1. SYMPOSIUM ON ADVANCED ONCOLOGICAL THERAPIES
Areces Foundation, Madrid, Oct 2014
Efficacy and Safety of Cancer
Nanomedicines: The Clinical Perspective
Alberto A. Gabizon, MD, PhD
Professor and Chairman,
Shaare Zedek Oncology Institute
Hebrew University-School of Medicine
Jerusalem, ISRAEL

2. Disclosures
• Receives Grant Support from Janssen
Pharmaceuticals (DOXIL®)
• Founder and Director of Lipomedix
Pharmaceuticals (PROMITIL®)
• SAB Member of Cristal Therapeutics (CriPEC®)

3. Nanomedicine in Cancer Therapy:
Engineering nano-scale systems for drug delivery
Nanoparticle

4. Liposomal Anti-Cancer Agents Clinically Tested
Pegylated Non-Pegylated Regional therapy Non-cytotoxic
DOXIL/Caelyx,
Lipodox (PLD)
Myocet (NPLD) DepoCyt
(intrathecal)
L-MTP-PE
Nanoliposomal
Irinotecan
DaunoXome L-NDDP (intrapleural) Liposomal ATRA
Liposomal
Eribulin
Liposomal
Annamycin
Liposomal
Camptothecin
(aerosol)
BLP25 Liposomal
Vaccine
SPI-077 Marqibo (Lip.
Vincristine)
Liposomal IL2
(aerosol)
Liposomal antisense
Oligonucleotides
Lipoplatin Lurtotecan (OSI-211)
TS inhib. (OSI-7904L)
Liposomal E1A
(intra-tumoral)
S-CKD602 LE-Paclitaxel
Targeted liposomes
αHer2-Doxil
MCC-465
Combo’s:
5FU-Irinorecan
Ara C-Dauno

5. -TUMORS-
“Conventional”
Liposomes
“Leaky”
Liposomes
“Stealth”
Liposomes

6. 1. Liposomes can display in vivo vastly different PK-BD
profiles
2. There is a correlation between liposome circulation
time and deposition in tumors
Changes in lipid composition result in:
- 60-fold increase in the fraction of recovered dose in blood.
- 4-fold decrease of the recovered dose in liver and spleen,
- 25-fold increase of the liposome concentration in tumor.
Proc. Natl. Acad. Sci. USA, 1988
Liposome formulations with prolonged circulation time in blood
and enhanced uptake by tumors
A. GABIZON AND D. PAPAHADJOPOULOS

7.  Pegylated Liposomal Doxorubicin (DOXIL) – The case
for long-circulating systems
 Ligand Targeting of Liposomal Drugs: The relevance
for specific drugs
 Co-encapsulation of Drugs in Liposomes –
Bisphosphonates and chemotherapeutic agents
 Pegylated Liposomal Mitomycin Prodrug (PROMITIL):
A double safety valve

8. Pegylated Liposomal Doxorubicin (DOXIL, Caelyx)
1. PEG Coating (Stealth Effect):  long circulation time
2. Ammonium sulfate drug loading gradient:  stability in circulation
PEG
Doxorubicin
Lipid Bilayer
Phospholipid+Cholesterol
80-90 nm
Cryo-TEM
“coffee bean”
DOXIL vial for
clinical use

9. Plasma Levels in Humans: DOXIL vs. doxorubicin
- Impressive change in PK profile
1000-fold increase in AUC
Hours After Infusion
Doxorubicin (μg/mL)
0 4 8 12 16 20 24
25 .0
10.0
2.5
1 .0
0 .2
0 .1
DOXIL 50mg/m2
Doxorubicin 50mg/m2
Gabizon et al., Cancer Res. 1994

10. DOXIL: doxorubicin remains in liposome-encapsulated
form in circulation
Doxorubicin (μg/mL)
10.0 Total Doxorubicin
Total Doxorubicin
0 1 2 3 4 5 6 7
25.0
2.5
1.0
0.2
0.1
Encapsulated Doxorubicin
Days After Infusion
Gabizon et al., Cancer Res. 1994

11. Gamma Scintigraphy after Injection of
Lung
Tumor
[DTPA-In111] Stealth Liposomes
Liver,
Spleen
Spleen
Bone
Marrow
Posterior view 48h
Kaposi Sarcom
Harrington et al., Clin. Cancer Res. 2001

12. Normal liver
Normal liver
Tumor
Tumor
Conventional liposomes do not target liver tumors
(Gabizon et al. BJC 1991)

13. Blood Vessels: The Achyless Heel of Cancer
Extravasation of liposomes across tumor vessel:
Skin-fold window in vivo model (R. Jain et al.)

