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Lakhani N, Cosman R, Banerji U, Rasco D, Tomaszewska-Kiecana M, Garralda E, Kornacki D, Li J, Tian C, Bourayou N, Powderly J. A first-in-human phase I study of the PD-1 inhibitor, retifanlimab (INCMGA00012), in patients with advanced solid tumors (POD1UM-101). ESMO Open 2024; 9:102254. [PMID: 38387109 DOI: 10.1016/j.esmoop.2024.102254] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/22/2023] [Revised: 12/12/2023] [Accepted: 01/14/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Retifanlimab is a humanized, hinge-stabilized immunoglobulin G4κ monoclonal antibody against human programmed cell death protein 1 (PD-1). This first-in-human, phase I study assessed the safety and efficacy of retifanlimab in patients with advanced solid tumors and identified optimal dosing. PATIENTS AND METHODS POD1UM-101 was conducted in two parts: (i) dose escalation-evaluated retifanlimab [1 mg/kg every 2 weeks (q2w), 3 or 10 mg/kg q2w or every 4 weeks (q4w)] in patients with relapsed/refractory, unresectable, locally advanced or metastatic solid tumors; (ii) cohort expansion-biomarker-unselected tumor-specific cohorts [endometrial, cervical, sarcoma, non-small-cell lung cancer (NSCLC)] received retifanlimab 3 mg/kg q2w, and tumor-agnostic cohorts received flat dosing [375 mg every 3 weeks (q3w), or 500 and 750 mg q4w]. Primary objectives were safety and tolerability; secondary objective was efficacy in selected tumor types. RESULTS Thirty-seven patients were enrolled in dose escalation, 134 in PD-1 therapy-naïve tumor-specific cohort expansion (endometrial, n = 29; cervical, NSCLC, soft tissue sarcoma, each n = 35), and 45 in flat dosing (375 mg q3w, 500 and 750 mg q4w, each n = 15). No dose-limiting toxicities occurred during dose escalation; maximum tolerated dose was not reached and 3-mg/kg q2w expansion dose was selected based on safety and pharmacokinetic data. Immune-related adverse events were experienced by 40 patients (30%) in tumor-specific cohorts (most frequently hypothyroidism, hyperthyroidism, colitis, nephritis) and 6 (13%) in flat dosing (most frequently hypothyroidism, hyperthyroidism). Objective response rate (95% confidence interval) was 14% (4.8 to 30.3), 14% (3.9 to 31.7), 20% (8.4 to 36.9), and 3% (0.1 to 14.9) in advanced NSCLC, endometrial, cervical, and sarcoma tumor-specific cohorts that progressed after multiple prior systemic therapies. CONCLUSIONS Retifanlimab demonstrated clinical pharmacology, safety, and antitumor activity consistent with the programmed death (ligand)-1 inhibitor class. POD1UM-101 results support further exploration of retifanlimab as monotherapy and backbone immunotherapy in combination treatments, with recommended doses of 500 mg q4w and 375 mg q3w.
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Affiliation(s)
| | - R Cosman
- Medical Oncology, The Kinghorn Cancer Centre, St. Vincent's Hospital, Sydney, Darlinghurst, Australia; School of Medicine, University of New South Wales, Kensington, Australia
| | - U Banerji
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - E Garralda
- Early Drug Development Unit, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | | | - J Li
- Incyte Corporation, Wilmington, USA
| | - C Tian
- Incyte Corporation, Wilmington, USA
| | - N Bourayou
- Incyte Biosciences International Sàrl, Morges, Switzerland
| | - J Powderly
- Carolina BioOncology Institute, Huntersville, USA
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Rodney S, Banerji U. Optimizing the FDA's Project Optimus: opportunities and challenges. Nat Rev Clin Oncol 2024; 21:165-166. [PMID: 38129533 DOI: 10.1038/s41571-023-00853-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Simon Rodney
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
| | - Udai Banerji
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
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Dillon MT, Guevara J, Mohammed K, Patin EC, Smith SA, Dean E, Jones GN, Willis SE, Petrone M, Silva C, Thway K, Bunce C, Roxanis I, Nenclares P, Wilkins A, McLaughlin M, Jayme-Laiche A, Benafif S, Nintos G, Kwatra V, Grove L, Mansfield D, Proszek P, Martin P, Moore L, Swales KE, Banerji U, Saunders MP, Spicer J, Forster MD, Harrington KJ. Durable responses to ATR inhibition with ceralasertib in tumors with genomic defects and high inflammation. J Clin Invest 2024; 134:e175369. [PMID: 37934611 PMCID: PMC10786692 DOI: 10.1172/jci175369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUNDPhase 1 study of ATRinhibition alone or with radiation therapy (PATRIOT) was a first-in-human phase I study of the oral ATR (ataxia telangiectasia and Rad3-related) inhibitor ceralasertib (AZD6738) in advanced solid tumors.METHODSThe primary objective was safety. Secondary objectives included assessment of antitumor responses and pharmacokinetic (PK) and pharmacodynamic (PD) studies. Sixty-seven patients received 20-240 mg ceralasertib BD continuously or intermittently (14 of a 28-day cycle).RESULTSIntermittent dosing was better tolerated than continuous, which was associated with dose-limiting hematological toxicity. The recommended phase 2 dose of ceralasertib was 160 mg twice daily for 2 weeks in a 4-weekly cycle. Modulation of target and increased DNA damage were identified in tumor and surrogate PD. There were 5 (8%) confirmed partial responses (PRs) (40-240 mg BD), 34 (52%) stable disease (SD), including 1 unconfirmed PR, and 27 (41%) progressive disease. Durable responses were seen in tumors with loss of AT-rich interactive domain-containing protein 1A (ARID1A) and DNA damage-response defects. Treatment-modulated tumor and systemic immune markers and responding tumors were more immune inflamed than nonresponding.CONCLUSIONCeralasertib monotherapy was tolerated at 160 mg BD intermittently and associated with antitumor activity.TRIAL REGISTRATIONClinicaltrials.gov: NCT02223923, EudraCT: 2013-003994-84.FUNDINGCancer Research UK, AstraZeneca, UK Department of Health (National Institute for Health Research), Rosetrees Trust, Experimental Cancer Medicine Centre.
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Affiliation(s)
- Magnus T. Dillon
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jeane Guevara
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Kabir Mohammed
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Emma Dean
- Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | | | | | - Marcella Petrone
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Carlos Silva
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Khin Thway
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Anna Wilkins
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Adoracion Jayme-Laiche
- UCL Cancer Institute and University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Sarah Benafif
- UCL Cancer Institute and University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Georgios Nintos
- King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vineet Kwatra
- King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lorna Grove
- The Institute of Cancer Research, London, United Kingdom
| | | | - Paula Proszek
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Philip Martin
- Oncology R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Luiza Moore
- Oncology R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | | | - Udai Banerji
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - James Spicer
- King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Martin D. Forster
- UCL Cancer Institute and University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Kevin J. Harrington
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
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4
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Lau R, Yu L, Roumeliotis TI, Stewart A, Pickard L, Riisanes R, Gurel B, de Bono JS, Choudhary JS, Banerji U. Unbiased differential proteomic profiling between cancer-associated fibroblasts and cancer cell lines. J Proteomics 2023; 288:104973. [PMID: 37481068 DOI: 10.1016/j.jprot.2023.104973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/03/2023] [Accepted: 07/04/2023] [Indexed: 07/24/2023]
Abstract
Cancer-associated fibroblasts (CAFs) are a key component of tumors. We aimed to profile the proteome of cancer cell lines representing three common cancer types (lung, colorectal and pancreatic) and a representative CAF cell line from each tumor type to gain insight into CAF function and novel CAF biomarkers. We used isobaric labeling, liquid chromatography and mass spectrometry to evaluate the proteome of 9 cancer and 3 CAF cell lines. Of the 9460 proteins evaluated, functional enrichment analysis revealed an upregulation of N-glycan biosynthesis and extracellular matrix proteins in CAFs. 85 proteins had 16-fold higher expression in CAFs compared to cancer cells, including previously known CAF markers like fibroblast activation protein (FAP). Novel overexpressed CAF biomarkers included heat shock protein β-6 (HSPB6/HSP20) and cyclooxygenase 1 (PTGS1/COX1). SiRNA knockdown of the genes encoding these proteins did not reduce contractility in lung CAFs, suggesting they were not crucial to this function. Immunohistochemical analysis of 30 tumor samples (10 lung, 10 colorectal and 10 pancreatic) showed restricted HSPB6 and PTGS1 expression in the stroma. Therefore, we describe an unbiased differential proteome analysis of CAFs compared to cancer cells, which revealed higher expression of HSPB6 and PTGS1 in CAFs. Data are available via ProteomeXchange (PXD040360). SIGNIFICANCE: Cancer-associated fibroblasts (CAFs) are highly abundant stromal cells present in tumors. CAFs are known to influence tumor progression and drug resistance. Characterizing the proteome of CAFs could give potential insights into new stromal drug targets and biomarkers. Mass spectrometry-based analysis comparing proteomic profiles of CAFs and cancers characterized 9460 proteins of which 85 proteins had 16-fold higher expression in CAFs compared to cancer cells. Further interrogation of this rich resource could provide insight into the function of CAFs and could reveal putative stromal targets. We describe for the first time that heat shock protein β-6 (HSPB6/HSP20) and cyclooxygenase 1 (PTGS1/COX1) are overexpressed in CAFs compared to cancer cells.
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Affiliation(s)
- Rachel Lau
- Clinical Pharmacology and Adaptive Therapy Group, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 15 Cotswold Road, London SM2 5NG, United Kingdom.
| | - Lu Yu
- Functional Proteomics group, Chester Beatty Laboratories, The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, United Kingdom
| | - Theodoros I Roumeliotis
- Functional Proteomics group, Chester Beatty Laboratories, The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, United Kingdom
| | - Adam Stewart
- Clinical Pharmacology and Adaptive Therapy Group, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 15 Cotswold Road, London SM2 5NG, United Kingdom
| | - Lisa Pickard
- Clinical Pharmacology and Adaptive Therapy Group, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 15 Cotswold Road, London SM2 5NG, United Kingdom
| | - Ruth Riisanes
- Cancer Biomarkers Group, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 15 Cotswold Road, London SM2 5NG, United Kingdom
| | - Bora Gurel
- Cancer Biomarkers Group, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 15 Cotswold Road, London SM2 5NG, United Kingdom
| | - Johann S de Bono
- Cancer Biomarkers Group, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 15 Cotswold Road, London SM2 5NG, United Kingdom
| | - Jyoti S Choudhary
- Functional Proteomics group, Chester Beatty Laboratories, The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, United Kingdom.
| | - Udai Banerji
- Clinical Pharmacology and Adaptive Therapy Group, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 15 Cotswold Road, London SM2 5NG, United Kingdom.
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Ingles Garces AH, Porta N, Graham TA, Banerji U. Corrigendum to "Clinical trial designs for evaluating and exploiting cancer evolution" [Cancer Treat. Rev. 118 (2023) 101583]. Cancer Treat Rev 2023; 119:102596. [PMID: 37419039 DOI: 10.1016/j.ctrv.2023.102596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Affiliation(s)
- Alvaro H Ingles Garces
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, UK
| | - Nuria Porta
- Clinical Trials and Statistical Unit, The Institute of Cancer Research, UK
| | - Trevor A Graham
- Centre for Evolution and Cancer, The Institute of Cancer Research, UK
| | - Udai Banerji
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, UK.
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6
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Spicer J, Basu B, Montes A, Banerji U, Kristeleit R, Miller R, Veal GJ, Corrigan CJ, Till SJ, Figini M, Canevari S, Barton C, Jones P, Mellor S, Carroll S, Selkirk C, Nintos G, Kwatra V, Funingana IG, Doherty G, Gould HJ, Pellizzari G, Nakamura M, Ilieva KM, Khiabany A, Stavraka C, Chauhan J, Gillett C, Pinder S, Bax HJ, Josephs DH, Karagiannis SN. Safety and anti-tumour activity of the IgE antibody MOv18 in patients with advanced solid tumours expressing folate receptor-alpha: a phase I trial. Nat Commun 2023; 14:4180. [PMID: 37491373 PMCID: PMC10368744 DOI: 10.1038/s41467-023-39679-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
All antibodies approved for cancer therapy are monoclonal IgGs but the biology of IgE, supported by comparative preclinical data, offers the potential for enhanced effector cell potency. Here we report a Phase I dose escalation trial (NCT02546921) with the primary objective of exploring the safety and tolerability of MOv18 IgE, a chimeric first-in-class IgE antibody, in patients with tumours expressing the relevant antigen, folate receptor-alpha. The trial incorporated skin prick and basophil activation tests (BAT) to select patients at lowest risk of allergic toxicity. Secondary objectives were exploration of anti-tumour activity, recommended Phase II dose, and pharmacokinetics. Dose escalation ranged from 70 μg-12 mg. The most common toxicity of MOv18 IgE is transient urticaria. A single patient experienced anaphylaxis, likely explained by detection of circulating basophils at baseline that could be activated by MOv18 IgE. The BAT assay was used to avoid enrolling further patients with reactive basophils. The safety profile is tolerable and maximum tolerated dose has not been reached, with evidence of anti-tumour activity observed in a patient with ovarian cancer. These results demonstrate the potential of IgE therapy for cancer.
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Affiliation(s)
- James Spicer
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Bristi Basu
- Cambridge University Hospitals NHS Foundation Trust, and Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Ana Montes
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Udai Banerji
- Institute of Cancer Research and Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | | | | | - Gareth J Veal
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Christopher J Corrigan
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Stephen J Till
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Mariangela Figini
- ANP2, Department of Advanced Diagnostics, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Claire Barton
- Centre for Drug Development, Cancer Research UK, London, UK
- Barton Oncology Ltd, Hertfordshire, UK
| | - Paul Jones
- Centre for Drug Development, Cancer Research UK, London, UK
- UCB Pharma Ltd., Slough, UK
| | - Sarah Mellor
- Centre for Drug Development, Cancer Research UK, London, UK
| | - Simon Carroll
- Centre for Drug Development, Cancer Research UK, London, UK
| | - Chris Selkirk
- Centre for Drug Development, Cancer Research UK, London, UK
| | - George Nintos
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vineet Kwatra
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ionut-Gabriel Funingana
- Cambridge University Hospitals NHS Foundation Trust, and Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Gary Doherty
- Cambridge University Hospitals NHS Foundation Trust, and Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - Hannah J Gould
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK
- Randall Centre for Cell and Molecular Biophysics, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Giulia Pellizzari
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Mano Nakamura
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Kristina M Ilieva
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Atousa Khiabany
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Chara Stavraka
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Jitesh Chauhan
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Cheryl Gillett
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Health Partners Cancer Biobank, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarah Pinder
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Health Partners Cancer Biobank, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Heather J Bax
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Debra H Josephs
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
- Breast Cancer Now Research Unit, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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Ingles Garces AH, Porta N, Graham TA, Banerji U. Clinical trial designs for evaluating and exploiting cancer evolution. Cancer Treat Rev 2023; 118:102583. [PMID: 37331179 DOI: 10.1016/j.ctrv.2023.102583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/21/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
The evolution of drug-resistant cell subpopulations causes cancer treatment failure. Current preclinical evidence shows that it is possible to model herding of clonal evolution and collateral sensitivity where an initial treatment could favourably influence the response to a subsequent one. Novel therapy strategies exploiting this understanding are being considered, and clinical trial designs for steering cancer evolution are needed. Furthermore, preclinical evidence suggests that different subsets of drug-sensitive and resistant clones could compete between themselves for nutrients/blood supply, and clones that populate a tumour do so at the expense of other clones. Treatment paradigms based on this clinical application of exploiting cell-cell competition include intermittent dosing regimens or cycling different treatments before progression. This will require clinical trial designs different from the conventional practice of evaluating responses to individual therapy regimens. Next-generation sequencing to assess clonal dynamics longitudinally will improve current radiological assessment of clinical response/resistance and be incorporated into trials exploiting evolution. Furthermore, if understood, clonal evolution can be used to therapeutic advantage, improving patient outcomes based on a new generation of clinical trials.
