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Structure-Guided Blockade of CSF1R Kinase in Tenosynovial Giant-Cell Tumor
William D Tap1, Zev A Wainberg, Stephen P Anthony
1From Memorial Sloan Kettering Cancer Center (W.D.T., J.H.H.) and Weill Cornell Medical College (W.D.T.) - both in New York; University of California, Los Angeles, Medical Center, Los Angeles (Z.A.W., B.C., A.S.S.), Plexxikon, Berkeley (P.N.I., C.Z., J.Z., G.H., Y.Z., E.A.B., G.V., L.S., P.S., H.N., M.J.K., A.M., G.T., R.S., C.G., B.L.W., P.H., K.N., H.H.H., P.S.L., S.T.-S., G.B.), and Stanford University School of Medicine, Stanford (M.R.) - all in California; Evergreen Hematology and Oncology, Spokane, WA (S.P.A.); University of Pennsylvania School of Medicine, Philadelphia (A.P.S.); Rocky Mountain Cancer Centers, Denver (A.L.C.); Dana-Farber Cancer Institute (G.I.S., A.J.W.) and Massachusetts General Hospital (E.L.K.) - both in Boston; Vanderbilt University Medical Center, Nashville (V.L.K., I.P.); Virginia G. Piper Cancer Center at Scottsdale Healthcare-Translational Genomics Research Institute (TGen), Scottsdale, AZ (D.D.V.H., G.J.W., R.K.R.); and Spire Sciences, Boca Raton, FL (C.P.).
Background:
Expression of the colony-stimulating factor 1 (CSF1) gene is elevated in most tenosynovial giant-cell tumors. This observation has led to the discovery and clinical development of therapy targeting the CSF1 receptor (CSF1R).
Methods:
Using x-ray co-crystallography to guide our drug-discovery research, we generated a potent, selective CSF1R inhibitor, PLX3397, that traps the kinase in the autoinhibited conformation. We then conducted a multicenter, phase 1 trial in two parts to analyze this compound. In the first part, we evaluated escalations in the dose of PLX3397 that was administered orally in patients with solid tumors (dose-escalation study). In the second part, we evaluated PLX3397 at the chosen phase 2 dose in an extension cohort of patients with tenosynovial giant-cell tumors (extension study). Pharmacokinetic and tumor responses in the enrolled patients were assessed, and CSF1 in situ hybridization was performed to confirm the mechanism of action of PLX3397 and that the pattern of CSF1 expression was consistent with the pathological features of tenosynovial giant-cell tumor.
Results:
A total of 41 patients were enrolled in the dose-escalation study, and an additional 23 patients were enrolled in the extension study. The chosen phase 2 dose of PLX3397 was 1000 mg per day. In the extension study, 12 patients with tenosynovial giant-cell tumors had a partial response and 7 patients had stable disease. Responses usually occurred within the first 4 months of treatment, and the median duration of response exceeded 8 months. The most common adverse events included fatigue, change in hair color, nausea, dysgeusia, and periorbital edema; adverse events rarely led to discontinuation of treatment.
Conclusions:
Treatment of tenosynovial giant-cell tumors with PLX3397 resulted in a prolonged regression in tumor volume in most patients. (Funded by Plexxikon; ClinicalTrials.gov number, NCT01004861.).
Insights
PLX3397, a CSF1R inhibitor, demonstrated significant tumor regression in patients with tenosynovial giant-cell tumors. This targeted therapy offers a promising treatment option with manageable side effects.
Area of Science:
- Oncology
- Pharmacology
- Biochemistry
Background:
- Elevated colony-stimulating factor 1 (CSF1) gene expression is characteristic of most tenosynovial giant-cell tumors (TGCT).
- This finding supports the development of therapies targeting the CSF1 receptor (CSF1R).
Purpose of the Study:
- To evaluate the safety and efficacy of PLX3397, a novel CSF1R inhibitor, in patients with solid tumors and TGCT.
- To confirm the mechanism of action of PLX3397 in TGCT.
Main Methods:
- X-ray co-crystallography guided the design of PLX3397, a potent and selective CSF1R inhibitor.
- A multicenter, phase 1 trial assessed PLX3397 in two parts: dose escalation in solid tumors and an extension cohort in TGCT patients.
- Pharmacokinetic analysis, tumor response assessment, and CSF1 in situ hybridization were performed.
Main Results:
- The phase 2 dose of PLX3397 was determined to be 1000 mg daily.
- In the TGCT extension study, 12 of 23 patients achieved a partial response, and 7 had stable disease.
- Responses were observed within 4 months, with a median duration exceeding 8 months. Common adverse events were generally mild and rarely led to treatment discontinuation.
Conclusions:
- PLX3397 treatment led to prolonged tumor volume regression in the majority of TGCT patients.
- The study confirms PLX3397 as a viable therapeutic agent for tenosynovial giant-cell tumors.
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