Summary Background Current treatment options for patients with relapsed or refractory (RR) lymphoma and multiple myeloma (MM) are limited, highlighting the unmet need for effective therapies in these disease settings. CUDC-907 is an oral, first-in-class, small molecule that is designed to inhibit both histone deacetylase (HDAC) and phosphoinositide 3-kinase (PI3K) enzymes, which are members of common oncogenic pathways in hematologic malignancies. This study examines CUDC-907 monotherapy in patients with RR lymphoma and MM. Methods This open-label, non-randomized, first-in-man, phase 1 multi-center trial enrolled adult patients with lymphoma or MM who were refractory to or relapsed after ≥2 prior regimens. CUDC-907 was orally administered in a standard 3+3 dose escalation design using three different dosing schedules which enrolled sequentially as follows: once daily (QD), then intermittent twice (BIW) or thrice weekly (TIW) that enrolled simultaneously, and finally five days on/two days off (5/2) in 21-day cycles. Dosing started at 30 mg for QD and 60 mg for other schedules, escalating in 30 mg increments. Patients continued to receive CUDC-907 until disease progression or other treatment discontinuation criteria were met. The primary objective was to determine the maximum-tolerated dose and recommended phase 2 dose (RP2D); secondary objectives were to assess the safety and tolerability, and preliminary anti-cancer activity. Results from the completed dose escalation phase are presented. Safety analyses were conducted in all patients who received at least one dose of study medication; efficacy analyses were conducted in all patients who received at least one dose of study drug and underwent at least one post-baseline response assessment. This ongoing trial is registered at ClinicalTrials.gov, number NCT01742988. Findings Forty-four heavily pretreated patients received CUDC-907 up to a maximum of 60 mg for the QD and 5/2 schedules, and 150 mg for the intermittent schedules in the dose escalation phase. The most common Grade ≥3 adverse events were thrombocytopenia (n=9, 20%), neutropenia (n=3, 7%), and hyperglycemia (n=3, 7%). Dose limiting toxicities (DLTs) were diarrhea and hyperglycemia; no DLTs were observed on the 5/2 schedule. Eleven of 44 patients reported serious AEs, 3 of which were considered treatment-related: epistaxis and the DLTs of diarrhea and hyperglycemia. AEs led to dose reductions in 6 patients and treatment discontinuation in 7 patients. Thirty-seven patients were evaluable for response. Five out of 9 patients with diffuse large B-cell lymphoma (DLBCL) achieved objective responses (2 complete responses [CR], 3 partial responses [PR]). Three of these objective responses (1 CR, 2PR) occurred in patients with transformed follicular (t-FL) DLBCL. Stable disease (SD) has been observed in 21 (57%) of 37 response-evaluable patients including DLBCL, Hodgkin lymphoma (HL), and MM. On the basis of the response and tolerability profile, the RP2D of CUDC-907 was determined to be 60 mg on the 5/2 sch...

Using an every 3-week-schedule of SAR3419 for six cycles, the MTD is 160 mg/m(2). SAR3419 can be safely administered to patients with relapsed B-cell lymphoma and demonstrates promising clinical activity, including patients who were refractory to rituximab.

SB1518 has encouraging activity in relapsed lymphoma, providing the first proof-of-principle of the potential therapeutic value of targeting the JAK/STAT pathway in lymphoma in the clinical setting.

BACKGROUND The prognosis of patients with relapsed Hodgkin lymphoma, especially those who relapsed after stem cell transplant, remains poor, and the development of new agents for this relatively young patient population represents an unmet medical need. In this study, we examined the safety and efficacy of mocetinostat, an oral isotype-selective histone deacetylase inhibitor, in patients with relapsed classical Hodgkin lymphoma METHODS Patients with relapsed or refractory classical Hodgkin lymphoma aged 18 years or older were treated with mocetinostat administered as an oral dose three-times weekly, in 28-day cycles. Two dose cohorts were evaluated (85 mg and 110 mg). Patients were treated until disease progression or prohibitive toxicity. The primary objective was to estimate the disease control rate induced by mocetinostat, defined as CR, PR or SD (for at least 6 cycles) analysed by intention to treat. This trial has been completed and is registered with ClinicalTrials.gov, number NCT00358982 FINDINGS A total of 51 patients were enrolled. Initially, 23 patients were enrolled in the 110 mg cohort. Subsequently, 28 additional patients were treated with a reduced dose of 85 mg to improve treatment tolerance. Based on intent to treat analysis, the overall disease control rate was 34.8% and 25% for the 110 mg and 85 mg groups, respectively. Thirty-four out of 42 (81%) patients who completed at least 2 cycles of therapy had a decrease in their tumor measurements. Forty-seven percent (24/51) discontinued therapy due to disease progression, 57% (16/28) in the 85 mg cohort and 34% in the 110 mg cohort. Twenty-four percent (12/51) discontinued due to adverse events, 32% (9/28) in the 85 mg cohort and 13% (3/23) in the 110 mg cohort. The most frequent treatment-related grade 3 and 4 adverse events included neutropenia, which was observed in 4 (17.4%) patients in the 110 mg group and in 3 (10.7%) patients in the 85 mg group; fatigue (in 5 (21.7%) of the 110 mg group vs 3 (10.7%) of the 85 mg group); and pneumonia (4 (17.4%) of the 110 mg group vs 2 (7.1% of the 85 mg group). Four patients, all in the 110 mg cohort, died during study, of whom two were considered possibly related to treatment. INTERPRETATION Mocetinostat 85 mg three-times weekly has promising single-agent clinical activity with manageable toxicity in patients with relapsed classical Hodgkin lymphoma. FUNDING MethylGene Inc., Montreal, Canada; Celgene Corporation, Summit, New Jersey; Tufts Medical Center, Boston, MA

Purpose To evaluate the safety and efficacy of panobinostat plus everolimus in patients with relapsed Hodgkin and non-Hodgkin lymphoma. The concept was supported by the single agent clinical activity of histone deacetylase inhibitors and mTOR inhibitors, and on the in vitro mechanism-based synergistic antiproliferative activity. Experimental Design This was a phase I study in patients with relapsed or refractory Hodgkin and non-Hodgkin lymphoma using panobinostat orally on Monday/Wednesday/Friday and everolimus orally daily. Toxicity and responses were assessed in dose escalation cohort followed by expansion cohort at maximum tolerated dose. Exploratory analysis of serum cytokine levels were performed. Results Thirty patients were enrolled onto four dose levels The dose limiting toxicity was thrombocytopenia. The maximal tolerated dose was panobinostat 20 mg and everolimus 10 mg. Grade 3/4 toxicity included thrombocytopenia (64%), neutropenia (47%), anemia (20%), infection (10%), fatigue (7%) and dyspnea (7%). A total of 10 patients (33%) (indolent lymphoma, T-cell lymphoma, mantle cell lymphoma, and Hodgkin lymphoma) achieved objective responses. In patients with Hodgkin lymphoma (n=14), overall response rate was 43% with complete response rate of 15%. In patients with Hodgkin lymhpoma, multiple serum cytokine levels decreased significantly after treatment with this combination therapy. Of note, clinical responses were associated with a decrease in serum interleukin-5 levels (day 8, p=0.013 and day 15, p=0.021). Conclusions Our data suggest that the combination therapy is active but with significant thrombocytopenia. Future studies should explore alternate scheduling and different compounds that target the same pathways to improve the tolerability of this novel combination.