Reid, Joel M.

Abstract Epidemiologic studies have shown that diabetics receiving the biguanide metformin, as compared with sulfonylureas or insulin, have a lower incidence of breast cancer. Metformin increases levels of activated AMPK (AMP-activated protein kinase) and decreases circulating IGF-1; encouraging its potential use in both cancer prevention and therapeutic settings. In anticipation of clinical trials in nondiabetic women, the efficacy of metformin in nondiabetic rat and mouse mammary cancer models was evaluated. Metformin was administered by gavage or in the diet, at a human equivalent dose, in standard mammary cancer models: (i) methylnitrosourea (MNU)-induced estrogen receptor–positive (ER+) mammary cancers in rats, and (ii) MMTV-Neu/p53KO ER− (estrogen receptor–negative) mammary cancers in mice. In the MNU rat model, metformin dosing (150 or 50 mg/kg BW/d, by gavage) was ineffective in decreasing mammary cancer multiplicity, latency, or weight. Pharmacokinetic studies of metformin (150 mg/kg BW/d, by gavage) yielded plasma levels (Cmax and AUC) higher than humans taking 1.5 g/d. In rats bearing small palpable mammary cancers, short-term metformin (150 mg/kg BW/d) treatment increased levels of phospho-AMPK and phospho-p53 (Ser20), but failed to reduce Ki67 labeling or expression of proliferation-related genes. In the mouse model, dietary metformin (1,500 mg/kg diet) did not alter final cancer incidence, multiplicity, or weight. Metformin did not prevent mammary carcinogenesis in two mammary cancer models, raising questions about metformin efficacy in breast cancer in nondiabetic populations. Cancer Prev Res; 8(3); 231–9. ©2015 AACR.

Abstract Purpose: To determine the MTD, dose-limiting toxicities (DLT), pharmacokinetics, and biologic effects of cixutumumab administered in combination with temsirolimus to children with refractory solid tumors. Experimental Design: Cixutumumab and temsirolimus were administered intravenously once every 7 days in 28-day cycles. Pharmacokinetic and biology studies, including assessment of mTOR downstream targets in peripheral blood mononuclear cells, were performed during the first cycle. Results: Thirty-nine patients, median age 11.8 years (range, 1–21.5), with recurrent solid or central nervous system tumors were enrolled, of whom 33 were fully assessable for toxicity. There were four dose levels, which included two dose reductions and a subsequent intermediated dose escalation: (i) IMC-A12 6 mg/kg, temsirolimus 15 mg/m2; (ii) IMC-A12 6 mg/kg, temsirolimus 10 mg/m2; (iii) IMC-A12 4 mg/kg, temsirolimus 8 mg/m2; and (iv) IMC-A12 6 mg/kg, temsirolimus 8 mg/m2. Mucositis was the predominant DLT. Other DLTs included hypercholesterolemia, fatigue, thrombocytopenia, and increased alanine aminotransferase. Target inhibition (decreased S6K1 and PAkt) in peripheral blood mononuclear cells was noted at all dose levels. Marked interpatient variability in temsirolimus pharmacokinetic parameters was noted. At 8 mg/m2, the median temsirolimus AUC was 2,946 ng • h/mL (range, 937–5,536) with a median sirolimus AUC of 767 ng • h/mL (range, 245–3,675). Conclusions: The recommended pediatric phase II doses for the combination of cixutumumab and temsirolimus are 6 mg/kg and 8 mg/m2, respectively. Clin Cancer Res; 21(7); 1558–65. ©2014 AACR.

