Effect of Pevonedistat, an Investigational NEDD8-Activating Enzyme Inhibitor, on the QTc Interval in Patients With Advanced Solid Tumors

Xiaofei Zhou, Debra L. Richardson, Afshin Dowlati, Sanjay Goel, Solmaz Sahebjam, James Strauss, Sant Chawla, Ding Wang, Diane R. Mould, Vivek Samnotra, Douglas V. Faller, Karthik Venkatakrishnan, Neeraj Gupta

Research output: Contribution to journalArticlepeer-review


The purpose of this study was to assess the effect of pevonedistat, a neural precursor cell expressed, developmentally down-regulated protein 8 (NEDD8)-activating enzyme inhibitor, on the heart rate-corrected QT (QTc) interval in cancer patients. Patients were randomized 1:1 to receive pevonedistat 25 or 50 mg/m2 on day 1 and the alternate dose on day 8. Triplicate electrocardiograms were collected at intervals over 0–11 hours and at 24 hours via Holter recorders on days −1 (baseline), 1, and 8. Changes from time-matched baseline values were calculated for QTc by Fridericia (QTcF), PR, and QRS intervals. Serial time-matched blood samples for analysis of pevonedistat plasma pharmacokinetics were collected and a concentration–QTc analysis conducted. Safety was assessed by monitoring vital signs, physical examinations, and clinical laboratory tests. Forty-four patients were included in the QTc analysis. Maximum least square (LS) mean increase from time-matched baseline in QTcF was 3.2 milliseconds at 1 hour postdose for pevonedistat at 25 mg/m2, while the LSs mean change from baseline in QTcF was −1.7 milliseconds 1 hour postdose at 50 mg/m2. The maximum 2-sided 90% upper confidence bound was 6.7 and 2.9 milliseconds for pevonedistat at 25 and 50 mg/m2, respectively. Pevonedistat did not result in clinically relevant effects on heart rate, nor on PR or QRS intervals. Results from pevonedistat concentration–QTc analysis were consistent with these findings. Administration of pevonedistat to cancer patients at a dose of up to 50 mg/m2 showed no evidence of QT prolongation, indicative of the lack of clinically meaningful effects on cardiac repolarization. ClinicalTrials.gov identifier: NCT03330106 (first registered on November 6, 2017).

Original languageEnglish (US)
Pages (from-to)257-266
Number of pages10
JournalClinical Pharmacology in Drug Development
Issue number3
StatePublished - Mar 2023
Externally publishedYes


  • NEDD8-activating enzyme inhibitor
  • QTc interval
  • pevonedistat
  • pharmacokinetics

ASJC Scopus subject areas

  • Pharmaceutical Science
  • Pharmacology (medical)


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