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Affiliation(s)
- Alvaro H Ingles Garces
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, UK
| | - Nuria Porta
- Clinical Trials and Statistical Unit, The Institute of Cancer Research, UK
| | - Trevor A Graham
- Centre for Evolution and Cancer, The Institute of Cancer Research, UK
| | - Udai Banerji
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, UK.
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Kristeleit R, Plummer R, Jones R, Carter L, Blagden S, Sarker D, Arkenau T, Evans TRJ, Danson S, Symeonides SN, Veal GJ, Klencke BJ, Kowalski MM, Banerji U. A Phase 1/2 trial of SRA737 (a Chk1 inhibitor) administered orally in patients with advanced cancer. Br J Cancer 2023; 129:38-45. [PMID: 37120671 PMCID: PMC10307885 DOI: 10.1038/s41416-023-02279-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND This was a first-in-human Phase 1/2 open-label dose-escalation study of the novel checkpoint kinase 1 (Chk1) inhibitor SRA737. METHODS Patients with advanced solid tumours enrolled in dose-escalation cohorts and received SRA737 monotherapy orally on a continuous daily (QD) dosing schedule in 28-day cycles. Expansion cohorts included up to 20 patients with prospectively selected, pre-specified response predictive biomarkers. RESULTS In total, 107 patients were treated at dose levels from 20-1300 mg. The maximum tolerated dose (MTD) of SRA737 was 1000 mg QD, the recommended Phase 2 dose (RP2D) was 800 mg QD. Common toxicities of diarrhoea, nausea and vomiting were generally mild to moderate. Dose-limiting toxicity at daily doses of 1000 and 1300 mg QD SRA737 included gastrointestinal events, neutropenia and thrombocytopenia. Pharmacokinetic analysis at the 800 mg QD dose showed a mean Cmin of 312 ng/mL (546 nM), exceeding levels required to cause growth delay in xenograft models. No partial or complete responses were seen. CONCLUSIONS SRA737 was well tolerated at doses that achieved preclinically relevant drug concentrations but single agent activity did not warrant further development as monotherapy. Given its mechanism of action resulting in abrogating DNA damage repair, further clinical development of SRA737 should be as combination therapy. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT02797964.
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Affiliation(s)
| | - Ruth Plummer
- Newcastle University and Newcastle Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - Robert Jones
- Velindre School of Medicine, Cardiff University, and Velindre University NHS Trust, Cardiff, UK
| | - Louise Carter
- Division of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Sarah Blagden
- Early Phase Clinical Trials Unit, Churchill Hospital, Oxford University Hospital NHS Trust, Oxford, UK
| | | | | | - Thomas R Jeffry Evans
- The Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow, UK
| | - Sarah Danson
- Sheffield ECMC, Department of Oncology and Metabolism, University of Sheffield, and Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Stefan N Symeonides
- Edinburgh ECMC, Institute of Genetics & Cancer, University of Edinburgh, Edinburgh Cancer Centre, Edinburgh, UK
| | - Gareth J Veal
- Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | | | | | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK.
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Banerjee S, Giannone G, Clamp AR, Ennis DP, Glasspool RM, Herbertson R, Krell J, Riisnaes R, Mirza HB, Cheng Z, McDermott J, Green C, Kristeleit RS, George A, Gourley C, Lewsley LA, Rai D, Banerji U, Hinsley S, McNeish IA. Efficacy and Safety of Weekly Paclitaxel Plus Vistusertib vs Paclitaxel Alone in Patients With Platinum-Resistant Ovarian High-Grade Serous Carcinoma: The OCTOPUS Multicenter, Phase 2, Randomized Clinical Trial. JAMA Oncol 2023; 9:675-682. [PMID: 36928279 PMCID: PMC10020933 DOI: 10.1001/jamaoncol.2022.7966] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/05/2022] [Indexed: 03/18/2023]
Abstract
Importance Patients with platinum-resistant or refractory ovarian high-grade serous carcinoma (PR-HGSC) have a poor prognosis and few therapeutic options. Preclinical studies support targeting PI3K/AKT/mTOR signaling in this setting, and a phase 1 study of the dual mTORC1/mTORC2 inhibitor vistusertib with weekly paclitaxel showed activity. Objective To evaluate whether the addition of vistusertib to weekly paclitaxel improves clinical outcomes in patients with PR-HGSC. Design, Setting, and Participants This phase 2, double-blind, placebo-controlled multicenter randomized clinical trial recruited patients from UK cancer centers between January 2016 and March 2018. Patients with PR-HGSC of ovarian, fallopian tube, or primary peritoneal origin and with measurable or evaluable disease (Response Evaluation Criteria in Solid Tumors version 1.1 and/or Gynecological Cancer Intergroup cancer antigen 125 criteria) were eligible. There were no restrictions on number of lines of prior therapy. Data analysis was performed from May 2019 to January 2022. Interventions Patients were randomized (1:1) to weekly paclitaxel (80 mg/m2 days 1, 8, and 15 of a 28-day cycle) plus oral vistusertib (50 mg twice daily) or placebo. Main Outcomes and Measures The primary end point was progression-free survival in the intention-to-treat population. Secondary end points included response rate, overall survival, and quality of life. Results A total of 140 patients (median [range] age, 63 [36-86] years; 17.9% with platinum-refractory disease; 53.6% with ≥3 prior therapies) were randomized. In the paclitaxel plus vistusertib vs paclitaxel plus placebo groups, there was no difference in progression-free survival (median, 4.5 vs 4.1 months; hazard ratio [HR], 0.84; 80% CI, 0.67-1.07; 1-sided P = .18), overall survival (median, 9.7 vs 11.1 months; HR, 1.21; 80% CI, 0.91-1.60) or response rate (odds ratio, 0.86; 80% CI, 0.55-1.36). Grade 3 to 4 adverse events were 41.2% (weekly paclitaxel plus vistusertib) vs 36.7% (weekly paclitaxel plus placebo), and there was no difference in quality of life. Conclusions and Relevance In this randomized clinical trial of weekly paclitaxel and dual mTORC1/2 inhibition in patients with PR-HGSC, vistusertib did not improve clinical activity of weekly paclitaxel. Trial Registration isrctn.org Identifier: ISRCTN16426935.
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Affiliation(s)
- Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Gaia Giannone
- Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Andrew R. Clamp
- The Christie NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| | - Darren P. Ennis
- Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, United Kingdom
| | | | - Rebecca Herbertson
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Jonathan Krell
- Medical Oncology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ruth Riisnaes
- Division of Cancer Therapeutics, Institute of Cancer Research, London, United Kingdom
| | - Hasan B. Mirza
- Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Zhao Cheng
- Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Jacqueline McDermott
- Department of Histopathology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Clare Green
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Rebecca S. Kristeleit
- Research Department of Oncology, UCL Cancer Institute, University College London, London, United Kingdom
- Now with Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Angela George
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Charlie Gourley
- Cancer Research UK Scotland Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Liz-Anne Lewsley
- CRUK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Debbie Rai
- CRUK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Udai Banerji
- Division of Cancer Therapeutics, Institute of Cancer Research, London, United Kingdom
| | - Samantha Hinsley
- CRUK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Iain A. McNeish
- Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, United Kingdom
- Medical Oncology, Imperial College Healthcare NHS Trust, London, United Kingdom
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Halford S, Veal GJ, Wedge SR, Payne GS, Bacon CM, Sloan P, Dragoni I, Heinzmann K, Potter S, Salisbury BM, Chenard-Poirier M, Greystoke A, Howell EC, Innes WA, Morris K, Plummer C, Rata M, Petrides G, Keun HC, Banerji U, Plummer R. A Phase I Dose-escalation Study of AZD3965, an Oral Monocarboxylate Transporter 1 Inhibitor, in Patients with Advanced Cancer. Clin Cancer Res 2023; 29:1429-1439. [PMID: 36652553 PMCID: PMC7614436 DOI: 10.1158/1078-0432.ccr-22-2263] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/20/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
PURPOSE Inhibition of monocarboxylate transporter (MCT) 1-mediated lactate transport may have cytostatic and/or cytotoxic effects on tumor cells. We report results from the dose-escalation part of a first-in-human trial of AZD3965, a first-in-class MCT1 inhibitor, in advanced cancer. PATIENTS AND METHODS This multicentre, phase I, dose-escalation and dose-expansion trial enrolled patients with advanced solid tumors or lymphoma and no standard therapy options. Exclusion criteria included history of retinal and/or cardiac disease, due to MCT1 expression in the eye and heart. Patients received daily oral AZD3965 according to a 3+3 then rolling six design. Primary objectives were to assess safety and determine the MTD and/or recommended phase II dose (RP2D). Secondary objectives for dose escalation included measurement of pharmacokinetic and pharmacodynamic activity. Exploratory biomarkers included tumor expression of MCT1 and MCT4, functional imaging of biological impact, and metabolomics. RESULTS During dose escalation, 40 patients received AZD3965 at 5-30 mg once daily or 10 or 15 mg twice daily. Treatment-emergent adverse events were primarily grade 1 and/or 2, most commonly electroretinogram changes (retinopathy), fatigue, anorexia, and constipation. Seven patients receiving ≥20 mg daily experienced dose-limiting toxicities (DLT): grade 3 cardiac troponin rise (n = 1), asymptomatic ocular DLTs (n = 5), and grade 3 acidosis (n = 1). Plasma pharmacokinetics demonstrated attainment of target concentrations; pharmacodynamic measurements indicated on-target activity. CONCLUSIONS AZD3965 is tolerated at doses that produce target engagement. DLTs were on-target and primarily dose-dependent, asymptomatic, reversible ocular changes. An RP2D of 10 mg twice daily was established for use in dose expansion in cancers that generally express high MCT1/low MCT4).
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Affiliation(s)
- Sarah Halford
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Gareth J Veal
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Stephen R Wedge
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Geoffrey S Payne
- Cancer Research UK Imaging Centre, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Chris M Bacon
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Philip Sloan
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ilaria Dragoni
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Kathrin Heinzmann
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Sarah Potter
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Becky M Salisbury
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Maxime Chenard-Poirier
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Alastair Greystoke
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Elizabeth C Howell
- Newcastle University Centre for In Vivo Imaging, Newcastle, United Kingdom
| | - William A Innes
- Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Type, United Kingdom
| | - Karen Morris
- Cancer Research UK Manchester Institute Cancer Biomarker Centre, Manchester, United Kingdom
| | - Chris Plummer
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Mihaela Rata
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Ruth Plummer
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
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11
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Rodney S, Stewart AR, Perez VS, Morton C, Pickard LA, Shakouri T, Prout T, Parmar M, Turner AJ, Coma S, Pachter J, Finneran L, Hall E, Spicer J, Minchom A, Banerji U. Abstract 3461: Preclinical and clinical evaluation of the RAF/MEK clamp avutometinib (VS-6766) in combination with the mTOR inhibitor everolimus for the treatment of KRAS mutated non-small cell lung cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-3461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: KRAS mutations (mt) are found in ~30% of non-small cell lung cancers (NSCLC). Despite the approval and development of KRAS G12C and KRAS G12D inhibitors respectively, mechanisms of resistance to MAPK pathway inhibitors are emerging and combination strategies are needed for patients with KRAS mt NSCLC . Avutometinib (VS-6766) is a unique RAF/MEK clamp that inhibits MEK kinase activity and blocks RAF-mediated phosphorylation of MEK. We studied the preclinical and clinical activity of the combination of avutometinib with the mTOR inhibitor everolimus in KRAS mt NSCLC.
Methods: A panel of KRAS mt NSCLC cell lines were treated for 1 hour with clinically relevant concentrations of avutometinib and everolimus and changes in phosphoproteins were measured using an antibody array. We then tested for synergy of avutometinib and everolimus in 3D proliferation assays and in the H441 NSCLC xenograft model. A clinical trial is ongoing (NCT02407509) testing the combination of 3.2 mg avutometinib with 5 mg of everolimus administered twice weekly 3 weeks on/1 week off in 28-day cycles (previously defined as the recommended phase 2 dose) in a cohort of patients with KRAS mt NSCLC.
Results: Avutometinib inhibited the MAPK pathway (p-MEK, p-ERK, p-90RSK) with an increase in p-PRAS40, suggesting activation of the PI3K pathway as an adaptive resistance mechanism. Everolimus inhibited the PI3K pathway (p-p70S6K and p-RPS6). Among a panel of KRAS mt NSCLC cell lines, avutometinib + everolimus showed synergistic anti-proliferative activity across KRAS G12C, G12V and G12D variants (mean synergy score of ~18). In the H441 KRAS G12V NSCLC xenograft model, there was a significant reduction in tumor volume and increase in survival with the combination of avutometinib and everolimus (87% TGI; 66 days vs 36.5 days in control group) compared to control. In the clinical trial expansion, 16 patients with KRAS mt NSCLC have been treated so far with avutometinib and everolimus (5 G12V, 3 Q61H, 2 G12C, 2 G12A, 2 G12D, 1 G13A, 1 G13D; median prior lines = 2). The current objective response rate (ORR) among the 14 patients who have at least one post assessment scan is 3/14 (21%; 1 G12V, 1 G12A, 1 G13A) with 11/14 showing a reduction in tumor size as best response. The current progression free survival (PFS) is 5.3 months (95% CI 2.8-7.4 months) with 4 patients still on study. Updated data on the planned cohort size of 20 patients will be presented.
