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A Phase 1 Pharmacokinetic and Pharmacodynamic Study of the Histone Deacetylase Inhibitor Belinostat in Patients with Advanced Solid Tumors

Authors' Affiliations: ¹ The Beatson West of Scotland Cancer Centre; ² Centre for Oncology and Applied Pharmacology, University of Glasgow, Glasgow, United Kingdom; ³ Royal Marsden Hospital, Sutton, Surrey, United Kingdom; ⁴ Topotarget, Copenhagen, Denmark; and ⁵ CuraGen Corporation, Branford, Connecticut

Requests for reprints: Nicola Steele, The Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom. Phone: 44-141-301-7000; Fax: 44-141-301-7061; E-mail: nicola.steele{at}northglasgow.scot.nhs.uk.

Purpose: To determine the safety, dose-limiting toxicity, maximum tolerated dose, and pharmacokinetic and pharmacodynamic profiles of the novel hydroxamate histone deacetylase inhibitor belinostat (previously named PXD101) in patients with advanced refractory solid tumors.

Experimental Design: Sequential dose-escalating cohorts of three to six patients received belinostat administered as a 30-min i.v. infusion on days 1 to 5 of a 21-day cycle. Pharmacokinetic variables were evaluated at all dose levels. Pharmacodynamic measurements included acetylation of histones extracted from peripheral blood mononuclear cells, caspase-dependent cleavage of cytokeratin-18, and interleukin-6 levels.

Results: Forty-six patients received belinostat at one of six dose levels (150-1,200 mg/m²/d). Dose-limiting toxicities were grade 3 fatigue (one patient at 600 mg/m²; one patient at 1,200 mg/m²), grade 3 diarrhea combined with fatigue (one patient at 1,200 mg/m²), grade 3 atrial fibrillation (one patient at 1,200 mg/m²; one patient at 1,000 mg/m²), and grade 2 nausea/vomiting leading to inability to complete a full 5-day cycle (two patients at 1,000 mg/m²). The maximum tolerated dose was 1,000 mg/m²/d. I.v. belinostat displayed linear pharmacokinetics with respect to C_max and AUC. The intermediate elimination half-life was 0.3 to 1.3 h and was independent of dose. Histone H4 hyperacetylation was observed after each infusion and was sustained for 4 to 24 h in a dose-dependent manner. Increases in interleukin-6 levels were detected following belinostat treatment. Stable disease was observed in a total of 18 (39%) patients, including 15 treated for 4 cycles, and this was associated with caspase-dependent cleavage of cytokeratin-18. Of the 24 patients treated at the maximum tolerated dose (1,000 mg/m²/d), 50% achieved stable disease.

Conclusions: I.v. belinostat is well tolerated, exhibits dose-dependent pharmacodynamic effects, and has promising antitumor activity.