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Phase II Activity of Belinostat (PXD-101), Carboplatin, and Paclitaxel in Women With Previously Treated Ovarian Cancer

Dizon, Don S. MD, FACP*; Damstrup, Lars MD, PhD; Finkler, Neil J. MD; Lassen, Ulrik MD, PhD§; Celano, Paul MD; Glasspool, Ros MD; Crowley, Elizabeth MD#; Lichenstein, Henri S. PhD#; Knoblach, Poul; Penson, Richard T. MD**

International Journal of Gynecological Cancer: July 2012 - Volume 22 - Issue 6 - p 979–986
doi: 10.1097/IGC.0b013e31825736fd
Ovarian Cancer

Background: Preclinical data show that belinostat (Bel) is synergistic with carboplatin and paclitaxel in ovarian cancer. To further evaluate the clinical activity of belinostat, carboplatin, and paclitaxel (BelCaP), a phase 1b/2 study was performed, with an exploratory phase 2 expansion planned specifically for women with recurrent epithelial ovarian cancer (EOC).

Methods: Thirty-five women were treated on the phase 2 expansion cohort. BelCap was given as follows: belinostat, 1000 mg/m2 daily for 5 days with carboplatin, AUC 5; and paclitaxel, 175 mg/m2 given on day 3 of a 21-day cycle. The primary end point was overall response rate (ORR), using a Simon 2 stage design.

Results: The median age was 60 years (range, 39–80 years), and patients had received a median of 3 prior regimens (range, 1–4). Fifty-four percent had received more than two prior platinum-based combinations, sixteen patients (46%) had primary platinum-resistant disease, whereas 19 patients (54%) recurred within 6 months of their most recent platinum treatment. The median number of cycles of BelCaP administered was 6 (range, 1–23). Three patients had a complete response, and 12 had a partial response, for an ORR of 43% (95% confidence interval, 26%–61%). When stratified by primary platinum status, the ORR was 44% among resistant patients and 63% among sensitive patients. The most common drug-related adverse events related to BelCaP were nausea (83%), fatigue (74%), vomiting (63%), alopecia (57%), and diarrhea (37%). With a median follow-up of 4 months (range, 0–23.3 months), 6-month progression-free survival is 48% (95% confidence interval, 31%–66%). Median overall survival was not reached during study follow-up.

Conclusions: Belinostat, carboplatin, and paclitaxel combined was reasonably well tolerated and demonstrated clinical benefit in heavily-pretreated patients with EOC. The addition of belinostat to this platinum-based regimen represents a novel approach to EOC therapy and warrants further exploration.

*Program in Women’s Oncology, Women & Infants’ Hospital/Alpert Medical School of Brown University, Providence, RI; †TopoTarget A/S, Copenhagen, Denmark; ‡Florida Hospital Cancer Institute, Orlando, FL; §University Hospital, Copenhagen, Denmark; ∥Greater Baltimore Medical Center, Baltimore, MD; ¶Beatson West of Scotland Cancer Center, Glasgow, United Kingdom; #CuraGen Corporation, Branford, CT; and **Massachusetts General Hospital, Boston, MA.

Address correspondence and reprint requests to Don S. Dizon, MD, FACP, Program in Women’s Oncology. Women & Infants’ Hospital. 101 Dudley St, Providence, RI 02905. E-mail: ddizon@wihri.org.

The study was fully supported by Topotarget and Curagen Corporation.

Conflict of Interest: Institutional funds received for clinical trial support: Glasspool, Dizon. Research funding from Topotarget: Penson Employee of Topotarget (makers of belinostat): Damstrup, Knoblauch, Lichenstein (previously employed), Crowley (previously employed). No conflicts of interest: Celano, Lassen, Finkler.

Form will be submitted per guidelines by individual authors.

This work was presented at the 2008 American Society of Clinical Oncology Annual Meeting.

Author Contributions: All authors contributed equally to this work. DS Dizon, NJ Finkler, J Micha, U Lassen, P Celano, R Glasspool, and RT Penson all enrolled patients to this study, and reviewed and edited the final manuscript. DS Dizon, L. Damstrup, E Crowley, HS Lichenstein, P Knoublach, and U Lassen were responsible for the design, implementation, and statistical analysis of this study. DS Dizon, L. Damstrup, HS Lichenstein, and RT Penson wrote the original manuscript and its final draft. All authors approved the final manuscript.

Institutional review was obtained by each institution before study initiation.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.ijgc.net).

Received January 20, 2012

Accepted March 25, 2012

Copyright © 2012 by IGCS and ESGO