Antitumour activity of MDV3100 in castration-resistant prostate cancer: A phase 1-2 study

H. I. Scher, A. Anand, D. Rathkopf, J. Shelkey, M. J. Morris, D. C. Danila, S. Larson, J. Humm, M. Fleisher, C. L. Sawyers, Tomasz (Tom) Beer, Joshi Alumkal, C. L. Sawyers, C. S. Higano, E. Y. Yu, M. E. Taplin, E. Efstathiou, D. Hung, M. Hirmand, L. Seely

    Research output: Contribution to journalArticle

    777 Citations (Scopus)

    Abstract

    Background MDV3100 is an androgen-receptor antagonist that blocks androgens from binding to the androgen receptor and prevents nuclear translocation and co-activator recruitment of the ligand-receptor complex. It also induces tumour cell apoptosis, and has no agonist activity. Because growth of castration-resistant prostate cancer is dependent on continued androgen-receptor signalling, we assessed the antitumour activity and safety of MDV3100 in men with this disease. Methods This phase 1-2 study was undertaken in fi ve US centres in 140 patients. Patients with progressive, metastatic, castration-resistant prostate cancer were enrolled in dose-escalation cohorts of three to six patients and given an oral daily starting dose of MDV3100 30 mg. The fi nal daily doses studied were 30 mg (n=3), 60 mg (27), 150 mg (28), 240 mg (29), 360 mg (28), 480 mg (22), and 600 mg (3). The primary objective was to identify the safety and tolerability profi le of MDV3100 and to establish the maximum tolerated dose. The trial is registered with ClinicalTrials.gov, number NCT00510718. Findings We noted antitumour eff ects at all doses, including decreases in serum prostate-specifi c antigen of 50% or more in 78 (56%) patients, responses in soft tissue in 13 (22%) of 59 patients, stabilised bone disease in 61 (56%) of 109 patients, and conversion from unfavourable to favourable circulating tumour cell counts in 25 (49%) of the 51 patients. PET imaging of 22 patients to assess androgen-receptor blockade showed decreased18F-fl uoro-5α-dihydrotestosterone binding at doses from 60 mg to 480 mg per day (range 20-100%). The median time to progression was 47 weeks (95% CI 34-not reached) for radiological progression. The maximum tolerated dose for sustained treatment (>28 days) was 240 mg. The most common grade 3-4 adverse event was dose-dependent fatigue (16 [11%] patients), which generally resolved after dose reduction. Interpretation We recorded encouraging antitumour activity with MDV3100 in patients with castration-resistant prostate cancer. The results of this phase 1-2 trial validate in man preclinical studies implicating sustained androgenreceptor signalling as a driver in this disease. Funding Medivation, the Prostate Cancer Foundation, National Cancer Institute, the Howard Hughes Medical Institute, Doris Duke Charitable Foundation, and Department of Defense Prostate Cancer Clinical Trials Consortium.

    Original languageEnglish (US)
    Pages (from-to)1437-1446
    Number of pages10
    JournalThe Lancet
    Volume375
    Issue number9724
    DOIs
    StatePublished - 2010

    Fingerprint

    Castration
    Prostatic Neoplasms
    Androgen Receptors
    Maximum Tolerated Dose
    Androgen Receptor Antagonists
    MDV 3100
    Circulating Neoplastic Cells
    Safety
    National Cancer Institute (U.S.)
    Dihydrotestosterone
    Bone Diseases
    Androgens
    Fatigue
    Prostate
    Cell Count
    Clinical Trials
    Apoptosis
    Ligands
    Antigens

    ASJC Scopus subject areas

    • Medicine(all)

    Cite this

    Scher, H. I., Anand, A., Rathkopf, D., Shelkey, J., Morris, M. J., Danila, D. C., ... Seely, L. (2010). Antitumour activity of MDV3100 in castration-resistant prostate cancer: A phase 1-2 study. The Lancet, 375(9724), 1437-1446. https://doi.org/10.1016/S0140-6736(10)60172-9

