Andrew G. Stead

Phase I Safety, Pharmacokinetics, and Clinical Activity Study of Lapatinib (GW572016), a Reversible Dual Inhibitor of Epidermal Growth Factor Receptor Tyrosine Kinases, in Heavily Pretreated Patients With Metastatic Carcinomas

PURPOSE This study (EGF10004) assessed the safety/tolerability, pharmacokinetics, and clinical activity of daily oral dosing with lapatinib (GW572016) in patients with ErbB1-expressing and/or ErbB2-overexpressing advanced-stage refractory solid tumors. PATIENTS AND METHODS Heavily pretreated patients with ErbB1-expressing and/or ErbB2-overexpressing metastatic cancers were randomly assigned to one of five dose cohorts of lapatinib administered once daily. Pharmacokinetic samples were obtained on days 1 and 20. Clinical response was assessed every 8 weeks. RESULTS Sixty-seven patients with metastatic solid tumors were treated with lapatinib. The most frequently reported drug-related adverse events were diarrhea (42%) and rash (31%). No grade 4 drug-related adverse events were reported. Five grade 3 drug-related toxicities (gastrointestinal events and rash) were experienced by four patients. Drug-related interstitial pneumonitis or cardiac dysfunction associated with other ErbB-targeted therapies was not reported. Four patients with trastuzumab-resistant metastatic breast cancer-two of whom were classified as having inflammatory breast cancer-had partial responses (PRs). Twenty-four patients with various other carcinomas experienced stable disease, of whom 10 received lapatinib for > or = 6 months. The relationships between lapatinib dose or serum concentration and clinical response could not be adequately characterized due to the limited response data. The incidence of diarrhea increased with increasing dose, whereas the incidence of rash was not related to dose. CONCLUSION Lapatinib was well tolerated at doses ranging from 500 to 1,600 mg once daily. Clinical activity was observed in heavily pretreated patients with ErbB1-expressing and/or ErbB2-overexpressing metastatic cancers, including four PRs in patients with trastuzumab-resistant breast cancers and prolonged stable disease in 10 patients.

Study of the Biologic Effects of Lapatinib, a Reversible Inhibitor of ErbB1 and ErbB2 Tyrosine Kinases, on Tumor Growth and Survival Pathways in Patients With Advanced Malignancies

PURPOSE This was a pilot study to assess the biologic effects of lapatinib on various tumor growth/survival pathways in patients with advanced ErbB1 and/or ErbB2-overexpressing solid malignancies. PATIENTS AND METHODS Heavily pretreated patients with metastatic cancers overexpressing ErbB2 and/or expressing ErbB1 were randomly assigned to one of five dose cohorts of lapatinib (GW572016) administered orally once daily continuously. The biologic effects of lapatinib on tumor growth and survival pathways were assessed in tumor biopsies obtained before and after 21 days of therapy. Clinical response was determined at 8 weeks. RESULTS Sequential tumor biopsies from 33 patients were examined. Partial responses occurred in four patients with breast cancer, and disease stabilization occurred in 11 others with various malignancies. Responders exhibited variable levels of inhibition of p-ErbB1, p-ErbB2, p-Erk1/2, p-Akt, cyclin D1, and transforming growth factor alpha. Even some nonresponders demonstrated varying degrees of biomarker inhibition. Increased tumor cell apoptosis (TUNEL) occurred in patients with evidence of tumor regression but not in nonresponders (progressive disease). Clinical response was associated with a pretreatment TUNEL score > 0 and increased pretreatment expression of ErbB2, p-ErbB2, Erk1/2, p-Erk1/2, insulin-like growth factor receptor-1, p70 S6 kinase, and transforming growth factor alpha compared with nonresponders. CONCLUSION Lapatinib exhibited preliminary evidence of biologic and clinical activity in ErbB1 and/or ErbB2-overexpressing tumors. However, the limited sample size of this study and the variability of the biologic endpoints suggest that further work is needed to prioritize biomarkers for disease-directed studies, and underscores the need for improved trial design strategies in early clinical studies of targeted agents.