Batracylin (NSC-320846) is a dual inhibitor of DNA topoisomerases I and II. Batracylin advanced as an anticancer agent to Phase I clinical trials where dose limiting hemorrhagic cystitis (bladder inflammation and bleeding) was observed. To further investigate batracylin’s mechanism of toxicity, studies were conducted in Fischer 344 rats. Once daily oral administration of 16 or 32 mg/kg batracylin to rats for 4 days caused overt toxicity. Abnormal clinical observations and adverse effects on clinical pathology, urinalysis, and histology indicated acute renal damage and urothelial damage and bone marrow dysfunction. Scanning electron microscopy revealed sloughing of the superficial and intermediate urothelial layers. DNA damage was evident in kidney and bone marrow as indicated by histone γ-H2AX immunofluorescence. After a single oral administration of 16 or 32 mg/kg, the majority of batracylin was converted to N-acetylbatracylin (NAB) with a half-life of 4 hr to 11 hr. Mesna (Mesnex™), a drug known to reduce the incidence of hemorrhagic cystitis induced by ifosfamide or cyclophosphamide, was administered to rats prior to batracylin, but did not alleviate batracylin-induced bladder and renal toxicity. These findings suggest that batracylin results in DNA damage-based mechanisms of toxicity and not an acrolein-based mechanism of toxicity as occurs after ifosfamide or cyclophosphamide administration.

Abstract Metformin is a bi-guanidine employed in treating Type II diabetes. Epidemiologic studies have suggested that diabetics receiving metformin vs thialidizones or insulin have a lower incidence of cancer. In addition, metformin decreases levels of AMPK and IGF1; encouraging its use in both cancer prevention and therapy settings. Most preclinical studies with metformin have employed cell culture or xenografts. We examined its efficacy in multiple in situ animal cancer models. The preventive effect of Metformin administered by gavage or in the diet, at roughly the human equivalent dose (HED), was determined in four standard animal models: (1) methylnitrosourea (MNU)-induced ER+ mammary cancers; (2) MMTV-Neu ER− mammary cancers; (3) hydroxybutyl(butyl)nitrosamine (OH-BBN) induced urinary bladder cancers; and (4) Min mouse model of intestinal tumorigenesis. In the MNU model, Metformin (150 or 50 mg/Kg BW/day) was ineffective as a preventive dose; decreasing neither tumor multiplicity nor latency. Furthermore, both doses increased final tumor weights in treated rats. PK studies at the higher dose of Metformin (150 mg/kg BW/day) showed serum levels slightly higher than humans taking 1.5 g per day. In the MMTV-Neu model, dietary metformin (1200 PPM in diet) decreased the latency of tumor development as well as slightly, but insignificantly, increasing the final tumor multiplicity. Metformin (1200 ppm in diet) in the Min mouse model marginally increased the multiplicity of intestinal adenomas. In contrast, the NSAID naproxen (400 ppm in diet) examined simultaneously in the min mouse strongly inhibited adenoma development. Metformin (150 mg/Kg BW/day) in the OH-BBN induced model of urinary bladder cancer failed to significantly reduce bladder cancers despite relatively high levels of Metformin in the urine. In the MNU model, when rats were placed on a high fat diet to induce a pre-diabetic state, we observed roughly a 20% decrease in tumor multiplicity in the metformin treated rats (P> 0.10). In contrast, tamoxifen and Targretin (an RXR agonist) that were used as positive controls were highly effective in rats on a high fat diet. Metformin didn't decrease tumorigenesis in these standard models, but actually increased tumor formation (incidence, multiplicity, weight) in three of the four models at their HED. These results should particularly discourage any large phase clinical trials in individuals without insulin resistance. The final study certainly raises the question whether the agent might be effective in animals that are diabetic or show insulin resistance Citation Format: Clinton J. Grubbs, Margie L. Clapper, Joel M. Reid, Vernon E. Steele, Ronald A. Lubet. Metformin promotes tumorigenesis in animal models of cancer prevention. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2273. doi:10.1158/1538-7445.AM2013-2273