    Antitumour activity of MDV3100 in castration-resistant prostate cancer : A phase 1-2 study. / Scher, H. I.; Anand, A.; Rathkopf, D.; Shelkey, J.; Morris, M. J.; Danila, D. C.; Larson, S.; Humm, J.; Fleisher, M.; Sawyers, C. L.; Beer, Tomasz (Tom); Alumkal, Joshi; Sawyers, C. L.; Higano, C. S.; Yu, E. Y.; Taplin, M. E.; Efstathiou, E.; Hung, D.; Hirmand, M.; Seely, L.

    In: The Lancet, Vol. 375, No. 9724, 2010, p. 1437-1446.

    Research output: Contribution to journalArticle

    Scher, HI, Anand, A, Rathkopf, D, Shelkey, J, Morris, MJ, Danila, DC, Larson, S, Humm, J, Fleisher, M, Sawyers, CL, Beer, TT, Alumkal, J, Sawyers, CL, Higano, CS, Yu, EY, Taplin, ME, Efstathiou, E, Hung, D, Hirmand, M & Seely, L 2010, 'Antitumour activity of MDV3100 in castration-resistant prostate cancer: A phase 1-2 study', The Lancet, vol. 375, no. 9724, pp. 1437-1446. https://doi.org/10.1016/S0140-6736(10)60172-9
    Scher HI, Anand A, Rathkopf D, Shelkey J, Morris MJ, Danila DC et al. Antitumour activity of MDV3100 in castration-resistant prostate cancer: A phase 1-2 study. The Lancet. 2010;375(9724):1437-1446. https://doi.org/10.1016/S0140-6736(10)60172-9
    Scher, H. I. ; Anand, A. ; Rathkopf, D. ; Shelkey, J. ; Morris, M. J. ; Danila, D. C. ; Larson, S. ; Humm, J. ; Fleisher, M. ; Sawyers, C. L. ; Beer, Tomasz (Tom) ; Alumkal, Joshi ; Sawyers, C. L. ; Higano, C. S. ; Yu, E. Y. ; Taplin, M. E. ; Efstathiou, E. ; Hung, D. ; Hirmand, M. ; Seely, L. / Antitumour activity of MDV3100 in castration-resistant prostate cancer : A phase 1-2 study. In: The Lancet. 2010 ; Vol. 375, No. 9724. pp. 1437-1446.
    @article{b7ef34e05e0e4b1097f7a3cda02ba9bd,
    title = "Antitumour activity of MDV3100 in castration-resistant prostate cancer: A phase 1-2 study",
    abstract = "Background MDV3100 is an androgen-receptor antagonist that blocks androgens from binding to the androgen receptor and prevents nuclear translocation and co-activator recruitment of the ligand-receptor complex. It also induces tumour cell apoptosis, and has no agonist activity. Because growth of castration-resistant prostate cancer is dependent on continued androgen-receptor signalling, we assessed the antitumour activity and safety of MDV3100 in men with this disease. Methods This phase 1-2 study was undertaken in fi ve US centres in 140 patients. Patients with progressive, metastatic, castration-resistant prostate cancer were enrolled in dose-escalation cohorts of three to six patients and given an oral daily starting dose of MDV3100 30 mg. The fi nal daily doses studied were 30 mg (n=3), 60 mg (27), 150 mg (28), 240 mg (29), 360 mg (28), 480 mg (22), and 600 mg (3). The primary objective was to identify the safety and tolerability profi le of MDV3100 and to establish the maximum tolerated dose. The trial is registered with ClinicalTrials.gov, number NCT00510718. Findings We noted antitumour eff ects at all doses, including decreases in serum prostate-specifi c antigen of 50{\%} or more in 78 (56{\%}) patients, responses in soft tissue in 13 (22{\%}) of 59 patients, stabilised bone disease in 61 (56{\%}) of 109 patients, and conversion from unfavourable to favourable circulating tumour cell counts in 25 (49{\%}) of the 51 patients. PET imaging of 22 patients to assess androgen-receptor blockade showed decreased18F-fl uoro-5α-dihydrotestosterone binding at doses from 60 mg to 480 mg per day (range 20-100{\%}). The median time to progression was 47 weeks (95{\%} CI 34-not reached) for radiological progression. The maximum tolerated dose for sustained treatment (>28 days) was 240 mg. The most common grade 3-4 adverse event was dose-dependent fatigue (16 [11{\%}] patients), which generally resolved after dose reduction. Interpretation We recorded encouraging antitumour activity with MDV3100 in patients with castration-resistant prostate cancer. The results of this phase 1-2 trial validate in man preclinical studies implicating sustained androgenreceptor signalling as a driver in this disease. Funding Medivation, the Prostate Cancer Foundation, National Cancer Institute, the Howard Hughes Medical Institute, Doris Duke Charitable Foundation, and Department of Defense Prostate Cancer Clinical Trials Consortium.",
    author = "Scher, {H. I.} and A. Anand and D. Rathkopf and J. Shelkey and Morris, {M. J.} and Danila, {D. C.} and S. Larson and J. Humm and M. Fleisher and Sawyers, {C. L.} and Beer, {Tomasz (Tom)} and Joshi Alumkal and Sawyers, {C. L.} and Higano, {C. S.} and Yu, {E. Y.} and Taplin, {M. E.} and E. Efstathiou and D. Hung and M. Hirmand and L. Seely",
    year = "2010",
    doi = "10.1016/S0140-6736(10)60172-9",
    language = "English (US)",
    volume = "375",
    pages = "1437--1446",
    journal = "The Lancet",
    issn = "0140-6736",
    publisher = "Elsevier Limited",
    number = "9724",