14. Control Free Dox PLD (Doxil)
EPR
Effect
M109
Tumor
86 μg/g
Free Dox, 2hr
PLD, 48hr
Dose: i.v. 20mg/kg
Skin
0.5 μg/g
Halo
40 μg/g
Tumor Vessels
Mitchinton and Tannock, 2007

15. DOXIL - Mechanism Of Action: EPR Effect
Extravasation and Release of Liposomal Drug
Cargo in Tumor Interstitial Fluid
Tumor compartment:
Interstitial fluid
Tumor Cells
Vascular
space
5
No Functional Lymphatics

16. In Vivo Delivery of Nanomedicines:
EPR and more

17. DOXIL vs. Doxorubicin in Tumors
μg Drug/gm Tumor
50 100 150 200
Hours
DOXIL
Doxorubicin
8
6
4
2
0
30- fold increase in AUC
0 5 10 15 20
160
140
120
100
80
60
40
20
0
DOXIL
Free DXR
Dose mg/kg
g doxorubicin-equiv. / g
Human Xenograft
Mouse M109 Tumor
Dose dependency
 EPR also seen in human tumor
s.c. xenografts (Vaage et al.)
 Increasing dose
favors DOXIL for
tumor delivery

18. COMPARING DIFFERENT NANOMEDICINES:
Accumulation in tumors correlates with circulation half-life
B16F10 s.c. tumour levels
Time (h)
Tumour accumulation (% dose/g tumour)
DOXIL®
0 20 40 60 80
15
10
5
0
HPMA-Dox
PAMAM (gen 3,5)
Dendrimer-DOX
DOX
Time (h)
Levels in blood (% dose)
DOXIL®
HPMA-Dox
PAMAM (gen 3,5)
Dendrimer-DOX
DOX
0 20 40 60 80 100
100
10
1
0.1
0.01
Blood clearance
(all 5 mg/kg)
Sat and Duncan 1999

19. Anti-Tumor Effect of DOXIL is >4-fold than
doxorubicin (DXR) in M109 mouse tumor*
Median Tumor Weight (% Cures)
Treatment given on I.V. day 15
at the indicated doses (mg/kg).
Three weeks later, on day 36,
mice sacrificed, tumors dissected
and weighed.
Values inside bars:
% Tumor-Free Mice
800
700
600
500
400
300
200
100
0
Control DXR
2.5
P<0.05
DOXIL
2.5
DXR
10
DOXIL
10
0 17
29
11
27
* Also demonstrated for mouse 3LL and human N87 Gabizon et al, 2002

20. DOXIL Clinical Proofs of Added Value
• Cardiac function: Major reduction of cardiotoxicity as compared to free
doxorubicin in all settings. (2000)
• AIDS-related Kaposi’s Sarcoma: Superior efficacy over former
conventional therapy (1995)
• Recurrent Ovarian Cancer: Superior efficacy and improved safety
profile over comparator drug (topotecan) (1998)
• Metastatic Breast Cancer: Equivalent efficacy and reduced
cardiotoxicity compared to free doxorubicin (2003)
• Multiple Myeloma: Equivalent efficacy and improved safety profile
compared to free doxorubicin combo. Superior efficacy in combination with
bortezomib over single agent bortezomib. (2007)

21. Doxil in Ovarian Ca: Major Improvement
in Survival in “Pt-Sensitive” Patients*
DOXIL (n=109)
Topotecan (n=111)
0 20 40 60 80 100 120 140
Weeks Since First Dose
100
90
80
70
60
50
40
30
20
10
0
P=.008 DOXIL
25.2 mths
Topotecan
15.6 mths
Gordon AN, et al. J Clin Oncol. 2001;19:3312-3322.
* Median survival for all patients:
DOXIL=15mth; Topotecan=13mth
(p=0.025)

