RAGE inhibition to decrease cancer therapy related cardiotoxicity in women with early breast cancer (RAGE).
Authors: Candace Bavette Mainor, Claudine Isaacs, Deena Mary Atieh Graham, Jaeil Ahn, Ami Chitalia, Barry I. Hudson, Stephen Garrett Marcus, Nanette H. Bishopric, Marc E. Lippman
Journal: Journal of Clinical Oncology (2024)

TPS619 Background: Anthracyclines are commonly used to treat high risk early-stage breast cancer (BC). Anthracycline-induced myocardial toxicity is a rare but morbid complication in BC survivors. The mechanism is not completely elucidated but may involve the generation of reactive oxygen species and other inflammatory mediators. RAGE, the receptor for advanced glycation end-products, signaling is upregulated in inflammatory conditions and has been linked to the development and progression of cardiovascular disease and cancer. In experimental models, blocking RAGE protects against cardiac damage and reduces the development of metastases. TTP488 is an orally bioavailable small molecule inhibitor of RAGE. This project is designed to characterize the role of TTP488 to decrease therapy related cardiac toxicity, and it will provide preliminary data about the safety, tolerability, and pharmacokinetics (PK) of common BC (neo)adjuvant chemotherapy agents in the presence of TTP488. Methods: Eligible patients have stage I-III breast cancer and are planned to receive chemotherapy. Enrolled patients will be assigned to 1 of 4 cohorts based on the chemotherapy regimen assigned for the last 2 doses of planned therapy. In Cohort 1, 6 patients will receive dose dense paclitaxel (ddT). In Cohort 2, 6 patients will receive docetaxel and cyclophosphamide (TC). In Cohort 3, 6 patients will receive docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP). In Cohort 4, 6 patients will receive dose dense doxorubicin and cyclophosphamide (ddAC). All chemotherapy is dosed per standard institutional operational practice. For each patient, the first dose of chemotherapy is given in the absence of study drug to serve as the control for the safety and PK assessments. On day -7, prior to the 2 nd dose of chemotherapy, TTP 488, 60mg daily for 6 days followed by 20mg daily, is administered and then subjects receive the 2 nd dose of chemotherapy. With each cycle, hs-troponin and B-type natriuretic peptide (BNP) are collected prior to chemotherapy administration, and at 4hrs(hs-troponin only) and 24hrs after chemotherapy administration. With each cycle, PK sampling occurs prior to and immediately after chemotherapy (0hr), 1hr, 4hr, and 24hrs after chemotherapy. Primary objectives are to evaluate the change in high sensitivity troponin level before and during treatment with TTP488 and to evaluate the safety and tolerability of TTP488 when administered with chemotherapy. The secondary objective is to characterize the PK and bioavailability of chemotherapy agents with TTP488. Descriptive statistics for the change in troponin level and safety will be summarized. As of 2/1/24, 4 patients have been enrolled, with 4 undergoing screening. At the completion of this trial, we plan a randomized trial to evaluate the role of TTP488 to decrease cardiotoxicity, cancer related cognitive decline and disease recurrence. Clinical trial information: NCT05256745 .