A Phase Ib Clinical Trial of Metformin and Chloroquine in Patients with <i>IDH1</i>-Mutated Solid Tumors

• Main Authors: Mohammed Khurshed, Remco J. Molenaar, Myra E. van Linde, Ron A. Mathôt, Eduard A. Struys, Tom van Wezel, Cornelis J. F. van Noorden, Heinz-Josef Klümpen, Judith V. M. G. Bovée, Johanna W. Wilmink
• Format: Article
• Language: English
• Published: MDPI AG 2021-05-01
• Series: Cancers
• Subjects: metformin; chloroquine; cancer; isocitrate dehydrogenase; pharmacokinetics; glioblastoma
• Online Access: https://www.mdpi.com/2072-6694/13/10/2474

Background: Mutations in isocitrate dehydrogenase 1 (<i>IDH1</i>) occur in 60% of chondrosarcoma, 80% of WHO grade II-IV glioma and 20% of intrahepatic cholangiocarcinoma. These solid <i>IDH1</i>-mutated tumors produce the oncometabolite <i>D</i>-2-hydroxyglutarate (<i>D</i>-2HG) and are more vulnerable to disruption of their metabolism. Methods: Patients with <i>IDH1</i>-mutated chondrosarcoma, glioma and intrahepatic cholangiocarcinoma received oral combinational treatment with the antidiabetic drug metformin and the antimalarial drug chloroquine. The primary objective was to determine the occurrence of dose-limiting toxicities (DLTs) and the maximum tolerated dose (MTD). Radiological and biochemical tumor responses to metformin and chloroquine were investigated using CT/MRI scans and magnetic resonance spectroscopy (MRS) measurements of <i>D</i>-2HG levels in serum. Results: Seventeen patients received study treatment for a median duration of 43 days (range: 7–74 days). Of twelve evaluable patients, 10 patients discontinued study medication because of progressive disease and two patients due to toxicity. None of the patients experienced a DLT. The MTD was determined to be 1500 mg of metformin two times a day and 200 mg of chloroquine once a day. A serum <i>D/L</i>-2HG ratio of ≥4.5 predicted the presence of an <i>IDH1</i> mutation with a sensitivity of 90% and a specificity of 100%. By utilization of digital droplet PCR on plasma samples, we were able to detect tumor-specific <i>IDH1</i> hotspot mutations in circulating tumor DNA (ctDNA) in investigated patients. Conclusion: Treatment of advanced <i>IDH1</i>-mutated solid tumors with metformin and chloroquine was well tolerated but did not induce a clinical response in this phase Ib clinical trial.