    }

    TY - JOUR

    T1 - Antitumour activity of MDV3100 in castration-resistant prostate cancer

    T2 - A phase 1-2 study

    AU - Scher, H. I.

    AU - Anand, A.

    AU - Rathkopf, D.

    AU - Shelkey, J.

    AU - Morris, M. J.

    AU - Danila, D. C.

    AU - Larson, S.

    AU - Humm, J.

    AU - Fleisher, M.

    AU - Sawyers, C. L.

    AU - Beer, Tomasz (Tom)

    AU - Alumkal, Joshi

    AU - Sawyers, C. L.

    AU - Higano, C. S.

    AU - Yu, E. Y.

    AU - Taplin, M. E.

    AU - Efstathiou, E.

    AU - Hung, D.

    AU - Hirmand, M.

    AU - Seely, L.

    PY - 2010

    Y1 - 2010

    N2 - Background MDV3100 is an androgen-receptor antagonist that blocks androgens from binding to the androgen receptor and prevents nuclear translocation and co-activator recruitment of the ligand-receptor complex. It also induces tumour cell apoptosis, and has no agonist activity. Because growth of castration-resistant prostate cancer is dependent on continued androgen-receptor signalling, we assessed the antitumour activity and safety of MDV3100 in men with this disease. Methods This phase 1-2 study was undertaken in fi ve US centres in 140 patients. Patients with progressive, metastatic, castration-resistant prostate cancer were enrolled in dose-escalation cohorts of three to six patients and given an oral daily starting dose of MDV3100 30 mg. The fi nal daily doses studied were 30 mg (n=3), 60 mg (27), 150 mg (28), 240 mg (29), 360 mg (28), 480 mg (22), and 600 mg (3). The primary objective was to identify the safety and tolerability profi le of MDV3100 and to establish the maximum tolerated dose. The trial is registered with ClinicalTrials.gov, number NCT00510718. Findings We noted antitumour eff ects at all doses, including decreases in serum prostate-specifi c antigen of 50% or more in 78 (56%) patients, responses in soft tissue in 13 (22%) of 59 patients, stabilised bone disease in 61 (56%) of 109 patients, and conversion from unfavourable to favourable circulating tumour cell counts in 25 (49%) of the 51 patients. PET imaging of 22 patients to assess androgen-receptor blockade showed decreased18F-fl uoro-5α-dihydrotestosterone binding at doses from 60 mg to 480 mg per day (range 20-100%). The median time to progression was 47 weeks (95% CI 34-not reached) for radiological progression. The maximum tolerated dose for sustained treatment (>28 days) was 240 mg. The most common grade 3-4 adverse event was dose-dependent fatigue (16 [11%] patients), which generally resolved after dose reduction. Interpretation We recorded encouraging antitumour activity with MDV3100 in patients with castration-resistant prostate cancer. The results of this phase 1-2 trial validate in man preclinical studies implicating sustained androgenreceptor signalling as a driver in this disease. Funding Medivation, the Prostate Cancer Foundation, National Cancer Institute, the Howard Hughes Medical Institute, Doris Duke Charitable Foundation, and Department of Defense Prostate Cancer Clinical Trials Consortium.

