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Open Access 22-09-2023 | Solid Tumor | Original Article

A phase I study of the ceramide nanoliposome in patients with advanced solid tumors

Authors: Aaron Ciner, Theodore Gourdin, Jeff Davidson, Mylisa Parette, Susan J. Walker, Todd E. Fox, Yixing Jiang

Published in: Cancer Chemotherapy and Pharmacology

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Abstract

Purpose

Ceramide is a sphingolipid metabolite that deactivates multiple oncogenic signaling pathways and promotes cell death. In-vivo data demonstrate single-agent anti-cancer activity and enhanced efficacy with combination strategies. This phase I dose-escalation trial evaluated Ceramide nanoLiposomes (CNL) in patients with advanced solid tumors and no standard treatment option.

Methods

The primary objective was to establish the maximum tolerated dose. Secondary objectives included determining the recommended phase II dose, the safety and tolerability, the pharmacokinetic profile and preliminary anti-tumor efficacy.

Results

15 patients with heavily pretreated metastatic disease enrolled. Safety data were analyzed for all patients, while pharmacokinetic data were available for 14 patients. There were no grade 3 or higher treatment-related adverse events. The maximum tolerated dose was not reached and there were no dose-limiting toxicities. The most common grade 1 or 2 treatment-related adverse events included headache, fatigue, constipation, nausea and transaminitis. The maximum concentration and area under the curve increased with dose. Clearance was consistent between doses and was observed mainly through the liver without significant hepatotoxicity. The half-life ranged from 20 to 30 h and the volume of distribution was consistent with a lipophilic drug.

Conclusions

CNL exhibited an encouraging safety profile and pharmacokinetic parameters, with some signals of efficacy including prolonged stable disease in 1 patient with refractory pancreatic cancer. Pre-clinical data indicate potential synergy between CNL and multiple systemic therapies including chemotherapy, targeted therapy, and immunotherapy. Future studies are planned investigating CNL in combination strategies.

