title: A phase 1 study of efatutazone, an oral peroxisome proliferator-activated receptor gamma agonist, administered to patients with advanced malignancies.
abstract: BACKGROUND
  Efatutazone (CS-7017), a novel peroxisome proliferator-activated receptor gamma (PPARγ) agonist, exerts anticancer activity in preclinical models. The authors conducted a phase 1 study to determine the recommended phase 2 dose, safety, tolerability, and pharmacokinetics of efatutazone.
  
  
  METHODS
  Patients with advanced solid malignancies and no curative therapeutic options were enrolled to receive a given dose of efatutazone, administered orally (PO) twice daily for 6 weeks, in a 3 + 3 intercohort dose-escalation trial. After the third patient, patients with diabetes mellitus were excluded. Efatutazone dosing continued until disease progression or unacceptable toxicity, with measurement of efatutazone pharmacokinetics and plasma adiponectin levels.
  
  
  RESULTS
  Thirty-one patients received efatutazone at doses ranging from 0.10 to 1.15 mg PO twice daily. Dose escalation stopped when maximal impact on PPARγ-related biomarkers had been reached before any protocol-defined maximum-tolerated dose level. On the basis of a population pharmacokinetic/pharmacodynamic analysis, the recommended phase 2 dose was 0.5 mg PO twice daily. A majority of patients experienced peripheral edema (53.3%), often requiring diuretics. Three episodes of dose-limiting toxicities, related to fluid retention, were noted in the 0.10-, 0.25-, and 1.15-mg cohorts. Of 31 treated patients, 27 were evaluable for response. A sustained partial response (PR; 690 days on therapy) was observed in a patient with myxoid liposarcoma. Ten additional patients had stable disease (SD) for ≥60 days. Exposures were approximately dose proportional, and adiponectin levels increased after 4 weeks of treatment at all dose levels. Immunohistochemistry of archived specimens demonstrated that PPARγ and retinoid X receptor expression levels were significantly greater in patients with SD for ≥60 days or PR (P = .0079), suggesting a predictive biomarker.
  
  
  CONCLUSIONS
  Efatutazone demonstrates acceptable tolerability with evidence of disease control in patients with advanced malignancies.
authors.affiliation: Lombardi Comprehensive Cancer Center, Developmental Therapeutics Program, Georgetown University Medical Center, Washington, DC 20007, USA. pishvaim@georgetown.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pishvaian
authors.forename: John L
authors.initials: JL
authors.lastname: Marshall
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Wagner
authors.forename: Jimmy J
authors.initials: JJ
authors.lastname: Hwang
authors.forename: Shakun
authors.initials: S
authors.lastname: Malik
authors.forename: Ion
authors.initials: I
authors.lastname: Cotarla
authors.forename: John F
authors.initials: JF
authors.lastname: Deeken
authors.forename: A Ruth
authors.initials: AR
authors.lastname: He
authors.forename: Hirut
authors.initials: H
authors.lastname: Daniel
authors.forename: Abdel-Baset
authors.initials: AB
authors.lastname: Halim
authors.forename: Hamim
authors.initials: H
authors.lastname: Zahir
authors.forename: Catherine
authors.initials: C
authors.lastname: Copigneaux
authors.forename: Kejian
authors.initials: K
authors.lastname: Liu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Beckman
authors.forename: George D
authors.initials: GD
authors.lastname: Demetri
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D047495:PPAR gamma / Q000819:agonists*; D045162:Thiazolidinediones / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics
chemical_list: D000970:Antineoplastic Agents; D047495:PPAR gamma; D045162:Thiazolidinediones; C510342:efatutazone