Cited by 895Cell death mechanisms and regulationLymphoma Diagnosis and TreatmentChronic Lymphocytic Leukemia Research

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Navitoclax, a targeted high-affinity inhibitor of BCL-2, in lymphoid malignancies: a phase 1 dose-escalation study of safety, pharmacokinetics, pharmacodynamics, and antitumour activity

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Wilson, Wyndham H, O'Connor, Owen A, Czuczman, Myron S, LaCasce, Ann S, Gerecitano, John F, Leonard, John P, Tulpule, Anil, Dunleavy, Kieron, Xiong, Hao, Chiu, Yi-Lin, Cui, Yue, Busman, Todd, Elmore, Steven W, Rosenberg, Saul H, Krivoshik, Andrew P, Enschede, Sari H, Humerickhouse, Rod A·2010·The Lancet Oncology

DOI 10.1016/s1470-2045(10)70261-8PMC PMC3025495

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Abstract

Background Proteins of the BCL-2 family regulate clonal selection and survival of lymphocytes, and are frequently overexpressed in lymphomas. Navitoclax is a targeted high-affinity small molecule that inhibits the anti-apoptotic activity of BCL-2 and BCL-XL. We aimed to assess the safety and antitumour activity of navitoclax in patients with lymphoid tumours, and establish the drug's pharmacokinetic and pharmacodynamic profiles.Methods In this phase 1 dose-escalation study, patients (aged ≥18 years) with relapsed or refractory lymphoid malignancies were enrolled and treated at seven sites in the USA between November, 2006, and November, 2009. A modified Fibonacci 3+3 design was used to assign patients to receive oral navitoclax once daily by one of two dosing schedules: intermittently for the first 14 days of a 21-day cycle (14/21) at doses of 10, 20, 40, 80, 110, 160, 225, 315, or 440 mg/day; or continuously for 21 days of a 21-day cycle (21/21) at doses of 200, 275, 325, or 425 mg/day. Study endpoints were safety, maximum tolerated dose, pharmacokinetic profile, pharmacodynamic effects on platelets and T cells, and antitumour activity. This trial is registered with ClinicalTrials.gov, number NCT00406809.Findings 55 patients were enrolled (median age 59 years, IQR 51-67), 38 to receive the 14/21 dosing schedule, and 17 to receive the 21/21 dosing schedule. Common toxic effects included grade 1 or 2 anaemia (41 patients), infection (39), diarrhoea (31), nausea (29), and fatigue (21); and grade 3 or 4 thrombocytopenia (29), lymphocytopenia (18), and neutropenia (18). On the intermittent 14/21 schedule, dose-limiting toxic effects were hospital admissions for bronchitis (one) and pleural effusion (one), grade 3 increase in aminotransferases (one), grade 4 thrombocytopenia (one), and grade 3 cardiac arrhythmia (one). To reduce platelet nadir associated with intermittent 14/21 dosing, we assessed a 150 mg/day lead-in dose followed by a continuous 21/21 dosing schedule. On the 21/21 dosing schedule, two patients did not complete the first cycle and were excluded from assessment of dose-limiting toxic effects; dose-limiting toxic effects were grade 4 thrombocytopenia (one), grade 3 increase in aminotransferases (one), and grade 3 gastrointestinal bleeding (one). Navitoclax showed a pharmacodynamic effect on circulating platelets and T cells. Clinical responses occurred across the range of doses and in several tumour types. Ten of 46 patients with assessable disease had a partial response, and these responders had median progression-free survival of 455 days (IQR 40-218).Interpretation Navitoclax has a novel mechanism of peripheral thrombocytopenia and T-cell lymphopenia, attributable to high-affinity inhibition of BCL-XL and BCL-2, respectively. On the basis of these findings, a 150 mg 7-day lead-in dose followed by a 325 mg dose administered on a continuous 21/21 dosing schedule was selected for phase 2 study.Funding Abbott Laboratories, Genentech, and National Cancer Institute, National Institutes of Health.

