title: A phase I study of oral BMS-275291, a novel nonhydroxamate sheddase-sparing matrix metalloproteinase inhibitor, in patients with advanced or metastatic cancer.
abstract: OBJECTIVE
  BMS-275291 is a novel broad-spectrum inhibitor of matrix metalloproteinase (MMPs) rationally designed to spare a class of closely related metalloproteinases known as sheddases. Inadvertent sheddase inhibition is hypothesized to play a role in the dose-limiting joint toxicities occurring with hydroxamate-based MMP inhibitors. This trial was conducted to establish the recommended phase II dose; determine safety, toxicity, and pharmacokinetics of BMS-275291; and to assess potential markers of sheddase activity [tumor necrosis factor-alpha (TNFalpha) release and TNFalpha-RII shedding].
  
  
  METHODS
  This was an open label, single arm, phase I study conducted at two centers. Patients with advanced or metastatic cancer were treated with once-daily oral BMS-275291 at doses escalating from 600 to 2400 mg/day. Six to eight patients/dose level were to be studied with the recommended phase II dose level expanded to a total of 15 patients. Pharmacokinetic sampling was performed on days 1, 15, and 29 at 0, 0.5, 1, 2, 4, 6, 8, and 24 h after dosing. Radiological tumor assessment was performed every 8 weeks.
  
  
  RESULTS
  Forty-four evaluable patients were enrolled in this study with the most frequent tumor types being colorectal cancer and non-small cell lung cancer. Dose limiting toxicities were observed at 600 mg/day (one of eight patients with grade 3 transaminitis) and at 1200 mg/day (1 of 15 patients with grade 3 rash and grade 4 shortness of breath), both in the context of predisposing conditions. No dose-limiting toxicities occurred at 900, 1800, or 2400 mg/day. The most frequent adverse events considered possibly, probably, or definitely drug-related were joint toxicity (myalgia/arthralgia), rash, fatigue, headache, nausea, and taste change, all of which were mild, grade 1, grade 2, and not dose-limiting. No objective tumor responses were observed. Twelve of forty-four patients received treatment for 4+ months, six for 8+ months, three for >1 year. Desired trough levels of parent BMS-275291 were maintained with once daily dosing. The mean plasma concentration of parent BMS-275291 at trough exceeded the calculated in vitro IC(80) value for MMP-2 and IC(90) value for MMP-9 at the recommended phase II dose of 1200 mg/day. No major changes in serum concentrations of sheddase enzymatic products, TNFalpha or TNFalpha-RII, were observed.
  
  
  CONCLUSIONS
  BMS-275291 is a nonhydroxamate MMP inhibitor with a novel mercaptoacyl zinc-binding group. In this study, plasma concentrations of BMS-275291 continuously exceeded in vitro MMP IC(50) values without dose-limiting joint toxicity. In this refractory patient population, a suggestion of disease stabilization was observed in 12 patients. On the basis of preclinical, clinical, and pharmacokinetic data, the recommended phase II dose for future study is 1200 mg/day.
authors.affiliation: Developmental Therapeutics Program, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC, USA. rizvin@mskcc.org
authors.forename: Naiyer A
authors.initials: NA
authors.lastname: Rizvi
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Humphrey
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Ness
authors.forename: Michael D
authors.initials: MD
authors.lastname: Johnson
authors.forename: Elora
authors.initials: E
authors.lastname: Gupta
authors.forename: Kathleen
authors.initials: K
authors.lastname: Williams
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Daly
authors.forename: Daryl
authors.initials: D
authors.lastname: Sonnichsen
authors.forename: Delina
authors.initials: D
authors.lastname: Conway
authors.forename: John
authors.initials: J
authors.lastname: Marshall
authors.forename: Herbert
authors.initials: H
authors.lastname: Hurwitz
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000633:toxicity*; D005260:Female; D006801:Humans; D007093:Imidazoles; D008297:Male; D061965:Matrix Metalloproteinase Inhibitors; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D009930:Organic Chemicals / Q000633:toxicity*; D012449:Safety
chemical_list: D000970:Antineoplastic Agents; D007093:Imidazoles; D061965:Matrix Metalloproteinase Inhibitors; D009930:Organic Chemicals; C422302:N-((2S)-2-mercapto-1-oxo-4-(3,4,4- trimethyl-2,5-dioxo-1-imidazolidinyl)butyl)-L-leucyl-N,3- dimethyl-L-Valinamide