Pilot clinical trial of hedgehog pathway inhibitor GDC-0449 (vismodegib) in combination with gemcitabine in patients with metastatic pancreatic adenocarcinoma

Edward Kim, Vaibhav Sahai, Ethan V. Abel, Kent A. Griffith, Joel K. Greenson, Naoko Takebe, Gazala N. Khan, John L. Blau, Ronald Craig, Ulysses G. Balis, Mark M. Zalupski, Diane M. Simeone

Research output: Contribution to journalArticle

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Abstract

Purpose: The hedgehog (HH) signaling pathway is a key regulator in tumorigenesis of pancreatic adenocarcinoma and is upregulated in pancreatic adenocarcinoma cancer stem cells (CSCs). GDC-0449 is an oral small-molecule inhibitor of the HH pathway. This study assessed the effect of GDC-0449-mediated HH inhibition in paired biopsies, followed by combined treatment with gemcitabine, in patients with metastatic pancreatic adenocarcinoma. Experimental Design: Twenty-five patients were enrolled of which 23 underwent core biopsies at baseline and following 3 weeks of GDC-0449. On day 29, 23 patients started weekly gemcitabine while continuing GDC-0449. We evaluated GLI1 and PTCH1 inhibition, change in CSCs, Ki-67, fibrosis, and assessed tumor response, survival and toxicity. Results: On pretreatment biopsy, 75% of patients had elevated sonic hedgehog (SHH) expression. On posttreatment biopsy, GLI1 and PTCH1 decreased in 95.6% and 82.6% of 23 patients, fibrosis decreased in 45.4% of 22, and Ki-67 in 52.9% of 17 evaluable patients. No significant changes were detected in CSCs preand postbiopsy. The median progression-free and overall survival for all treated patients were 2.8 and 5.3 months. The response and disease control rate was 21.7% and 65.2%. No significant correlation was noted between CSCs, fibrosis, SHH, Ki-67, GLI1, PTCH1 (baseline values or relative change on posttreatment biopsy), and survival. Grade ≥3 adverse events were noted in 56% of patients. Conclusion: We show that GDC-0449 for 3 weeks leads to downmodulation of GLI1 and PTCH1, without significant changes in CSCs compared with baseline. GDC-0449 and gemcitabine were not superior to gemcitabine alone in the treatment of metastatic pancreatic cancer.

Original languageEnglish (US)
Pages (from-to)5937-5945
Number of pages9
JournalClinical Cancer Research
Volume20
Issue number23
DOIs
StatePublished - Dec 1 2014

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gemcitabine
HhAntag691
Adenocarcinoma
Neoplastic Stem Cells
Clinical Trials
Biopsy
Fibrosis
Pancreatic Neoplasms
Survival
Disease-Free Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Pilot clinical trial of hedgehog pathway inhibitor GDC-0449 (vismodegib) in combination with gemcitabine in patients with metastatic pancreatic adenocarcinoma. / Kim, Edward; Sahai, Vaibhav; Abel, Ethan V.; Griffith, Kent A.; Greenson, Joel K.; Takebe, Naoko; Khan, Gazala N.; Blau, John L.; Craig, Ronald; Balis, Ulysses G.; Zalupski, Mark M.; Simeone, Diane M.

In: Clinical Cancer Research, Vol. 20, No. 23, 01.12.2014, p. 5937-5945.

Research output: Contribution to journalArticle

Kim, E, Sahai, V, Abel, EV, Griffith, KA, Greenson, JK, Takebe, N, Khan, GN, Blau, JL, Craig, R, Balis, UG, Zalupski, MM & Simeone, DM 2014, 'Pilot clinical trial of hedgehog pathway inhibitor GDC-0449 (vismodegib) in combination with gemcitabine in patients with metastatic pancreatic adenocarcinoma', Clinical Cancer Research, vol. 20, no. 23, pp. 5937-5945. https://doi.org/10.1158/1078-0432.CCR-14-1269
Kim, Edward ; Sahai, Vaibhav ; Abel, Ethan V. ; Griffith, Kent A. ; Greenson, Joel K. ; Takebe, Naoko ; Khan, Gazala N. ; Blau, John L. ; Craig, Ronald ; Balis, Ulysses G. ; Zalupski, Mark M. ; Simeone, Diane M. / Pilot clinical trial of hedgehog pathway inhibitor GDC-0449 (vismodegib) in combination with gemcitabine in patients with metastatic pancreatic adenocarcinoma. In: Clinical Cancer Research. 2014 ; Vol. 20, No. 23. pp. 5937-5945.
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abstract = "Purpose: The hedgehog (HH) signaling pathway is a key regulator in tumorigenesis of pancreatic adenocarcinoma and is upregulated in pancreatic adenocarcinoma cancer stem cells (CSCs). GDC-0449 is an oral small-molecule inhibitor of the HH pathway. This study assessed the effect of GDC-0449-mediated HH inhibition in paired biopsies, followed by combined treatment with gemcitabine, in patients with metastatic pancreatic adenocarcinoma. Experimental Design: Twenty-five patients were enrolled of which 23 underwent core biopsies at baseline and following 3 weeks of GDC-0449. On day 29, 23 patients started weekly gemcitabine while continuing GDC-0449. We evaluated GLI1 and PTCH1 inhibition, change in CSCs, Ki-67, fibrosis, and assessed tumor response, survival and toxicity. Results: On pretreatment biopsy, 75{\%} of patients had elevated sonic hedgehog (SHH) expression. On posttreatment biopsy, GLI1 and PTCH1 decreased in 95.6{\%} and 82.6{\%} of 23 patients, fibrosis decreased in 45.4{\%} of 22, and Ki-67 in 52.9{\%} of 17 evaluable patients. No significant changes were detected in CSCs preand postbiopsy. The median progression-free and overall survival for all treated patients were 2.8 and 5.3 months. The response and disease control rate was 21.7{\%} and 65.2{\%}. No significant correlation was noted between CSCs, fibrosis, SHH, Ki-67, GLI1, PTCH1 (baseline values or relative change on posttreatment biopsy), and survival. Grade ≥3 adverse events were noted in 56{\%} of patients. Conclusion: We show that GDC-0449 for 3 weeks leads to downmodulation of GLI1 and PTCH1, without significant changes in CSCs compared with baseline. GDC-0449 and gemcitabine were not superior to gemcitabine alone in the treatment of metastatic pancreatic cancer.",
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AU - Sahai, Vaibhav

AU - Abel, Ethan V.

AU - Griffith, Kent A.

AU - Greenson, Joel K.

AU - Takebe, Naoko

AU - Khan, Gazala N.

AU - Blau, John L.

AU - Craig, Ronald

AU - Balis, Ulysses G.

AU - Zalupski, Mark M.

AU - Simeone, Diane M.

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