Conclusion: The combination of avutometinib and everolimus overcomes the activation of the PI3K/AKT/mTOR pathway which is an adaptive resistance mechanism to MAPK pathway inhibition. We have shown that avutometinib and everolimus induce synergistic anti-tumor effects preclinically, and preliminary data suggest clinically meaningful ORR and PFS in patients with KRAS mt NSCLC including non-G12C variants.
Citation Format: Simon Rodney, Adam R. Stewart, Victoria Sanchez Perez, Cienne Morton, Lisa A. Pickard, Taleen Shakouri, Toby Prout, Mona Parmar, Alison J. Turner, Silvia Coma, Jonathan Pachter, Laura Finneran, Emma Hall, James Spicer, Anna Minchom, Udai Banerji. Preclinical and clinical evaluation of the RAF/MEK clamp avutometinib (VS-6766) in combination with the mTOR inhibitor everolimus for the treatment of KRAS mutated non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3461.
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Affiliation(s)
- Simon Rodney
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Victoria Sanchez Perez
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Cienne Morton
- 3Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | | | - Toby Prout
- 2The Institute of Cancer Research, London, United Kingdom
| | - Mona Parmar
- 2The Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Laura Finneran
- 2The Institute of Cancer Research, London, United Kingdom
| | - Emma Hall
- 2The Institute of Cancer Research, London, United Kingdom
| | | | - Anna Minchom
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Udai Banerji
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
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12
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Jones R, Plummer R, Moreno V, Carter L, Roda D, Garralda E, Kristeleit R, Sarker D, Arkenau T, Roxburgh P, Walter HS, Blagden S, Anthoney A, Klencke BJ, Kowalski MM, Banerji U. A Phase I/II Trial of Oral SRA737 (a Chk1 Inhibitor) Given in Combination with Low-Dose Gemcitabine in Patients with Advanced Cancer. Clin Cancer Res 2023; 29:331-340. [PMID: 36378548 PMCID: PMC10539020 DOI: 10.1158/1078-0432.ccr-22-2074] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/21/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE This was a Phase I/II trial of the novel checkpoint kinase 1 (Chk1) inhibitor SRA737 given in combination with gemcitabine. Its objectives were to establish the safety profile, recommended Phase 2 dose (RP2D), pharmacokinetics profile, and clinical activity of SRA737. PATIENTS AND METHODS Patients with advanced solid tumors were enrolled into dose-escalation cohorts and treated in 28-day cycles with oral SRA737 on days 2, 3, 9, 10, 16, and 17, and intravenous gemcitabine on days 1, 8, and 15. Treatment was continued until progression. Each expansion cohort included up to 20 patients with specific genetically defined tumors. RESULTS The RP2D was determined to be 500 mg SRA737 combined with low-dose (250 mg/m2) gemcitabine. Of 143 enrolled patients, 77 were treated at doses of at least 500 mg SRA737 combined with 250 mg/m2 gemcitabine. Common toxicities of nausea, vomiting, fatigue, and diarrhea were primarily mild to moderate, and rarely led to treatment discontinuation. Anemia, neutropenia, and thrombocytopenia were grade ≥3 in 11.7%, 16.7%, and 10% of patients treated at the RP2D, respectively. The objective response rate (ORR) was 10.8% overall and notably the ORR in anogenital cancer was 25%. Partial tumor responses were observed in anogenital cancer, cervical cancer, high-grade serous ovarian cancer, rectal cancer, and small cell lung cancer. CONCLUSIONS SRA737 in combination with low-dose gemcitabine was well tolerated with lower myelotoxicity than has been seen at standard doses of gemcitabine or with other combinations of Chk1 inhibitors with gemcitabine. Tumor responses were observed in anogenital and other solid tumors.
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Affiliation(s)
- Robert Jones
- Velindre School of Medicine, Cardiff University, and Velindre University NHS Trust, Cardiff, United Kingdom
| | - Ruth Plummer
- Newcastle University and Newcastle Hospitals NHS Trust, Newcastle Upon Tyne, United Kingdom
| | - Victor Moreno
- START Madrid-Fundación Jiménez Díaz, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Louise Carter
- Division of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Elena Garralda
- Hospital Universitario Vall d'Hebron, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Debashis Sarker
- King's College London and Guy's Hospital, London, United Kingdom
| | | | - Patricia Roxburgh
- University of Glasgow and Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Harriet S. Walter
- University Hospitals of Leicester and University of Leicester, Leicester, United Kingdom
| | - Sarah Blagden
- Early Phase Clinical Trials Unit, Churchill Hospital, Oxford University Hospital NHS Trust, Oxford, United Kingdom
| | - Alan Anthoney
- Leeds Institute of Medical Research, University of Leeds and St. James' University Hospital, Leeds, United Kingdom
| | | | | | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation trust, London, United Kingdom
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13
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Banerjee S, Michalarea V, Ang JE, Ingles Garces A, Biondo A, Funingana IG, Little M, Ruddle R, Raynaud F, Riisnaes R, Gurel B, Chua S, Tunariu N, Porter JC, Prout T, Parmar M, Zachariou A, Turner A, Jenkins B, McIntosh S, Ainscow E, Minchom A, Lopez J, de Bono J, Jones R, Hall E, Cook N, Basu B, Banerji U. A Phase I Trial of CT900, a Novel α-Folate Receptor-Mediated Thymidylate Synthase Inhibitor, in Patients with Solid Tumors with Expansion Cohorts in Patients with High-Grade Serous Ovarian Cancer. Clin Cancer Res 2022; 28:4634-4641. [PMID: 35984704 PMCID: PMC9623233 DOI: 10.1158/1078-0432.ccr-22-1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/07/2022] [Accepted: 08/17/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE CT900 is a novel small molecule thymidylate synthase inhibitor that binds to α-folate receptor (α-FR) and thus is selectively taken up by α-FR-overexpressing tumors. PATIENTS AND METHODS A 3+3 dose escalation design was used. During dose escalation, CT900 doses of 1-6 mg/m2 weekly and 2-12 mg/m2 every 2 weeks (q2Wk) intravenously were evaluated. Patients with high-grade serous ovarian cancer were enrolled in the expansion cohorts. RESULTS 109 patients were enrolled: 42 patients in the dose escalation and 67 patients in the expansion cohorts. At the dose/schedule of 12 mg/m2/q2Wk (with and without dexamethasone, n = 40), the most common treatment-related adverse events were fatigue, nausea, diarrhea, cough, anemia, and pneumonitis, which were predominantly grade 1 and grade 2. Levels of CT900 more than 600 nmol/L needed for growth inhibition in preclinical models were achieved for >65 hours at a dose of 12 mg/m2. In the expansion cohorts, the overall response rate (ORR), was 14/64 (21.9%). Thirty-eight response-evaluable patients in the expansion cohorts receiving 12 mg/m2/q2Wk had tumor evaluable for quantification of α-FR. Patients with high or medium expression had an objective response rate of 9/25 (36%) compared with 1/13 (7.7%) in patients with negative/very low or low expression of α-FR. CONCLUSIONS The dose of 12 mg/m2/q2Wk was declared the recommended phase II dose/schedule. At this dose/schedule, CT900 exhibited an acceptable side effect profile with clinical benefit in patients with high/medium α-FR expression and warrants further investigation.
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Affiliation(s)
- Susana Banerjee
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Vasiliki Michalarea
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Joo Ern Ang
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alvaro Ingles Garces
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Andrea Biondo
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ionut-Gabriel Funingana
- Cambridge University Hospitals NHS Foundation Trust and University of Cambridge, Cambridge, United Kingdom
| | - Martin Little
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ruth Ruddle
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Florence Raynaud
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ruth Riisnaes
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Bora Gurel
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Sue Chua
- Radiology and Nuclear Medicine Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nina Tunariu
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Radiology and Nuclear Medicine Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Joanna C. Porter
- UCL Respiratory, University College London and Interstitial Lung Disease Service, University College London NHS Foundation Trust, London, United Kingdom
| | - Toby Prout
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Mona Parmar
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Anna Zachariou
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison Turner
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ben Jenkins
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | | | | | - Anna Minchom
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Juanita Lopez
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Johann de Bono
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Robert Jones
- Cardiff University, School of Medicine, Velindre University NHS Trust, Cardiff, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Natalie Cook
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Bristi Basu
- Cambridge University Hospitals NHS Foundation Trust and University of Cambridge, Cambridge, United Kingdom
| | - Udai Banerji
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Pal A, Daly R, Mohamedkhan S, Grochot R, Stapleton S, Yap C, Magkos D, Baikady BR, Minchom A, Banerji U, De Bono J, Karikios D, Boyle F, Lopez J. CONSENT - A Randomised Controlled Trial of Enhanced Informed Consent Compared to Standard Informed Consent to Improve Patient Understanding of Early Phase Oncology Clinical Trials – GBM Cohort (Nonrandomised) Analysis. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac200.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
AIMS
Early phase cancer clinical trials have become more complicated and patients often misunderstand their nature and purpose. CONSENT (NCT04407676) is a randomised controlled trial testing whether enhanced informed consent for patient education can improve comprehension – since patients with glioblastoma multiforme (GBM) have a higher rate of baseline cognitive impairment, we studied this group separately.
METHOD
GBM patients (from the ICE-CAP Phase 1 study - NCT03673787), underwent the schedule for the standard CONSENT arm - full length trial PIS, Quality of Informed Consent Questionnaire Parts A and B (QuIC-A and QuIC-B), experimental intervention (2 page study aid and 10 educational videos), and a repeat QuIC-A and QuIC-B. The primary endpoint for this subgroup was the difference in QuIC-A scores before and after the intervention using a paired t-test.
RESULTS
6 patients with GBM were recruited - 3 did not complete any study questionnaires. The three pre intervention QuIC-A scores were 70, 81, 88, with a mean of 75 (unit reference 76). The three pre intervention QuIC-B scores were 69, 62, 75 with a mean of 69 (unit reference is 91). Only one patient completed the post intervention questionnaire - their QuIC-A score moved from 88 to 100.
CONCLUSION
This study demonstrates the significant difficulties in studying comprehension in patients with GBM considering early phase trials. There is a need for creative multi-modality solutions to provide information to GBM patients considering clinical trials, and novel tools to assess the effectiveness of these solutions.
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Affiliation(s)
- Abhijit Pal
- Drug Development Unit, Royal Marsden Hospital , Sutton
| | - Robert Daly
- Drug Development Unit, Royal Marsden Hospital , Sutton
| | | | | | | | - Christina Yap
- Drug Development Unit, Royal Marsden Hospital , Sutton
| | | | | | - Anna Minchom
- Drug Development Unit, Royal Marsden Hospital , Sutton
| | - Udai Banerji
- Drug Development Unit, Royal Marsden Hospital , Sutton
| | | | | | | | - Juanita Lopez
- Drug Development Unit, Royal Marsden Hospital , Sutton
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Ingles Russo Garces A, Milite S, Oliveira E, Fernandez-Mateos J, Chen B, Pickard L, Stewart A, Lau R, De Haven Brandon A, Paranjape E, Sottoriva A, Banerjee S, Banerji U. 1697P Drug-induced evolutionary dynamics in BRCA-mutant/non-mutant ovarian cancer models. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Stewart AR, Pickard L, Paranjape E, Perez VS, Chowdhury S, Lustgarten S, Coma S, Pachter JA, Carey MS, DiMattia G, Badham HC, Prout T, Parmar M, Mahmud M, Yap C, Krebs MG, Banerjee S, Banerji U. Abstract 3476: Mechanistic evaluation of VS-6766 (dual RAF/MEK inhibitor) and defactinib (FAK inhibitor) in low-grade serous ovarian cancer models with correlations to clinical response. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Low-grade serous ovarian cancer (LGSOC) constitutes up to 10% of all ovarian cancer and has clinical and molecular characteristics (resistance to chemotherapy, presence of RAS/RAF mutations, lack of TP53 mutations) distinct from high-grade serous ovarian cancer. Here, we characterized the effects of the dual RAF/MEK inhibitor VS-6766 and the FAK inhibitor defactinib on signal transduction and viability in LGSOC cell lines and patient-derived organoids. To correlate molecular characteristics with clinical response, we characterized genomic alterations in archival tumor samples from patients with LGSOC treated with the combination of VS-6766 and defactinib on a clinical trial (FRAME).
Material and Methods: We exposed 5 LGSOC cell lines to clinical Cmax concentrations adjusted for protein binding of VS-6766 and defactinib. We quantified phospho- and total proteins (n=66) with an antibody-bead based assay normalized to GAPDH. We also studied growth inhibitory effects of the combination on KRAS mutant (mt) LGSOC patient-derived organoids. We performed next generation sequencing on archival samples from LGSOC patients treated with VS-6766 in combination with defactinib.
Results: Signal transduction changes at 1 hr included reduction of p-FAK in 5/5 cell lines in response to defactinib. Cells exposed to VS-6766 showed a reduction in p-ERK and p-p90-RSK in 4/5 cell lines. Additionally, VS-6766 decreased p-cJUN and increased p-IκB in 4/5 cell lines, changes correlated with apoptosis. At 24 hrs, p-ERK and p-p90-RSK inhibition were maintained in 3/5 cell lines. Both drugs increased cleaved PARP in 4/5 cell lines and VS-6766 increased p-SMAD3 and BIM levels, indicating an increase in cell death/apoptosis. The combination of VS-6766 + defactinib showed synergistic growth inhibition in a KRAS mt LGSOC organoid model (combination index 0.51). The clinical combination of VS-6766 and defactinib (September 2021 cut-off) has shown an objective response rate (ORR) of 11/24 (46%) across all patients with LGSOC, and an ORR of 64% (7/11) for patients with KRAS mt LGSOC (n=11). In addition to mutations in KRAS, emerging data may suggest a correlation of U2AF1 and MED12 mutations with response.
Conclusions: VS-6766, the dual RAF/MEK inhibitor, induces significant inhibition of ERK pathway signaling in addition to perturbations in TNF/NFκB signaling. Both defactinib and VS-6766 induce apoptosis in LGSOC models. The results provide mechanistic insights into the encouraging response rates observed in patients with LGSOC treated with VS-6766 and defactinib (NCT03875820). These data support the ongoing randomized phase II ENGOTov60/GOG3052/RAMP201 study (NCT04625270).
Citation Format: Adam R. Stewart, Lisa Pickard, Ekta Paranjape, Victoria Sanchez Perez, Sanjib Chowdhury, Stephanie Lustgarten, Silvia Coma, Jonathan A. Pachter, Mark S. Carey, Gabriel DiMattia, Hannah C. Badham, Toby Prout, Mona Parmar, Muneeb Mahmud, Christina Yap, Matthew G. Krebs, Susana Banerjee, Udai Banerji. Mechanistic evaluation of VS-6766 (dual RAF/MEK inhibitor) and defactinib (FAK inhibitor) in low-grade serous ovarian cancer models with correlations to clinical response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3476.
