Document Type
Article
Abstract
Abstract
Background
Despite the positive impact of targeted therapies on metastatic renal cell carcinoma (mRCC), durable responses are infrequent and an unmet need exists for novel therapies with distinct mechanisms of action. We investigated the combination of recombinant Interleukin 21 (IL-21), a cytokine with unique immunostimulatory properties, plus sorafenib, a VEGFR tyrosine kinase inhibitor.
Methods
In this phase 1/2 study, 52 mRCC patients received outpatient treatment with oral sorafenib 400 mg twice daily plus intravenous IL-21 (10–50 mcg/kg) on days 1–5 and 15–19 of each 7-week treatment course. The safety, antitumor activity, pharmacokinetic and pharmacodynamic effects of the combination were evaluated.
Results
In phase 1 (n = 19), the maximum tolerated dose for IL-21 with the standard dose of sorafenib was determined to be 30 mcg/kg/day; grade 3 skin rash was the only dose-limiting toxicity. In phase 2, 33 previously-treated patients tolerated the combination therapy well with appropriate dose reductions; toxicities were mostly grade 1 or 2. The objective response rate was 21% and disease control rate was 82%. Two patients have durable responses that are ongoing, despite cessation of both IL-21 and sorafenib, at 41+ and 30+ months, respectively. The median progression-free survival in phase 2 was 5.6 months. The pharmacokinetic and pharmacodynamic properties of IL-21 appeared to be preserved in the presence of sorafenib.
Conclusion
IL-21 plus sorafenib has antitumor activity and acceptable safety in previously treated mRCC patients. IL-21 may represent a suitable immunotherapy in further exploration of combination strategies in mRCC.
Trial registration
ClinicalTrials.gov Identifier: NCT00389285
Disciplines
Cell and Developmental Biology | Microbiology
Recommended Citation
Bhatia et al.: Recombinant interleukin-21 plus sorafenib for metastatic renal cell carcinoma: a phase 1/2 study. Journal for Immuno- Therapy of Cancer 2014 2:2.
Acknowledgements
The authors would like to thank Audrey Mollerup (University of Washington) and Janet Kramer (Zymogenetics) for their contributions to the conduct of this study and to the development of IL-21 in general. Most importantly, the patients and their families who participated in this study deserve a special mention for entrusting us with their care.