Phase I pharmacokinetic studies evaluating single and multiple doses of oral GW572016, a dual EGFR-ErbB2 inhibitor, in healthy subjects

GW572016 is a dual EGFR-ErbB2 inhibitor that has promise as an anticancer agent. Two phase I studies were conducted to determine the safety, tolerability and pharmacokinetics of single and multiple doses given to healthy subjects. The single dose study evaluated two groups of eight subjects in an ascending dose, 4-way cross-over, while the multiple dose study evaluated twenty-seven healthy volunteers in an ascending dose, double-blind, randomized, placebo-controlled, staggered parallel design. No serious adverse events were seen in either study. The most common adverse events for subjects receiving GW572016 were headache, diarrhea, rash, cold symptoms, gastrointestinal symptoms, and elevated LFTs, which were similar between treatment and placebo groups. Absorption of single doses of GW572016 was slightly delayed, with median tlag of 15 minutes (range 0–90 minutes) and achieved peak serum concentrations at a median of three hours (range 1.5–6 hours) post-dose. Serum concentrations after multiple doses of GW572016 demonstrated no significant accumulation at the 25 mg dose, and approximately 50% accumulation at the 100 mg and 175 mg doses, achieving steady state in six to seven days. A modest time-dependent increase in serum concentrations also was detected with multiple doses of GW572016. Single and multiple oral doses of GW572016 were well tolerated in healthy subjects, and resulted in dose-related systemic exposure of GW572016.

Effects of Food on the Relative Bioavailability of Lapatinib in Cancer Patients

PURPOSE This study was conducted to characterize the effect of food on the relative bioavailability of lapatinib. PATIENTS AND METHODS A single 1,500-mg, oral dose of lapatinib was administered to 27 patients with advanced solid tumors on each of three occasions that were 1 week apart, in random order: after an overnight fast, with a low-fat breakfast, and with a high-fat breakfast. RESULTS The low-fat breakfast produced mean increases in lapatinib area under the concentration-time curve (AUC) of 167% (2.67-fold) and maximum concentration (C(max)) of 142% (2.42-fold). The high-fat breakfast produced mean increases in lapatinib AUC of 325% (4.25-fold) and C(max) of 203% (3.03-fold) compared with the fasted state. Increased bioavailability in the fed state did not significantly decrease relative variability. Therefore, absolute variability in systemic exposure was increased. CONCLUSION These large increases in lapatinib bioavailability and absolute variability support the recommendation for dosing in the fasted state to achieve consistent therapeutic exposure. Prescribers and patients should consider the potential consequences of toxicity or diminished efficacy that might result from dosing without regard to variations in diet.

Species comparison of acute inhalation toxicity of ozone and phosgene

A comparison of the concentration-response effects of inhaled ozone (O3) and phosgene (COCl2) in different species of laboratory animals was made in order to better understand the influence of the choice of species in inhalation toxicity studies. The effect of 4-h exposures to ozone at concentrations of 0.2, 0.5, 1.0, and 2.0 ppm, and to COCl2 and 0.1, 0.2, 0.5, and 1.0 ppm was determined in rabbits, guinea pigs, rats, hamsters, and mice. Lavage fluid protein (LFP) accumulation 18-20 h after exposure was used as the indicator of O3- and COCl2-induced pulmonary edema. All species had similar basal levels of LFP (250-350 mg/ml) when a volume of saline that approximated the total lung capacity was used to lavage the collapsed lungs. Ozone effects were most marked in guinea pigs, which showed significant effects at 0.2 ppm and above. Mice, hamsters, and rats showed effects at 1.0 ppm O3 and above, while rabbits responded only at 2.0 ppm O3. Phosgene similarly affected mice, hamsters, and rats at 0.2 ppm and above, while guinea pigs and rabbits were affected at 0.5 ppm and above. Percent recovery of lavage fluid varied significantly between species, guinea pigs having lower recovery than other species with both gases. Lavage fluid recovery was lower following exposure to higher levels of O3 but not COCl2. Results of this study indicate that significant species differences are seen in the response to low levels of O3 and COCl2. These differences do not appear to be related in a simple manner to body weight.