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Affiliation(s)
| | - Lisa Pickard
- 1The Institute of Cancer Research, London, United Kingdom
| | - Ekta Paranjape
- 1The Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | | | - Mark S. Carey
- 4University of British Columbia, Canada, Vancouver, British Columbia, Canada
| | - Gabriel DiMattia
- 5University of Western Ontario, London, Canada, London, Ontario, Canada
| | | | - Toby Prout
- 1The Institute of Cancer Research, London, United Kingdom
| | - Mona Parmar
- 1The Institute of Cancer Research, London, United Kingdom
| | - Muneeb Mahmud
- 1The Institute of Cancer Research, London, United Kingdom
| | - Christina Yap
- 1The Institute of Cancer Research, London, United Kingdom
| | | | - Susana Banerjee
- 2The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Udai Banerji
- 7The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
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Lau R, Yu L, Roumeliotis T, Pickard L, Stewart A, Choudhary J, Banerji U. Abstract 3187: Understanding the role of cancer-associated fibroblasts (CAFs) on pathogenesis of KRAS mutated cancers by defining differences in the basal state proteome and secretome. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: KRAS is commonly mutated in solid tumors. Cancer-associated fibroblasts (CAFs) are a key tumor stroma component, which can affect cancer progression and drug response. We hypothesized that defining the differential secreted proteins between CAFs and KRAS mutant-cancer cells could reveal potential mechanisms by which CAFs influence cancer progression and drug resistance.
Methods: We studied 12 cell lines: 3 KRAS mutant-colorectal cancer cell lines (H747, LIM2099 and SW620), 3 KRAS mutant-lung cancer cell lines (H1792, H2030 and H23), 3 KRAS mutant-pancreatic cancer cell lines (CAPAN1, DANG, MIAPACA2) and 3 CAF cell line models (colorectal and lung CAF and pancreatic stellate cells). We quantified proteins in cell lines and serum-free media after 24 hour incubation in cells using mass spectrometry in a multiplexed manner (12plex) in triplicates to characterize the proteome and the profile of secreted proteins (secretome), respectively. Prediction software (signalP, secretomeP, TMHMM) and databases (surfaceome and cell surface protein atlas) were used to annotate secreted or transmembrane proteins.
Results: Our proteome analysis quantified 9307 proteins. T-test between the cell types (CAF vs cancer) identified 1770 differentially expressed proteins, where 712 proteins were CAF-enriched. This included known CAF markers (e.g α smooth muscle actin) but also proteins not known to be CAF markers such as heat shock protein beta-5/6 (HSPB5/6). The secretome analysis identified 2330 secreted or transmembrane proteins where 202 were differentially expressed between cancer cells and CAFs. 190 proteins were CAF-enriched with the highest ranking being syndecan-2 (SDC2), collagen α-28(I) chain (COL28A1), decorin (DCN) and wnt family member 5B (WNT5B). Interestingly, basal proteome analysis of KRAS mutant-cancer cells showed expression of receptors corresponding to the CAF-enriched ligands, such as receptor tyrosine kinase-like orphan receptor 1/2 (ROR1/2) which respond to WNT5B. This suggests that CAF-enriched ligands may activate certain downstream pathways, including non-canonical WNT signaling, in KRAS mutant-cancer cells.
Conclusion: We undertook deep quantitative proteomics where we identified potential novel CAF markers HSPB5/6. We have also found proteins in the CAF secretome, such as WNT5B, which may drive drug resistance in KRAS mutant-cancer cells.
Citation Format: Rachel Lau, Lu Yu, Theodoros Roumeliotis, Lisa Pickard, Adam Stewart, Jyoti Choudhary, Udai Banerji. Understanding the role of cancer-associated fibroblasts (CAFs) on pathogenesis of KRAS mutated cancers by defining differences in the basal state proteome and secretome [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3187.
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Affiliation(s)
- Rachel Lau
- 1The Institute of Cancer Research, Sutton, United Kingdom
| | - Lu Yu
- 2The Institute of Cancer Research, Chelsea, United Kingdom
| | | | - Lisa Pickard
- 1The Institute of Cancer Research, Sutton, United Kingdom
| | - Adam Stewart
- 1The Institute of Cancer Research, Sutton, United Kingdom
| | | | - Udai Banerji
- 1The Institute of Cancer Research, Sutton, United Kingdom
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Papadatos-Pastos D, Yuan W, Pal A, Crespo M, Ferreira A, Gurel B, Prout T, Ameratunga M, Chénard-Poirier M, Curcean A, Bertan C, Baker C, Miranda S, Masrour N, Chen W, Pereira R, Figueiredo I, Morilla R, Jenkins B, Zachariou A, Riisnaes R, Parmar M, Turner A, Carreira S, Yap C, Brown R, Tunariu N, Banerji U, Lopez J, de Bono J, Minchom A. Phase 1, dose-escalation study of guadecitabine (SGI-110) in combination with pembrolizumab in patients with solid tumors. J Immunother Cancer 2022; 10:jitc-2022-004495. [PMID: 35717027 PMCID: PMC9240883 DOI: 10.1136/jitc-2022-004495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 12/14/2022] Open
Abstract
Background Data suggest that immunomodulation induced by DNA hypomethylating agents can sensitize tumors to immune checkpoint inhibitors. We conducted a phase 1 dose-escalation trial (NCT02998567) of guadecitabine and pembrolizumab in patients with advanced solid tumors. We hypothesized that guadecitabine will overcome pembrolizumab resistance. Methods Patients received guadecitabine (45 mg/m2 or 30 mg/m2, administered subcutaneously on days 1–4), with pembrolizumab (200 mg administered intravenously starting from cycle 2 onwards) every 3 weeks. Primary endpoints were safety, tolerability and maximum tolerated dose; secondary and exploratory endpoints included objective response rate (ORR), changes in methylome, transcriptome, immune contextures in pre-treatment and on-treatment tumor biopsies. Results Between January 2017 and January 2020, 34 patients were enrolled. The recommended phase II dose was guadecitabine 30 mg/m2, days 1–4, and pembrolizumab 200 mg on day 1 every 3 weeks. Two dose-limiting toxicities (neutropenia, febrile neutropenia) were reported at guadecitabine 45 mg/m2 with none reported at guadecitabine 30 mg/m2. The most common treatment-related adverse events (TRAEs) were neutropenia (58.8%), fatigue (17.6%), febrile neutropenia (11.8%) and nausea (11.8%). Common, grade 3+ TRAEs were neutropaenia (38.2%) and febrile neutropaenia (11.8%). There were no treatment-related deaths. Overall, 30 patients were evaluable for antitumor activity; ORR was 7% with 37% achieving disease control (progression-free survival) for ≥24 weeks. Of 12 evaluable patients with non-small cell lung cancer, 10 had been previously treated with immune checkpoint inhibitors with 5 (42%) having disease control ≥24 weeks (clinical benefit). Reduction in LINE-1 DNA methylation following treatment in blood (peripheral blood mononuclear cells) and tissue samples was demonstrated and methylation at transcriptional start site and 5’ untranslated region gene regions showed enriched negative correlation with gene expression. Increases in intra-tumoural effector T-cells were seen in some responding patients. Patients having clinical benefit had high baseline inflammatory signature on RNAseq analyses. Conclusions Guadecitabine in combination with pembrolizumab is tolerable with biological and anticancer activity. Reversal of previous resistance to immune checkpoint inhibitors is demonstrated.
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Affiliation(s)
| | - Wei Yuan
- Cancer Biomarkers Team, Institute of Cancer Research, Sutton, UK
| | - Abhijit Pal
- Drug Development Unit, Royal Marsden Hospital/Institute of Cancer Research, Sutton, UK
| | - Mateus Crespo
- Cancer Biomarkers Team, Institute of Cancer Research, Sutton, UK
| | - Ana Ferreira
- Cancer Biomarkers Team, Institute of Cancer Research, Sutton, UK
| | - Bora Gurel
- Cancer Biomarkers Team, Institute of Cancer Research, Sutton, UK
| | - Toby Prout
- Drug Development Unit - Investigator Initiated Trials Team, Institute of Cancer Research, Sutton, UK
| | - Malaka Ameratunga
- Drug Development Unit, Royal Marsden Hospital/Institute of Cancer Research, Sutton, UK
| | | | - Andra Curcean
- Drug Development Unit, Royal Marsden Hospital/Institute of Cancer Research, Sutton, UK
| | - Claudia Bertan
- Cancer Biomarkers Team, Institute of Cancer Research, Sutton, UK
| | - Chloe Baker
- Cancer Biomarkers Team, Institute of Cancer Research, Sutton, UK
| | - Susana Miranda
- Cancer Biomarkers Team, Institute of Cancer Research, Sutton, UK
| | - Nahal Masrour
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Wentin Chen
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rita Pereira
- Cancer Biomarkers Team, Institute of Cancer Research, Sutton, UK
| | - Ines Figueiredo
- Cancer Biomarkers Team, Institute of Cancer Research, Sutton, UK
| | - Ricardo Morilla
- Drug Development Unit, Royal Marsden Hospital/Institute of Cancer Research, Sutton, UK
| | - Ben Jenkins
- Clinical Trials and Statistics Unit, Institute of Cancer Research, Sutton, UK
| | - Anna Zachariou
- Drug Development Unit - Investigator Initiated Trials Team, Institute of Cancer Research, Sutton, UK
| | - Ruth Riisnaes
- Cancer Biomarkers Team, Institute of Cancer Research, Sutton, UK
| | - Mona Parmar
- Drug Development Unit - Investigator Initiated Trials Team, Institute of Cancer Research, Sutton, UK
| | - Alison Turner
- Drug Development Unit - Investigator Initiated Trials Team, Institute of Cancer Research, Sutton, UK
| | - Suzanne Carreira
- Cancer Biomarkers Team, Institute of Cancer Research, Sutton, UK
| | - Christina Yap
- Clinical Trials and Statistics Unit, Institute of Cancer Research, Sutton, UK
| | - Robert Brown
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nina Tunariu
- Drug Development Unit, Royal Marsden Hospital/Institute of Cancer Research, Sutton, UK
| | - Udai Banerji
- Drug Development Unit, Royal Marsden Hospital/Institute of Cancer Research, Sutton, UK
| | - Juanita Lopez
- Drug Development Unit, Royal Marsden Hospital/Institute of Cancer Research, Sutton, UK
| | - Johann de Bono
- Cancer Biomarkers Team, Institute of Cancer Research, Sutton, UK.,Drug Development Unit, Royal Marsden Hospital/Institute of Cancer Research, Sutton, UK
| | - Anna Minchom
- Drug Development Unit, Royal Marsden Hospital/Institute of Cancer Research, Sutton, UK
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Coker EA, Stewart A, Ozer B, Minchom A, Pickard L, Ruddle R, Carreira S, Popat S, O'Brien M, Raynaud F, de Bono J, Al-Lazikani B, Banerji U. Individualized Prediction of Drug Response and Rational Combination Therapy in NSCLC Using Artificial Intelligence-Enabled Studies of Acute Phosphoproteomic Changes. Mol Cancer Ther 2022; 21:1020-1029. [PMID: 35368084 PMCID: PMC9381105 DOI: 10.1158/1535-7163.mct-21-0442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/15/2021] [Accepted: 03/11/2022] [Indexed: 01/07/2023]
Abstract
We hypothesize that the study of acute protein perturbation in signal transduction by targeted anticancer drugs can predict drug sensitivity of these agents used as single agents and rational combination therapy. We assayed dynamic changes in 52 phosphoproteins caused by an acute exposure (1 hour) to clinically relevant concentrations of seven targeted anticancer drugs in 35 non-small cell lung cancer (NSCLC) cell lines and 16 samples of NSCLC cells isolated from pleural effusions. We studied drug sensitivities across 35 cell lines and synergy of combinations of all drugs in six cell lines (252 combinations). We developed orthogonal machine-learning approaches to predict drug response and rational combination therapy. Our methods predicted the most and least sensitive quartiles of drug sensitivity with an AUC of 0.79 and 0.78, respectively, whereas predictions based on mutations in three genes commonly known to predict response to the drug studied, for example, EGFR, PIK3CA, and KRAS, did not predict sensitivity (AUC of 0.5 across all quartiles). The machine-learning predictions of combinations that were compared with experimentally generated data showed a bias to the highest quartile of Bliss synergy scores (P = 0.0243). We confirmed feasibility of running such assays on 16 patient samples of freshly isolated NSCLC cells from pleural effusions. We have provided proof of concept for novel methods of using acute ex vivo exposure of cancer cells to targeted anticancer drugs to predict response as single agents or combinations. These approaches could complement current approaches using gene mutations/amplifications/rearrangements as biomarkers and demonstrate the utility of proteomics data to inform treatment selection in the clinic.
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Affiliation(s)
- Elizabeth A. Coker
- Department of Data Science, The Institute of Cancer Research, London, United Kingdom
- Wellcome Sanger Institute, Hinxton, United Kingdom
- Healx Ltd., Cambridge, United Kingdom
| | - Adam Stewart
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Bugra Ozer
- Department of Data Science, The Institute of Cancer Research, London, United Kingdom
- Healx Ltd., Cambridge, United Kingdom
| | - Anna Minchom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lisa Pickard
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Ruth Ruddle
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Suzanne Carreira
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Sanjay Popat
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Mary O'Brien
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Florence Raynaud
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Johann de Bono
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Bissan Al-Lazikani
- Department of Data Science, The Institute of Cancer Research, London, United Kingdom
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Udai Banerji
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Minchom AR, Sanchez Perez V, Morton C, Manickavasagar T, Nintos G, Lai-Kwon JE, Guo C, Tunariu N, Parker T, Prout T, Parmar M, Turner AJ, Finneran L, Hall E, Pachter JA, Denis LJ, Spicer JF, Banerji U. Phase I trial of the RAF/MEK clamp VS-6766 in combination with everolimus using an intermittent schedule with expansion in NSCLC across multiple KRAS variants. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9018 Background: VS-6766 is a small molecule RAF/MEK clamp that results in the reduction of p-MEK and p-ERK. Preclinical data show synergy of VS-6766 with the mTOR inhibitor everolimus across a panel of KRAS mutated (mt) NSCLC cell lines. This clinical trial evaluated the safety and efficacy of a novel intermittent regimen of VS-6766 and everolimus with an expansion in KRAS mt NSCLC (NCT02407509). Methods: The trial used a 3+3 dose escalation design with an intermittent once a week schedule A, and if tolerated, twice a week schedule B (Mon-Thu or Tue-Fri) for both drugs on a 3 weeks on/1 week off, 28 day cycle. Patients with RAS or RAF mt cancers were eligible for the dose escalation cohort, and 20 patients with KRAS mt NSCLC will be treated in the dose expansion cohort. Toxicity was evaluated by NCI CTC V4 and efficacy was evaluated using RECIST 1.1. Results: A total of 28 patients have been treated; median age 60 yrs (range 36-78), and median lines of previous treatment 3 (range 0-7). Sixteen patients have been treated in the dose escalation (3 in schedule A and 13 in the schedule B). The doses of 4 mg of VS-6766 and 5 mg everolimus (once weekly) were tolerated with no dose limiting toxicities (DLTs) and the dose intensity escalated to schedule B (twice weekly). At 4 mg VS-6766 twice weekly, DLTs were observed in two out of six patients and included grade 4 CPK elevation and grade 3 rash. Thus, the dose in schedule B (twice weekly) was de-escalated to 3.2 mg VS-6766 and the dose of everolimus was kept at 5 mg. No DLTs were reported in 6 patients and thus this was declared as the recommended phase 2 dose (RP2D). At the RP2D, the grade 3-4 drug related AE were rash (18%) and pruritus (7%). In the dose escalation cohorts, 3 partial responses (PRs) were reported (2 KRAS G12D low grade serous ovarian cancer and 1 NRAS Q61K mt thyroid cancer). In the KRAS mt NSCLC expansion cohort, 10 patients are evaluable for efficacy and 2 confirmed responses were reported ( KRAS mutations G12V and G13A) with an objective response rate (ORR) 20% to date. The disease control rate (PR + SD) at the first scheduled evaluation was 90%. The median progression free survival (PFS) in the KRAS mt NSCLC cohort is 6.35 months (95% CI 3.52 – not reached). Updated ORR and PFS data will be presented. Conclusions: A tolerable intermittent dosing schedule targeting both the MAPK and PI3K pathways has been established. The combination of VS-6766 with everolimus has shown activity in patients with a variety of KRAS mutation variants including responses in KRAS mt NSCLC.
