Peking University Cancer Hospital and Institute, Beijing.
Fudan University Shanghai Cancer Center, Shanghai.
Haematologica. 2024 Jul 1;109(7):2165-2176. doi: 10.3324/haematol.2022.282401.
Sovleplenib (HMPL-523) is a selective spleen tyrosine kinase (Syk) inhibitor with anti-tumor activity in preclinical models of B-cell malignancy. We conducted a dose-escalation and dose-expansion phase I study of sovleplenib in patients with relapsed/ refractory mature B-cell tumors. Dose escalation followed a 3+3 design; patients received oral sovleplenib (200-800 mg once daily [q.d.] or 200 mg twice daily [b.i.d.], 28-day cycles). During dose expansion, patients were enrolled into four cohorts per lymphoma classification and treated at the recommended phase II dose (RP2D) (clinicaltrials gov. Identifier: NCT02857998). Overall, 134 Chinese patients were enrolled (dose escalation, N=27; dose expansion, N=107). Five patients experienced dose-limiting toxicities: one each of amylase increased (200 mg q.d.), febrile neutropenia (800 mg q.d.), renal failure (800 mg q.d.), hyperuricemia and blood creatine phosphokinase increased (200 mg b.i.d.) and blood bilirubin increased and pneumonia (200 mg b.i.d.). RP2D was determined as 600 mg (>65 kg) or 400 mg (≤65 kg) q.d.. The primary efficacy end point of independent review committee-assessed objective response rate in indolent B-cell lymphoma was 50.8% (95% confidence interval: 37.5- 64.1) in 59 evaluable patients at RP2D (follicular lymphoma: 60.5%, marginal zone lymphoma: 28.6%, lymphoplasmacytic lymphoma/Waldenström macroglobulinemia, 0%). The most common (≥10% patients) grade ≥3 treatment-related adverse events in the dose-expansion phase were decreased neutrophil count (29.9%), pneumonia (12.1%) and decreased white blood cell count (11.2%). Pharmacokinetic exposures increased dose-proportionally with ascending dose levels from 200-800 mg, without observed saturation. Sovleplenib showed anti-tumor activity in relapsed/refractory B-cell lymphoma with acceptable safety. Further studies are warranted.
索凡替尼(HMPL-523)是一种选择性脾酪氨酸激酶(Syk)抑制剂,在 B 细胞恶性肿瘤的临床前模型中具有抗肿瘤活性。我们在复发性/难治性成熟 B 细胞肿瘤患者中进行了索凡替尼的剂量递增和扩展的 I 期研究。剂量递增采用 3+3 设计;患者接受口服索凡替尼(200-800mg 每日一次 [qd] 或 200mg 每日两次 [bid],28 天周期)。在剂量扩展期间,根据淋巴瘤分类将患者分为四组,在推荐的 II 期剂量(RP2D)下进行治疗(clinicaltrials.gov 标识符:NCT02857998)。总体而言,共有 134 名中国患者入组(剂量递增,N=27;剂量扩展,N=107)。有 5 名患者发生剂量限制毒性:1 例淀粉酶升高(200mg qd),1 例发热性中性粒细胞减少症(800mg qd),1 例肾功能衰竭(800mg qd),1 例高尿酸血症和血肌酸磷酸激酶升高(200mg bid),1 例血胆红素升高和肺炎(200mg bid)。确定 RP2D 为 600mg(>65kg)或 400mg(≤65kg)qd。在 RP2D 下,独立审查委员会评估的惰性 B 细胞淋巴瘤的客观缓解率是 59 例可评估患者中的 50.8%(95%置信区间:37.5-64.1)(滤泡性淋巴瘤:60.5%,边缘区淋巴瘤:28.6%,淋巴浆细胞性淋巴瘤/华氏巨球蛋白血症:0%)。在剂量扩展阶段,最常见(≥10%的患者)≥3 级治疗相关不良事件是中性粒细胞计数减少(29.9%)、肺炎(12.1%)和白细胞计数减少(11.2%)。药代动力学暴露随剂量从 200-800mg 呈剂量比例增加,无观察到饱和。索凡替尼在复发性/难治性 B 细胞淋巴瘤中具有抗肿瘤活性,安全性可接受。需要进一步研究。