Analysis of Coarsely Grouped Data from the Lognormal Distribution

Abstract A missing information technique is applied to blood lead data that is both grouped and assumed to be lognormally distributed. These maximum likelihood techniques are extended from the simple lognormal case to obtain solutions for a general linear model case. Various models are fitted to the data, and likelihood ratio statistics are computed to test for significance of various parameterizations. The techniques are applied to a data set of over 130,000 blood lead values collected by the city of New York. The data, collected from 1970 to 1976, are part of a large-scale screening program and have implications for the current ambient air lead standard.

Nitrogen dioxide exposure and lung antioxidants in ascorbic acid-deficient guinea pigs☆

We have previously found that ascorbic acid (AA) deficiency in guinea pigs enhances the pulmonary toxicity of nitrogen dioxide (NO2). The present study showed that exposure to NO2 (4.8 ppm, 3 hr) significantly increased lung lavage fluid protein (a sensitive indicator of pulmonary edema) only in guinea pigs fed rabbit chow (a diet not supplemented with vitamin C) for at least 7 days, at which time lung AA was about 50% of normal. The rabbit chow diet did not cause reduced body weight as did commercial synthetic scorbutic diets, even when they were supplemented with AA. After 14 days of feeding rabbit chow, lung AA was reduced to 15% of control. At this time, alpha-tocopherol (AT) in the same lungs was reduced to 85% of control, and lung nonprotein sulfhydryls (NPSH) were increased to 114% of control. Exposure of the guinea pigs to NO2 (4.5 ppm, 16 hr) increased wet lung weight and further altered the antioxidants in deficient (but not normally fed) animals in the following manner: NPSH content was increased to 130% of control, AT was decreased to 74% of control, and AA was increased from 15 to 50% of control. These findings suggest that depletion of AA in guinea pigs removes an important defense against NO2. The lung appears to be able to partially compensate for the dietary lack of antioxidant by accumulating AA from other tissues and by increasing NPSH concentrations. However, sufficient exposure to NO2 leads to oxidation of AT and pulmonary edema. Conditions in which NO2 produced edema were accompanied by only a slight consumption of AT, and no detectable oxidation of lung AA or NPSH.

Hexachlorobenzene-Induced Hyperparathyroidism and Osteosclerosis in Rats,

Hexachlorobenzene (HCB) exposure has been shown to alter the normal concentrations of parathyroid hormone and 1,25-dihydroxyvitamin D3 in rats and to result in osteoporosis in humans. Experiments were undertaken to investigate the effects of HCB on the homeostatic mechanism of calcium metabolism and to determine its effect on bone in rats. Fischer 344 rats were dosed 5 days/week for 5, 10, or 15 weeks with 0, 0.1, 10.0, or 25.0 mg HCB/kg body wt. Body weight was not affected by any of the exposure conditions. Liver weight was significantly elevated above control values at the two higher dose levels at all three time periods. Kidney weight and kidney-to-body weight ratio were significantly elevated at the highest dose level after 10 weeks and at the two higher dose levels after 15 weeks of exposure. Serum alkaline phosphatase was significantly decreased at the two higher dose levels after both 10 and 15 weeks of exposure. 1,25-Dihydroxyvitamin D3 was measured in the 5-week exposure group only and was significantly elevated in the three higher dose levels. After 5 and 15 weeks of HCB exposure, parathyroid hormone concentration was significantly elevated at the two higher dose levels at both time periods. Wet femur density was significantly increased at the two higher dose levels of HCB after 10 weeks of exposure and the three higher dose levels after 15 weeks of exposure. Dry femur density was also increased in the cases where wet femur density was increased. However, femur weight was not affected at any dose level. The results from this study indicate that HCB induces hyperparathyroidism in rats, as demonstrated by increased serum parathyroid hormone levels and osteosclerosis of the femur.(ABSTRACT TRUNCATED AT 250 WORDS)

