Biomarker‐based phase I dose‐escalation, pharmacokinetic, and pharmacodynamic study of oral apricoxib in combination with erlotinib in advanced nonsmall cell lung cancer

Abstract

BACKGROUND: Apricoxib, a novel once-daily selective cyclooxygenase-2 inhibitor, was investigated in combination with erlotinib for recurrent stage IIIB/IV nonsmall cell lung cancer to determine the maximum tolerated dose, doselimiting toxicity, and recommended phase II dose (RP2D) based on changes in urinary prostaglandin E 2 metabolite (PGE-M). METHODS: Patients received escalating doses of apricoxib (100, 200, and 400 mg/day) in combination with erlotinib 150 mg/day until disease progression or unacceptable toxicity. Urinary PGE-M was used to assess biologic activity and inform the optimal biologic dose. RESULTS: Twenty patients were treated (3 at 100 mg; 3 at 200 mg; 14 at 400 mg apricoxib) with a median of 4 cycles (range, 2-14 cycles); 8 patients (40%) received prior EGFRdirected therapies. No dose-limiting toxicity was observed. Study drug-related adverse events (AEs) included diarrhea, rash, dry skin, anemia, fatigue, and increased serum creatinine; 4 patients had grade !3 drug-related AEs (diarrhea, perforated duodenal ulcer, hypophosphatemia, and deep vein thrombosis). The RP2D was 400 mg/day based on safety, biologic activity based on decreases in urinary PGE-M, and pharmacokinetics. One patient had a partial response, and 11 had stable disease. Stable disease was observed in patients who had received prior EGFR inhibitor therapy but was greater in patients not previously treated with an EGFR inhibitor. Seventeen patients had elevated urinary PGE-M at baseline, and 14 (70%) had a decrease from baseline, which was associated with disease control. CONCLUSIONS: Apricoxib plus erlotinib was well tolerated and yielded a 60% disease control rate. A phase II trial is currently investigating 400 mg/day apricoxib plus 150 mg/day erlotinib in patients selected based on change in urinary PGE-M. Cancer 2011;117:809-18.

Apricoxib, a Novel Inhibitor of COX-2, Markedly Improves Standard Therapy Response in Molecularly Defined Models of Pancreatic Cancer

“…PGE 2 can transactivate EGFR, which can subsequently increase expression of COX-2. In addition, PGE 2 , via promotion of epithelial-to-mesenchymal transition (EMT), can increase resistance to EGFR inhibitors (22). Furthermore, short circuiting both pathways simultaneously can have synergistic effects in preclinical cancer models (23–25).…”

COX-2 Inhibitors, a Potential Synergistic Effect with Antineoplastic Drugs in Lung Cancer

“…They selected NSCLC patients based on a 50% decrease from baseline levels of a urinary metabolite of PGE2 (PGEM) in response to apricoxib, but the primary endpoint of the trial was not met, possibly due to the low cutpoint for the decline in PGEM [65]. Reckamp et al evaluated COX-2 expression in a phase II trial [66] by measuring levels of baseline PGEM based on results of their phase I trial in NSCLC [67,68]. They reported that COX-2 pathway represents a novel mechanism of resistance to EGFR TKI therapy in NSCLC patients.…”

Lipidomics for Pharmaceutical Research

“…In Alzheimer's disease, associations between disease states and sphingolipid contents or abnormality of cell membrane component both in brain and in cholesterol metabolism have been reported [6][7][8][9][10][11]. For cancer, prostaglandins and leukotrienes regulated tumor proliferation have been suggested [12,13] and as a result inhibitors for prostaglandin synthesis have been proposed as anticancer agents [14,15]. Similarly, breast cancer and prostate cancer could also be explained in part by the imbalance of steroid hormones [16][17][18][19].…”