Background
The triterpenoid 2-Cyano-3, 12-Dioxoolean-1, 9-Dien-28-Oic Acid (CDDO, previously RTA-401) is a multifunctional molecule that controls cellular growth and differentiation. It is capable of activating the transcription factor peroxisome proliferator activator receptor-γ (PPARγ) and inducing apoptosis in malignant cells in vitro and in vivo. We conducted a phase I dose-escalation study to determine the toxicity, the maximum tolerated dose, and the pharmacokinetics and pharmacodynamics of CDDO, administered as a 5-day continuous infusion every 28 days in patients with advanced cancers.
Methods
An accelerated titration design was followed, with one patient per cohort entered, and doses ranging from 0.6 mg/m2/hr to 38.4 mg/m2/hr. Pharmacokinetics of CDDO was assessed and cleaved poly (ADP-ribose) polymerase (c-PARP), as a marker of apoptosis, was measured in peripheral blood mononuclear cells to assess drug effect.
Results
Seven patients, one patient per dose level up to dose level 7 (38.4 mg/m2/hr), were enrolled and received a total of 11 courses of treatment. Cmax increased proportionally with dose. Preclinically determined efficacious blood level (1 μM) of drug was attained at the highest dose level. One patient, at dose level 6, experienced grade 2 mucositis, nausea, vomiting, and anorexia. Four patients, on different dose levels, developed thromboembolic events subsequently considered as dose-limiting toxicity. No anti-tumor activity was noted.
Conclusion
A causal relationship of observed thromboembolic events to CDDO was considered possible but could not be established. Because of the adverse events and the development of an orally bioavailable derivative compound, CDDO methyl ester, this trial was terminated.