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Pediatr Blood Cancer. 2015 Oct;62(10):1717-24. doi: 10.1002/pbc.25575. Epub 2015 May 13.

A phase 1 dosing study of ruxolitinib in children with relapsed or refractory solid tumors, leukemias, or myeloproliferative neoplasms: A Children's Oncology Group phase 1 consortium study (ADVL1011).

Author information

1
Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California.
2
Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
3
Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
4
Department of Pediatrics and Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
5
Department of Pediatrics, Division of Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
6
Division of Pediatric Hematology/Oncology, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas.
7
Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland.
8
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
9
College of Medicine, Mayo Clinic, Rochester, Minnesota.
10
Incyte Corporation, Wilmington, Delaware.
11
Children's Oncology Group, Arcadia, California.
12
University of Minnesota, Minneapolis, Minnesota.

Abstract

BACKGROUND:

Ruxolitinib, an orally bioavailable JAK1/JAK2 inhibitor, may treat cancers with CRLF2 and/or JAK pathway mutations.

PROCEDURE:

A phase 1 trial of ruxolitinib was performed to determine the maximum tolerated or recommended phase 2 dose, dose-limiting toxicities (DLTs), pharmacokinetics (PK), and pharmacodynamics (PD) in children with recurrent/refractory solid tumors (STs). Ruxolitinib was administered twice daily (BID) in 28-day cycles at five dose levels (15, 21, 29, 39, and 50 mg/m(2)/dose). PK and PD studies were performed during cycle 1. Toxicity, preliminary efficacy, and PK/PD were also assessed in children with relapsed/refractory hematologic malignancies (HMs).

RESULTS:

Forty-nine patients were enrolled, 28 with STs (dose escalation cohort) and 21 with HMs. Ruxolitinib was well-tolerated with one DLT per cohort of six patients at dose levels (DLs) 2-5. One patient with an ST had grade 5 multi-organ failure at DL2. One patient each at DL3 and DL4 had a grade 4 neutropenia, and one patient at DL5 had a grade 4 creatinine phosphokinase elevation. No objective responses were observed in patients with STs. One patient with polycythemia vera achieved a partial response and received 18 cycles of ruxolitinib. The PK of ruxolitinib were similar to that in adults. Partial inhibition of phosphorylated JAK2, STAT5, and S6 was observed in in vitro plasma inhibitory activity PD assay.

CONCLUSION:

Ruxolitinib was well tolerated in children with refractory cancer. The recommended phase 2 dose for continuous BID oral administration is 50 mg/m(2)/dose. Subsequent evaluation of ruxolitinib in combination with cytotoxic chemotherapy in children, adolescents, and young adults with JAK-mutant leukemias is planned.

KEYWORDS:

JAK inhibitor; childhood cancer; pediatric; pharmacokinetics; ruxolitinib

PMID:
25976292
PMCID:
PMC4546537
DOI:
10.1002/pbc.25575
[Indexed for MEDLINE]
Free PMC Article

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