22. Reduced rate of cardiac events with DOXIL (vs doxorubicin)
O’Brien M E R et al. Ann Oncol 2004;15:440-449
PLD
50 mg/m2 q4w
Doxorubicin,
60 mg/m2 q3w
Hazard Ratio
(95% CI)
Cardiac
Events
6.6% 25.7% 3.16
(1.58-6.31)
CHF 0 5.3%

23. Long-term response to pegylated liposomal doxorubicin
in patients with metastatic soft tissue sarcomas
Computed tomography scan of the chest (a) shows a mass 6.4x3.9 cm (maximal
size slice) in the left lower lobe of the lung involving chest wall. Patient treated
with pegylated liposomal doxorubicin (PLD) for 30 months. (b) Marked decrease
in the size of the mass to 2.6x1.1 cm (Grenader et al, AntiCancer Drugs, 2009)

24. Palmar-Plantar Erythema
(Hand-Foot Syndrome)

25. DOXIL (PLD) vs Doxorubicin: Change of toxicity profile
Side Effect Effect of liposome delivery
Vesicant effect Absent (irritation only)
Nausea/Vomiting Reduced
Myelosuppression Reduced (no neutropenic fever)
Stomatitis/Mucositis Increased
Hand-Foot (PPE) Increased
Cardiotoxicity Reduced or Absent
Alopecia Reduced or Absent
Maximal Single Dose Slightly decreased
(50-60mg/m2)
Maximal Cumulative
Dose
Greatly increased
(undetermined >900mg/m2)

26. CriPec® Platform
Transiently stable nanomedicines
Rijcken et al, Biomaterials 28 (2007) 5581–5593
29
Crielaard et al, Angew Chem 51 (2012) 7254–7258
ZAve ~ 60 nm
PD < 0.2

27. Chemical structure: thermosensitive
poly(ethylene glycol)-b-poly(N-
(2hydroxypropyl)-methacrylamide-lactate)
(mPEG-b-pHPMAmLacn) block copolymers
(1) Micelle formation and encapsulation of hydrophobic drug derivatives by
rapid heating; (2) Copolymerization of methacrylated lactate side chains and
drug derivatives in the micelle core; (3) Hydrolytic liberation of lactate
moieties, drugs and drug linkers, leading to micellar destabilization and drug
release.

28. CriPec® docetaxel vs Taxotere
Increased efficacy – PK profile
10000 Taxotere 30 mg/kg
1000
100
10
1
0.01
EFF-12-004 0 EF2F4-13-006 48 72 96
31
100
75
0 14 28 42 56
2000
1750
1500
1250
1000
750
500
250
50
25
s.c. MDA-MB-231 breast xenografts in
nude mice (n=10±SD)
0
vehicle
Taxotere 30 mg/kg
CriPec docetaxel 90 mg/kg
single dose
time (days)
tumour volume (mm3)
48 hours 96 hours
0
Taxotere 30 mg/kg
CriPec® docetaxel 30 mg/kg
**
***
total docetaxel
in tumour (ng/mg)
CriPec® docetaxel 90 mg/kg
4 days 7 days
100
75
50
25
0
Taxotere 30 mg/kg
*** ***
total docetaxel
in tumour (ng/mg)
0.1
CriPec docetaxel 90 mg/kg
time post administration (hours)
total docetaxel in blood
(μg/mL)

29. Ligand targeting of liposomal drugs to a receptor-expressing tumor
The rate limiting step of liposome localization in tumors is extravasation !
Goren et al., 1996; Gabizon et al., 2003

30. A1
In Vitro uptake of folate-targeted liposomes (A1-2)
labeled with rhodamine by M109-HiFR tumor cells.
Note extensive internalization after 4 h incubation.
Nontargeted liposomes are not taken up (not shown)

31. Micellar insertion of lipophilic ligands into preformed liposomes
Pharmaceutical approach to design of ligand-targeted liposomes
• Adding lipophilic ligands to
preformed (drug- loaded)
liposomes
Blood
• Stable retention Vessel
of ligand*
• Maintaining liposome
long circulation time
•Demonstrated for Folate and anti-Her2
(Shmeeda et al, JCR, 2009)