Abstract NSC 161128 is a phenylurea thiocarbamate that has shown differential activity in the NCI60 anticancer screen and in xenograft models. The best in vivo activity was observed against the DU-145 prostate cell line. Previous studies conducted by DTP/NCI demonstrated that NSC 161128 is rapidly metabolized after administration to mice or rats, with the major detected metabolite being N-methyl-N’-phenylurea (M10). The other putative metabolite(s) arising from cleavage of the N-S bond, dimethyldithiocarbamate (M85) and/or its disulfide [bis(dimethyldithiocarbamoyl)disulfide, M17] were not detected in animal plasma using available methodologies. NSC 161128 was also shown to be rapidly degraded in aqueous solution at low and high pH, forming M10 and M17. As part of the preclinical evaluation of NSC 161128, we developed a sensitive, specific LC/MS/MS method to quantitate NSC 161128, M10 and M17 in biological samples, explored the stability of NSC 161128 in cell culture medium, and characterized the pharmacokinetics and in vivo metabolism of NSC 161128 following i.p. administration to athymic nude mice. We developed and validated suitable positive ionization lc/ms/ms methodology for measuring NSC 161128, M10 and M17. The assay utilized liquid extraction with isopropanol:1-chlorobutane, 1:9 (v/v) and MS/MS detection with the 270>177, 151>94 and 241>120 transitions for NSC 161128, M10 and M17, respectively. Baseline separation was achieved on an Atlantis T3 column under a mobile phase consisting of 40:60 methanol:water containing 0.1% formic acid. Standard curves were linear over the concentration range 1.0-1000 ng/mL with a lower limit of detection of 1.0 ng/mL. The parent compound was stable under acidic and neutral conditions, but some degradation (<10%) was detected under basic conditions. NSC 161128 disappearance (∼20%) was also detected during 24-h incubation in RPMI medium +/- FBS. M10 was a minor product in those same incubations, suggesting that reactive metabolites are not formed in cell culture medium. Rapid degradation of NSC161128 and concomitant formation of M10 was observed in plasma at room temperature. While degradation was reduced by incubation on ice, substantial loss of drug (>40%) was noted within 30 minutes, and samples for pharmacokinetic studies were kept cold and processed quickly to prevent degradation. NSC 161128 pharmacokinetics were characterized in male CD1 mice after i.p. administration of a 200 mg/kg dose. The peak plasma concentration of 255 ng/ml was observed 5 minutes after drug administration and the plasma half-life was 138 min. The peak concentration of 14.7 μg/ml M10 was detected 15 min after the NSC 161128 dose and the half-life was 560 min. Analysis of the pharmacokinetics of the thiol metabolites will be presented. Supported by NCI contract N01-CM-2011-00014. Citation Format: Chad A. Walden, Joel M. Reid, Renee M. McGovern, Joseh M. Covey, Matthew M. Ames. LC/MS/MS assay and mouse pharmacokinetics of the phenylurea thiocarbamate NSC 161128. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4557. doi:10.1158/1538-7445.AM2013-4557

Abstract NSC 373981 is 1-ethanol, 2-nitro-naphtho[2,1-b]furan that has demonstrated activity in the NCI60 anticancer screen and in the mouse hollow-fiber assay. Growth inhibitory activity was also observed in several xenograft models. There is some evidence that antitumor activity is greater in vivo than would be predicted by the in vitro results, suggesting the possibility of activating metabolism. While the mechanism of anticancer activity is unknown, naphthofurans have been reported to modulate certain nuclear receptors. The purpose of this study was to characterize the plasma pharmacokinetics of NSC 373981 following i.v. and i.p. administration to athymic nude mice and to characterize potential metabolites of this compound in plasma, urine, and bile. We developed and validated suitable positive ionization LC/MS/MS methodology for measuring NSC 373981 that utilized liquid extraction with 1-chlorobutane and MS/MS detection with the 258>212 and 244>169 transitions, respectively, for NSC 373981 and NSC 329226, an analog that was used as the internal standard. Baseline separations were achieved on a Polaris C18 column under a mobile phase consisting of 70:30 methanol:water containing 0.1% formic acid. Standard curves were linear over the concentration range 2.5-1000 ng/mL with a lower limit of detection of 2.5 ng/mL. NSC 373981 was stable under acidic, neutral and basic conditions, as well as human and mouse plasma during 24-hr incubation at 37°C. NSC 373981 pharmacokinetics were characterized in male nu/nu mice after a 37.5 mg/kg i.v. dose or a 150 mg/kg i.p. dose. Plasma, bile, urine and feces were collected for 24-hr after drug administration. Following i.v. administration, the peak concentration was > 5.9 μg/mL and the terminal elimination half-life was 1.2 hours. Volume of distribution and plasma clearance values were 694 ml and 390 mL/hr, respectively. Following i.p. administration, NSC373981 reached a peak concentration of 2.1 μg/mL at 15 minutes and the terminal elimination half-life was 36.8 hours. The i.p. bioavailability of NSC373981 was 58%. In vivo metabolite profiles were characterized in plasma, urine, feces, and bile. We detected several Phase I metabolites in these samples including those produced by reduction of the aromatic nitro group, oxidation of the primary alcohol moiety on the reduced metabolite, oxidation of the primary alcohol moiety, benzylic hydroxylation, hydroxylation and dihydrodiol formation on the naphthalene moiety, and Phase II metabolites including glucuronidation of the carboxylic acids and a glutathione metabolite of hydroxylated NSC 373981. Supported by NCI contract N01-CM-2011-00014. Citation Format: Joel M. Reid, Sarah A. Buhrow, Renee M. McGovern, Joseph M. Covey, Matthew M. Ames. Pharmacokinetics and in vivo metabolism of the naphthofuran NSC373981 in male nu/nu mice. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2462. doi:10.1158/1538-7445.AM2013-2462

