Tumor survivin is downregulated by the antisense oligonucleotide LY2181308: a proof-of-concept, first-in-human dose study.
OBJECTIVE
Enhanced tumor cell survival through expression of inhibitors of apoptosis (IAP) is a hallmark of cancer. Survivin, an IAP absent from most normal tissues, is overexpressed in many malignancies and associated with a poorer prognosis. We report the first-in-human dose study of LY2181308, a second-generation antisense oligonucleotide (ASO) directed against survivin mRNA.


METHODS
A dose-escalation study evaluating the safety, pharmacokinetics, and pharmacodynamics of LY2181308 administered intravenously for 3 hours as a loading dose on 3 consecutive days and followed by weekly maintenance doses. Patients were eligible after signing informed consent, had exhausted approved anticancer therapies and agreed to undergo pre- and posttreatment tumor biopsies to evaluate reduction of survivin protein and gene expression.


RESULTS
A total of 40 patients were treated with LY2181308 at doses of 100 to 1,000 mg. Twenty-six patients were evaluated at the recommended phase 2 dose of 750 mg, at which level serial tumor sampling and [(11)C]LY2183108 PET (positron emission tomography) imaging demonstrated that ASO accumulated within tumor tissue, reduced survivin gene and protein expression by 20% and restored apoptotic signaling in tumor cells in vivo. Pharmacokinetics were consistent with preclinical modeling, exhibiting rapid tissue distribution, and terminal half-life of 31 days.


CONCLUSIONS
The tumor-specific, molecularly targeted effects demonstrated by this ASO in man underpin confirmatory studies evaluating its therapeutic efficacy in cancer.
Department of Medical Oncology, University of Oxford, Oxford Radcliffe Hospitals NHS Trust, Oxford, United Kingdom. denis.talbot@medonc.ox.ac.uk
Denis C
DC
Talbot
Malcolm
M
Ranson
Joanna
J
Davies
Michael
M
Lahn
Sophie
S
Callies
Valérie
V
André
Sunil
S
Kadam
Michael
M
Burgess
Christopher
C
Slapak
Anna L
AL
Olsen
Peter J
PJ
McHugh
Johann S
JS
de Bono
Julian
J
Matthews
Azeem
A
Saleem
Patricia
P
Price
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D015536:Down-Regulation / Q000187:drug effects; D055317:Evidence-Based Practice; D005260:Female; D015972:Gene Expression Regulation, Neoplastic / Q000187:drug effects; D015316:Genetic Therapy / Q000379:methods; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins; D008297:Male; D008869:Microtubule-Associated Proteins / Q000037:antagonists & inhibitors* / Q000235:genetics*; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009369:Neoplasms / Q000235:genetics* / Q000628:therapy*; D009841:Oligonucleotides / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology*; D016376:Oligonucleotides, Antisense / Q000494:pharmacology; D010865:Pilot Projects; D000077022:Survivin
D000970:Antineoplastic Agents; C107489:BIRC5 protein, human; D051034:Inhibitor of Apoptosis Proteins; C529350:LY 2181308; D008869:Microtubule-Associated Proteins; D009841:Oligonucleotides; D016376:Oligonucleotides, Antisense; D000077022:Survivin