    AB - Background MDV3100 is an androgen-receptor antagonist that blocks androgens from binding to the androgen receptor and prevents nuclear translocation and co-activator recruitment of the ligand-receptor complex. It also induces tumour cell apoptosis, and has no agonist activity. Because growth of castration-resistant prostate cancer is dependent on continued androgen-receptor signalling, we assessed the antitumour activity and safety of MDV3100 in men with this disease. Methods This phase 1-2 study was undertaken in fi ve US centres in 140 patients. Patients with progressive, metastatic, castration-resistant prostate cancer were enrolled in dose-escalation cohorts of three to six patients and given an oral daily starting dose of MDV3100 30 mg. The fi nal daily doses studied were 30 mg (n=3), 60 mg (27), 150 mg (28), 240 mg (29), 360 mg (28), 480 mg (22), and 600 mg (3). The primary objective was to identify the safety and tolerability profi le of MDV3100 and to establish the maximum tolerated dose. The trial is registered with ClinicalTrials.gov, number NCT00510718. Findings We noted antitumour eff ects at all doses, including decreases in serum prostate-specifi c antigen of 50% or more in 78 (56%) patients, responses in soft tissue in 13 (22%) of 59 patients, stabilised bone disease in 61 (56%) of 109 patients, and conversion from unfavourable to favourable circulating tumour cell counts in 25 (49%) of the 51 patients. PET imaging of 22 patients to assess androgen-receptor blockade showed decreased18F-fl uoro-5α-dihydrotestosterone binding at doses from 60 mg to 480 mg per day (range 20-100%). The median time to progression was 47 weeks (95% CI 34-not reached) for radiological progression. The maximum tolerated dose for sustained treatment (>28 days) was 240 mg. The most common grade 3-4 adverse event was dose-dependent fatigue (16 [11%] patients), which generally resolved after dose reduction. Interpretation We recorded encouraging antitumour activity with MDV3100 in patients with castration-resistant prostate cancer. The results of this phase 1-2 trial validate in man preclinical studies implicating sustained androgenreceptor signalling as a driver in this disease. Funding Medivation, the Prostate Cancer Foundation, National Cancer Institute, the Howard Hughes Medical Institute, Doris Duke Charitable Foundation, and Department of Defense Prostate Cancer Clinical Trials Consortium.

    UR - http://www.scopus.com/inward/record.url?scp=77952105685&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=77952105685&partnerID=8YFLogxK

    U2 - 10.1016/S0140-6736(10)60172-9

    DO - 10.1016/S0140-6736(10)60172-9

    M3 - Article

    C2 - 20398925

    AN - SCOPUS:77952105685

    VL - 375

    SP - 1437

    EP - 1446

    JO - The Lancet

    JF - The Lancet

    SN - 0140-6736

    IS - 9724

    ER -