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Combination of Trastuzumab and Tanespimycin (17-AAG, KOS-953) Is Safe and Active in Trastuzumab-Refractory HER-2–Overexpressing Breast Cancer: A Phase I Dose-Escalation Study

Shanu Modi, Alison T. Stopeck, Michael S. Gordon, David Mendelson, David B. Solit, Rochelle Bagatell, Weining Ma, Jennifer Wheler, Neal Rosen, Larry Norton, Gillian F. Cropp, Robert G. Johnson, Alison L. Hannah, Clifford A. Hudis

From the Memorial Sloan-Kettering Cancer Center, New York, NY; Arizona Cancer Center, Tucson/Scottsdale, AZ; and Kosan Biosciences Inc, Hayward, CA

Address reprint requests to Shanu Modi, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; e-mail: modis{at}mskcc.org

Purpose This phase I study examined whether a heat shock protein (Hsp) 90 inhibitor tanespimycin (17-AAG; KOS-953) could be administered safely in combination with trastuzumab at a dose that inhibits Hsp90 function in vivo in lymphocytes.

Patients and Methods Patients with an advanced solid tumor progressing during standard therapy were eligible. Patients were treated with weekly trastuzumab followed by intravenous tanespimycin, assessed in escalating dose levels.

Results Twenty-five patients were enrolled onto four tanespimycin dose levels: 225 (n = 4), 300 (n = 3), 375 (n = 8), and 450 mg/m² (n = 10). Dose-limiting toxicity (DLT) was observed at the third and fourth cohort (1 patient each): more than 2-week delay for grade 4 fatigue/grade 2 nausea and anorexia (375 mg/m²); more than 2-week delay for thrombocytopenia (450 mg/m²). Drug-related grade 3 toxicity included emesis, increased ALT, hypersensitivity reactions (two patients each), and drug-induced thrombocytopenia (n = 1). Common mild to moderate toxicities included fatigue, nausea, diarrhea, emesis, headache, rash/pruritus, increased AST/ALT, and anorexia. Pharmacokinetic analysis demonstrated no difference in tanespimycin kinetics with or without trastuzumab. Pharmacodynamic testing showed reactive induction of Hsp70 (a marker of Hsp90 inhibition) in lymphocytes at all dose levels. Antitumor activity was noted (partial response, n = 1; minor response, n = 4; stable disease 4 months, n = 4). Tumor regressions were seen only in patients with human epidermal growth factor receptor 2 (HER-2)-positive metastatic breast cancer.

Conclusion Tanespimycin plus trastuzumab is well tolerated and has antitumor activity in patients with HER-2+ breast cancer whose tumors have progressed during treatment with trastuzumab. These data suggest that Hsp90 function can be inhibited in vivo to a degree sufficient to cause inhibition of tumor growth.

Supported in part by Kosan Biosciences Inc.

Presented in part at the San Antonio Breast Cancer Symposium, San Antonio, TX, December 2005; American Association of Cancer Research Meeting, Washington, DC, 2006; American Society of Clinical Oncology Meeting, Atlanta, GA, 2006.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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