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Froesch P, Mark M, Rothschild SI, Li Q, Godar G, Rusterholz C, Oppliger Leibundgut E, Schmid S, Colombo I, Metaxas Y, König D, Sessa C, Gautschi O, Früh M. Binimetinib, pemetrexed and cisplatin, followed by maintenance of binimetinib and pemetrexed in patients with advanced non-small cell lung cancer (NSCLC) and KRAS mutations. The phase 1B SAKK 19/16 trial. Lung Cancer 2021; 156:91-99. [PMID: 33933896 DOI: 10.1016/j.lungcan.2021.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND KRAS mutations are found in 20-25 % of non-squamous non-small cell lung cancer (NSCLC) and therapies targeting the RAS/MEK/ERK pathway are in development. We performed a multicenter open-label phase 1B trial to determine the recommended phase 2 dose and early antitumor activity of the MEK-inhibitor binimetinib combined with cisplatin and pemetrexed. METHODS Eligible patients (pts) had stage III-IV NSCLC unsuitable for curative treatment, KRAS exon 2 or 3 (codon 12, 13 or 61) mutations, no prior systemic therapy. Pts were enrolled into part 1: 3 + 3 design with dose escalation in 2 dose levels (DL) of binimetinib and part 2: expansion cohort at the maximum tolerated dose (MTD). Pts received 4 cycles of cisplatin 75 mg/m2, pemetrexed 500 mg/m2and binimetinib 30 (DL1)/45 mg (DL2) orally twice a day (bid) d1-14 q3w followed by pemetrexed and binimetinib until progressive disease (PD) or unacceptable toxicity. RESULTS From May 2017 to Dec 2019, 18 pts (13 dose escalation, 5 expansion cohort) were enrolled. Median age was 60 (48-73, range). KRAS mutations were 87.5 % at codon 12. No DLT occurred in the dose escalation cohort. Median number of cycles was 2 (1-17, range). Treatment discontinuation was mainly due to PD (33 %) or pts/physicians' decision (27 %). Together with the expansion cohort, 16 pts were evaluable for safety. Most frequent treatment-related grade 3 AEs were lung infection (25 %), fatigue (19 %), anemia (19 %). Overall response rate among 9 evaluable pts receiving binimetinib at MTD (45 mg bid) was 33 % (7-70 %, 95 % CI). Median progression-free survival was 5.7 months (1.1-14.0, 95 % CI) and overall survival 6.5 months (1.8-NR, 95 % CI). CONCLUSIONS Pts treated with combination of cisplatin, pemetrexed and binimetinib presented no unexpected toxicity. No early signal of increased antitumor activity of binimetinib added to chemotherapy was observed in our pts population.
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Affiliation(s)
- Patrizia Froesch
- Oncology Institute of Southern Switzerland, Via Ospedale, 6500 Bellinzona, Switzerland.
| | - Michael Mark
- Department of Medical Oncology/Hematology, Cantonal Hospital Graubünden, Loëstrasse 170, 7000 Chur, Switzerland.
| | - Sacha I Rothschild
- Department of Medical Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Qiyu Li
- SAKK Coordinating Center, Effingerstrasse 33, 3008 Bern, Switzerland.
| | - Gilles Godar
- SAKK Coordinating Center, Effingerstrasse 33, 3008 Bern, Switzerland.
| | | | - Elisabeth Oppliger Leibundgut
- Department of Hematology, University Hospital Bern, and Department for BioMedical Research (DBMR), Bern University, 3010 Bern, Switzerland.
| | - Sabine Schmid
- Department of Oncology/Hematology, Cantonal Hospital St.Gallen, Rorschacher Strasse 95, 9007 St.Gallen, Switzerland.
| | - Ilaria Colombo
- Oncology Institute of Southern Switzerland, Via Ospedale, 6500 Bellinzona, Switzerland.
| | - Yannis Metaxas
- Department of Medical Oncology/Hematology, Cantonal Hospital Graubünden, Loëstrasse 170, 7000 Chur, Switzerland.
| | - David König
- Department of Medical Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Cristiana Sessa
- Oncology Institute of Southern Switzerland, Via Ospedale, 6500 Bellinzona, Switzerland.
| | - Oliver Gautschi
- Medical Oncology, Cantonal Hospital Lucerne, Spitalstrasse, 6004 Lucerne, Switzerland; University of Berne, Hochschulstrasse 6, 3012 Bern, Switzerland.
| | - Martin Früh
- University of Berne, Hochschulstrasse 6, 3012 Bern, Switzerland; Department of Oncology/Hematology, Cantonal Hospital St.Gallen, Rorschacher Strasse 95, 9007 St.Gallen, Switzerland.
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Abstract
INTRODUCTION Non-small cell lung cancer (NSCLC) comprises of 84% of all lung cancer cases. The treatment options for NSCLC at advanced stages are chemotherapy and radiotherapy. Chemotherapy involves conventional nonspecific chemotherapeutics, and targeted-protein/receptor-specific small molecule inhibitors. Biologically targeted therapies such as an antibody-based immunotherapy have been approved in combination with conventional therapeutics. Approved targeted chemotherapy is directed against the kinase domains of mutated cellular receptors such as epidermal growth factor receptor (EGFR), anaplastic lymphoma kinases (ALK), neurotrophic receptor kinases (NTRK) and against downstream signaling molecules such as BRAF (v-raf murine sarcoma viral oncogene homolog B1). Approved biologically targeted therapy involves the use of anti-angiogenesis antibodies and antibodies against immune checkpoints. AREAS COVERED The rationale for the employment of targeted therapeutics and the resistance that may develop to therapy are discussed. Novel targeted therapeutics in clinical trials are also included. EXPERT OPINION Molecular and histological profiling of a given tumor specimen to determine the aberrant onco-driver is a must before deciding a targeted therapeutic regimen for the patient. Periodic monitoring of the patients response to a given therapeutic regimen is also mandatory so that any semblance of resistance to therapy can be deciphered and the regimen may be accordingly altered.
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Affiliation(s)
- Archana Upadhya
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM'S NMIMS , Mumbai, Maharashtra, India
| | - Khushwant S Yadav
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM'S NMIMS , Mumbai, Maharashtra, India
| | - Ambikanandan Misra
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM'S NMIMS , Mumbai, Maharashtra, India
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