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Affiliation(s)
- Anna Rachel Minchom
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Vicky Sanchez Perez
- The Institute of Cancer Research and Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Cienne Morton
- Guy's and St Thomas'NHS Foundation Trust, London, United Kingdom
| | - Thubeena Manickavasagar
- The Institute of Cancer Research and Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - George Nintos
- Guy's and St Thomas'NHS Foundation Trust, London, United Kingdom
| | - Julia Elizabeth Lai-Kwon
- The Institute of Cancer Research and Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Christina Guo
- The Institute of Cancer Research and Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Nina Tunariu
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Tom Parker
- The Institute of Cancer Research, London, United Kingdom
| | - Toby Prout
- The Institute of Cancer Research, London, United Kingdom
| | - Mona Parmar
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Udai Banerji
- Drug Development Unit, The Institute of Cancer Research, London, United Kingdom
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Sarker D, Banerji U, Blagden SP, Cook N, Evans TJ, Plummer ER, Braun M, Cleverly A, Diaz N, Jones P, Matthews I, Glatt S. A multi-modular phase I/II study of UCB6114, a first-in-class, fully human IgG4P anti-Gremlin-1 monoclonal antibody, as monotherapy and in combination with mFOLFOX6 or trifluridine/tipiracil, for patients with advanced gastrointestinal (GI) tumors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.tps221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS221 Background: Despite recent advances, effective treatment for GI cancers remains a significant unmet medical need. Gremlin-1 is secreted by the peri-tumoral stroma and down-regulates bone morphogenetic proteins (BMP) -2, -4, and -7 (members of the transforming growth factor-β superfamily), thereby allowing malignant cell expansion, renewal, and a more treatment-resistant mesenchymal phenotype. Gremlin-1 mRNA is highly expressed in multiple solid tumors including >60% of colorectal, pancreatic and esophageal cancers. UCB6114 is a first-in-class, fully human IgG4P monoclonal antibody optimized for neutralizing the activity of human Gremlin-1 thereby restoring BMP signaling. Preclinical studies have demonstrated that UCB6114 binds to Gremlin-1, inhibits its pharmacological activity, and has antitumor activity in several in vivo mouse models (including several GI cancers). Methods: ONC001 (clinicaltrials.gov: NCT04393298) is an ongoing multi-part, multicenter, nonrandomized, open-label, Phase I/II study evaluating the safety, pharmacokinetics (PK) and antitumor activity of UCB6114 administered intravenously as monotherapy or in combination with selected standard of care (SOC) regimens. Eligible patients (pts) are: aged ≥18 years; resistant or refractory to standard therapy; ECOG performance status 0/1; and have adequate renal, hepatic and bone marrow function. In the Phase I monotherapy dose escalation and adaption part (part A and A1; modified rolling 6 design), up to 66 pts with advanced solid tumors associated with high levels of Gremlin-1 mRNA expression will be recruited. In parts B and C (modified toxicity probability interval design), up to 54 pts with locally advanced or metastatic colorectal, gastric or gastroesophageal junction adenocarcinomas will receive UCB6114 in escalating doses in combination with either mFOLFOX6 (5-fluorouracil, leucovorin and oxaliplatin) or trifluridine/tipiracil, given at SOC dosing and schedules. The overarching objective of the phase I parts of the study (Parts A‒C) is to identify the recommended phase II dose of UCB6114 either as monotherapy or in combination. The primary objective is to characterize the safety profile of UCB6114; secondary and exploratory objectives include PK, antitumor activity (RECIST v1.1), and pharmacodynamics (including circulating Gremlin-1). Enrollment in ONC001 began in July 2020; as of Sept 2021, four dose escalation levels in the monotherapy dose-escalation module (Part A) have been completed without DLT. Recruitment to parts B and C is due to commence in Q4 2021. Clinical trial information: NCT04393298.
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Affiliation(s)
| | - Udai Banerji
- Drug Development Unit, The Institute of Cancer Research, London, United Kingdom
| | | | - Natalie Cook
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - T.R. Jeffry Evans
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
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22
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Manickavasagar T, Stavraka C, Anam K, Coma S, Chowdhury S, Pachter JA, Parker T, Parmar M, Finneran L, Hall E, Spicer J, Minchom A, Banerji U. Abstract P036: Trial in progress: Combination of the dual RAF/MEK inhibitor VS-6766 with the mTOR inhibitor everolimus with expansion in patients with KRAS mutant NSCLC. Mol Cancer Ther 2021. [DOI: 10.1158/1535-7163.targ-21-p036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The RAS/RAF/MEK/ERK (MAPK) pathway is a frequently deregulated oncogenic pathway in cancer driven by RAS and RAF mutations as well as being a key signaling pathway downstream of deregulated receptor tyrosine kinases. Although RAF and MEK have been validated as anticancer targets and several BRAF and MEK inhibitors are FDA approved, acquired resistance develops in most patients. Preclinically, inhibition of RAF or MEK has been found to activate AKT/mTOR signaling as a potential resistance mechanism, and combination of MEK inhibition with an inhibitor of the AKT/mTOR pathway yields improved anti-tumor activity. However, combined inhibition of MEK with an AKT or mTOR inhibitor has typically shown poor clinical tolerability. VS-6766 is a unique dual RAF/MEK inhibitor which blocks MEK activity without the compensatory MEK activation that limits the efficacy of other MEK inhibitors. VS-6766 has shown clinical responses as a single agent in gynecological cancers and KRAS mutant non-small cell lung cancer (NSCLC) (Guo Lancet Oncology 2020), and has shown clinical responses in combination with the focal adhesion kinase (FAK) inhibitor defactinib in patients with low-grade serous ovarian cancer and KRAS mutated NSCLC. To explore the combination of VS-6766 with blockade of the AKT/mTOR pathway, we tested the combination of VS-6766 with the mTOR inhibitor everolimus for potential synergy across a variety of RAS pathway mutations and tumor types in preclinical experiments. In 3D proliferation assays in vitro, VS-6766 was synergistic with everolimus in reducing viability of cell lines representing multiple MAPK pathway alterations, including KRAS (G12C, G12D, G12V and G13D), BRAF V600E, NRAS and NF1 mutations. Synergy of VS-6766 with everolimus was observed in 8/9 NSCLC, 16/20 colorectal cancer, 7/10 melanoma and 5/7 pancreatic cancer cell lines tested. These preclinical data support testing the combination of VS-6766 with everolimus in patients with KRAS mutant NSCLC as well as in numerous other cancer indications with various MAPK pathway alterations. A phase I study is ongoing to assess the combination of VS-6766 with everolimus with an intermittent dosing schedule. The clinical trial uses a rule-based design of 3+3 dose escalation cohorts, initially with once weekly dosing of VS-6766 in combination with everolimus. If this was found to be tolerable, the combination of twice weekly dosing of both compounds was to be explored. Following establishment of the recommended phase 2 dose (RP2D) for the combination, an expansion cohort (n = 10) in patients with KRAS mutant NSCLC was planned. The trial is currently recruiting into an expansion cohort of patients with KRAS mutated NSCLC ;NCT02407509, (Trial in Progress).
Citation Format: Thubeena Manickavasagar, Chara Stavraka, Kaiser Anam, Silvia Coma, Sanjib Chowdhury, Jonathan A. Pachter, Tom Parker, Mona Parmar, Laura Finneran, Emma Hall, James Spicer, Anna Minchom, Udai Banerji. Trial in progress: Combination of the dual RAF/MEK inhibitor VS-6766 with the mTOR inhibitor everolimus with expansion in patients with KRAS mutant NSCLC [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P036.
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Affiliation(s)
- Thubeena Manickavasagar
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
| | - Chara Stavraka
- 2King's College London, Guy's Hospital, London, United Kingdom,
| | - Kaiser Anam
- 2King's College London, Guy's Hospital, London, United Kingdom,
| | | | | | | | - Tom Parker
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
| | - Mona Parmar
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
| | - Laura Finneran
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
| | - Emma Hall
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
| | - James Spicer
- 2King's College London, Guy's Hospital, London, United Kingdom,
| | - Anna Minchom
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
| | - Udai Banerji
- 1The Institute of Cancer Research and The Royal Marsden Hospital NHS Trust, London, United Kingdom,
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Tiu C, Shinde R, Pal A, Biondo A, Lee A, Tunariu N, Jhanji S, Grover V, Tatham K, Gruber P, Banerji U, De Bono JS, Nicholson E, Minchom AR, Lopez JS. A Wolf in Sheep's Clothing: Systemic Immune Activation Post Immunotherapy. Journal of Immunotherapy and Precision Oncology 2021; 4:189-195. [PMID: 35665022 PMCID: PMC9138480 DOI: 10.36401/jipo-21-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/25/2022]
Abstract
Introduction Immune checkpoint inhibitors (ICIs) are increasingly a standard of care for many cancers; these agents can result in immune-related adverse events (irAEs) including fever, which is common but can rarely be associated with systemic immune activation (SIA or acquired HLH). Methods All consecutive patients receiving ICIs in the Drug Development Unit of the Royal Marsden Hospital between May 2014 and November 2019 were retrospectively reviewed. Patients with fever ≥ 38°C or chills/rigors (without fever) ≤ 6 weeks of commencing ICIs were identified for clinical data collection. Results Three patients met diagnostic criteria for SIA/HLH with median time to onset of symptoms of 10 days. We describe the clinical evolution, treatment used, and outcomes for these patients. High-dose steroids are used first-line with other treatments, such as tocilizumab, immunoglobulin and therapeutic plasmapheresis can be considered for steroid-refractory SIA/HLH. Conclusion SIA/HLH post ICI is a rare but a potentially fatal irAE that presents with fever and a constellation of nonspecific symptoms. Early recognition and timely treatment are key to improving outcomes.
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Affiliation(s)
- Crescens Tiu
- Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Rajiv Shinde
- Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Abhijit Pal
- Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Andrea Biondo
- Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Alex Lee
- Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Nina Tunariu
- Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Shaman Jhanji
- Critical Care Unit, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Vimal Grover
- Critical Care Unit, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Kate Tatham
- Critical Care Unit, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Pascale Gruber
- Critical Care Unit, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Udai Banerji
- Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Johann S. De Bono
- Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Emma Nicholson
- Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Anna R. Minchom
- Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Juanita S. Lopez
- Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
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Tiu C, Welsh L, Jones T, Zachariou A, Prout T, Turner A, Daly R, Tunariu N, Riisnaes R, Gurel B, Crespo M, Carreira S, Vivanco I, Jenkins B, Yap C, Minchom A, Banerji U, deBono J, Lopez J. Preliminary evidence of antitumour activity of Ipatasertib (Ipat) and Atezolizumab (ATZ) in glioblastoma patients (pts) with PTEN loss from the Phase 1 Ice-CAP trial (NCT03673787). Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab195.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Despite improved understanding of effector T-cell trafficking into the central nervous system, initial trials with anti-PD1/PD-L1 immune checkpoint inhibitors (ICIs) have failed to meet their primary endpoints. PTEN loss of function is frequent in GBM and has been correlated with not only poor overall prognosis, but also impaired antitumour responses, including reduced T cell infiltration into tumour and reduced efficacy of ICIs.
Ipatasertib is a novel, potent, selective, small-molecule inhibitor of Akt. We have shown that Ipatasertib efficiently depletes FOXP3+ regulatory T cells from the tumour microenvironment (TME) resulting in increased infiltration of effector T cells in solid tumours (Lopez 2020, AACR).
We hypothesize that the use of AKT inhibition in PTEN glioblastomas may deplete the TME of suppressive immune cells, and render malignant brain tumours more responsive to ICIs. We present updated data for the combination of Ipat+ATZ in patients with glioblastoma.
Method
Patients with relapsed WHO grade IV GBM with stable neurological symptoms ≥5 days prior to enrolment, requiring <3mg Dexamethasone were recruited into two cohorts of this early phase, open-label, single-centre trial studying the combination of Ipatasertib (Ipat) and Atezolizumab (ATZ): a dose finding cohort (A2; n=9) and an expansion cohort (B3; n=7, recruitment ongoing).
The Ice-CAP A2 cohort assessed safety, pharmacodynamic, and preliminary clinical activity of Ipat (200mg or 400mg OD) + ATZ (1200mg Q3W) in pts with potentially resectable relapsed WHO Grade IV GBM. Pts had a 14-21-day run-in phase of Ipat then surgical tumour resection. Combination Ipat+ATZ commenced post surgery. Patients who declined surgery or who were deemed high risk for surgery proceeded directly to combination.
Patients in the expansion cohort B3 commenced directly on Ipat+ATZ at the RP2D of 400mg Ipat with ATZ.
Results
16 evaluable recurrent GBM pts were enrolled across two cohorts. Median age 56 yrs (25-71 yrs). Median ECOG PS 1. Median lines of prior therapy 1 (range 1-4). 10 pts had PTEN loss by IHC (H<30) and/or PTEN mutations on next generation sequencing.