Abstract Purpose: Effective sensitizing strategies potentially can extend the benefit of temozolomide (TMZ) therapy in patients with glioblastoma (GBM). We previously demonstrated that robust TMZ-sensitizing effects of the [poly (ADP-ribose) polymerase] (PARP) inhibitor veliparib (ABT-888) are restricted to TMZ-sensitive GBM xenografts. The focus of this study is to provide an understanding for the differential sensitization in paired TMZ-sensitive and -resistant GBM models. Experimental Design: The impact of veliparib on TMZ-induced cytotoxicity and DNA damage was evaluated in vitro and in vivo in models of acquired TMZ resistance (GBM12TMZ-mgmtHigh, GBM12TMZ-mgmtLow, and U251TMZ), inherent TMZ resistance (T98G), and TMZ-sensitive (U251 and GBM12). In vivo drug efficacy, pharmacokinetics, and pharmacodynamics were analyzed using clinically relevant dosing regimens. Results: Veliparib enhanced TMZ cytotoxicity and DNA-damage signaling in all GBM models in vitro with more pronounced effects in TMZ-resistant lines at 3 to 10 μmol/L veliparib. In vivo, combined TMZ/veliparib, compared with TMZ alone, significantly delayed tumor growth and enhanced DNA-damage signaling and γH2AX levels in the sensitive GBM12 xenograft line but not in the resistant GBM12TMZ lines. The pharmacokinetic profile of veliparib was similar for GBM12 and GBM12TMZ tumors with Cmax (∼1.5 μmol/L) in tissue significantly lower than concentrations associated with optimal in vitro sensitizing effects for resistant tumors. In contrast, robust suppression of PARP-1 expression by shRNA significantly increased TMZ sensitivity of U251TMZ in vitro and in vivo. Conclusions: In vitro cytotoxicity assays do not adequately model the therapeutic index of PARP inhibitors, as concentrations of veliparib and TMZ required to sensitize TMZ-resistant cancer cells in vivo cannot be achieved using a tolerable dosing regimen. Clin Cancer Res; 20(14); 3730–41. ©2014 AACR.