Polychlorinated biphenyl‐degrading pseudomonads: Survival in mouse intestines and competition with normal flora

Although naturally occurring and mutant organisms, historically, have been released into the environment for various purposes, health concerns associated with the release of microorganisms have recently resurfaced. Federal agencies have been given the task of reassuring society that any released organisms are not likely to produce adverse health effects. Methods, therefore, for evaluating the potential health effects due to environmental release of mutant and genetically engineered microorganisms are under investigation. A mouse model was developed that examines morbidity, mortality, and more indirect effects such as colonization potential of the intestinal tract, as well as competition with and alteration of the intestinal microbiota populations. The Pseudomonas spp. used in this study were isolated from a commercial product and used for degrading polychlorinated biphenyls. Mice were dosed individually with 10(3), 10(6), and 10(9) colony-forming units of each microorganism. At specific time intervals the intestines were removed and examined for the presence of the dosed microorganism. At the two higher doses, 10(6) and 10(9) colony-forming units, P. maltophilia strain BC6 and two P. aeruginosa strains, BC16 and BC18, were recoverable 48 h after dosing. The naturally occurring P. aeruginosa strain, PAMG, isolated from a mouse intestinal homogenate produced a similar response. Statistical analysis indicated that in some of the dosed animals, an alteration in the distribution of normal intestinal microflora occurred. Pseudomonas maltophilia strain BC6 and P. aeruginosa strains BC16 and BC17 caused a change in the obligately anaerobic predominantly gram-negative rod counts, and P. aeruginosa strain BC17 produced a dose effect on the total anaerobic count at the 10% confidence level. The total aerobic count was unaffected by the presence of the dosed pseudomonads.

A safety, tolerability, and pharmacokinetic (PK) study of GW572016 in patients with solid tumors

3179 Background: GW572106 is a reversible inhibitor of ErbB1/ErbB2 tyrosine kinases. This phase I monotherapy study evaluated safety, tolerability, and PK in patients with advanced solid tumors at once (QD) and twice daily (BID) dosing schedules. METHODS Patients (pts) were administered GW572106 on a QD or BID continuous schedule. QD doses ranged from 175 to 1800 mg and BID doses were 500, 750, and 900 mg per dose. In addition to standard evaluations, serial MUGAs were obtained. PK on days 1 and 14 and disease assessments every 8 weeks (RECIST criteria) were obtained. RESULTS 81 pts with various carcinomas were enrolled; 64 pts (39 QD, 25 BID) included in safety and disease assessment; 57 included in PK. Median age was 62 yrs; 39 males/25 females. The majority of drug-related AEs were grade I (75% of pts QD, 71% pts BID). Diarrhea was the most frequent AE (17% QD, 29% BID of pts). Two pts had grade 3 diarrhea at 900 mg BID. Other AEs were fatigue (16%), nausea (16%) and rash (9%) on QD and nausea (11%) and rash (11%) on BID dosing. While serial MUGAs revealed no significant median change in LVEF, only 1 of the 81 pts experienced cardiac toxicity; a grade 2, asymptomatic decline in LVEF was observed. There were no clinically significant changes in the other safety evaluations. The severity of diarrhea and rash were not correlated with dose; severity of rash but not diarrhea appeared to correlate with serum concentration. CONCLUSION Administration of GW572106 on a QD schedule was well-tolerated at all doses while 500 and 750 mg BID were better tolerated than 900 mg BID. The majority of AEs were grade 1 or 2 skin and/or GI toxicities, manageable with symptomatic treatment. [Table: see text].