higher dose cohorts. Downstream signaling pathways were also inhibited; signal transducer and activator of transcription 5 (STAT5) was reduced primarily in internal tandem duplication patients and at late time points in FLT3-WT patients, whereas extracellular signal-regulated kinase (ERK) activity was reduced in the majority of patients, independent of FLT3 inhibition. Conclusions: This novel translational study bridges preclinical models to the patient setting and provides the first evidence of anti-FLT3 activity in patients. Proof of target inhibition accomplishes a crucial milestone in the development of novel oncology therapeutics.",
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    AU - Foran, James M.

    AU - Fiedler, Walter

    AU - Serve, Hubert

    AU - Paquette, Ron L.

    AU - Cooper, Maureen A.

    AU - Yuen, Helene A.

    AU - Louie, Sharianne G.

    AU - Kim, Heidi

    AU - Nicholas, Susan

    AU - Heinrich, Michael

    AU - Berdel, Wolfgang E.

    AU - Bello, Carlo

    AU - Jacobs, Mark

    AU - Scigalla, Paul

    AU - Manning, William C.

    AU - Kelsey, Stephen

    AU - Cherrington, Julie M.

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