e13121 Background: XMT-1001 is a water soluble macromolecular conjugate of camptothecin (CPT). In this novel CPT prodrug, CPT is conjugated with a 70 kDa biodegradable hydrophilic polyacetal, poly (1-hydroxymethylethylene hydroxymethylformal). XMT-1001 has an improved therapeutic window compared with irinotecan in human tumor xenograft models, providing a compelling rationale for its clinical development. Methods: This is a dose-escalation study of XMT-1001 given as an IV infusion once every 3 weeks. The objectives are to determine the maximum tolerated dose (MTD) and assess safety and pharmacokinetics (PK) of XMT-1001. Three patients (pts) are entered at each dose level, with expansion to 6 pts if there is dose-limiting toxicity. Analyses of plasma and urine were performed for XMT-1001 (conjugated CPT), 2 major drug release products, and for unconjugated (free) CPT. Results: To date, 54 pts have received 160 cycles of XMT-1001 at dose levels from 1.0 to 113 mg CPT equivalents (eq.)/m2. Two pts had Gr 3 infusion reactions to study drug. After the introduction of clinical trial material with an improved formulation, no infusion reactions suggestive of hypersensitivity have occurred (33 pts, 98 cycles). No hemorrhagic cystitis or ≥ Gr 3 diarrhea was noted. Gr 2-4 neutropenia occurred in 3 pts treated at 85 mg CPT eq. /m2. Stable disease was observed in 14 of 50 evaluable pts with the following tumor types and doses in mg CPT eq./m2: sarcoma (85 mg/m2, 6 wks), NSCLC (1.0 mg/m2, 6 wks; 20.5 mg/m2, 36 wks; 36.3 mg/m2, 18 wks), nasopharyngeal (36.3 mg/m2, 12 wks), ovarian (4.9 mg/m2, 12 wks), pancreas (4.9 mg/m2, 36 wks), appendiceal (7.3 mg/m2, 12 wks), bile duct (9.1 mg/m2, 18 wks), basal cell (11.6 mg/m2, 6 wks), colon (15.4 mg/m2, 18 wks), gastric (20.5 mg/m2, 12 wks), prostate (85 mg/m2, 6 wks), and rectal (27.3 mg/m2, 6 wks). Tumor shrinkage was noted in a pt with colon cancer at the 15.4 mg/m2 dose level. The exposure to XMT-1001 and its release products, as measured by Cmax and AUC, demonstrated dose proportional increases with respect to dose of XMT-1001. Levels of free CPT in urine have been low. Conclusions: XMT-1001 can be given safely to patients; XMT-1001 has a favorable PK profile; and prolonged stable disease ≥ 12 wks was seen in 9 pts at doses below the MTD. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Mersana Pharmaceuticals Mersana Pharmaceuticals, Mersana Therapeutics, Inc. Mersana Therapeutics, Inc.
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