Phase 1 study of ARQ 761, a β-lapachone analogue that promotes NQO1-mediated programmed cancer cell necrosis
David E Gerber, M Shaalan Beg, Farjana Fattah, Arthur E Frankel, Oluwatomilade Fatunde, Yull Arriaga, Jonathan E Dowell, Ajit Bisen, Richard D Leff, Claudia C Meek, William C Putnam, Raja Reddy Kallem, Indhumathy Subramaniyan, Ying Dong, Joyce Bolluyt, Venetia Sarode, Xin Luo, Yang Xie, Brian Schwartz, David A Boothman, David E Gerber, M Shaalan Beg, Farjana Fattah, Arthur E Frankel, Oluwatomilade Fatunde, Yull Arriaga, Jonathan E Dowell, Ajit Bisen, Richard D Leff, Claudia C Meek, William C Putnam, Raja Reddy Kallem, Indhumathy Subramaniyan, Ying Dong, Joyce Bolluyt, Venetia Sarode, Xin Luo, Yang Xie, Brian Schwartz, David A Boothman
Abstract
Background: NAD(P)H:quinone oxidoreductase 1 (NQO1) is a two-electron oxidoreductase expressed in multiple tumour types. ARQ 761 is a β-lapachone (β-lap) analogue that exploits the unique elevation of NQO1 found in solid tumours to cause tumour-specific cell death.
Methods: We performed a 3+3 dose escalation study of 3 schedules (weekly, every other week, 2/3 weeks) of ARQ 761 in patients with refractory advanced solid tumours. Tumour tissue was analysed for NQO1 expression. After 20 patients were analysed, enrolment was restricted to patients with NQO1-high tumours (H-score ≥ 200).
Results: A total of 42 patients were treated. Median number of prior lines of therapy was 4. Maximum tolerated dose was 390 mg/m2 as a 2-h infusion every other week. Dose-limiting toxicity was anaemia. The most common treatment-related adverse events were anaemia (79%), fatigue (45%), hypoxia (33%), nausea (17%), and vomiting (17%). Transient grade 3 hypoxia, reflecting possible methemoglobinaemia, occurred in 26% of patients. Among 32 evaluable patients, best response was stable disease (n = 12); 6 patients had tumour shrinkage. There was a trend towards improved efficacy in NQO1-high tumours (P = 0.06).
Conclusions: ARQ 761 has modest single-agent activity, which appears associated with tumour NQO1 expression. Principal toxicities include anaemia and possible methemoglobinaemia.
Trial registration: ClinicalTrials.gov NCT01502800.
Conflict of interest statement
D.E.G. has received research funding from ArQule, Inc. B.S. is an employee of ArQule, Inc. The other authors declare no competing interests.
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