Phase I study of vorinostat with gefitinib in BIM deletion polymorphism/epidermal growth factor receptor mutation double-positive lung cancer.

Journal Article (Journal Article;Multicenter Study)

Patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) harboring BIM deletion polymorphism (BIM deletion) have poor responses to EGFR TKI. Mechanistically, the BIM deletion induces preferential splicing of the non-functional exon 3-containing isoform over the functional exon 4-containing isoform, impairing TKI-induced, BIM-dependent apoptosis. Histone deacetylase inhibitor, vorinostat, resensitizes BIM deletion-containing NSCLC cells to EGFR-TKI. In the present study, we determined the safety of vorinostat-gefitinib combination and evaluated pharmacodynamic biomarkers of vorinostat activity. Patients with EGFR-mutated NSCLC with the BIM deletion, pretreated with EGFR-TKI and chemotherapy, were recruited. Vorinostat (200, 300, 400 mg) was given daily on days 1-7, and gefitinib 250 mg was given daily on days 1-14. Vorinostat doses were escalated based on a conventional 3 + 3 design. Pharmacodynamic markers were measured using PBMC collected at baseline and 4 hours after vorinostat dose on day 2 in cycle 1. No dose-limiting toxicities (DLT) were observed in 12 patients. We determined 400 mg vorinostat as the recommended phase II dose (RP2D). Median progression-free survival was 5.2 months (95% CI: 1.4-15.7). Disease control rate at 6 weeks was 83.3% (10/12). Vorinostat preferentially induced BIM mRNA-containing exon 4 over mRNA-containing exon 3, acetylated histone H3 protein, and proapoptotic BIMEL protein in 11/11, 10/11, and 5/11 patients, respectively. These data indicate that RP2D was 400 mg vorinostat combined with gefitinib in BIM deletion/EGFR mutation double-positive NSCLC. BIM mRNA exon 3/exon 4 ratio in PBMC may be a useful pharmacodynamic marker for treatment.

Full Text

Duke Authors

Cited Authors

  • Takeuchi, S; Hase, T; Shimizu, S; Ando, M; Hata, A; Murakami, H; Kawakami, T; Nagase, K; Yoshimura, K; Fujiwara, T; Tanimoto, A; Nishiyama, A; Arai, S; Fukuda, K; Katakami, N; Takahashi, T; Hasegawa, Y; Ko, TK; Ong, ST; Yano, S

Published Date

  • February 2020

Published In

Volume / Issue

  • 111 / 2

Start / End Page

  • 561 - 570

PubMed ID

  • 31782583

Pubmed Central ID

  • PMC7004511

Electronic International Standard Serial Number (EISSN)

  • 1349-7006

Digital Object Identifier (DOI)

  • 10.1111/cas.14260


  • eng

Conference Location

  • England