Endoxifen (4-hydroxy-N-desmethyl-tamoxifen), one of the major active metabolites of tamoxifen, has substantially greater estrogen antagonist properties and antiproliferative effects in breast tumor cells than tamoxifen, a mixed estrogen agonist/antagonist. An associated risk of endometrial cancer and hyperplasia has been linked to the estrogen agonist properties of tamoxifen. We evaluated endoxifen using a classic uterotrophic effects method. Rats were given endoxifen or tamoxifen orally for 3 days. Estradiol was the positive control. Endoxifen and tamoxifen plasma levels exceeded those previously observed clinically. Uterine weight was 3-fold higher in the estradiol group than in the tamoxifen or endoxifen groups, which did not differ from vehicle controls. Tamoxifen and endoxifen caused a greater increase in luminal epithelial cell height than estradiol. Both tamoxifen and endoxifen produced an increase in the stromal BrdU labeling index (LI) that was ≤ estradiol and inversely related to dose, but did not affect luminal epithelial cell BrdU LI. As expected, estradiol increased luminal epithelial cell proliferation. These results indicate that endoxifen induces uterotrophic effects, but is less potent than estradiol in eliciting these effects. Given prior preclinical observations that endoxifen has superior antitumor activity than tamoxifen, the observations of similar uterine effects suggest that the endoxifen risk/benefit ratio may be superior to tamoxifen.

BackgroundWe report results of a phase I trial designed to estimate the maximum tolerated dose (MTD), describe dose‐limiting toxicities (DLT), and characterize the pharmacokinetic profile of MK‐2206, an AKT inhibitor, in children with refractory or recurrent malignancies.ProcedureMK‐2206 was administered either every other day (Schedule 1), or once a week (Schedule 2) in a 28‐day cycle. Dose escalations in increments of ∼30% were independently made in each part using the rolling‐six design. Serial pharmacokinetic (PK) studies were obtained. Biological studies include analysis of PI3K/PTEN/AKT‐cell signaling pathway in pre and post‐therapy in PBMC and in tumors at diagnosis or recurrence.ResultsFifty patients (26 males, median age 12.6 years [range, 3.1–21.9]) with malignant glioma (16), ependymoma (4), hepatocellular carcinoma (3), gliomatosis cereberi (2), or other tumors (22) were enrolled; 40 were fully evaluable for toxicity (Schedule 1, n = 23; Schedule 2, n = 17). Schedule 1 DLTs included: grade 3 dehydration in 1/6 patients at 28 mg/m2; grade 4 hyperglycemia and neutropenia in 1/6 patients at 45 mg/m2; and grade 3 rash in 3/6 patients at dose level 4 (58 mg/m2). Schedule 2 DLTs included: grade 3 alkaline phosphatase in 1/6 patients at 90 mg/m2; grade 3 rash in 1/6 patients at 120 mg/m2; and grade 3 rash in 2/6 patients at 155 mg/m2.ConclusionsThe recommended pediatric phase 2 dose of MK‐2206 is 45 mg/m2/dose every other day or 120 mg/m2/dose weekly. PK appeared linear over the dose range studied. Pediatr Blood Cancer 2014;61:1246–1251. © 2014 Wiley Periodicals, Inc.

Abstract Purpose: Imetelstat is a covalently-lipidated 13-mer thiophosphoramidate oligonucleotide that acts as a potent specific inhibitor of telomerase. It binds with high affinity to the template region of the RNA component of human telomerase (hTERC) and is a competitive inhibitor of telomerase enzymatic activity. The purpose of this study was to determine the recommended phase II dose of imetelstat in children with recurrent or refractory solid tumors. Experimental Design: Imetelstat was administered intravenously more than two hours on days 1 and 8, every 21 days. Dose levels of 225, 285, and 360 mg/m2 were evaluated, using the rolling-six design. Imetelstat pharmacokinetic and correlative biology studies were also performed during the first cycle. Results: Twenty subjects were enrolled (median age, 14 years; range, 3–21). Seventeen were evaluable for toxicity. The most common toxicities were neutropenia, thrombocytopenia, and lymphopenia, with dose-limiting myelosuppression in 2 of 6 patients at 360 mg/m2. Pharmacokinetics is dose dependent with a lower clearance at the highest dose level. Telomerase inhibition was observed in peripheral blood mononuclear cells at 285 and 360 mg/m2. Two confirmed partial responses, osteosarcoma (n = 1) and Ewing sarcoma (n = 1), were observed. Conclusions: The recommended phase II dose of imetelstat given on days 1 and 8 of a 21-day cycle is 285 mg/m2. Clin Cancer Res; 19(23); 6578–84. ©2013 AACR.