Phase 1 trial of olaratumab monotherapy and in combination with chemotherapy in pediatric patients with relapsed/refractory solid and central nervous system tumors. (20th January 2021)

• Record Type: Journal Article
• Authors: Mascarenhas, Leo; Ogawa, Chitose; Laetsch, Theodore W.; Weigel, Brenda J.; Bishop, Michael W.; Krystal, Julie; Borinstein, Scott C.; Slotkin, Emily K.; Muscal, Jodi A.; Hingorani, Pooja; Levy, Donna E.; Mo, Gary; Shahir, Ashwin; Wright, Jennifer; DuBois, Steven G.
• Is Part Of: Cancer medicine. Volume 10:Number 3(2021)
• Page Start: 843
• Page End: 856
• Publication Date: 2021-01-20
• Subjects: chemotherapy -- olaratumab -- pediatric cancer -- platelet‐derived growth factor receptor; 616.994005
• DOI: 10.1002/cam4.3658
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Olaratumab is a monoclonal antibody that specifically binds to platelet‐derived growth factor receptor alpha (PDGFRα) and blocks receptor activation. We conducted a phase 1 trial to evaluate the safety of olaratumab and determine a recommended dose in combination with three different chemotherapy regimens in children. Patients <18 years with relapsed/refractory solid or central nervous system tumors were enrolled to two dose levels of olaratumab. Patients received olaratumab monotherapy at 15 mg/kg (Part A) or 20 mg/kg (Part B) on Days 1 and 8 of the first 21‐day cycle, followed by olaratumab combined with standard fixed doses of chemotherapy with doxorubicin, vincristine/irinotecan, or high‐dose ifosfamide by investigator choice for subsequent 21‐day cycles. In Part C, patients received olaratumab 20 mg/kg plus assigned chemotherapy for all cycles. Parts A‐C enrolled 68 patients across three chemotherapy treatment arms; olaratumab in combination with doxorubicin (N = 16), vincristine/irinotecan (N = 26), or ifosfamide (N = 26). Three dose‐limiting toxicities (DLTs) occurred during olaratumab monotherapy (at 15 mg/kg, grade [G] 4 alanine aminotransferase [ALT]; at 20 mg/kg, G3 lung infection and G3 gamma‐glutamyl transferase). One DLT occurred during vincristine/irinotecan with olaratumab 20 mg/kg therapy (G3 ALT). Treatment‐emergent adverse events ≥G3 in >25% of patients included neutropenia, anemia, leukopenia, lymphopenia, and thrombocytopenia. Pharmacokinetic profiles of olaratumab with chemotherapy were within the projected range based on adult data. There was one complete response (rhabdomyosarcoma [Part B vincristine/irinotecan arm]) and three partial responses (two rhabdomyosarcoma [Part A doxorubicin arm and Part C doxorubicin arm]; one pineoblastoma [Part B vincristine/irinotecan arm]). Olaratumab was tolerable and safely administered in combination with chemotherapy regimens commonly used in children and adolescents. Abstract : Observed pharmacokinetic (PK) data and model predicted PK profiles by weight in pediatric patients treated with olaratumab. The overlay was limited to the first seven cycles where observed data were available to provide meaningful comparison. Overall, there was general agreement between the observed and model predicted serum concentrations as the observed values (colored circle) overlap with the prediction interval (shaded region) from the PK model. The colored circles correspond to each patient in the study. The shaded region represents the 90% prediction interval and the solid line represents the median of predicted concentration.