Modulation of tumor eIF4E by antisense inhibition: A phase I/II translational clinical trial of ISIS 183750an antisense oligonucleotide against eIF4Ein combination with irinotecan in solid tumors and irinotecan-refractory colorectal cancer

The eukaryotic translation initiation factor 4E (eIF4E) is a potent oncogene that is found to be dysregulated in 30% of human cancer, including colorectal carcinogenesis (CRC). ISIS 183750 is a second-generation antisense oligonucleotide (ASO) designed to inhibit the production of the eIF4E protein. In preclinical studies we found that EIF4e ASOs reduced expression of EIF4e mRNA and inhibited proliferation of colorectal carcinoma cells. An additive antiproliferative effect was observed in combination with irinotecan. We then performed a clinical trial evaluating this combination in patients with refractory cancer. No dose-limiting toxicities were seen but based on pharmacokinetic data and tolerability the dose of irinotecan was reduced to 160 mg/m(2) biweekly. Efficacy was evaluated in 15 patients with irinotecan-refractory colorectal cancer. The median time of disease control was 22.1 weeks. After ISIS 183750 treatment, peripheral blood levels of eIF4E mRNA were decreased in 13 of 19 patients. Matched pre- and posttreatment tumor biopsies showed decreased eIF4E mRNA levels in five of nine patients. In tumor tissue, the intracellular and stromal presence of ISIS 183750 was detected by IHC in all biopsied patients. Although there were no objective responses stable disease was seen in seven of 15 (47%) patients who were progressing before study entry, six of whom were stable at the time of the week 16 CT scan. We were also able to confirm through mandatory pre- and posttherapy tumor biopsies penetration of the ASO into the site of metastasis. What's new? Antisense technologies offer a number of potential advantages over more traditional therapeutic approaches, including improved specificity. Here the authors treated individuals afflicted with chemo-refractory colorectal cancer with an antisense oligonucleotide (ASO) against eIF4E, a critical translational factor often dysregulated in malignant tumors. Treatment was performed in combination with the chemotherapeutic irinotecan and halted disease progression in less than half of the treated individuals. The authors speculate based on detection of the ASO in tumor biopsies that stromal binding may reduce intracellular penetrance and lower effectiveness of the treatment.