Cancer Therapy : Clinical Phase I Study of NGR-hTNF , a Selective Vascular Targeting Agent , in Combination with Cisplatin in Refractory Solid Tumors

Purpose: NGR-hTNF exploits the tumor-homing peptide asparagine-glycine-arginine (NGR) for selectively targeting TNF-a to an aminopeptidase N overexpressed on cancer endothelial cells. Preclinical synergism with cisplatin was displayed even at low doses. This study primarily aimed to explore the safety of low-dose NGR-hTNF combined with cisplatin in resistant/refractory malignancies. Secondary aims included pharmacokinetics (PKs), pharmacodynamics, and activity. Experimental Design:NGR-hTNFwas escalated using a doubling-dose scheme (0.2–0.4–0.8–1.6mg/m) in combinationwith fixed-dose of cisplatin (80mg/m), both given intravenously once every threeweeks. PKs and circulating TNF-receptors (sTNF-Rs) were assessed over the first three cycles. Results: Globally, 22 patients (12 pretreated with platinum) received a range of one to ten cycles. Consistently with the low-dose range tested, maximum-tolerated dose was not reached. No dose-limiting toxicities (DLTs) were observed at 0.2 (n 1⁄4 4) and 0.4 mg/m (n 1⁄4 3). One DLT (grade 3 infusion-related reaction) was observed at 0.8 mg/m. This dose cohort was expanded to six patients without further DLTs. NoDLTs were noted also at 1.6 mg/m (n1⁄4 3). NGR-hTNF exposure increased dose-proportionally without apparent PK interactions with cisplatin. No shedding of sTNF-Rs was detected up to 0.8 mg/m. At the dose level of 0.8 mg/m, expanded to 12 patients for activity assessment, a platinum-pretreated lung cancer patient achieved a partial response lastingmore than sixmonths and five patientsmaintained stable disease for a median time of 5.9 months. Conclusions: The combination of NGR-hTNF 0.8 mg/m with cisplatin 80 mg/m showed favorable toxicity profile and promising antitumor activity. Clin Cancer Res; 17(7); 1–9. 2011 AACR.