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Choudhury AD, Higano CS, de Bono JS, Cook N, Rathkopf DE, Wisinski KB, Martin-Liberal J, Linch M, Heath EI, Baird RD, García-Carbacho J, Quintela-Fandino M, Barry ST, de Bruin EC, Colebrook S, Hawkins G, Klinowska T, Maroj B, Moorthy G, Mortimer PG, Moschetta M, Nikolaou M, Sainsbury L, Shapiro GI, Siu LL, Hansen AR. A Phase I Study Investigating AZD8186, a Potent and Selective Inhibitor of PI3Kβ/δ, in Patients with Advanced Solid Tumors. Clin Cancer Res 2022; 28:2257-2269. [PMID: 35247924 PMCID: PMC9662946 DOI: 10.1158/1078-0432.ccr-21-3087] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/21/2021] [Accepted: 03/01/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To characterize safety and tolerability of the selective PI3Kβ inhibitor AZD8186, identify a recommended phase II dose (RP2D), and assess preliminary efficacy in combination with abiraterone acetate or vistusertib. PATIENTS AND METHODS This phase I open-label study included patients with advanced solid tumors, particularly prostate cancer, triple-negative breast cancer, and squamous non-small cell lung cancer. The study comprised four arms: (i) AZD8186 monotherapy dose finding; (ii) monotherapy dose expansion; (iii) AZD8186/abiraterone acetate (with prednisone); and (iv) AZD8186/vistusertib. The primary endpoints were safety, tolerability, and identification of the RP2D of AZD8186 monotherapy and in combination. Secondary endpoints included pharmacokinetics (PK), pharmacodynamics, and tumor and prostate-specific antigen (PSA) responses. RESULTS In total, 161 patients were enrolled. AZD8186 was well tolerated across all study arms, the most common adverse events being gastrointestinal symptoms. In the monotherapy dose-finding arm, four patients experienced dose-limiting toxicities (mainly rash). AZD8186 doses of 60-mg twice daily [BID; 5 days on, 2 days off (5:2)] and 120-mg BID (continuous and 5:2 dosing) were taken into subsequent arms. The PKs of AZD8186 were dose proportional, without interactions with abiraterone acetate or vistusertib, and target inhibition was observed in plasma and tumor tissue. Monotherapy and combination therapy showed preliminary evidence of limited antitumor activity by imaging and, in prostate cancer, PSA reduction. CONCLUSIONS AZD8186 monotherapy had an acceptable safety and tolerability profile, and combination with abiraterone acetate/prednisone or vistusertib was also tolerated. There was preliminary evidence of antitumor activity, meriting further exploration of AZD8186 in subsequent studies in PI3Kβ pathway-dependent cancers.
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Affiliation(s)
- Atish D. Choudhury
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Celestia S. Higano
- Department of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Johann S. de Bono
- Drug Development Unit, The Institute of Cancer Research and Royal Marsden, London, United Kingdom
| | - Natalie Cook
- The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | - Dana E. Rathkopf
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, New York
| | - Kari B. Wisinski
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin
| | - Juan Martin-Liberal
- Medical Oncology Department, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mark Linch
- University College London (UCL) Cancer Institute and UCL Hospital, London, United Kingdom
| | - Elisabeth I. Heath
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Javier García-Carbacho
- Department of Medical Oncology (Hospital Clinic Barcelona)/Translational Genomics and Targeted Therapies in Solid Tumors (IDIBAPS), Barcelona, Spain
| | | | | | | | | | | | | | - Brijesh Maroj
- Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Ganesh Moorthy
- Clinical Pharmacology & Quantitative Pharmacology (CPQP), Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Boston, Massachusetts
| | | | | | | | - Liz Sainsbury
- Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Geoffrey I. Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lillian L. Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aaron R. Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Corresponding Author: Aaron R. Hansen, Princess Margaret Cancer Center, 700 University Avenue, Suite 7-623, Toronto, ON M5G 1×6, Canada. E-mail:
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Smyth LM, Tamura K, Oliveira M, Ciruelos EM, Mayer IA, Sablin MP, Biganzoli L, Ambrose HJ, Ashton J, Barnicle A, Cashell DD, Corcoran C, de Bruin EC, Foxley A, Hauser J, Lindemann JPO, Maudsley R, McEwen R, Moschetta M, Pass M, Rowlands V, Schiavon G, Banerji U, Scaltriti M, Taylor BS, Chandarlapaty S, Baselga J, Hyman DM. Capivasertib, an AKT Kinase Inhibitor, as Monotherapy or in Combination with Fulvestrant in Patients with AKT1 E17K-Mutant, ER-Positive Metastatic Breast Cancer. Clin Cancer Res 2020; 26:3947-3957. [PMID: 32312891 PMCID: PMC7415507 DOI: 10.1158/1078-0432.ccr-19-3953] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/20/2020] [Accepted: 04/16/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE The activating mutation AKT1 E17K occurs in approximately 7% of estrogen receptor-positive (ER+) metastatic breast