Thursday, June 9, 2011

Silence Therapeutics Reports at ASCO 2011 that Atu027 has Achieved Important Pharmacokinetic and Safety Endpoints

On Monday at ASCO 2011, Silence Therapeutics provided an extensive update on its ongoing phase I trial of Atu027 for the treatment of advanced solid tumors (additional background on Atu027 and the current study provided here and here). While there are a few signs already that the drug candidate may have some anti-tumor activity, the even more important message was that Atu027 has been remarkably safe and well tolerated, while reaching drug exposures in the ongoing dose escalation at which, based on the pre-clinical experience, bona fide RNAi knockdown of the targeted gene can be expected.

In cancer drug development in particular, the name of the game in phase I trials is to test how much drug can be given without causing severe, dose-limiting toxicities. Often, in studies like this one, patients of highly varied, late-stage cancers are enrolled and too few of them are treated at the high dose levels. In that regard, the trial progress can be called quite satisfactory in that no dose-limiting toxicities were reported and the SAEs judged as unrelated to study drug. The most commonly reported side-effect was minor grade 1 fatigue. It is possible that this is drug-related, although many cancer patients suffer from fatigue for many reasons. Also of note, and as indicated in the abstract, the observed complement activations were transient and not clinically significant.

Making the safety findings even more meaningful, the measured pharmacokinetic data indicate that the drug was safe at concentrations in the blood where RNAi knockdown can be expected based on the preclinical studies in rodents and monkeys and the known knockdown potency of the RNAi trigger in tissue culture cells.

There were also preliminary signs of anti-tumor efficacy. 9 of the 24 patients had stable disease one week after receiving the last of 9 doses 2 months after study initiation, 6 of which remained stable until the end of the study (3 months after initiation). Moreover, there were two cases where tumor masses were notably reduced. Particularly notable was the case of the individual with the neuroendocrine cancer where a 2-3cm tumor mass disappeared following the re-peat administration of Atu027 (see also my earlier blog on the abstract). However, none of these apparent responses could be scored as responses by stringent RECIST criteria. It is possible that this is because other masses present in those patients did not respond. Also, stable disease did not appear to be dose-related, which may not be surprising given that most of the 24 patients enrolled so far were not given pharmacologically relevant dosages.

Outlook

Considering the safety profile so far, i.e. the absence of dose-limiting and other dose-proportional toxicities, I am hopeful that even higher dosages will be tolerated. Silence Therapeutics may even want to seek an extension of the study should the remaining 3 dose cohorts remain uneventful in terms of safety. As for Alnylam’s ALN-VSP02, the future development plan, especially a narrower patient selection and combination treatments, remain unclear and will be best explored in collaboration with a larger partner so that Atu027 can test and reach its full potential in a timely manner. Further investments seem more than justified and the main risk may be in the drug target.

7 comments:

Anonymous said...

Excellent summary. Dirk's read is as keen as usual. Looks like RNAi field is moving forward into the next phase of better target selection to improve efficacy. Silence CEO in his interview with Doug Macron intentionally hinting "declare victory and move on", move on with another target?

Anonymous said...

This field needs just one homerun and then we're off to the races. I hope that Silence can knock it out of the park.

Anonymous said...

Dirk:

I don't understand the last two sentences of this post. Will you elaborate?

Gene Genie- let yourself go said...

Dirk , could you review delivery methods for SI and SHRNA ? Seems to be changing what are Aptamers and how are they developed ? What is the lipid area like now ? What about viral and bacterial envelope delivery ? What is the state of play of replicate able viral and bacterial vectors? Are there some good research papers to look at on each ?
Next area is cancer gene target , seems so many are getting results in vitro? Is there a good paper or series of papers you could refer us too?

Dirk Haussecker said...

The last 2 sentences...sorry for my convoluted English. I really only meant to say that with cancer drug candidates such as Atu027 or ALN-VSP02 that have just been entered into clinical development involving relatively few, but diverse and advanced cancer patients, one of the challenges is in finding out where they have most utility. Larger, more experienced cancer drug developers that for example share an interest in the particular drug targets (e.g. PKN3 in Atu027)may be better suited to maximize the value of such candidates.

Anonymous said...

Yeah. It will be interesting to see whether any one picks up either the Silence or Alnylam program. With limited Silence market capitalization and Alnylam's ambitious 5x15 program, I don't think either one can push those two agents beyond P1. Any rumors brewing?

Anonymous said...

The most important issue is delivering, how to transport useful RNAi into target cell,
The problem is vertor related.
However, I find the Takara USA is going to use lentivector to do the drugs, which is also used in Oxford Biomedica,
Dirk,What is your comment on Lentivector? Is there a efficacy problem ? How about the immune system response ?

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