RT Journal Article
SR Electronic
T1 First-in-human phase I study of immunomodulatory E7046, an antagonist of PGE<sub>2</sub>-receptor E-type 4 (EP4), in patients with advanced cancers
JF Journal for ImmunoTherapy of Cancer
JO J Immunother Cancer
FD BMJ Publishing Group Ltd
SP e000222
DO 10.1136/jitc-2019-000222
VO 8
IS 1
A1 David S Hong
A1 Aparna Parikh
A1 Geoffrey I Shapiro
A1 Andrea Varga
A1 Aung Naing
A1 Funda Meric-Bernstam
A1 Özlem Ataman
A1 Larisa Reyderman
A1 Terri A Binder
A1 Min Ren
A1 Mingjie Liu
A1 Satish Dayal
A1 Amy Y Siu
A1 Pallavi Sachdev
A1 Lucy Xu
A1 Vijay Bhagawati-Prasad
A1 Ilian Tchakov
A1 Chean Eng Ooi
A1 Xingfeng Bao
A1 Aurelien Marabelle
YR 2020
UL http://jitc.bmj.com/content/8/1/e000222.abstract
AB Background E7046 is a highly selective, small-molecule antagonist of the E-type prostanoid receptor 4 (EP4) for prostaglandin E2, an immunosuppressive mediator of the tumor immune microenvironment. This first-in-human phase 1 study assessed the safety, tolerability, pharmacokinetics, pharmacodynamics, maximum tolerated dose (MTD) and recommended phase 2 dose of E7046.Methods This first-in-human study enrolled 30 patients with advanced tumors of cancer types associated with high levels of myeloid infiltrates. E7046 was administered orally once-daily in sequential escalating dose cohorts (125, 250, 500, and 750 mg) with ≥6 patients per cohort. Tumor assessments were performed every 6 weeks. Paired tumor biopsies and blood samples, before and on treatment, were collected for pharmacokinetic and pharmacodynamic characterization of the treatment.Results No dose-limiting toxicities were observed, and the MTD was not reached. E7046 had an elimination half-life (t1/2) of 12 hours, and drug exposure increased dose-dependently from 125 to 500 mg. Target modulation by E7046 was supported by changes in genes downstream of EP4 with concurrent enhanced antitumoral immune responses. A best response of stable disease (per irRECIST) was reported in 23% of patients treated with E7046 (n=30) (125 mg: n=2; 250 mg: n=2; 750 mg: n=3). Over half (4/7) of the patients with stable disease had treatment duration of 18 weeks or more, and three patients (3/15; 20%) achieved metabolic responses.Conclusions In this first-in-human study, E7046 administered orally once daily demonstrated manageable tolerability, immunomodulatory effects, and a best response of stable disease (≥18 weeks) in several heavily pretreated patients with advanced malignancies. The 250 and 500 mg doses are proposed for further development in the combination setting.Trial registration number NCT02540291.