cancer (MBC). We report, from a multipart, first-in-human, phase I study (NCT01226316), tolerability and activity of capivasertib, an oral AKT inhibitor, as monotherapy or combined with fulvestrant in expansion cohorts of patients with AKT1 E17K-mutant ER+ MBC. PATIENTS AND METHODS Patients with an AKT1 E17K mutation, detected by local (next-generation sequencing) or central (plasma-based BEAMing) testing, received capivasertib 480 mg twice daily, 4 days on, 3 days off, weekly or 400 mg twice daily combined with fulvestrant at the labeled dose. Study endpoints included safety, objective response rate (ORR; RECIST v1.1), progression-free survival (PFS), and clinical benefit rate at 24 weeks (CBR24). Biomarker analyses were conducted in the combination cohort. RESULTS From October 2013 to August 2018, 63 heavily pretreated patients received capivasertib (20 monotherapy, 43 combination). ORR was 20% with monotherapy, and within the combination cohort was 36% in fulvestrant-pretreated and 20% in fulvestrant-naïve patients, although the latter group may have had more aggressive disease at baseline. AKT1 E17K mutations were detectable in plasma by BEAMing (95%, 41/43), droplet digital PCR (80%, 33/41), and next-generation sequencing (76%, 31/41). A ≥50% decrease in AKT1 E17K at cycle 2 day 1 was associated with improved PFS. Combination therapy appeared more tolerable than monotherapy [most frequent grade ≥3 adverse events: rash (9% vs. 20%), hyperglycemia (5% vs. 30%), diarrhea (5% vs. 10%)]. CONCLUSIONS Capivasertib demonstrated clinically meaningful activity in heavily pretreated patients with AKT1 E17K-mutant ER+ MBC, including those with prior disease progression on fulvestrant. Tolerability and activity appeared improved by the combination.
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Affiliation(s)
| | | | - Mafalda Oliveira
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | | | - Laura Biganzoli
- Breast Centre, Oncology Department, Hospital of Prato, Prato, Italy
| | | | - Jack Ashton
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Alan Barnicle
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Des D Cashell
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | | | | | - Andrew Foxley
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Joana Hauser
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | | | | | - Robert McEwen
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | | | - Martin Pass
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | | | - Gaia Schiavon
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Udai Banerji
- Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Barry S Taylor
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - José Baselga
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Hyman
- Memorial Sloan Kettering Cancer Center, New York, New York
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3
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Dean E, Banerji U, Schellens JHM, Krebs MG, Jimenez B, van Brummelen E, Bailey C, Casson E, Cripps D, Cullberg M, Evans S, Foxley A, Lindemann J, Rugman P, Taylor N, Turner G, Yates J, Lawrence P. A Phase 1, open-label, multicentre study to compare the capsule and tablet formulations of AZD5363 and explore the effect of food on the pharmacokinetic exposure, safety and tolerability of AZD5363 in patients with advanced solid malignancies: OAK. Cancer Chemother Pharmacol 2018; 81:873-883. [PMID: 29541803 PMCID: PMC5907623 DOI: 10.1007/s00280-018-3558-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/01/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE AZD5363 is a potent pan-AKT inhibitor originally formulated as a capsule; a tablet was developed for patient convenience and manufacturing ease. This study assessed the PK comparability of both formulations (Part A) and the effect of food (Part B) on the PK/safety of the tablet. METHODS Adults with advanced solid tumours received AZD5363 480 mg bid in a partially fasted state by tablet (Week 1) and capsule (Week 2) in a '4-days-on/3-days-off' schedule (Part A). PK parameters were evaluated using pre-defined 90% CIs for AUCτ and Cmax ratios of 0.75-1.33 to assess comparability. In Part B, AZD5363 tablet was given to a new cohort of patients under the same conditions as Part A, except on the morning of PK assessment days, when it was administered after an overnight fast (Week 1) and standard meal (Week 2). RESULTS In evaluable patients (N = 11), the geometric least-squares mean ratios (tablet:capsule) for AUCτ and Cmax were 0.90 (0.77-1.06) and 1.02 (0.86-1.20), respectively, demonstrating comparable PK in the partially fasted state. Tablet and capsule safety data were also comparable. Tablet PK profiles indicated later tmax and lower Cmax after food versus overnight fast. Fed and fasted AUCτ and Cmax ratios were 0.89 (0.76-1.05) and 0.67 (0.55-0.82), respectively (N = 9). The safety/tolerability profile of the tablet was comparable between fed and fasted states. CONCLUSIONS PK and safety/tolerability of AZD5363 tablet and capsule were comparable. Food did not affect the bioavailability of AZD5363, but reduced the absorption rate without discernibly affecting safety/tolerability.
