Abstract
Angiogenesis may play a role in the pathophysiology and progression of myelodysplastic syndromes (MDS). The oral agent PTK787/ZK222584 (PTK/ZK; Novartis and Schering AG) inhibits receptor tyrosine kinases of vascular endothelial growth factor (VEGF), platelet derived growth factor (PDGF) and Kit. In a phase II trial, we examined if PTK/ZK induces hematological responses and/or delays progression to acute myeloid leukemia (AML) or death in MDS. Patients (pts) previously untreated with cytotoxic agents for MDS received PTK/ZK 1,250 mg orally once daily for 28-day cycles until disease progression/unacceptable toxicity. To improve tolerability, the regimen was changed after 80 pts (cohort 1: C-I) to dose escalation: 750 mg for the first 28 d, escalated in the absence of pre-defined toxicity levels to 1,000 mg for 28 d, then 1,250 mg thereafter for cohort 2 (C-II; N=58 pts). Between 03/04 and 06/06, 138 pts were enrolled (median age, 70 yrs [range, 21–91]; 64% males) and continuous toxicity and efficacy assessments made. During the 3 months (mo) prior to study entry, 50% had received red cell and 12% received platelet transfusions. Toxicity data are available for 118/138 (85%) pts. A large proportion of toxicities occurred in the first 2 cycles, but the large majority resolved on drug discontinuation. The most common NIH Common Terminology Criteria for Adverse Events gr 2–4 non-heme toxicities at least possibly attributable to PTK/ZK were fatigue (56% in C-I; 37% in C-II), nausea (47%; 19%), vomiting (28%; 12%), dizziness (28%; 12%), ataxia (16%; 7%), anorexia (16%; 5%) and diarrhea (11%; 7%). The overall incidence of any gr 4 non-heme toxicity was 11% in C-I and 5% in C-II. We recently reported marked inter-individual variability in PTK/ZK exposure in C-I pts, but could not find an association between drug exposure and early non-heme adverse events (
Disclosures: Dr. Ravi Vij has received research funding from Novartis for an investigator-initiated trial of PTK/ZK in myeloma.
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