title: 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.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Discovery Medicine and Clinical Pharmacology, GlaxoSmithKline, Five Moore Dr, Research Triangle Park, NC 27709-3398, USA. Neil.L.Spector@gsk.com
authors.forename: Neil L
authors.initials: NL
authors.lastname: Spector
authors.forename: Wenle
authors.initials: W
authors.lastname: Xia
authors.forename: Howard
authors.initials: H
authors.lastname: Burris
authors.forename: Herbert
authors.initials: H
authors.lastname: Hurwitz
authors.forename: E Claire
authors.initials: EC
authors.lastname: Dees
authors.forename: Afshin
authors.initials: A
authors.lastname: Dowlati
authors.forename: Bert
authors.initials: B
authors.lastname: O'Neil
authors.forename: Beth
authors.initials: B
authors.lastname: Overmoyer
authors.forename: Paul K
authors.initials: PK
authors.lastname: Marcom
authors.forename: Kimberly L
authors.initials: KL
authors.lastname: Blackwell
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Smith
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Koch
authors.forename: Andrew
authors.initials: A
authors.lastname: Stead
authors.forename: Steven
authors.initials: S
authors.lastname: Mangum
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Ellis
authors.forename: Leihua
authors.initials: L
authors.lastname: Liu
authors.forename: Albert K
authors.initials: AK
authors.lastname: Man
authors.forename: Troy M
authors.initials: TM
authors.lastname: Bremer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Harris
authors.forename: Sarah
authors.initials: S
authors.lastname: Bacus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017209:Apoptosis; D014408:Biomarkers, Tumor / Q000032:analysis; D002470:Cell Survival; D004305:Dose-Response Relationship, Drug; D023381:Endpoint Determination; D066246:ErbB Receptors / Q000096:biosynthesis*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D000077341:Lapatinib; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D011799:Quinazolines / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000096:biosynthesis*; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D066246:ErbB Receptors; D000077341:Lapatinib; D011799:Quinazolines; D018719:Erb-b2 Receptor Tyrosine Kinases