32. Targeting of Doxil with anti-Her2 ligand (HT-PLD) enhances
cytotoxic effect on Her2+ tumor cells but not more than Free Dox
Shmeeda et al., JCR 2008
SKBR-3 breast carcinoma

33. Nitrogen-containing Bisphosphonates
alendronate
Clezardin, P. et al. Cancer Res 2005;65:4971-4974

34. Targeting of L-ZOL with Folate Ligand (FTL-ZOL) enhances cytotoxic
effect on FR+ tumor cells much more than Free ZOL
0 2 4 6 8 10
110
100
90
80
70
60
50
40
30
20
10
0
25 50 75 100125150175200
Free ZOL
L-ZOL
FTL-ZOL
Free Dox
Concentration (ZOL, Dox) M
Growth Inhibition (% Control)
IGROV1 ovarian carcinoma
FTL-ZOL is as cytotoxic
as Free Dox, and ~100-
fold more cytotoxic than
Free ZOL and L-ZOL!
Shmeeda et al., J Control Rel 2010

35. Enhanced tumor-sensitizing effect of FR-targeted liposomal NBP (LZ-FR),
on Vγ9-V2 T cell destruction of autologous ovarian cancer spheres .
Study of Drs. John Maher and Ana Parente-Pereira (KCL)

36. Adoptive Gamma-Delta T Cell immunotherapy of epithelial
ovarian cancer potentiated by liposomal alendronic acid
Ana C. Parente-Pereira al. (John Maher’s Lab, J. Immuol, in press))
Survival

37. Rationale for combining bisphosphonates with
doxorubicin in the same liposome
• Double attack on tumor cells and tumor-infiltrating macrophages
• Different MoA’s, Non-overlapping toxicities
• Possible immunological anti-tumor effects
• Co-delivery ensures timely co-exposure to both agents
Bisphosphonate
Doxorubicin

38. PLAD (Pegylated liposomal alendronate of doxorubicin)
I. Passive Encapsulation: Ammonium ALD
Alendronic acid (ALD)
Liposome aqueous
phase
II. Active Loading: DOX
Doxorubicin (DOX) HCl
Liposome aqueous
phase
DOX-NH2
( NH + + (NH4)ALD 4) ALD + H2O
DOX -NH3 –ALD
DOX-NH2 +H +
DOX-NH3
External medium
NH4OH + ALD..H
NH3
NH3+ H+
(Precipitate)
pH 6.0
DOX-NH3Cl DOX-NH3
+ +Cl -
HSPC: cholesterol: PEG2000 DSPE
55:40:5 mole ratio

39. Cryo-TEM before and after Dox loading (PLAD formulation):
Note round vesicles with precipitated salt of doxorubicin
alendronate in the interior water phase
Before Dox After Dox

40. PK of PLAD: Slow clearance from blood (t½ =15-20 h) with similar “Stealth”
profile as DOXIL. PLAD i.v.10mg/kg, Sabra mice - Results based on Dox plasma levels
Similar clearance profile for H3-ALD label
24 hours

41. Superior activity of PLAD over PLD (DOXIL) in M109R tumor model
100
90
80
70
60
50
40
30
20
10
Untreated Table-Tumor Growth
5 10 15 20 25 30 35 40
6.0
5.5
5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
Days
PLAD vs PLD p=0.0001
PLAD vs PLA+PLD p=0.0101
PLD Table -Tumor Growth
Untreated
0 5 10 15 20 25 30 35 40
6.0
5.5
5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
Days
PLAD Table -Tumor Growth
0 5 10 15 20 25 30 35 40
6.0
5.5
5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
Days
Time to treatment failure - M109R
5 10 15 20 25 30 35 40
0
PLD 5mg/kg d.7,14,21
PLAD 5mg/kg d.7,14,21
Days after tumor inoculation
Percent survival with tumor4mm
PLA+PLD 5mg/kg d.7,14,21
Similar results in 4T1 tumor model

42. Liposomal Prodrug Approach- Rationale
• Long-circulating liposomes are required for selective
accumulation in tumors based on the EPR effect
• For effective payload retention, long circulation
imposes stringent stability requirements.
• Attachment of drugs to bilayer-compatible lipids is a
known way of ensuring prolonged association with a
liposome.
• The choice of the linkage is critical for the release rate
of the active drug from the Prodrug.

