Activity of 2 methoxyestradiol (Panzem NCD) in advanced, platinum-resistant ovarian cancer and primary peritoneal carcinomatosis: a Hoosier Oncology Group trial.
BACKGROUND
2-Methoxyestradiol (Panzem, 2ME2) is an endogenous metabolite of estradiol that destabilizes microtubules and exerts anti-angiogenic properties. This study was conducted to determine the activity and safety of 2ME2 administered as a NanoCrystal dispersion (NCD) formulation in patients with recurrent, platinum-resistant epithelial ovarian cancer (EOC).


METHODS
Eligible patients had relapsed, platinum-resistant or refractory EOC with measurable or detectable disease. There was no limit on the number of prior treatment regimens. 2ME2 NCD 1000 mg orally four times daily (q.i.d.) was administered continuously during 4 week cycles. The primary endpoint was objective response rate (ORR). Secondary endpoints were assessment of toxicity, rate of clinical benefit defined as the number of patients experiencing an objective response, a CA125 response or stable disease (SD) >3 months, mean change in CA-125, progression-free survival (PFS), and pharmacokinetic analyses of 2ME2.


RESULTS
Eighteen patients were enrolled. Median age was 65.5 (range 40-73). Patients had received a median of five prior treatments. The most common adverse events were fatigue (78%), nausea (78%), diarrhea (39%), neuropathy (50%), edema (39%), and dyspnea (44%), the majority being grade 1-2. There were no objective responses, but seven patients had SD as best response. Of those, two patients had SD for greater than 12 months. The rate of clinical benefit was 31.3%. Fairly stable plasma levels of 2ME2 ranging within the predicted therapeutic window were observed.


CONCLUSIONS
The NCD formulation of 2ME2 is well tolerated in patients with heavily pretreated EOC. Few of these heavily pretreated patients had sustained stable disease.
Matei
Daniela
D
Indiana University Department of Medicine, USA; Indiana University Department of Obstetrics and Gynecology, USA; Indiana University Melvin and Bren Cancer Center, USA; Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN, 46202, USA. Electronic address: dmatei@iupui.edu.
Schilder
Jeanne
J
Indiana University Department of Obstetrics and Gynecology, USA; Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN, 46202, USA.
Sutton
Gregory
G
St. Vincent Gynecologic Oncology, USA; Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN, 46202, USA.
Perkins
Susan
S
Indiana University Division of Biostatistics, USA; Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN, 46202, USA.
Breen
Tim
T
Indiana University Division of Biostatistics, USA; Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN, 46202, USA.
Quon
Check
C
iNDa Consulting, Inc., Hockessin DE, USA; Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN, 46202, USA.
Sidor
Carolyn
C
EntreMed, Inc., Rockville MD, USA; Indiana University School of Medicine, 535 Barnhill Drive, Indianapolis, IN, 46202, USA.
D000077584:2-Methoxyestradiol; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D018394:CA-125 Antigen / Q000097:blood; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D004958:Estradiol / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006894:Hydroxyestrones / Q000097:blood; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000188:drug therapy / Q000378:metabolism; D009944:Organoplatinum Compounds / Q000494:pharmacology; D010051:Ovarian Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D010534:Peritoneal Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism
D000970:Antineoplastic Agents; D018394:CA-125 Antigen; D006894:Hydroxyestrones; D009944:Organoplatinum Compounds; D004958:Estradiol; D000077584:2-Methoxyestradiol; C003655:2-methoxyestrone