No DLTs, treatment-related (TR) serious adverse events (AEs), or immune-related AEs were observed. Most common TR AEs were G1 diarrhoea (44%), mucositis (17%), rash (28%).
Clinical benefit rate (CR, PR and SD> 6 cycles) at clinical cutoff date (23/02/21) in patients with PTEN aberration was 30% (3/10). A 58-year-old man with PTEN loss had MRI at Cycle 5 showing worsening enhancement suggestive of disease progression. Resection of the lesion showed intense lymphocyte infiltration and pathological CR. He is currently on Cycle 22 with no evidence of disease. Two other patients with PTEN loss with radiological stable disease per RANO criteria remain well on study for >6 cycles.
Conclusion
Combination Ipat+ATZ appears safe and tolerable in GBM pts, with 400mg Ipatasertib OD + 1200mg ATZ Q3W declared as RP2D. Early efficacy signals were detected with PTEN loss being a promising predictive biomarker for response to combination. An expansion cohort enriched with pts with PTEN loss is ongoing.
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Affiliation(s)
- Crescens Tiu
- Royal Marsden Hospital
- Institute of Cancer Research, Royal Marsden Hospital
| | | | - Timothy Jones
- St George’s University Hospital NHS Foundation Trust
| | | | - Toby Prout
- Institute of Cancer Research, Royal Marsden Hospital
| | - Alison Turner
- Institute of Cancer Research, Royal Marsden Hospital
| | - Rob Daly
- Institute of Cancer Research, Royal Marsden Hospital
| | - Nina Tunariu
- Royal Marsden Hospital
- Institute of Cancer Research, Royal Marsden Hospital
| | - Ruth Riisnaes
- Institute of Cancer Research, Royal Marsden Hospital
| | - Bora Gurel
- Institute of Cancer Research, Royal Marsden Hospital
| | - Mateus Crespo
- Institute of Cancer Research, Royal Marsden Hospital
| | | | - Igor Vivanco
- Institute of Cancer Research, Royal Marsden Hospital
| | - Ben Jenkins
- Institute of Cancer Research, Royal Marsden Hospital
| | - Christina Yap
- Institute of Cancer Research, Royal Marsden Hospital
| | - Anna Minchom
- Royal Marsden Hospital
- Institute of Cancer Research, Royal Marsden Hospital
| | - Udai Banerji
- Royal Marsden Hospital
- Institute of Cancer Research, Royal Marsden Hospital
| | - Johann deBono
- Royal Marsden Hospital
- Institute of Cancer Research, Royal Marsden Hospital
| | - Juanita Lopez
- Royal Marsden Hospital
- Institute of Cancer Research, Royal Marsden Hospital
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Georgiou A, Stewart A, Vlachogiannis G, Pickard L, Valeri N, Cunningham D, Whittaker SR, Banerji U. A phospho-proteomic study of cetuximab resistance in KRAS/NRAS/BRAF V600 wild-type colorectal cancer. Cell Oncol (Dordr) 2021; 44:1197-1206. [PMID: 34462871 PMCID: PMC8516765 DOI: 10.1007/s13402-021-00628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE We hypothesised that plasticity in signal transduction may be a mechanism of drug resistance and tested this hypothesis in the setting of cetuximab resistance in patients with KRAS/NRAS/BRAFV600 wild-type colorectal cancer (CRC). METHODS A multiplex antibody-based platform was used to study simultaneous changes in signal transduction of 55 phospho-proteins in 12 KRAS/NRAS/BRAFV600 wild-type CRC cell lines (6 cetuximab sensitive versus 6 cetuximab resistant) following 1 and 4 h in vitro cetuximab exposure. We validated our results in CRC patient samples (n = 4) using ex vivo exposure to cetuximab in KRAS/NRAS/BRAFV600 cells that were immunomagnetically separated from the serous effusions of patients with known cetuximab resistance. RESULTS Differences in levels of phospho-proteins in cetuximab sensitive and resistant cell lines included reductions in phospho-RPS6 and phospho-PRAS40 in cetuximab sensitive, but not cetuximab resistant cell lines at 1 and 4 h, respectively. In addition, phospho-AKT levels were found to be elevated in 3/4 patient samples following ex vivo incubation with cetuximab for 1 h. We further explored these findings by studying the effects of combinations of cetuximab and two PI3K pathway inhibitors in 3 cetuximab resistant cell lines. The addition of PI3K pathway inhibitors to cetuximab led to a significantly higher reduction in colony formation capacity compared to cetuximab alone. CONCLUSION Our findings suggest activation of the PI3K pathway as a mechanism of cetuximab resistance in KRAS/NRAS/BRAFV600 wild-type CRC.
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Affiliation(s)
- Alexandros Georgiou
- Division of Cancer Therapeutics, The Institute of Cancer Research, Sycamore House, Downs Road, London, SM2 5PT, UK.
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sycamore House, Downs Road, London, SM2 5PT, UK.
| | - Adam Stewart
- Division of Cancer Therapeutics, The Institute of Cancer Research, Sycamore House, Downs Road, London, SM2 5PT, UK
| | - Georgios Vlachogiannis
- Division of Molecular Pathology, The Institute of Cancer Research, Sycamore House, Downs Road, London, SM2 5PT, UK
| | - Lisa Pickard
- Division of Cancer Therapeutics, The Institute of Cancer Research, Sycamore House, Downs Road, London, SM2 5PT, UK
| | - Nicola Valeri
- Division of Molecular Pathology, The Institute of Cancer Research, Sycamore House, Downs Road, London, SM2 5PT, UK
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sycamore House, Downs Road, London, SM2 5PT, UK
| | - David Cunningham
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sycamore House, Downs Road, London, SM2 5PT, UK
| | - Steven R Whittaker
- Division of Cancer Therapeutics, The Institute of Cancer Research, Sycamore House, Downs Road, London, SM2 5PT, UK
| | - Udai Banerji
- Division of Cancer Therapeutics, The Institute of Cancer Research, Sycamore House, Downs Road, London, SM2 5PT, UK.
- Division of Clinical Studies, The Institute of Cancer Research, Sycamore House, Downs Road, London, SM2 5PT, UK.
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Coma S, Chowdhury S, Musteanu M, Stewart A, Pickard L, Krebs M, Minchom A, Banerji U, Barbacid M, Pachter J. P52.05 Dual RAF/MEK Inhibitor VS-6766 for Treatment of KRAS Mutant NSCLC: Novel Combinations Targeting G12C or G12V Variants. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pal A, Stapleton S, Yap C, Lai-Kwon J, Daly R, Magkos D, Baikady BR, Minchom A, Banerji U, De Bono J, Karikios D, Boyle F, Lopez J. Study protocol for a randomised controlled trial of enhanced informed consent compared to standard informed consent to improve patient understanding of early phase oncology clinical trials (CONSENT). BMJ Open 2021; 11:e049217. [PMID: 34489282 PMCID: PMC8422487 DOI: 10.1136/bmjopen-2021-049217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Early phase cancer clinical trials have become increasingly complicated in terms of patient selection and trial procedures-this is reflected in the increasing length of participant information sheets (PIS). Informed consent for early phase clinical trials has been contentious due to the potential ethical issues associated with performing experimental research on a terminally ill population which has exhausted standard treatment options. Empirical studies have demonstrated significant gaps in patient understanding regarding the nature and intent of these trials. This study aims to test whether enhanced informed consent for patient education can improve patient scores on a validated questionnaire testing clinical trial comprehension. METHODS AND ANALYSIS This is a randomised controlled trial that will allocate patients who are eligible to participate in one of four investigator-initiated clinical trials at the Royal Marsden Drug Development Unit to either a standard arm or an experimental arm, stratified by age and educational level. The standard arm will involve the full length trial PIS, followed by electronic or paper administration of the Quality of Informed Consent Questionnaire Parts A and B (QuIC-A and QuIC-B). The experimental arm will involve the full length trial PIS, exposure to a two-page study aid and 10 online educational videos, followed by administration of the QuIC-A and QuIC-B. The primary endpoint will be the difference (using a one-sided two-sample t-test) in the QuIC-A score, which measures objective understanding, between the standard and experimental arm. Accrual target is at least 17 patients per arm to detect an 8 point difference (80% power, alpha 0.05). ETHICS AND DISSEMINATION Ethics approval was granted by the National Health Service Health Research Authority on 15 June 2020-IRAS Project ID 277065, Protocol Number CCR5165, REC Reference 20/EE/0155. Results will be disseminated via publication in a relevant journal. TRIAL REGISTRATION NUMBER NCT04407676; Pre-results.
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Affiliation(s)
- Abhijit Pal
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
- The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Stapleton
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Christina Yap
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK
| | - Julia Lai-Kwon
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Robert Daly
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Dimitrios Magkos
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Bindumalini Rao Baikady
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Anna Minchom
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Udai Banerji
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Johann De Bono
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
| | - Deme Karikios
- The University of Sydney, Sydney, New South Wales, Australia
| | - Frances Boyle
- The University of Sydney, Sydney, New South Wales, Australia
| | - Juanita Lopez
- Institute of Cancer Research, London, UK
- Drug Development Unit, Royal Marsden Hospital Sutton, London, UK
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Banerjee S, Grochot R, Shinde R, Lima J, Krebs M, Rahman R, Little M, Tunariu N, Curcean A, Badham H, Mahmud M, Turner A, Parmar M, Yap C, Minchom A, Lopez J, de Bono J, Banerji U. 725MO Phase I study of the combination of the dual RAF/MEK inhibitor VS-6766 and the FAK inhibitor defactinib: Results of efficacy in low grade serous ovarian cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Krebs MG, Shinde R, Rahman RA, Grochot R, Little M, King J, Kitchin J, Parmar M, Turner A, Mahmud M, Yap C, Tunariu N, Lopez J, De Bono JS, Banerji U, Minchom A. Abstract CT019: A phase I trial of the combination of the dual RAF-MEK inhibitor VS-6766 and the FAK inhibitor defactinib: Evaluation of efficacy in KRAS mutated NSCLC. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
KRAS is a known oncogenic driver in non-small cell lung cancer (NSCLC), with KRAS G12C and G12V mutations occurring in ~13% and ~7% of the of NSCLC ( adenocarcinoma subtype). The dual RAF-MEK inhibitor VS-6766 has shown single agent activity against G12V KRAS mutated NSCLC (Guo C et al Lancet Oncology 2020, 21:1478-88). Based on pre-clinical data, we hypothesised that augmented focal adhesion kinase (FAK) signalling is a mechanism of resistance to MEK inhibition and devised the current clinical trial. We have previously reported the safety of an intermittent schedule of the combination of VS-6766 and the FAK inhibitor defactinib and its efficacy in low grade serous ovarian cancer (Shinde et al., AACR 2020). We now report the activity of the combination in KRAS mutated NSCLC.
Methods
Patients were treated with an intermittent dose of drugs VS-6766 at 3.2 - 4 mg twice a week and defactinib 200 mg twice daily in the dose escalation and expansion cohorts of the study. Both drugs were administered three weeks on/one week off in 28-day cycles. We aim to recruit 20 patients with KRAS mutated NSCLC in an expansion cohort.
Results
To date, 19 patients with KRAS mutated NSCLC have been treated in the dose escalation and expansion cohorts. All patients had been previously treatment with a PD-1 or PDL-1 targeting immune checkpoint inhibitor. The median age was 64 years (22 - 73), M/F ratio was 7/12, and the median prior lines of treatment was 3. Currently, 17 of 19 patients have had at least one re-staging assessment, 2/17 (12%) patients had a partial response and 10/17 (59%) had stable disease as their best response. Of note, 11/17 (65%) patients had a degree of reduction in size of their tumours and 5/17 (29%) have been treated for 6 months or more with 3 patients still on treatment. Interestingly, 2/2 (100%) of the KRAS G12V NSCLC patients showed a partial response.
Conclusions
Developing new treatments for non-G12C KRAS mutated NSCLC is an area of unmet need. The combination of VS-6766 and defactinib treatment in cohorts of patients with NSCLC pre-treated with chemotherapy and immunotherapy has shown anti-tumour activity in subsets of patients with KRAS mutated NSCLC, in particular those with tumours harbouring KRAS G12V mutations. A registration-directed study evaluating VS-6766 ± defactinib for treatment of recurrent NSCLC with KRAS G12V mutation (NCT04620330) has been initiated
Citation Format: Matthew G. Krebs, Rajiv Shinde, Rozana Abdul Rahman, Rafael Grochot, Martin Little, Jenny King, Joseph Kitchin, Mona Parmar, Alison Turner, Muneeb Mahmud, Christina Yap, Nina Tunariu, Juanita Lopez, Johann S. De Bono, Udai Banerji, Anna Minchom. A phase I trial of the combination of the dual RAF-MEK inhibitor VS-6766 and the FAK inhibitor defactinib: Evaluation of efficacy in KRAS mutated NSCLC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT019.
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Affiliation(s)
- Matthew G. Krebs
- 1The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | - Rajiv Shinde
- 2The Royal Marsden Hospital, Sutton, United Kingdom
| | - Rozana Abdul Rahman
- 1The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | | | - Martin Little
- 1The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | - Jenny King
- 3The Institute of Cancer Research, Sutton, United Kingdom
| | - Joseph Kitchin
- 3The Institute of Cancer Research, Sutton, United Kingdom
| | - Mona Parmar
- 4The Institute of Cancer Research, London, United Kingdom
| | - Alison Turner
- 4The Institute of Cancer Research, London, United Kingdom
| | - Muneeb Mahmud
- 4The Institute of Cancer Research, London, United Kingdom
| | - Christina Yap
- 4The Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- 5Royal Marsden Hospital/The Institute of Cancer Research, London, United Kingdom
| | - Juanita Lopez
- 3The Institute of Cancer Research, Sutton, United Kingdom
| | | | - Udai Banerji
- 3The Institute of Cancer Research, Sutton, United Kingdom
| | - Anna Minchom
- 3The Institute of Cancer Research, Sutton, United Kingdom
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Tiu C, Biondo A, Welsh LC, Jones TL, Zachariou A, Prout T, Turner AJ, Daly R, Vivanco I, Yap C, Jenkins B, Crespo M, Riisnaes R, Carreira S, Gurel B, Tunariu N, Minchom A, Banerji U, de Bono JS, Lopez JS. Abstract CT120: Results of the glioblastoma multiforme (GBM) cohort of phase 1 trial Ice-CAP (NCT03673787): Preliminary evidence of antitumour activity of Ipatasertib (Ipa) and Atezolizumab (A) in patients (pts) with PTEN loss. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Hyperactivation of the PI3K/AKT pathway correlates with impaired antitumour response, including reduced T cell infiltration into tumour and reduced efficacy of immune checkpoint inhibitors (ICIs). PTEN loss of function, often observed in GBM, may contribute to refractoriness of ICIs in this disease. Methods: The Ice-CAP A2 cohort assessed safety, pharmacodynamic, and preliminary clinical activity of Ipa (200mg or 400mg OD) + A (1200mg Q3W) in pts with potentially resectable relapsed WHO Grade IV GBM. Key inclusion criteria were stable neurological symptoms ≥5 days prior to enrolment, steroid requirement <3mg Dexamethasone. Pts had a 14-21-day run-in phase of Ipa then surgical tumour resection. Combination Ipa+A commenced post surgery. Dose-limiting toxicity (DLT) period included run-in phase to Cycle 1 completion (≤11 wks). Results: 10 evaluable pts were enrolled (3 had Ipa at 200mg, 7 at 400mg); median age 58 (range 25-70y), ECOG score 1; median duration of treatment 8 wks. 2 remain on treatment. No DLTs, treatment-related (TR) serious adverse events (AEs), or immune-related AEs were observed. Most common TR AEs were G1 diarrhoea (60%), mucositis (30%), rash (20%). 7 pts had PTEN loss and/or PTEN mutations. Clinical benefit rate in pts with PTEN aberration was 2/7 (29%): 1 pCR and 1 SD >12wks, both on 400mg Ipa. A 58-year-old man with PTEN loss had MRI at Cycle 5 showing worsening enhancement suggestive of disease progression. Resection of the lesion showed intense lymphocyte infiltration and pathological CR. He is currently on Cycle 18 with no evidence of disease.