43. Pegylated Liposome with Lipid Bilater-Associated Prodrug
Lipophilic anchor
Active moiety
Examples:
Lipophilic moiety: Fatty acid conjugates, Squalenoylation, Carbonyl-Cholesterol.
Drugs: MTX, FdUR, Melphalan, Gemcitabine, Ara-C, Pacliraxel, Daunorubicin.

44. Mitomycin-C Lipid-based Prodrug (MLP)
A prodrug designed for liposomal delivery
 Drug moiety
– Latent toxicity in the bound form
 Linkage: benzyl urethane p-substituted by a disulfide
(dithiobenzyl, DTB)
– Stable until thiolytically cleaved by either endogenous of exogenous thiols
 Diacyl glycerol-type lipid anchor
– Provides avid association with liposomal membrane

45. Pegylated Liposomal Formulation of Mitomycin-C Lipophilic
Prodrug (PL-MLP) - PROMITIL®
Lipophilic prodrug in
bilayer
Internal water phase
(drug-free)
Lipid Membrane
(Phospholipid +/-
cholesterol)
Polyethylene Glycol
for RES evasion & tumor
accumulation
N N
CH3O
O
H2N
O
O
O
CH3
NH2
O
O S
O
C17H35
O
C17H35
O
S
O
Vesicle
Size:
80-110nm
CryoTEM
of Promitil
24+ month Shelf Stability at 5oC

46. Activation of Prodrug in PL-MLP by free thiols
(Cytotoxicity of PL-MLP in M109 cells 72 h, 37 °C  DTT)
100-fold increase of cytotoxicity of PL-MLP No change of Free MMC cytotoxicity
Free MMC
PL-MLP
PL-MLP+DTT
Free MMC
Free MMC+DTT

47. Intracellular Delivery of PL-MLP by Folate
Targeting enhances uptake and cytotoxicity
w/o added reducing agent
KB CELLS
Poster 41 – Yogita P. Patil et al.

48. PK analysis of PL-MLP in Sprague-Dawley Rats:
• Long half-life (14.5h) as compared to 0.25h for MMC;
• Cmax levels of PL-MLP are ~200 fold greater than for MMC
• AUC of PL-MLP ~1,000 fold greater than that for MMC
• MMC levels in PL-MLP-injected animals undetectable or minimal
0 10 20 30 40 50 60 70 80 90
100
10
Male Rats, Total MLP
Female Rats, Total MLP
800
4
Free MMC
T1/2=14.5h
T1/2=0.25h
Hours after injection
MLP g/ml plasma (SEM)
~15% of Cmax
at 24h

49. Tissue Distribution of Promitil (24h)
 MLP levels in mice are relatively lower than Liposome (H3-Chol) levels,
suggesting that MLP is quickly metabolized.
 In tumor-bearing mice, the highest levels of MLP were found in tumor,
suggesting relatively slower processing of MLP in tumor tissue.
20
18
16
14
12
10
8
6
4
2
0
spleen tumor kidney liver
μgMLP/gtisssue
Biodistribution in tumor bearing mice
BLLQ
12
10
8
6
4
2
0
Spleen Kidney Heart Lung Liver
%ID/gm of tissue
Biodistribution of MLP in normal mice
MLP
3H-Chol

50. Superior efficacy of Promitil in human tumor models over comparators
A2780/AD Ovarian Ca
2400
2000
1600
1200
800
400
0
- Plain Lip./No Rx
- Free Dox 2.5mg/kg
- MMC 4mg/kg
- Cisplatin 6mg/kg
- DOXIL 10mg/kg
- PL-MLP A/B
15mg/kg
0 10 20 30 40 50
Tumor Volume (mm3)
Time (days)
1100 Control
1000
900
800
700
600
500
400
300
200
150
100
50
0
Campto 75mg/kgx3
PL-MLP 15mg/kgx3
10 20 30 40 50 60 70 80
PL-MLP:
8 PR, 2 CR
p<0.0001
Inj. d.14,21,28
Day of study
MeanTumor Volume  SEM (mm3)
N87 Gastric Ca
0 20 40
100
90
80
70
60
50
40
30
20
10
0
Vehicle
Gemcitabine 120mg/kgq3dx4
PL-MLP 15mg/kgqwx3
Panc-1 CA
50 55 60 65 70 75
Day of Study
Percent remaining mice
p=0.016

