Clinical Research Papers:
A first in man phase I trial of the oral immunomodulator, indoximod, combined with docetaxel in patients with metastatic solid tumors
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Hatem H. Soliman1, Erica Jackson2, Tony Neuger1, E. Claire Dees3, R. Donald Harvey4, Hyo Han1, Roohi Ismail-Khan1, Susan Minton1, Nicholas N. Vahanian5, Charles Link5, Daniel M. Sullivan1, Scott Antonia1
1 H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
2 University of South Florida, Tampa, FL
3 University of North Carolina/Lineberger Cancer Center, Chapel Hill, NC
4 Winship Cancer Institute of Emory University, Atlanta, GA
5 NewLink Genetics Inc, Ames, IA
Dr. Hatem Soliman MD, e-mail: Hatem.firstname.lastname@example.org
Keywords: Indoximod, 1-methyl-D-tryptophan, immunomodulator, docetaxel, indoleamine 2, 3 dioxygenase
Received: June 12, 2014 Accepted: August 16, 2014 Published: August 21, 2014
Background: Indoleamine 2,3-dioxygenase (IDO) is an enzyme that tumors use to create a state of immunosuppression. Indoximod is an IDO pathway inhibitor. Preclinical studies demonstrated that indoximod combined with chemotherapy was synergistic in a mouse model of breast cancer. A phase I 3+3 trial was designed to study the combination of docetaxel and indoximod.
Methods: Docetaxel was administered at 60 mg/m2 intravenously every 3 weeks dose levels 1-4 and 75 mg/m2 for dose level 5. Indoximod was given at 300, 600, 1000, 2000, and 1200 mg PO twice daily continuously for levels 1-5, respectively. Serum drug levels were measured.
Results: Twenty-seven patients were treated, with 22 evaluable for response. DLTs included grade 3 dehydration (level 1), hypotension(level 4), mucositis (level 4) and grade 5 enterocolitis (level 2). Dose level 5 is the recommended phase II dose. The most frequent adverse events were fatigue (58.6%), anemia (51.7%), hyperglycemia (48.3%), infection (44.8%), and nausea (41.4%). There were 4 partial responses (2 breast, 1 NSCLC, 1 thymic tumor). No drug-drug interactions were noted.
Conclusions: Docetaxel plus indoximod was well tolerated with no increase in expected toxicities or pharmacokinetic interactions. It was active in a pretreated population of patients with metastatic solid tumors.
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