First-in-human study of LY3039478, an oral Notch signaling inhibitor in advanced or metastatic cancer

C. Massard*, A. Azaro, J. C. Soria, U. Lassen, C. Le Tourneau, D. Sarker, C. Smith, U. Ohnmacht, G. Oakley, B. K.R. Patel, E. S.M. Yuen, K. A. Benhadji, J. Rodon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

99 Citations (Scopus)
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Abstract

Background Deregulated Notch signaling due to mutation or overexpression of ligands and/or receptors is implicated in various human malignancies. Î 3-Secretase inhibitors inhibit Notch signaling by preventing cleavage of transmembrane domain of Notch protein. LY3039478 is a novel, potent Notch inhibitor decreases Notch signaling and its downstream biologic effects. In this first-in-human study, we report the safety, pharmacokinetic (PK) profile, pharmacodynamic effects, and antitumor activity of LY3039478 in patients with advanced or metastatic cancer. Methods This phase I, open-label, multicenter, nonrandomized, and dose-escalation phase study determined and confirmed the recommended phase II dose of LY3039478 (oral dose: 2.5-100 mg, thrice weekly (TIW) on a 28-day cycle). The primary objectives are to determine (part A) and confirm (part B) a recommended phase II dose that may be safely administered to patients with advanced or metastatic cancer, and secondary objectives include evaluation of safety, tolerability, PK parameters, and preliminary antitumor activity of LY3039478. Results A total of 110 patients were treated with LY3039478 monotherapy between 31 October 2012 and 15 July 2016. Dose-limiting toxicities were thrombocytopenia, colitis, and nausea. Most adverse events were gastrointestinal. The recommended phase II dose was 50 mg TIW, because of its better tolerability compared with 75 mg. The PKs of LY3039478 appeared dose proportional. Pharmacodynamic data indicate an '1/480% inhibition of plasma Aβ, and >50% inhibition of Notch-regulated genes hairy and enhancer of split-1, cyclin D1, and Notch-regulated ankyrin repeat at 45-100-mg dose. Clinical activity (tumor necrosis, metabolic response, or tumor shrinkage) was observed in patients with breast cancer, leiomyosarcoma, and adenoid cystic carcinoma. Conclusion Potent inhibition of Notch signaling by LY3039478 was well tolerated at doses associated with target engagement, and demonstrated evidence of clinical activity in heavily pretreated patients. Further investigation with LY3039478 as monotherapy and in combination with targeted agent or chemotherapy is ongoing. Clinicaltrials.gov ID NCT01695005.

Original languageEnglish
Pages (from-to)1911-1917
Number of pages7
JournalAnnals of Oncology
Volume29
Issue number9
Early online date28 Jul 2018
DOIs
Publication statusPublished - 1 Sept 2018

Keywords

  • colorectal cancer
  • LY3039478
  • metastatic cancer
  • Notch inhibition
  • Î 3-secretase inhibitors

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