51. 1. Combination Therapy results in high rate of complete tumor regressions
6.0
5.0
4.0
3.0
2.0
1.0
Promitil
5 6 8 11 12 13 15 18 20 22 26 29 32 34 36 39 41 43 46 48
1
2
3
4
5
6
7
8
9
6.0
5.0
4.0
3.0
2.0
6.0
5.0
4.0
3.0
2.0
1.0
Placebo
Paclitaxel
5 6 8 11 12 13 15 18 20 22 26 29 32 34 36 39 41 43 46 48
6.0
1
5.0
2
3
4.0
4
5
3.0
6
2.0
7
8 1.0
Promitil with Paclitaxel
5 6 8 11 12 13 15 18 20 22 26 29 32 34 36 39 41 43 46 48
1
2
3
4
5
6
7
8
9
1.0
5 6 8 11 12 13 15 18 20 22 26 29 32 34 36 39 41 43 46 48
1
2
3
4
5
6
7
Model N-87 Human Gastric Ca: Tumor size (mm) vs Days after Tumor Inoculation

52. 2. Combination Therapy results in high rate of complete tumor regressions
6.0
5.0
4.0
3.0
2.0
1.0
Doxil
5 6 8 11 12 13 15 18 20 22 26 29 32 34 36 39 41 43 46 48
1
2
3
4
5
6
7
8
6.0
5.0
4.0
3.0
2.0
6.0
5.0
4.0
3.0
2.0
1.0
Placebo
Promitil
5 6 8 11 12 13 15 18 20 22 26 29 32 34 36 39 41 43 46 48
1
2
3
4
5
6
7
8
9
6.0
5.0
4.0
3.0
2.0
1.0
Doxil with Promitil
5 6 8 11 12 13 15 18 20 22 26 29 32 34 36 39 41 43 46 48
1
2
3
4
5
6
7
8
9
1.0
5 6 8 11 12 13 15 18 20 22 26 29 32 34 36 39 41 43 46 48
1
2
3
4
5
6
7
N87 Tumor Model

53. Promitil in Chemoradiotherapy
In vivo Efficacy of Promitil + XRT in Ca-Skin Tumor Model
The combination of Promitil and 5-Fluorouracil
resulted in the greatest radiosensitization.

54. Promitil First-in-Man Phase 1 Study
(Nov2012)
Biweekly clinical and
AE assessments
Weekly clinical and
AE assessments
Current Cohort - CRC only (n=27)
Selected Dose=2 to 3mg/kg
w or w/o Capecitabine
START
START
Obtain informed
consent. Screen
subjects by
criteria; obtain
history document.
Day 29 Day 57
Clinical and AE
assessments
3 subjects
0.5 mg/kg
Weekly clinical and
AE assessments
Day -21 Day 1 Day 85 1 YEAR
Biweekly clinical and
AE assessments
Obtain informed
Cohort A
START
Cohort D
Cohort B
Obtain informed
consent. Screen
subjects by
criteria; obtain
history document.
Day 29 Day 57
Clinical and AE
assessments
Weekly clinical and
AE assessments
Weekly clinical and
AE assessments
3 subjects
1.0 mg/kg
Day -21 Day 1 Day 85 1 YEAR
Obtain informed
consent. Screen
subjects by
criteria; obtain
history document.
Weekly clinical and
Biweekly clinical and
Weekly clinical and
AE assessments
AE assessments
AE assessments
Day -21 Day 1 Day 29 Day 57
Day 85 Cohort C
3 subjects
1.5 mg/kg
3 subjects
2.0 mg/kg
PK PK