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“A Phase I study with the pan Bcl-family inhibitor Navitoclax (15) in relapsed or refractory lymphoid malignancies established the optimum dosing regimen, pharmacokinetics, pharmacodynamics and tolerability of the drug and demonstrated some efficacy [45].”
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“…grade 3/4 adverse events, including febrile neutropenia (47%), neutropenia (38%), and thrombocytopenia (26%), which is at a lower frequency than thrombocytopenia recorded with navitoclax monotherapy in an earlier trial [103], potentially attributable to the use of low-dose navitoclax [104].”
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“Although navitoclax demonstrated efficacy in clinical trials for chronic lymphocytic leukemia (CLL) and small-cell lung cancer, it caused dose-limiting thrombocytopenia due to Bcl-XL’s role in platelet production [21,22].”

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Phase 1 study of the safety, pharmacokinetics, and antitumour activity of the BCL 2 inhibitor navitoclax in combination with rituximab in patients with relapsed or refractory CD 20+ lymphoid malignancies
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Authors: Wilson, W. H., O'Connor, O. A., Czuczman, M. S., LaCasce, A. S., Gerecitano, J. F., Leonard, J. P., Tulpule, A., Dunleavy, K., Xiong, H., Chiu, Y.-L., Cui, Y., Busman, T., Elmore, S. W., Rosenberg, S. H., Krivoshik, A. P., Enschede, S. H., & Humerickhouse, R. A.
Affiliations: National Institutes of Health (US)
Roswell Park Comprehensive Cancer Center (US)
Dana-Farber Cancer Institute (US)
Memorial Sloan Kettering Cancer Center (US)
Cornell University (US)
University of Southern California (US)
Abbott (United States) (US)
Corresponding author: Wilson, Wyndham H
ORCID: Wilson, Wyndham H
LaCasce, Ann S
Gerecitano, John F
Leonard, John P
Dunleavy, Kieron
Xiong, Hao
Chiu, Yi-Lin
Cui, Yue
Venue: The Lancet Oncology
Publisher: Elsevier BV
Published: 2010-12
Volume: 11
Issue: 12
Pages: 1149-1159
ISSN: 1470-2045 (ISSN-L)
DOI: 10.1016/s1470-2045(10)70261-8
PMC: PMC3025495
OpenAlex: W2150680216
Cited by: 876
References: 47
Citations by year: 2026: 44 · 2025: 58 · 2024: 66 · 2023: 49 · 2022: 66 · 2021: 69 · 2020: 70 · 2019: 43 · 2018: 42 · 2017: 53 · 2016: 52 · 2015: 63 · 2014: 60 · 2013: 55 · 2012: 50
FWCI: 18.10
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The Lancet Oncology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: Abbott Fund
Abbott Laboratories
National Institutes of Health
National Cancer Institute (ZIABC010716)
Topics: Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Cell death mechanisms and regulation
Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
Health Sciences › Medicine › Hematology › Chronic Lymphocytic Leukemia Research
Keywords: navitoclax, BCL-2 inhibitor, Bcl-xL, lymphoid malignancies, relapsed/refractory lymphoma, dose-limiting toxicity, thrombocytopenia, neutropenia, anemia, pharmacokinetics, pharmacodynamics, T cell proliferation, platelet function, antitumour activity, intermittent dosing
MeSH terms: Aged, Aniline Compounds, Antineoplastic Agents, Blood Platelets, Dosage Forms, Humans, Lymphoma, Middle Aged, Sulfonamides, T-Lymphocytes, Survival Analysis, Drug Delivery Systems, Proto-Oncogene Proteins c-bcl-2, Maximum Tolerated Dose

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Navitoclax, a targeted high-affinity inhibitor of BCL-2, in lymphoid malignancies: a phase 1 dose-escalation study of safety, pharmacokinetics, pharmacodynamics, and antitumour activity

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