Phase i study of nelfinavir in liposarcoma

Janet Pan, Michelle Mott, Bixin Xi, Ernestine Hepner, Min Guan, Kristen Fousek, Rachel Magnusson, Raechelle Tinsley, Frances Valdes, Paul Frankel, Timothy Synold, Warren A. Chow

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25 Scopus citations

Abstract

Purpose HIV protease inhibitors are associated with HIV protease inhibitor-related lipodystrophy syndrome. We hypothesized that liposarcomas would be similarly susceptible to the apoptotic effects of an HIV protease inhibitor, nelfinavir. Methods We conducted a phase I trial of nelfinavir for liposarcomas. There was no limit to prior chemotherapy. The starting dose was 1,250 mg twice daily (Level 1). Doses were escalated in cohorts of three to a maximally evaluated dose of 4,250 mg (Level 5). One cycle was 28 days. Steady-state pharmacokinetics (PKs) for nelfinavir and its primary active metabolite, M8, were determined at Levels 4 (3,000 mg) and 5. Results Twenty subjects (13 males) were enrolled. Median (range) age was 64 years (37-81). One subject at Level 1 experienced reversible, grade 3 pancreatitis after 1 week and was replaced. No other dose-limiting toxicities were observed. Median (range) number of cycles was 3 (0.6-13.5). Overall best responses observed were 1 partial response, 1 minor response, 4 stable disease, and 13 progressive disease. Mean peak plasma levels and AUCs for nelfinavir were higher at Level 4 (7.3 mg/L; 60.9 mg/L × h) than 5 (6.3 mg/L; 37.7 mg/L × h). The mean ratio of M8:nelfinavir AUCs for both levels was ~1:3. Conclusions PKs demonstrate auto-induction of nelfinavir clearance at the doses studied, although the mechanism remains unclear. Peak plasma concentrations were within range where anticancer activity was demonstrated in vitro. M8 metabolite is present at ~1/3 the level of nelfinavir and may also contribute to the anticancer activity observed.

Original languageEnglish (US)
Pages (from-to)791-799
Number of pages9
JournalCancer Chemotherapy And Pharmacology
Volume70
Issue number6
DOIs
StatePublished - Dec 1 2012

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Keywords

  • Liposarcoma
  • Nelfinavir
  • Pharmacokinetics
  • Phase I

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Pharmacology
  • Pharmacology (medical)
  • Toxicology

Cite this

Pan, J., Mott, M., Xi, B., Hepner, E., Guan, M., Fousek, K., Magnusson, R., Tinsley, R., Valdes, F., Frankel, P., Synold, T., & Chow, W. A. (2012). Phase i study of nelfinavir in liposarcoma. Cancer Chemotherapy And Pharmacology, 70(6), 791-799. https://doi.org/10.1007/s00280-012-1961-4