First-in-Humans Trial of an RNA Interference Therapeutic Targeting VEGF and KSP in Cancer Patients with Liver Involvement

First-in-Humans Trial of an RNA Interference Therapeutic Targeting VEGF and KSP in Cancer Patients with Liver Involvement

1. Josep Tabernero1,


2. Geoffrey I. Shapiro4,


3. Patricia M. LoRusso7,


4. Andres Cervantes2,


5. Gary K. Schwartz8,


6. Glen J. Weiss9,


7. Luis Paz-Ares3,


8. Daniel C. Cho5,


9. Jeffrey R. Infante10,


10. Maria Alsina1,


11. Mrinal M. Gounder8,


12. Rick Falzone6,


13. Jamie Harrop6,


14. Amy C. Seila White6,


15. Iva Toudjarska6,


16. David Bumcrot6,


17. Rachel E. Meyers6,


18. Gregory Hinkle6,


19. Nenad Svrzikapa6,


20. Renta M. Hutabarat6,


21. Valerie A. Clausen6,


22. Jeffrey Cehelsky6,


23. Saraswathy V. Nochur6,


24. Christina Gamba-Vitalo6,


25. Akshay K. Vaishnaw6,


26. Dinah W.Y. Sah6,


27. Jared A. Gollob6 and


28. Howard A. Burris III10

+ Author Affiliations

1. 
   Authors' Affiliations: ¹Medical Oncology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona; ²Institute of Health Research INCLIVA, University of Valencia, Valencia; ³Hospital Virgen del Rocio, Seville, Spain; ⁴Dana-Farber Cancer Institute; ⁵Beth Israel Deaconess Medical Center, Boston; ⁶Alnylam Pharmaceuticals, Inc., Cambridge, Massachusetts; ⁷Karmanos Cancer Institute, Detroit, Michigan; ⁸Memorial Sloan-Kettering Cancer Center, New York, New York; ⁹Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare, Scottsdale, Arizona; and ¹⁰Sarah Cannon Research Institute, Nashville, Tennessee
   
   

1. Corresponding Author:
   Josep Tabernero, Medical Oncology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035 Barcelona, Spain. Phone: 34-93-489-4301; Fax 34-93-274-6059; E-mail: jtabernero@vhio.net

Abstract

RNA interference (RNAi) is a potent and specific mechanism for regulating gene expression. Harnessing RNAi to silence genes involved in disease holds promise for the development of a new class of therapeutics. Delivery is key to realizing the potential of RNAi, and lipid nanoparticles (LNP) have proved effective in delivery of siRNAs to the liver and to tumors in animals. To examine the activity and safety of LNP-formulated siRNAs in humans, we initiated a trial of ALN-VSP, an LNP formulation of siRNAs targeting VEGF and kinesin spindle protein (KSP), in patients with cancer. Here, we show detection of drug in tumor biopsies, siRNA-mediated mRNA cleavage in the liver, pharmacodynamics suggestive of target downregulation, and antitumor activity, including complete regression of liver metastases in endometrial cancer. In addition, we show that biweekly intravenous administration of ALN-VSP was safe and well tolerated. These data provide proof-of-concept for RNAi therapeutics in humans and form the basis for further development in cancer.

Significance: The findings in this report show safety, pharmacokinetics, RNAi mechanism of action, and clinical activity with a novel first-in-class LNP-formulated RNAi therapeutic in patients with cancer. The ability to harness RNAi to facilitate specific multitargeting, as well as increase the number of druggable targets, has important implications for future drug development in oncology. Cancer Discov; 3(4); 1–12. ©2012 AACR.

Footnotes

• 
  Note: Supplementary data for this article are available at Cancer Discovery Online (http://cancerdiscovery.aacrjournals.org/).
  
  

• Received September 24, 2012.


• Revision received December 26, 2012.


• Accepted January 24, 2013.

• ©2012 American Association for Cancer Research.