Supplementary MaterialsSupp Dining tables1-2. as best response including patients with malignant peripheral nerve sheath tumor (1), Ewing sarcoma (1), hepatocellular carcinoma (1), and osteosarcoma (2). One patient with alveolar soft part sarcoma had a partial response. Kidney injury biomarkers were elevated at baseline; no trends were identified. Conclusions In children with refractory solid tumors, the maximum tolerated and recommended dose of axitinib is 2.4 mg/m2/dose, Itga4 which provides pharmacokinetic exposures similar to adults. strong class=”kwd-title” Keywords: VEGFR, pediatric solid tumor, phase I, axitinib, INLYTA Introduction Angiogenesis plays a critical role in growth and metastases of cancer.1C3 Vascular endothelial growth factor (VEGF) is a pro-angiogenic factor important for formation of tumor blood vessels CCT129202 and modulating vascular permeability. VEGF activity is usually mediated by its receptors VEGFR1, VEGFR2 and VEGFR3.3 Inhibition of the VEGF receptor tyrosine kinases CCT129202 (RTKs) has emerged as an anticancer strategy in adults with renal and hepatic carcinomas as well as soft tissue sarcomas.4C9 VEGF RTK inhibitors, evaluated in the NCI pediatric preclinical testing program solid tumor panel, exhibited tumor growth delay.10C12 Axitinib (INLYTA?), a potent and selective small molecule inhibitor of VEGFR1-3, binds to the inactive conformation of the catalytic domain name of VEGF RTKs.13C15 Studies in adults16C24 established a maximum tolerated dose (MTD) of 5 mg PO BID, and provided guidelines for intra-patient dose titration to a maximum of 10 mg PO BID.22 Common adverse effects include diarrhea, hypertension, fatigue, CCT129202 anorexia, nausea, weight loss, dysphonia, palmar-plantar erythrodysaesthesia syndrome, proteinuria, and vomiting. Hypertension and diarrhea are the most common grade 3/4 events.15,25 In adults, the median time to onset of axitinib associated grade 1C2 and grade 3 hypertension is 16 days and 24 days, respectively. Axitinib related hypertension resulted in dose interruptions in 12%, dose modification in 5%, and discontinuation in 1% of patients.26 Axitinib-treated patients with a diastolic blood pressure 90 mm Hg23 or increased diastolic BP 10C15 mm Hg from baseline had longer progression-free survival (PFS).24 Pharmacokinetic parameters in adults receiving axitinib 5 mg PO BID were highly variable. Populace PK analyses indicate that patients with higher axitinib exposures (AUC24h 200 CCT129202 h?ng/mL) may have a higher objective response rate and pattern toward improved PFS.22C24 However, there is insufficient data to recommend use of either pharmacokinetic parameters or blood pressure measurements as the exclusive guideline to up-titration of the axitinib dose.24 We conducted a Phase 1 trial to estimate the MTD or recommended phase 2 dose (RP2D), describe the toxicities, and characterize the pharmacokinetics of axitinib administered orally twice daily in pediatric patients with refractory sound tumors. Secondary aims were to describe the antitumor activity of axitinib within the confines of a phase 1 study, and to investigate biomarkers CCT129202 of severe kidney damage (AKI) and nephrotoxicity. Components and Methods Individual eligibility Patients a year and 18 years with the very least body surface (BSA) of 0.53 m2, and evaluable or measurable refractory/recurrent solid tumors, excluding primary human brain tumors, were eligible. Sufferers may have obtained prior anti-VEGF concentrating on antibodies or preventing tyrosine kinase inhibitors but might not have obtained axitinib. Sufferers will need to have recovered from acute toxic ramifications of prior therapy fully. Performance position of at least 50% (Karnofsky for sufferers 16 years of age, Lansky for 16 years) was needed. Body organ function requirements included total neutrophil count number (ANC) 1000/mm3, platelet count number 100,000/mm3, hemoglobin 8 gm/dL; creatinine radioisotope or clearance GFR 70mL/min/1.73 m2 or age-appropriate serum creatinine; bilirubin 1.5 times upper limit of normal (ULN) for age, SGPT (ALT) 110 U/L, SGOT (AST) 125 U/L,.