Conclusion: Combination Ipa+A appears safe and tolerable in GBM pts, with 400mg Ipa OD + 1200mg A Q3W declared as RP2D. PTEN loss may be a promising predictive biomarker for response to combination. An expansion cohort enriched with pts with PTEN loss is ongoing. Cytokine and FACS data will be presented at AACR
Table 1.Clinical Benefit Rate of glioblastoma patients stratified according to PTEN aberrationsPTEN statusnBest responseClinical Benefit RatePTEN loss on IHC (H<30)51 pCRa2/7 (29%)1 SD >12 wks, ongoingb3 PDPTEN aberration on NGS but PTEN protein expression pending11 PDcPTEN loss of heterozygozity on PCR11 PDWild type PTEN on NGS or IHC (H≥30)33 PDLegend: IHC = immunohistochemistry; NGS = next generation sequencing; PCR = polymerase chain reaction;pCR = pathologic complete response; SD = stable disease; PD = progressive diseaseaExceptional responder with PTEN H=5 on IHC and splice site 75_79+2delGACCTGT on NGSb PTENY68*; c PTENQ298*
Citation Format: Crescens Tiu, Andrea Biondo, Liam C. Welsh, Timothy L. Jones, Anna Zachariou, Toby Prout, Alison J. Turner, Robert Daly, Igor Vivanco, Christina Yap, Ben Jenkins, Mateus Crespo, Ruth Riisnaes, Suzanne Carreira, Bora Gurel, Nina Tunariu, Anna Minchom, Udai Banerji, Johann S. de Bono, Juanita S. Lopez. Results of the glioblastoma multiforme (GBM) cohort of phase 1 trial Ice-CAP (NCT03673787): Preliminary evidence of antitumour activity of Ipatasertib (Ipa) and Atezolizumab (A) in patients (pts) with PTEN loss [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT120.
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Affiliation(s)
- Crescens Tiu
- 1Royal Marsden NHS Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Andrea Biondo
- 1Royal Marsden NHS Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Liam C. Welsh
- 2Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | | | - Toby Prout
- 4Institute of Cancer Research, Sutton, United Kingdom
| | | | - Robert Daly
- 4Institute of Cancer Research, Sutton, United Kingdom
| | - Igor Vivanco
- 4Institute of Cancer Research, Sutton, United Kingdom
| | - Christina Yap
- 4Institute of Cancer Research, Sutton, United Kingdom
| | - Ben Jenkins
- 4Institute of Cancer Research, Sutton, United Kingdom
| | - Mateus Crespo
- 4Institute of Cancer Research, Sutton, United Kingdom
| | - Ruth Riisnaes
- 4Institute of Cancer Research, Sutton, United Kingdom
| | | | - Bora Gurel
- 4Institute of Cancer Research, Sutton, United Kingdom
| | - Nina Tunariu
- 1Royal Marsden NHS Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Anna Minchom
- 1Royal Marsden NHS Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Udai Banerji
- 1Royal Marsden NHS Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Johann S. de Bono
- 5Royal Marsden NHS Trust and Institute of Cancer Research, London, United Kingdom
| | - Juanita S. Lopez
- 1Royal Marsden NHS Trust and Institute of Cancer Research, Sutton, United Kingdom
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Banerji U, Tiu CD, Curcean A, Gurung S, O'Leary M, Bush N, Kotopoulis S, Healey A, Kvåle S, Hilary McElwaine-Johnn H, Bamber J, Miller R, Sontum P, Arbe-Barnes S, Tunariu N. Phase I trial of acoustic cluster therapy (ACT) with chemotherapy in patients with liver metastases of gastrointestinal origin (ACTIVATE study). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps3145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3145 Background: Response to existing chemotherapeutics (chemo) can be limited by exposure, itself limited by systemic toxicity. Interstitial fluid pressure can impede transport of drugs with, in some cases, <5% of systemic chemo penetrating the target tumour. ACT is an innovative platform technology using sonopermeation to induce ultrasound (US) mediated targeting of therapeutic agent of choice by co-administration of an emulsion of microbubble-microdroplet clusters (PS101) for intravenous injection. Dual-frequency US is applied to tumor tissue to concentrate the drug through expansion and oscillation of the clusters, increasing tumoral penetration. Early pre-clinical models of ACT indicate significant increase in uptake of co-administered product at the US targeted site and have demonstrated enhanced efficacy outcomes with co-administered ACT across a range of cancer models. All studies showed significant benefit in disease response and tumour regression/inhibition versus drug alone. The combination of US, microbubbles and chemo has been shown to be feasible in a clinical setting using commercially available equipment with no additional toxicities. This first in human study will primarily investigate the safety and tolerability of PS101 in combination with chemo together with any differential response in ACT-treated versus control lesions to identify the phase 2 recommended dose. Methods: This is an open label non-randomised study with central blinded assessment of tumor response. The study comprises two parts: Part 1, a dose escalation in a 3+3 design followed by dose expansion in Part 2. Patients with advanced solid tumors with liver metastases for whom FOLFOX/FOLFIRI is considered an appropriate treatment option are eligible for Part 1 (n=6-12); two separate cohorts of patients with liver metastases, one with metastatic colorectal cancer eligible for 1L or 2L standard of care (SOC) FOLFOX/FOLFIRI (n=25) and one with metastatic pancreatic ductal adenocarcinoma (n= 6) eligible for SOC gemcitabine-nab-paclitaxel will be treated in Part 2. The starting dose of PS101 is 20 µL/kg with a maximum feasible dose of 40 µL/kg. In Part 1, after sentinel administration of PS101 for PK profiling and toxicity assessment, patients receive PS101 (given as i.v. bolus x 3) in combination with FOLFOX or FOLFIRI and US (to one target lesion) in four q2w cycles. The DLT evaluation period comprises the PK-assessment period plus two cycles of ACT plus chemo. Patients receive a further two cycles of ACT and chemo prior to evaluation of tumor lesions by CT/MRI at the Week 8 timepoint. Assessment is made of the target lesion and the pre-defined control lesions outside of the US field. Part 1 has enrolled 5 patients without DLT, with part 2 expected to start in mid-2021. Clinical trial information: NCT04021277.
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Affiliation(s)
- Udai Banerji
- The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | | | - Andra Curcean
- The Institute of Cancer Research, Sutton, United Kingdom
| | - Sumita Gurung
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Mark O'Leary
- The Institute of Cancer Research, Sutton, United Kingdom
| | - Nigel Bush
- The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | | | | | - Jeff Bamber
- The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | | | - Nina Tunariu
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Manickavasagar T, Yuan W, Carreira S, Gurel B, Miranda S, Ferreira A, Crespo M, Riisnaes R, Baker C, O'Brien M, Bhosle J, Popat S, Banerji U, Lopez J, de Bono J, Minchom A. HER3 expression and MEK activation in non-small-cell lung carcinoma. Lung Cancer Manag 2021; 10:LMT48. [PMID: 34084213 PMCID: PMC8162178 DOI: 10.2217/lmt-2020-0031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We explore HER3 expression in lung adenocarcinoma (adeno-NSCLC) and identify potential mechanisms of HER3 expression. Materials & methods: Tumor samples from 45 patients with adeno-NSCLC were analyzed. HER3 and HER2 expression were identified using immunohistochemistry and bioinformatic interrogation of The Cancer Genome Atlas (TCGA). Results: HER3 was highly expressed in 42.2% of cases. ERBB3 copy number did not account for HER3 overexpression. Bioinformatic analysis of TCGA demonstrated that MEK activity score (a surrogate of functional signaling) did not correlate with HER3 ligands. ERBB3 RNA expression levels were significantly correlated with MEK activity after adjusting for EGFR expression. Conclusion: HER3 expression is common and is a potential therapeutic target by virtue of frequent overexpression and functional downstream signaling. HER3 expression is common in adeno-NSCLC and is a potential therapeutic target by virtue of frequent overexpression and functional downstream signaling.
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Affiliation(s)
| | - Wei Yuan
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Suzanne Carreira
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Bora Gurel
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Susana Miranda
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Ana Ferreira
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Mateus Crespo
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Ruth Riisnaes
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Chloe Baker
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Mary O'Brien
- Lung Unit, Royal Marsden Hospital, Sutton, SM2 5PT, UK
| | | | - Sanjay Popat
- Lung Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Udai Banerji
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Juanita Lopez
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Johann de Bono
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Anna Minchom
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK.,Lung Unit, Royal Marsden Hospital, Sutton, SM2 5PT, UK
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Collins DC, Sundar R, Constantinidou A, Dolling D, Yap TA, Popat S, O'Brien ME, Banerji U, de Bono JS, Lopez JS, Tunariu N, Minchom A. Correction to: Radiological evaluation of malignant pleural mesothelioma - defining distant metastatic disease. BMC Cancer 2021; 21:245. [PMID: 33685408 PMCID: PMC7938531 DOI: 10.1186/s12885-021-07999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
| | - Raghav Sundar
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd., Sutton, SM2 5PT, UK
| | - Anastasia Constantinidou
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd., Sutton, SM2 5PT, UK
| | - David Dolling
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd., Sutton, SM2 5PT, UK
| | - Timothy Anthony Yap
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd., Sutton, SM2 5PT, UK
| | - Sanjay Popat
- Lung Unit, Royal Marsden Hospital, Fulham Rd., London, SW3 6JJ, UK
| | | | - Udai Banerji
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd., Sutton, SM2 5PT, UK
| | - Johann Sebastian de Bono
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd., Sutton, SM2 5PT, UK
| | - Juanita Suzanne Lopez
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd., Sutton, SM2 5PT, UK
| | - Nina Tunariu
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd., Sutton, SM2 5PT, UK
| | - Anna Minchom
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd., Sutton, SM2 5PT, UK.
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Baird R, Oliveira M, Gil EMC, Patel MR, Bermejo de las Heras B, Ruiz-Borrego M, García-Corbacho J, Armstrong A, Banerji U, Twelves C, Boni V, Incorvati J, Kabos P, Cohen AL, de Paula B, Rodríguez MC, Wang JS, Hernando C, Gonzalez AF, Ruiz IV, Lai-Kwon J, Afghani A, Vaklavas C, Brier T, Fox S, Kirova B, Klinowska T, Leach C, Lindemann JPO, Mather R, Maudsley R, Morrow CJ, Sathiyayogan N, Sykes A, Zhang L, Hamilton E. Abstract PS11-05: Updated data from SERENA-1: A Phase 1 dose escalation and expansion study of the next generation oral SERD AZD9833 as a monotherapy and in combination with palbociclib, in women with ER-positive, HER2-negative advanced breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps11-05] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: AZD9833 is an oral selective estrogen receptor (ER) antagonist and degrader (SERD) in Phase 2 clinical development for the treatment of ER+ HER2− breast cancer. Here we report data from Parts C and D of the ongoing Phase 1 study (SERENA-1) examining AZD9833 in combination with palbociclib, together with updated data from Parts A and B examining AZD9833 monotherapy. Methods: SERENA-1 (NCT03616587) is an ongoing open-label Phase 1 study of AZD9833 in pre- and post-menopausal women with ER+, HER2− advanced breast cancer who have previously received ≥1 endocrine therapy and ≤2 prior chemotherapies. Prior treatment with fulvestrant and/or CDK4/6 inhibitors was permitted. The primary objective is to determine the safety and tolerability of once daily (QD) AZD9833, with dose-limiting toxicities (DLTs) in the first 28 days defining the maximum tolerated dose. Secondary objectives include anti-tumor response (including circulating tumor [ct] DNA response) and pharmacokinetics. Parts A (escalation) and B (expansion) assess AZD9833 as a monotherapy, and Parts C (escalation) and D (expansion) assess AZD9833 in combination with palbociclib. Results: At a data cut-off of March 24 2020, 17 patients had received either 150 mg or 300 mg AZD9833 in combination with palbociclib, given according to its product labeling. Eighty patients had received AZD9833 monotherapy at doses of 25, 75, 150, 300, and 450 mg QD. In patients treated with AZD9833 and palbociclib, treatment-related adverse events (AEs; experienced by ≥10% of patients) included visual disturbances*, bradycardia*, asthenia, anemia, QTcF prolongation, nausea, neutropenia, decreased white blood cell count, and vomiting (*combined terms). All instances of AZD9833-related bradycardia were Grade 1. One DLT was observed in the 150 mg cohort: CTCAE Grade 2 visual disturbances, which began on Cycle 1 Day 8 and resolved by Cycle 1 Day 9 following dose interruption. The patient restarted treatment on Cycle 1 Day 15 at 75 mg and continued this dose until data cut-off. No causally related AEs led to discontinuation of AZD9833. The tolerability of AZD9833 with palbociclib was consistent with the observed tolerability profile of AZD9833 monotherapy, and the known tolerability profile of palbociclib. Pharmacokinetic analysis showed similar AZD9833 exposure for monotherapy and palbociclib combination therapy. Similarly, palbociclib exposure was comparable with simulations using a published population pharmacokinetic model. In Part A, ESR1 hotspot mutations were detected in ctDNA at baseline in 26/56 (46%) patients; 13/26 (50%) of these patients achieved a partial response or stable disease at 24 weeks, including 5/10 (50%) with a Y537S ESR1 mutation. Further, in patients with ESR1 mutations and samples available for longitudinal ctDNA analysis, 17/20 (85%) exhibited a reduction or loss of mutant ESR1 on treatment with AZD9833. Efficacy data to be presented include objective response rate and clinical benefit rate at 24 weeks. Of note, unconfirmed partial responses have been observed in Part C after the data cut-off for this abstract. Conclusions: AZD9833 continues to show an encouraging efficacy and dose-dependent safety profile as a monotherapy or in combination with palbociclib. A Phase 2 study comparing the efficacy and safety of three doses of AZD9833 versus fulvestrant (NCT04214288), and a Phase 2 pre-surgical ‘window of opportunity’ study (EUDRA-CT; 2019-003706-2) are ongoing.
