Abstract B10: A phase I, dose-escalation and PK study of IV aflibercept (VEGF Trap) in combination with docetaxel (D), cisplatin (C), and 5-fluorouracil (F) administered every 3 weeks in patients with advanced solid malignancies

Abstract

Abstract Background: Aflibercept (AF) is a recombinant fusion protein of the human vascular endothelial growth factor (VEGF) receptor combining the Fc portion of human IgG1 with the extracellular ligand-binding domains of human VEGFR1 and VEGFR2. AF binds and neutralizes all VEGF-A isoforms plus placental growth factor. This study was designed to assess the safety, dose-limiting toxicities (DLTs)/ recommended dose (RD), and PK of AF + DCF. Methods: This phase I combination trial explored escalating IV doses of AF given on day 1 followed by DCF (fixed dose of D 75mg/m2, C 75mg/m2 both on day 1 and F 750 mg/m2/day from day 1 to 5), every 3 weeks. G-CSF and fluoroquinolone were given as primary prophylaxis. Patient characteristics: 44 pts (M/F 29/15, median age 53 [range: 33–74], baseline ECOG-PS 0/1/2: 16/27/1) were enrolled in 3 AF dose cohorts: 2 (n = 9), 4 (n = 14) and 6 (n = 21) mg/kg. Primary tumors were mostly gastro-intestinal (28, including 22 gastro-esophageal, 3 pancreas, 2 liver, 1 cholangiocarcinoma), 4 breast, 3 lung, 3 utero-vaginal, 2 thyroid, and 4 others. Sixteen (36%) pts received prior chemotherapy, median number of lines 2 (range 1–6). Preliminary Results: Pts received a median number of 6, 4, and 7 cycles respectively for each dose group of 2, 4, and 6 mg/kg (range 1–19). One AF-related DLT of pulmonary embolism was observed at the 6 mg/kg AF dose level. Most common Gr ≥ 3 adverse events included: fatigue/asthenia (46%), mucosal inflammation/stomatitis (41%), anorexia (18%), and febrile neutropenia (16%). Mild to moderate arterial hypertension and proteinuria were reported. Grade 1 or 2 epistaxis (61%) and dysphonia (41%) also were reported. Two fatal events were observed: gastrointestinal haemorrhage after C2 (cholangiocarcinoma, AF 6 mg/kg), pulmonary haemorrhage with bronchial necrosis after C12 (NSCL cancer, AF 6 mg/kg). Thirteen (35%) partial responses (PR) in various tumor types, and 20 stable disease (SD) including 14 pts with SD≥2 months were noted. PK analysis will be presented once available. Conclusions: AF 6 mg/kg combined with DCF q3wks was selected for further investigation, based on DLTs and overall safety profile. This dose is consistent with results from other aflibercept phase 1 studies. Encouraging signs of anti-tumor activity and disease control have been seen. Citation Information: Mol Cancer Ther 2009;8(12 Suppl):B10.