Phase 1/2a trial of intravenous BAL101553, a novel controller of the spindle assembly checkpoint, in advanced solid tumours

• Published in: British journal of cancer 2020-10, Vol.123 (9), p.1360-1369
• Main Authors: Kristeleit, Rebecca, Evans, Jeffry, Molife, L. Rhoda, Tunariu, Nina, Shaw, Heather, Slater, Sarah, Haris, Noor R. Md, Brown, Nicholas F., Forster, Martin D., Diamantis, Nikolaos, Rulach, Robert, Greystoke, Alastair, Asghar, Uzma, Rata, Mihaela, Anderson, Stephanie, Bachmann, Felix, Hannah, Alison, Kaindl, Thomas, Lane, Heidi A., Larger, Patrice J., Schmitt-Hoffmann, Anne, Engelhardt, Marc, Tzankov, Alexandar, Plummer, Ruth, Lopez, Juanita
• Format: Article
• Language: English
• Subjects: 692/4017; 692/4028/67; Adult; Aged; Aged, 80 and over; Benzimidazoles - administration & dosage; Benzimidazoles - adverse effects; Benzimidazoles - pharmacokinetics; Biomedical and Life Sciences; Biomedicine; Cancer Research; Disease control; Disease Progression; Drug Resistance; Epidemiology; Female; Gait; Humans; Infusions, Intravenous; Intravenous administration; Lysine; M Phase Cell Cycle Checkpoints - drug effects; Male; Maximum Tolerated Dose; Middle Aged; Molecular Medicine; Movement disorders; Neoplasms - drug therapy; Neoplasms - pathology; Oncology; Oxadiazoles - administration & dosage; Oxadiazoles - adverse effects; Oxadiazoles - pharmacokinetics; Peripheral neuropathy; Prodrugs - administration & dosage; Prodrugs - adverse effects; Prodrugs - pharmacokinetics; Solid tumors; Spindle Apparatus - drug effects; Titration; Tumors; United Kingdom
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/s41416-020-1010-8

Background BAL101553 (lisavanbulin), the lysine prodrug of BAL27862 (avanbulin), exhibits broad anti-proliferative activity in human cancer models refractory to clinically relevant microtubule-targeting agents. Methods This two-part, open-label, phase 1/2a study aimed to determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of 2-h infusion of BAL101553 in adults with advanced or recurrent solid tumours. The MTD was determined using a modified accelerated titration design in phase I. Patients received BAL101553 at the MTD and at lower doses in the phase 2a expansion to characterise safety and efficacy and to determine the recommended phase 2 dose (RP2D). Results Seventy-three patients received BAL101553 at doses of 15–80 mg/m 2 (phase 1, n  = 24; phase 2a, n  = 49). The MTD was 60 mg/m 2 ; DLTs observed at doses ≥60 mg/m 2 were reversible Grade 2–3 gait disturbance with Grade 2 peripheral sensory neuropathy. In phase 2a, asymptomatic myocardial injury was observed at doses ≥45 mg/m 2 . The RP2D for 2-h intravenous infusion was 30 mg/m 2 . The overall disease control rate was 26.3% in the efficacy population. Conclusions The RP2D for 2-h infusion of BAL101553 was well tolerated. Dose-limiting neurological and myocardial side effects were consistent with the agent’s vascular-disrupting properties. Clinical trial registration EudraCT: 2010-024237-23.