This work has developed a rabbit model of PD0325901-induced RVO that may be used to characterize the cellular and molecular mechanisms of this effect in humans.
BACKGROUND: Angiogenesis plays a key role in embryo-fetal development and, based on nonclinical safety data, the majority of vascular endothelial growth factor (VEGF)-targeted antiangiogenic agents used in cancer therapy are not recommended during pregnancy. We investigated the effects of sunitinib (an oral inhibitor of multiple receptor tyrosine kinases [RTKs] including VEGF-receptors) on embryo-fetal development. METHODS: Presumed-pregnant SpragueDawley rats and New Zealand White rabbits received repeated daily oral doses of sunitinib (0-30 mg/kg/day), during the major period of organogenesis. Clinical/physical examinations were performed throughout the gestation phase, and blood samples were collected to determine systemic exposure. Necropsy (including uterine examination) was performed on all animals and fetal morphology was examined. RESULTS: The no-observed-adverse-effect level was 1-5 mg/kg/ day for maternal toxicity and 3 mg/kg/day for developmental toxicity in rats; 1 and 0.5 mg/kg/day, respectively, in rabbits. Embryo-fetal toxicity included decreases in the number of live fetuses and increases in the numbers of resorptions and post-implantation/complete litter losses; these were observed at doses of Z5 mg/kg/day in rats and 5 mg/kg/day in rabbits. Malformations included fetal skeletal malformations (generally thoracic/lumbar vertebral alterations) in rats and cleft lip/palate in rabbits. These developmental effects were observed at B5.5-(rats) and B0.3-times (rabbits) the human systemic exposure at the approved sunitinib dose (50 mg/day). CONCLUSIONS: Similar effects have been reported with the prototype monoclonal antibody bevacizumab. As is typically observed for potent inhibitors of RTKs involved in angiogenesis, sunitinib was associated with embryo-fetal developmental toxicity in rats and rabbits at clinically relevant dose levels. Birth Defects Res (Part B) 86:204-213, 2009.
BackgroundCD40 is a compelling target for cancer immunotherapy, however, attempts to successfully target this pathway have consistently been hampered by dose-limiting toxicity issues in the clinic that prevents the administration of efficacious doses.MethodsHere, using cytokine and cytokine receptor depletion strategies in conjunction with a potent CD40 agonist, we investigated mechanisms underlying the two primary sources of CD40 agonist-associated toxicity, hepatotoxicity and cytokine release syndrome (CRS).ResultsWe demonstrate that CD40 agonist -induced hepatotoxicity and CRS are mechanistically independent. Historical data have supported a role for interleukin-6 (IL-6) in CRS-associated wasting, however, our findings instead show that an inflammatory cytokine network involving TNF, IL-12p40, and IFNγ underlie this process. Deficiency of TNF or IFNγ did not influence CD40-induced hepatitis however loss of IL-12p40 significantly decreased circulating concentrations of liver enzymes and reduced the frequency of activated CD14+MHCII+myeloid cells in the liver, indicating a role for IL-12p40 in liver pathology.ConclusionsAs clinical research programs aim to circumnavigate toxicity concerns while maintaining antitumor efficacy it will be essential to understand which features of CD40 biology mediate antitumor function to develop both safe and efficacious agonists.
Crizotinib (Xalkori) is a tyrosine kinase inhibitor of both anaplastic lymphoma kinase (ALK) and mesenchymal-epithelial transition factor (c-Met). Though not predicted from standard nonclinical toxicological evaluation, visual disturbance became a frequently observed adverse event in humans. To understand the possible mechanism of this vision effect, an in vivo electroretinogram (ERG) study was conducted to assess retinal functional changes following oral administration of crizotinib. Immunohistochemical (IHC) staining of ALK and c-Met in the neural retinas of human, non-human primate, dog, rat, and mouse was used to aid in the animal model selection. ALK IHC staining was identified predominantly in the ganglion cell and inner nuclear layers of most species evaluated, in the inner plexiform layer in human and rodent, and in the nerve fiber layer in human and rat only. There was no apparent staining of any layer of the neural retina for c-Met in any of the species evaluated. ERG measurements identified a significant reduction in b-wave amplitude during the initial phase of dark adaptation in the crizotinib-treated rats. ERGs were also taken following oral administration of PF-06463922 (an ALK-selective inhibitor), for an understanding of potential kinase involvement. ERG effects were not observed in PF-06463922-treated animals when comparable exposures in the vitreous humor were achieved. Collectively, our results suggest that the ERG b-wave amplitude decreases during dark adaption following crizotinib administration may be related to signaling changes within the retina in rats, likely independent of ALK inhibition.
Crizotinib is a small-molecule receptor tyrosine kinase inhibitor of anaplastic lymphoma kinase (ALK) and c-Met. Crizotinib has been shown to be effective in patients with ALK-positive non-small cell lung cancer. One common adverse event that has been observed is a grade 1 vision disorder (∼45% of patients) characterized as seeing shadows or streaks during changes in lighting conditions. Onset occurs during the first weeks of treatment, with most cases improving with continued treatment and not requiring treatment discontinuation. Such vision disorders were not predicted from preclinical toxicological evaluation of crizotinib. To further understand the possible mechanism of this vision disorder, a rat electroretinography (ERG) study was conducted to determine if retinal function is altered following repeat-dose administration of crizotinib. Male Long-Evans rats (8/group) were administered crizotinib by oral gavage at a dose of 100 mg/kg/day for up to 29 days, during which an evaluation of in-life parameters (clinical signs, body weight, and food consumption), ophthalmic examinations, and ERG were performed. As part of the ERG assessment, five light-stimulation protocols were applied to test scotopic (dark-adapted) and photopic (light-adapted) luminance responses, photopic and scotopic adaptometry, and photopic flicker responses. Terminal plasma and vitreous fluid were examined for crizotinib concentrations in main study animals, and a toxicokinetic profile was obtained from a satellite group of 6 animals. Results of the ERG measurements identified a statistically significant (∼30%) reduction in mean b-wave amplitude relative to control during the initial 16 and 32 minutes of dark adaptation on Days 15 (p<0.05) and 29 (p<0.01), respectively. The magnitude of the reduction did not worsen between Days 15 and 29. Following 2 hours of dark adaptation, b-wave amplitudes were comparable between control and crizotinib-treated animals on both Days 15 and 29. There were no crizotinib-related effects observed for any other ERG parameters or during ophthalmologic examinations. Plasma exposures were ∼6-fold those associated with vision disorders in patients, and vitreous humor concentrations were 0.66-fold those in plasma at an equivalent time post-dose. Results from this preclinical model show that crizotinib causes significant reductions in the rate of retinal dark adaptation, but not the ability to achieve full dark adaptation. Vision disorders reported in the clinical setting may thus be due to direct effects on the retina rather than a central CNS effect. Whether this is a pharmacologically mediated effect at ALK or c-Met receptors expressed in retina or an off-target effect is not clear. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4385. doi:10.1158/1538-7445.AM2011-4385
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