55. PK of Promitil in humans
Half-Life unchanged between
0.5-2mg/kg dose
0.5 1.0 1.5 2.0
50
45
40
35
30
25
20
15
10
5
0
T1/2 MLP 1st Cycle
T1/2 MLP 3rd Cycle
Dose MLP, mg/kg
MLP, Hours (SEM)
• High Plasma Levels
• Long T1/2 (~1 day)
• No sig levels of free MMC in
plasma)
• No change of PK with repeated
treatment
1.5mg/kg
0 10 20 30 40 50 60 70
3rd Cycle
0 10 20 30 40 50 60 70
100
10
1
100
10
1
0.1
160 170
MLP, g/ml plasma
0.5mg/kg
1mg/kg
1.5mg/kg
2mg/kg
Hours after infusion
0.1
160 170
MLP, g/ml plasma
0.5mg/kg
1mg/kg
2mg/kg
1st Cycle
Hours after infusion

56. 1 8 15 22 29
600
550
500
450
400
350
300
250
200
150
100
50
0
01-01M 0.5mg/kg
01-02F 0.5mg/kg
01-03M 1mg/kg
01-04F 1mg/kg
01-05M 1mg/kg
01-06F 1.5mg/kg
01-07M 1.5mg/kg
02-31M 0.5mg/kg
02-33M 1.5mg/kg
02-35F 2mg/kg
02-36F 2mg/kg
02-38F 2mg/kg
Days
Platelets x103/l
No dose limiting Thrombocytopenia
up to 2mg/kg
Promitil Safety:
• Infusion acute reaction in 2
patients
• Nausea and fatigue
• No hairloss
• No skin toxicity
• No mucosal toxicity
• No liver, lung, kidney or heart
toxicity
• No Dose-limiting toxicity up to
3.5 mg/kg in 1st cycle
• Delayed thromocytopenia after
3rd cycle resulted in MTD of 3
mg/kg

57. Response to Promitil in a Melanoma Patient:
Disappearance of Ascites, and Shrinkage of tumor mass between Nov 2012 to May 2013

58. Longest responder (Colon Ca) to Promitil (12+ mth) with good safety profile
Sustained decrease of CEA tumor marker - Stable disease (CT-scan)

59. PROMITIL Clinical Phase Interim Summary
- Phase I Study in cancer patients
 Start dose: 0.5mg/kg.
 Maximal dose: 3.5mg/kg.
- 27 patients accrued. MTD stablished at
3mg/kg due to delayed thrombocytopenia –
Results confirm preclinical observations of
reduced toxicity vs. free MMC (~3 Fold)
-PK observations: high plasma levels, long half-life,
slow plasma clearance, and small volume
of distribution
- Phase 1B continuation study in Colon CA -3rd
line therapy- ongoing: 27 patients

60. Take home Message
for Nanomedicines
• Different drugs / Different problems
 Different solutions
• Most effective weapon  Exploiting EPR
• Targeting important for specific drugs
• Know the PK/Clearance and Drug Release of
your system before attempting anything else

61. Combining
Therapeutics with
Imaging may help
to detect EPR and
predict Efficacy 
Karathanasis et al., Radiology 2009
Nanotheranostics
DOXIL
Poor
imaging
Good imaging

62. Acknowledgments:
• Lipomedix: Patricia Ohana, PhD
• Exptal. Oncology SZMC Lab:
 Hilary Shmeeda PhD
 Yasmine Amitay PhD
 Yogita Patil, PhD
 Jenny Gorin, M.Sc.
 Lidia Mak
 Dina Tzemach
Collaborators:
• Samuel Zalipsky, PhD (Promitil, San
Francisco)
• Irene La-Beck, PhD (Abilene, TX)
• Andrew Wang, MD (UNC)
• Franco Muggia, MD (NYU)
• Nano Charact. Lab (NCI)
• John Maher, M.D., Ana Parente, PhD,
Rafael Torres, PhD (KCL, London)
• Thomas Andresen, PhD (DTU, DK)
• Yechezkel Barenholz, Ph.D. (DOXIL,
HU, Jerusalem)
Liposome Community

63. Mouse – ‘Free’ 64Cu
1 h pi
Mouse – 64Cu-liposomes
1 h pi
Mouse – ‘Free’ 64Cu
24 h pi
Mouse – 64Cu-liposomes
24 h pi
Alendronate-Copper64
PET Labeling
From: Torres-Martin de Rosales Lab