Methods and monitoring of treatment with a DLL4 antagonist
Methods for treating diseases such as cancer comprising administering a DLL4 antagonist, either alone or in combination with other anti-cancer agents, and monitoring for cardiovascular side effects and/or toxicity.
1. A method of monitoring and reducing the development of cardiotoxicity related to treatment with a delta-like protein 4 (DLL4) antagonist and unrelated to hypertension, comprising:
(a) determining the level of a natriuretic peptide in a sample from a human subject who has cancer and has been receiving treatment with the DLL4 antagonist;
(b) comparing the level of the natriuretic peptide in the sample to a predetermined level of the natriuretic peptide; and
(c) administering to the subject a therapeutically effective amount of a cardioprotective medication if the level of the natriuretic peptide is above the predetermined level of the natriuretic peptide;
and wherein the DLL4 antagonist is an antibody that specifically binds human DLL4.
2. The method of claim 1 , wherein the natriuretic peptide is B-type natriuretic peptide (BNP).
3. The method of claim 1 , wherein the sample is blood, serum, or plasma.
4. The method of claim 1 , wherein a sample is obtained approximately every 2 weeks.
5. The method of claim 1 , wherein the predetermined level of the natriuretic peptide is:
(a) the amount of the natriuretic peptide in a sample obtained at an earlier date;
(b) the amount of the natriuretic peptide in a sample obtained prior to treatment; or
(c) a normal reference level.
6. The method of claim 5 , wherein the normal reference level for the natriuretic peptide is about 100 pg/ml or less in blood, serum, or plasma.
7. The method of claim 1 , wherein the predetermined level of the natriuretic peptide is about 100 pg/ml or less, about 150 pg/ml or less, about 200 pg/ml or less, or about 300 pg/ml or less.
8. The method of claim 1 , wherein the predetermined level of the natriuretic peptide is about 100 pg/ml or less.
9. The method of claim 1 , wherein the cardioprotective medication is an ACE inhibitor and/or a β-blocker.
10. The method of claim 1 , wherein the cardioprotective medication is carvedilol.
11. The method of claim 6 , wherein the natriuretic peptide is BNP.
12. The method of claim 1 , wherein the cancer is selected from the group consisting of: lung cancer, breast cancer, colon cancer, colorectal cancer, melanoma, pancreatic cancer, gastrointestinal cancer, renal cancer, ovarian cancer, liver cancer, endometrial cancer, kidney cancer, prostate cancer, thyroid cancer, neuroblastoma, glioma, glioblastoma multiforme, cervical cancer, stomach cancer, bladder cancer, hepatoma, and head and neck cancer.
13. The method of claim 1 , wherein the subject has been receiving treatment with the DLL4 antagonist in combination with one or more additional therapeutic agents.
14. The method of claim 13 , wherein the additional therapeutic agent is a chemotherapeutic agent.
15. The method of claim 13 , wherein the additional therapeutic agent(s) is:
(a) carboplatin and pemetrexed;
(b) gemcitabine;
(c) gemcitabine and albumin-bound paclitaxel; or
(d) paclitaxel.
16. The method of claim 1 , wherein the cardiotoxicity is left ventricular dysfunction or congestive heart failure.
17. The method of claim 1 , further comprising withholding treatment with the DLL4 antagonist if the level of the natriuretic peptide is above the predetermined level of the natriuretic peptide.
18. The method of claim 17 , wherein if the level of the natriuretic peptide decreases after administration of the cardioprotective medication, then treatment with the DLL4 antagonist is resumed.
19. The method of 1 , wherein the steps (a)-(c) are performed at least every four weeks during treatment with the DLL4 antagonist.
20. A method of monitoring and reducing the development of cardiotoxicity caused by treatment with a delta-like protein 4 (DLL4) antagonist and not caused by hypertension, comprising:
(a) determining the level of a natriuretic peptide in a sample from a human subject who has cancer and has been receiving treatment with the DLL4 antagonist;
(b) comparing the level of the natriuretic peptide in the sample to a predetermined level of the natriuretic peptide; and
(c) administering to the subject a therapeutically effective amount of a cardioprotective medication if the level of the natriuretic peptide is above the predetermined level of the natriuretic peptide;
wherein the DLL4 antagonist is an antibody that specifically binds human DLL4.
21. The method of 20 , wherein the steps (a)-(c) are performed at least every four weeks during treatment with the DLL4 antagonist.