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Affiliation(s)
- Emma Dean
- The Christie NHS Foundation Trust, The University of Manchester, Manchester, UK.
- AstraZeneca, Da Vinci Building, Melbourn Science Park, Melbourn, Hertfordshire, SG8 6HB, UK.
| | | | | | - Matthew G Krebs
- The Christie NHS Foundation Trust, The University of Manchester, Manchester, UK
| | | | | | | | - Ed Casson
- IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | | | | | | | | | | | - Paul Rugman
- IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | | | | | - James Yates
- IMED Biotech Unit, AstraZeneca, Cambridge, UK
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Banerji U, Dean EJ, Pérez-Fidalgo JA, Batist G, Bedard PL, You B, Westin SN, Kabos P, Garrett MD, Tall M, Ambrose H, Barrett JC, Carr TH, Cheung SYA, Corcoran C, Cullberg M, Davies BR, de Bruin EC, Elvin P, Foxley A, Lawrence P, Lindemann JPO, Maudsley R, Pass M, Rowlands V, Rugman P, Schiavon G, Yates J, Schellens JHM. A Phase I Open-Label Study to Identify a Dosing Regimen of the Pan-AKT Inhibitor AZD5363 for Evaluation in Solid Tumors and in PIK3CA-Mutated Breast and Gynecologic Cancers. Clin Cancer Res 2018; 24:2050-2059. [PMID: 29066505 DOI: 10.1158/1078-0432.ccr-17-2260] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/07/2017] [Accepted: 10/19/2017] [Indexed: 11/16/2022]
Abstract
Purpose: This phase I, open-label study (Study 1, D3610C00001; NCT01226316) was the first-in-human evaluation of oral AZD5363, a selective pan-AKT inhibitor, in patients with advanced solid malignancies. The objectives were to investigate the safety, tolerability, and pharmacokinetics of AZD5363, define a recommended dosing schedule, and evaluate preliminary clinical activity.Experimental Design: Patients were aged ≥18 years with World Health Organization (WHO) performance status of 0 to 1. Dose escalation was conducted within separate continuous and intermittent [4 days/week (4/7) or 2 days/week (2/7)] schedules with safety, pharmacokinetic, and pharmacodynamic analyses. Expansion cohorts of approximately 20 patients each explored AZD5363 activity in PIK3CA-mutant breast and gynecologic cancers.Results: MTDs were 320, 480, and 640 mg for continuous (n = 47), 4/7 (n = 21), and 2/7 (n = 22) schedules, respectively. Dose-limiting toxicities were rash and diarrhea for continuous, hyperglycemia for 2/7, and none for 4/7. Common adverse events were diarrhea (78%) and nausea (49%) and, for Common Terminology Criteria for Adverse Events grade ≥3 events, hyperglycemia (20%). The recommended phase II dose (480 mg bid, 4/7 intermittent) was assessed in PIK3CA-mutant breast and gynecologic expansion cohorts: 46% and 56% of patients, respectively, showed a reduction in tumor size, with RECIST responses of 4% and 8%. These responses were less than the prespecified 20% response rate; therefore, the criteria to stop further recruitment to the PIK3CA-mutant cohort were met.Conclusions: At the recommended phase II dose, AZD5363 was well tolerated and achieved plasma levels and robust target modulation in tumors. Proof-of-concept responses were observed in patients with PIK3CA-mutant cancers treated with AZD5363. Clin Cancer Res; 24(9); 2050-9. ©2017 AACRSee related commentary by Costa and Bosch, p. 2029.
