title: A phase I study of foretinib, a multi-targeted inhibitor of c-Met and vascular endothelial growth factor receptor 2.
abstract: OBJECTIVE
  Foretinib is an oral multikinase inhibitor targeting Met, RON, Axl, and vascular endothelial growth factor receptor. We conducted a phase I, first-time-in-human, clinical trial using escalating doses of oral foretinib. The primary objectives are to identify a maximum tolerated dose and determine the safety profile of foretinib. Secondary objectives included evaluation of plasma pharmacokinetics, long-term safety after repeated administration, preliminary antitumor activity, and pharmacodynamic activity.
  
  
  METHODS
  Patients had histologically confirmed metastatic or unresectable solid tumors for which no standard measures exist. All patients received foretinib orally for 5 consecutive days every 14 days. Dose escalation followed a conventional "3+3" design.
  
  
  RESULTS
  Forty patients were treated in eight dose cohorts. The maximum tolerated dose was defined as 3.6 mg/kg, with a maximum administered dose of 4.5 mg/kg. Dose-limiting toxicities included grade 3 elevations in aspartate aminotransferase and lipase. Additional non-dose-limiting adverse events included hypertension, fatigue, diarrhea, vomiting, proteinuria, and hematuria. Responses were observed in two patients with papillary renal cell cancer and one patient with medullary thyroid cancer. Stable disease was identified in 22 patients. Foretinib pharmacokinetics increased linearly with dose. Pharmacodynamic evaluation indicated inhibition of MET phosphorylation and decreased proliferation in select tumor biopsies at submaximal doses.
  
  
  CONCLUSIONS
  The recommended dose of foretinib was determined to be 240 mg, given on the first 5 days of a 14-day cycle. This dose and schedule were identified as having acceptable safety and pharmacokinetics, and will be the dose used in subsequent phase II trials.
authors.affiliation: Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Joseph Paul
authors.initials: JP
authors.lastname: Eder
authors.forename: Geoffrey I
authors.initials: GI
authors.lastname: Shapiro
authors.forename: Leonard J
authors.initials: LJ
authors.lastname: Appleman
authors.forename: Andrew X
authors.initials: AX
authors.lastname: Zhu
authors.forename: Dale
authors.initials: D
authors.lastname: Miles
authors.forename: Harold
authors.initials: H
authors.lastname: Keer
authors.forename: Belinda
authors.initials: B
authors.lastname: Cancilla
authors.forename: Felix
authors.initials: F
authors.lastname: Chu
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hitchcock-Bryan
authors.forename: Laurie
authors.initials: L
authors.lastname: Sherman
authors.forename: Stewart
authors.initials: S
authors.lastname: McCallum
authors.forename: Elisabeth I
authors.initials: EI
authors.lastname: Heath
authors.forename: Scott A
authors.initials: SA
authors.lastname: Boerner
authors.forename: Patricia M
authors.initials: PM
authors.lastname: LoRusso
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000813:Anilides / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019859:Proto-Oncogene Proteins c-met / Q000037:antagonists & inhibitors*; D011804:Quinolines / Q000627:therapeutic use*; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000037:antagonists & inhibitors*
chemical_list: D000813:Anilides; D000970:Antineoplastic Agents; C544831:GSK 1363089; D047428:Protein Kinase Inhibitors; D011804:Quinolines; D019859:Proto-Oncogene Proteins c-met; D040301:Vascular Endothelial Growth Factor Receptor-2