Trial registration

This study is registered under ClinicalTrials.gov ID: NCT02834611.
Literature
1.
go back to reference Hannun YA, Obeid LM (2018) Sphingolipids and their metabolism in physiology and disease. Nat Rev Mol Cell Biol 19(3):175–191 CrossRefPubMed Hannun YA, Obeid LM (2018) Sphingolipids and their metabolism in physiology and disease. Nat Rev Mol Cell Biol 19(3):175–191 CrossRefPubMed
2.
go back to reference Ogretmen B (2018) Sphingolipid metabolism in cancer signalling and therapy. Nat Rev Cancer 18(1):33–50 CrossRefPubMed Ogretmen B (2018) Sphingolipid metabolism in cancer signalling and therapy. Nat Rev Cancer 18(1):33–50 CrossRefPubMed
4.
go back to reference Bourbon NA, Sandirasegarane L, Kester M (2002) Ceramide-induced inhibition of Akt is mediated through protein kinase Czeta: implications for growth arrest. J Biol Chem 277(5):3286–3292 CrossRefPubMed Bourbon NA, Sandirasegarane L, Kester M (2002) Ceramide-induced inhibition of Akt is mediated through protein kinase Czeta: implications for growth arrest. J Biol Chem 277(5):3286–3292 CrossRefPubMed
5.
go back to reference Li G et al (2018) Nanoliposome C6-ceramide increases the anti-tumor immune response and slows growth of liver tumors in mice. Gastroenterology 154(4):1024-1036 e9 CrossRefPubMed Li G et al (2018) Nanoliposome C6-ceramide increases the anti-tumor immune response and slows growth of liver tumors in mice. Gastroenterology 154(4):1024-1036 e9 CrossRefPubMed
6.
go back to reference Doshi UA et al (2017) STAT3 mediates C6-ceramide-induced cell death in chronic lymphocytic leukemia. Sig Transduct Target Ther 2:17051 CrossRef Doshi UA et al (2017) STAT3 mediates C6-ceramide-induced cell death in chronic lymphocytic leukemia. Sig Transduct Target Ther 2:17051 CrossRef
7.
go back to reference Fox TE et al (2007) Ceramide recruits and activates protein kinase C zeta (PKC zeta) within structured membrane microdomains. J Biol Chem 282(17):12450–12457 CrossRefPubMed Fox TE et al (2007) Ceramide recruits and activates protein kinase C zeta (PKC zeta) within structured membrane microdomains. J Biol Chem 282(17):12450–12457 CrossRefPubMed
9.
go back to reference Morad SA, Cabot MC (2013) Ceramide-orchestrated signalling in cancer cells. Nat Rev Cancer 13(1):51–65 CrossRefPubMed Morad SA, Cabot MC (2013) Ceramide-orchestrated signalling in cancer cells. Nat Rev Cancer 13(1):51–65 CrossRefPubMed
10.
go back to reference Barth BM et al (2019) Sphingolipid metabolism determines the therapeutic efficacy of nanoliposomal ceramide in acute myeloid leukemia. Blood Adv 3(17):2598–2603 CrossRefPubMedPubMedCentral Barth BM et al (2019) Sphingolipid metabolism determines the therapeutic efficacy of nanoliposomal ceramide in acute myeloid leukemia. Blood Adv 3(17):2598–2603 CrossRefPubMedPubMedCentral
12.
go back to reference Barth BM, Cabot MC, Kester M (2011) Ceramide-based therapeutics for the treatment of cancer. Anticancer Agents Med Chem 11(9):911–919 CrossRefPubMed Barth BM, Cabot MC, Kester M (2011) Ceramide-based therapeutics for the treatment of cancer. Anticancer Agents Med Chem 11(9):911–919 CrossRefPubMed
13.
go back to reference Kester M et al (2015) Preclinical development of a C6-ceramide NanoLiposome, a novel sphingolipid therapeutic. Biol Chem 396(6–7):737–747 CrossRefPubMed Kester M et al (2015) Preclinical development of a C6-ceramide NanoLiposome, a novel sphingolipid therapeutic. Biol Chem 396(6–7):737–747 CrossRefPubMed
14.
go back to reference Jiang Y et al (2011) Combinatorial therapies improve the therapeutic efficacy of nanoliposomal ceramide for pancreatic cancer. Cancer Biol Ther 12(7):574–585 CrossRefPubMedPubMedCentral Jiang Y et al (2011) Combinatorial therapies improve the therapeutic efficacy of nanoliposomal ceramide for pancreatic cancer. Cancer Biol Ther 12(7):574–585 CrossRefPubMedPubMedCentral
15.
go back to reference Stover TC et al (2005) Systemic delivery of liposomal short-chain ceramide limits solid tumor growth in murine models of breast adenocarcinoma. Clin Cancer Res 11(9):3465–3474 CrossRefPubMed Stover TC et al (2005) Systemic delivery of liposomal short-chain ceramide limits solid tumor growth in murine models of breast adenocarcinoma. Clin Cancer Res 11(9):3465–3474 CrossRefPubMed
17.
go back to reference Liu X et al (2010) Targeting of survivin by nanoliposomal ceramide induces complete remission in a rat model of NK-LGL leukemia. Blood 116(20):4192–4201 CrossRefPubMedPubMedCentral Liu X et al (2010) Targeting of survivin by nanoliposomal ceramide induces complete remission in a rat model of NK-LGL leukemia. Blood 116(20):4192–4201 CrossRefPubMedPubMedCentral
18.
go back to reference Khokhlatchev AV et al (2022) Ceramide nanoliposomes augment the efficacy of venetoclax and cytarabine in models of acute myeloid leukemia. FASEB J 36(10):e22514 CrossRefPubMed Khokhlatchev AV et al (2022) Ceramide nanoliposomes augment the efficacy of venetoclax and cytarabine in models of acute myeloid leukemia. FASEB J 36(10):e22514 CrossRefPubMed
19.
go back to reference Zolnik BS et al (2008) Rapid distribution of liposomal short-chain ceramide in vitro and in vivo. Drug Metab Dispos 36(8):1709–1715 CrossRefPubMed Zolnik BS et al (2008) Rapid distribution of liposomal short-chain ceramide in vitro and in vivo. Drug Metab Dispos 36(8):1709–1715 CrossRefPubMed
21.
go back to reference Adiseshaiah PP et al (2013) Synergistic combination therapy with nanoliposomal C6-ceramide and vinblastine is associated with autophagy dysfunction in hepatocarcinoma and colorectal cancer models. Cancer Lett 337(2):254–265 CrossRefPubMedPubMedCentral Adiseshaiah PP et al (2013) Synergistic combination therapy with nanoliposomal C6-ceramide and vinblastine is associated with autophagy dysfunction in hepatocarcinoma and colorectal cancer models. Cancer Lett 337(2):254–265 CrossRefPubMedPubMedCentral
22.
go back to reference Tran MA et al (2008) Combining nanoliposomal ceramide with sorafenib synergistically inhibits melanoma and breast cancer cell survival to decrease tumor development. Clin Cancer Res 14(11):3571–3581 CrossRefPubMed Tran MA et al (2008) Combining nanoliposomal ceramide with sorafenib synergistically inhibits melanoma and breast cancer cell survival to decrease tumor development. Clin Cancer Res 14(11):3571–3581 CrossRefPubMed
23.
go back to reference Pearson JM et al (2020) Ceramide analogue SACLAC modulates sphingolipid levels and MCL-1 splicing to induce apoptosis in acute myeloid leukemia. Mol Cancer Res 18(3):352–363 CrossRefPubMed Pearson JM et al (2020) Ceramide analogue SACLAC modulates sphingolipid levels and MCL-1 splicing to induce apoptosis in acute myeloid leukemia. Mol Cancer Res 18(3):352–363 CrossRefPubMed
24.
go back to reference Qi X et al (2022) Nanoliposome C6-Ceramide in combination with anti-CTLA4 antibody improves anti-tumor immunity in hepatocellular cancer. FASEB J 36(4):e22250 CrossRefPubMed Qi X et al (2022) Nanoliposome C6-Ceramide in combination with anti-CTLA4 antibody improves anti-tumor immunity in hepatocellular cancer. FASEB J 36(4):e22250 CrossRefPubMed
Metadata
Title
A phase I study of the ceramide nanoliposome in patients with advanced solid tumors
Authors
Aaron Ciner
Theodore Gourdin
Jeff Davidson
Mylisa Parette
Susan J. Walker
Todd E. Fox
Yixing Jiang
Publication date
22-09-2023
Publisher
Springer Berlin Heidelberg
Keyword
Solid Tumor
Published in
Cancer Chemotherapy and Pharmacology
Print ISSN: 0344-5704
Electronic ISSN: 1432-0843
DOI
https://doi.org/10.1007/s00280-023-04588-7

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