Phase I Trial of a Selective c-MET Inhibitor ARQ 197 Incorporating Proof of Mechanism Pharmacodynamic Studies

• Published in: Journal of clinical oncology Vol. 29; no. 10; pp. 1271 - 1279
• Main Authors: Yap, Timothy A., Olmos, David, Brunetto, Andre T., Tunariu, Nina, Barriuso, Jorge, Riisnaes, Ruth, Pope, Lorna, Clark, Jeremy, Futreal, Andrew, Germuska, Michael, Collins, David, deSouza, Nandita M., Leach, Martin O., Savage, Ronald E., Waghorne, Carol, Chai, Feng, Garmey, Edward, Schwartz, Brian, Kaye, Stan B., de Bono, Johann S.
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 01.04.2011
• Subjects: Adolescent; Adult; Aged; Angiogenesis Inhibitors - adverse effects; Angiogenesis Inhibitors - pharmacokinetics; Angiogenesis Inhibitors - therapeutic use; Apoptosis - drug effects; Aryl Hydrocarbon Hydroxylases - genetics; Aryl Hydrocarbon Hydroxylases - metabolism; Biological and medical sciences; Biopsy; Cytochrome P-450 CYP2C19; Endothelial Cells - drug effects; Endothelial Cells - pathology; England; Female; Focal Adhesion Kinase 1 - metabolism; Humans; In Situ Nick-End Labeling; Magnetic Resonance Imaging; Male; Maximum Tolerated Dose; Medical sciences; Middle Aged; Neoplasms - blood supply; Neoplasms - drug therapy; Neoplasms - enzymology; Neoplasms - pathology; Neoplastic Cells, Circulating - drug effects; Neoplastic Cells, Circulating - pathology; Neovascularization, Pathologic - prevention & control; Phosphorylation; Polymorphism, Single Nucleotide; Protein Kinase Inhibitors - adverse effects; Protein Kinase Inhibitors - pharmacokinetics; Protein Kinase Inhibitors - therapeutic use; Proto-Oncogene Proteins c-met - antagonists & inhibitors; Proto-Oncogene Proteins c-met - metabolism; Pyrrolidinones - adverse effects; Pyrrolidinones - pharmacokinetics; Pyrrolidinones - therapeutic use; Quinolines - adverse effects; Quinolines - pharmacokinetics; Quinolines - therapeutic use; Receptors, Growth Factor - antagonists & inhibitors; Receptors, Growth Factor - metabolism; Signal Transduction - drug effects; Treatment Outcome; Tumors; Young Adult; Pharmacodynamics; Cancerology; C-Onc gene; Phase I trial; Inhibitor; Mechanism; Protooncogene
• ISSN: 0732-183X; 1527-7755; 1527-7755
• DOI: 10.1200/JCO.2010.31.0367

The hepatocyte growth factor/c-MET axis is implicated in tumor cell proliferation, survival, and angiogenesis. ARQ 197 is an oral, selective, non-adenosine triphosphate competitive c-MET inhibitor. A phase I trial of ARQ 197 was conducted to assess safety, tolerability, and target inhibition, including intratumoral c-MET signaling, apoptosis, and angiogenesis. Patients with solid tumors amenable to pharmacokinetic and pharmacodynamic studies using serial biopsies, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and circulating endothelial cell (CEC) and circulating tumor cell (CTC) enumeration were enrolled. Fifty-one patients received ARQ 197 at 100 to 400 mg twice per day. ARQ 197 was well tolerated, with the most common toxicities being grade 1 to 2 fatigue, nausea, and vomiting. Dose-limiting toxicities included grade 3 fatigue (200 mg twice per day; n = 1); grade 3 mucositis, palmar-plantar erythrodysesthesia, and hypokalemia (400 mg twice per day; n = 1); and grade 3 to 4 febrile neutropenia (400 mg twice per day, n = 2; 360 mg twice per day, n = 1). The recommended phase II dose was 360 mg twice per day. ARQ 197 systemic exposure was dose dependent and supported twice per day oral dosing. ARQ 197 decreased phosphorylated c-MET, total c-MET, and phosphorylated focal adhesion kinase and increased terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling (TUNEL) staining in tumor biopsies (n = 15). CECs decreased in 25 (58.1%) of 43 patients, but no significant changes in DCE-MRI parameters were observed after ARQ 197 treatment. Of 15 patients with detectable CTCs, eight (53.3%) had ≥ 30% decline in CTCs after treatment. Stable disease, as defined by Response Evaluation Criteria in Solid Tumors (RECIST), ≥ 4 months was observed in 14 patients, with minor regressions in gastric and Merkel cell cancers. ARQ 197 safely inhibited intratumoral c-MET signaling. Further clinical evaluation focusing on combination approaches, including an erlotinib combination in non-small-cell lung cancer, is ongoing.