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Affiliation(s)
- Udai Banerji
- Clinical Pharmacology and Trials, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Emma J Dean
- Medical Oncology (Drug Development), University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - J Alejandro Pérez-Fidalgo
- Department of Oncology and Hematology, INCLIVA Biomedical Research Institute, Hospital Clínico Universitario de Valencia, CIBERONC, Valencia, Spain
| | - Gerald Batist
- Department of Oncology, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Canada
| | - Philippe L Bedard
- Department of Medical Oncology, The Princess Margaret Cancer Centre, Toronto, Canada
| | - Benoit You
- Medical Oncology Department, Institut de Cancérologie des Hospices Civils de Lyon, CITOHL, Université Lyon 1, Lyon, France
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter Kabos
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | | | - Mathew Tall
- Clinical PD Biomarker Group, The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | | | | | | | | | | | | | - Paul Elvin
- IMED, AstraZeneca, Cambridge, United Kingdom
| | | | | | | | | | - Martin Pass
- IMED, AstraZeneca, Cambridge, United Kingdom
| | | | - Paul Rugman
- IMED, AstraZeneca, Cambridge, United Kingdom
| | | | - James Yates
- IMED, AstraZeneca, Cambridge, United Kingdom
| | - Jan H M Schellens
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
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Crafter C, Vincent JP, Tang E, Dudley P, James NH, Klinowska T, Davies BR. Combining AZD8931, a novel EGFR/HER2/HER3 signalling inhibitor, with AZD5363 limits AKT inhibitor induced feedback and enhances antitumour efficacy in HER2-amplified breast cancer models. Int J Oncol 2015; 47:446-54. [PMID: 26095475 PMCID: PMC4501645 DOI: 10.3892/ijo.2015.3062] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/16/2015] [Indexed: 12/18/2022] Open
Abstract
The phosphatidylinositol 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) signalling network is frequently de-regulated in breast cancer and has been shown to mediate resistance to anti-HER2 agents. Whilst constitutive activation of this pathway is emerging as a marker of sensitivity to various PI3K pathway inhibitors, activity of these agents in the clinic may be limited by the presence of feedback loops, leading to reactivation of receptor tyrosine kinases, such as HER2/HER3. To determine whether inhibition of HER2 could increase the efficacy of AZD5363, a novel AKT inhibitor, a panel of breast cancer cells was dosed with AZD5363 in combination with AZD8931, an inhibitor of EGFR/HER2/HER3 signalling. We show that the combined treatment resulted in synergistic growth inhibition and enhanced cell death, specifically in the HER2-amplified cell lines. Investigation of the mechanism by western blot analysis revealed that the addition of AZD8931 prevented the induction of HER2/HER3 phosphorylation induced by AZD5363 and resulted in concomitant inhibition of both the PI3K/AKT/mTOR and ERK signalling pathways and induction of apoptosis. Using the HCC1954 xenograft model, which is resistant to trastuzumab, we show that the combination of AZD5363 and AZD8931 is more efficacious than either agent alone, resulting in profound tumour regressions. We conclude that the activity of AZD5363 in HER2-amplified breast cancer cells is enhanced by the addition of AZD8931 and that dual targeting of AKT and EGFR/HER2/HER3 signalling is an attractive treatment option to be explored in the clinic.
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Affiliation(s)
- Claire Crafter
- Oncology iMED, AstraZeneca, Alderley Park, Macclesfield SK10 4TG, UK
| | - John P Vincent
- Oncology iMED, AstraZeneca, Alderley Park, Macclesfield SK10 4TG, UK
| | - Eric Tang
- Oncology iMED, AstraZeneca, Alderley Park, Macclesfield SK10 4TG, UK
| | - Phillippa Dudley
- Oncology iMED, AstraZeneca, Alderley Park, Macclesfield SK10 4TG, UK
| | - Neil H James
- Oncology iMED, AstraZeneca, Alderley Park, Macclesfield SK10 4TG, UK
| | - Teresa Klinowska
- Oncology iMED, AstraZeneca, Alderley Park, Macclesfield SK10 4TG, UK
| | - Barry R Davies
- Oncology iMED, AstraZeneca, Alderley Park, Macclesfield SK10 4TG, UK
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