Citation Format: Richard Baird, Mafalda Oliveira, Eva Maria Ciruelos Gil, Manish R Patel, Begoña Bermejo de las Heras, Manuel Ruiz-Borrego, Javier García-Corbacho, Anne Armstrong, Udai Banerji, Chris Twelves, Valentina Boni, Jason Incorvati, Peter Kabos, Adam L Cohen, Bruno de Paula, Marta Capelán Rodríguez, Judy S Wang, Christina Hernando, Alejandro Falcón Gonzalez, Ivan Victoria Ruiz, Julia Lai-Kwon, Anosheh Afghani, Christos Vaklavas, Tim Brier, Steven Fox, Bistra Kirova, Teresa Klinowska, Chris Leach, Justin PO Lindemann, Richard Mather, Rhiannon Maudsley, Christopher J Morrow, Nitharsan Sathiyayogan, Andy Sykes, Li Zhang, Erika Hamilton. Updated data from SERENA-1: A Phase 1 dose escalation and expansion study of the next generation oral SERD AZD9833 as a monotherapy and in combination with palbociclib, in women with ER-positive, HER2-negative advanced breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS11-05.
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Affiliation(s)
- Richard Baird
- 1Cancer Research UK, Cambridge Centre, Cambridge, United Kingdom
| | - Mafalda Oliveira
- 2Breast Cancer Center, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Manish R Patel
- 4Florida Cancer Specialists/Sarah Cannon Research Institute/Sarasota Memorial Hospital, Sarasota, FL
| | - Begoña Bermejo de las Heras
- 5Department of Medical Oncology, Hospital Clinico Universitario of Valencia, Biomedical Research Institute (INCLIVA), Valencia, Spain
| | | | | | - Anne Armstrong
- 8The Christie NHS Foundation Trust and the Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Udai Banerji
- 9Drug Development Unit, The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Chris Twelves
- 10St. James’s Hospital and University of Leeds, Leeds, United Kingdom
| | - Valentina Boni
- 11START Madrid, Centro Integral Oncologico Clara Campal (CIOCC), Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Jason Incorvati
- 12Fox Chase Cancer Center, East Norriton-Hospital Outpatient Center, Philadelphia, PA
| | - Peter Kabos
- 13Division of Medical Oncology, University of Colorado, Boulder, CO
| | - Adam L Cohen
- 14Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Bruno de Paula
- 1Cancer Research UK, Cambridge Centre, Cambridge, United Kingdom
| | | | - Judy S Wang
- 4Florida Cancer Specialists/Sarah Cannon Research Institute/Sarasota Memorial Hospital, Sarasota, FL
| | - Christina Hernando
- 5Department of Medical Oncology, Hospital Clinico Universitario of Valencia, Biomedical Research Institute (INCLIVA), Valencia, Spain
| | | | | | - Julia Lai-Kwon
- 8The Christie NHS Foundation Trust and the Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | | | | | - Tim Brier
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Steven Fox
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Bistra Kirova
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Teresa Klinowska
- 18Late Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Chris Leach
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Justin PO Lindemann
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Richard Mather
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Rhiannon Maudsley
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Christopher J Morrow
- 17Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | | | - Andy Sykes
- 19BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Li Zhang
- 19BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Erika Hamilton
- 20Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
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35
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Yap TA, Siu LL, Calvo E, Lolkema MP, LoRusso PM, Soria JC, Plummer R, de Bono JS, Tabernero J, Banerji U. SARS-CoV-2 vaccination and phase 1 cancer clinical trials. Lancet Oncol 2021; 22:298-301. [PMID: 33571468 PMCID: PMC7906739 DOI: 10.1016/s1470-2045(21)00017-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/28/2023]
Affiliation(s)
- Timothy A Yap
- Investigational Cancer Therapeutics (Phase I Program), University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Emiliano Calvo
- Early Phase Clinical Drug Development in Oncology, START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Patricia M LoRusso
- Early Phase Clinical Trials Program, Yale University Medical Center, New Haven, CT, USA
| | - Jean-Charles Soria
- Department of Drug Development, Gustave Roussy Cancer Institute, University Paris Saclay, Villejuif, France
| | - Ruth Plummer
- Northern Institute for Cancer Care, Freeman Hospital and Newcastle University, Newcastle upon Tyne, UK
| | - Johann S de Bono
- The Institute of Cancer Research, London, UK; Royal Marsden NHS Foundation Trust, London, UK
| | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Udai Banerji
- The Institute of Cancer Research, London, UK; Royal Marsden NHS Foundation Trust, London, UK
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Saturno G, Lopes F, Niculescu-Duvaz I, Niculescu-Duvaz D, Zambon A, Davies L, Johnson L, Preece N, Lee R, Viros A, Holovanchuk D, Pedersen M, McLeary R, Lorigan P, Dhomen N, Fisher C, Banerji U, Dean E, Krebs MG, Gore M, Larkin J, Marais R, Springer C. The paradox-breaking panRAF plus SRC family kinase inhibitor, CCT3833, is effective in mutant KRAS-driven cancers. Ann Oncol 2021; 32:269-278. [PMID: 33130216 PMCID: PMC7839839 DOI: 10.1016/j.annonc.2020.10.483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND KRAS is mutated in ∼90% of pancreatic ductal adenocarcinomas, ∼35% of colorectal cancers and ∼20% of non-small-cell lung cancers. There has been recent progress in targeting G12CKRAS specifically, but therapeutic options for other mutant forms of KRAS are limited, largely because the complexity of downstream signaling and feedback mechanisms mean that targeting individual pathway components is ineffective. DESIGN The protein kinases RAF and SRC are validated therapeutic targets in KRAS-mutant pancreatic ductal adenocarcinomas, colorectal cancers and non-small-cell lung cancers and we show that both must be inhibited to block growth of these cancers. We describe CCT3833, a new drug that inhibits both RAF and SRC, which may be effective in KRAS-mutant cancers. RESULTS We show that CCT3833 inhibits RAF and SRC in KRAS-mutant tumors in vitro and in vivo, and that it inhibits tumor growth at well-tolerated doses in mice. CCT3833 has been evaluated in a phase I clinical trial (NCT02437227) and we report here that it significantly prolongs progression-free survival of a patient with a G12VKRAS spindle cell sarcoma who did not respond to a multikinase inhibitor and therefore had limited treatment options. CONCLUSIONS New drug CCT3833 elicits significant preclinical therapeutic efficacy in KRAS-mutant colorectal, lung and pancreatic tumor xenografts, demonstrating a treatment option for several areas of unmet clinical need. Based on these preclinical data and the phase I clinical unconfirmed response in a patient with KRAS-mutant spindle cell sarcoma, CCT3833 requires further evaluation in patients with other KRAS-mutant cancers.
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Affiliation(s)
- G Saturno
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - F Lopes
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - I Niculescu-Duvaz
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - D Niculescu-Duvaz
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - A Zambon
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - L Davies
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - L Johnson
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - N Preece
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - R Lee
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - A Viros
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - D Holovanchuk
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - M Pedersen
- Targeted Therapy Team, the Institute of Cancer Research, London, UK
| | - R McLeary
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - P Lorigan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - N Dhomen
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - C Fisher
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U Banerji
- The Royal Marsden NHS Foundation Trust, London, UK
| | - E Dean
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M G Krebs
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M Gore
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J Larkin
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R Marais
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK.
| | - C Springer
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK.
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Biondo A, Pal A, Riisnaes R, Shinde R, Tiu C, Lockie F, Baker C, Bertan C, Crespo M, Ferreira A, Pereira R, Figueiredo I, Miranda S, Gurel B, Carreira S, Banerji U, de Bono J, Lopez J, Tunariu N, Minchom A. Research Related Tumour Biopsies in Early-Phase Trials with Simultaneous Molecular Characterisation - a Single Unit Experience. Cancer Treat Res Commun 2021; 27:100309. [PMID: 33549985 DOI: 10.1016/j.ctarc.2021.100309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/28/2023]
Abstract
Early-phase cancer clinical trials are becoming increasingly accessible for patients with advanced cancer who have exhausted standard treatment options and later phase trial options. Many of these trials mandate research tissue biopsies. Research biopsies have been perceived as ethically fraught due to the perception of potential coercion of vulnerable human subjects. We performed an audit of two years of practice to assess the safety of ultrasound (US)-guided research biopsies, and to look at the yield of a simultaneous tumour next-generation sequencing (NGS) and immunohistochemistry (IHC) molecular characterisation programme. We show that in our institution, US-guided research biopsies were safe, produced adequate tumour content and in a selected subset who underwent in-house NGS sequencing, showed a high rate of actionable mutations with 30% having a Tier 1 variant. Nevertheless, these research biopsies may only provide direct benefit for a minority of patients and we conclude with a reflection on the importance of obtaining truly informed consent.
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Affiliation(s)
- Andrea Biondo
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Abhijit Pal
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Ruth Riisnaes
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Rajiv Shinde
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Crescens Tiu
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Fran Lockie
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Chloe Baker
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Claudia Bertan
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Mateus Crespo
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Ana Ferreira
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Rita Pereira
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Ines Figueiredo
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Susana Miranda
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Bora Gurel
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Suzanne Carreira
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Udai Banerji
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Johann de Bono
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Juanita Lopez
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Nina Tunariu
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT
| | - Anna Minchom
- Drug Development Unit, Royal Marsden Hospital/The Institute of Cancer Research, Downs Road, Sutton, SM2 5PT.
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38
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Collins DC, Sundar R, Constantinidou A, Dolling D, Yap TA, Popat S, O'Brien ME, Banerji U, de Bono JS, Lopez JS, Tunariu N, Minchom A. Radiological evaluation of malignant pleural mesothelioma - defining distant metastatic disease. BMC Cancer 2020; 20:1210. [PMID: 33298007 PMCID: PMC7724793 DOI: 10.1186/s12885-020-07662-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is traditionally characterized by local destructive spread of the pleura and surrounding tissues. Patient outcomes in MPM with distant metastatic dissemination are lacking. METHODS In this retrospective study, we reviewed a cohort of 164 MPM patients referred to a Phase I trials unit, aiming to describe identified metastatic sites, and correlate with clinical outcomes. RESULTS 67% of patients were diagnosed with distant metastatic disease with a high incidence of bone (19%), visceral (14%), contralateral lung (35%) and peritoneal metastases (22%). Peritoneal metastases were more likely in epithelioid versus biphasic/ sarcomatoid MPM (p = 0.015). Overall survival was 23.8 months with no statistical difference in survival between those with distant metastases and those without. CONCLUSIONS This report highlights the frequency of distant metastases and encourages further radiological investigations in the presence of symptoms. In particular, given the relatively high incidence of bone metastases, bone imaging should be considered in advanced MPM clinical workflow and trial protocols. The presence of distant metastases does not appear to have prognostic implications under existing treatment paradigms. This cohort of MPM patients gives an indication of patterns of metastatic spread that are likely to become prevalent as prognosis improves with emerging treatment paradigms.
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Affiliation(s)
| | - Raghav Sundar
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd, Sutton, SM2 5PT, UK
| | - Anastasia Constantinidou
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd, Sutton, SM2 5PT, UK
| | - David Dolling
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd, Sutton, SM2 5PT, UK
| | - Timothy Anthony Yap
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd, Sutton, SM2 5PT, UK
| | - Sanjay Popat
- Lung Unit, Royal Marsden Hospital, Fulham Rd, London, SW3 6JJ, UK
| | | | - Udai Banerji
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd, Sutton, SM2 5PT, UK
| | - Johann Sebastian de Bono
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd, Sutton, SM2 5PT, UK
| | - Juanita Suzanne Lopez
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd, Sutton, SM2 5PT, UK
| | - Nina Tunariu
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd, Sutton, SM2 5PT, UK
| | - Anna Minchom
- Drug Development Unit, Royal Marsden Hospital/ Institute of Cancer Research, Down Rd, Sutton, SM2 5PT, UK.
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Guo C, Chénard-Poirier M, Roda D, de Miguel M, Harris SJ, Candilejo IM, Sriskandarajah P, Xu W, Scaranti M, Constantinidou A, King J, Parmar M, Turner AJ, Carreira S, Riisnaes R, Finneran L, Hall E, Ishikawa Y, Nakai K, Tunariu N, Basu B, Kaiser M, Lopez JS, Minchom A, de Bono JS, Banerji U. Intermittent schedules of the oral RAF-MEK inhibitor CH5126766/VS-6766 in patients with RAS/RAF-mutant solid tumours and multiple myeloma: a single-centre, open-label, phase 1 dose-escalation and basket dose-expansion study. Lancet Oncol 2020; 21:1478-1488. [PMID: 33128873 DOI: 10.1016/s1470-2045(20)30464-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND CH5126766 (also known as VS-6766, and previously named RO5126766), a novel MEK-pan-RAF inhibitor, has shown antitumour activity across various solid tumours; however, its initial development was limited by toxicity. We aimed to investigate the safety and toxicity profile of intermittent dosing schedules of CH5126766, and the antitumour activity of this drug in patients with solid tumours and multiple myeloma harbouring RAS-RAF-MEK pathway mutations. METHODS We did a single-centre, open-label, phase 1 dose-escalation and basket dose-expansion study at the Royal Marsden National Health Service Foundation Trust (London, UK). Patients were eligible for the study if they were aged 18 years or older, had cancers that were refractory to conventional treatment or for which no conventional therapy existed, and if they had a WHO performance status score of 0 or 1. For the dose-escalation phase, eligible patients had histologically or cytologically confirmed advanced or metastatic solid tumours. For the basket dose-expansion phase, eligible patients had advanced or metastatic solid tumours or multiple myeloma harbouring RAS-RAF-MEK pathway mutations. During the dose-escalation phase, we evaluated three intermittent oral schedules (28-day cycles) in patients with solid tumours: (1) 4·0 mg or 3·2 mg CH5126766 three times per week; (2) 4·0 mg CH5126766 twice per week; and (3) toxicity-guided dose interruption schedule, in which treatment at the recommended phase 2 dose (4·0 mg CH5126766 twice per week) was de-escalated to 3 weeks on followed by 1 week off if patients had prespecified toxic effects (grade 2 or worse diarrhoea, rash, or creatinine phosphokinase elevation). In the basket dose-expansion phase, we evaluated antitumour activity at the recommended phase 2 dose, determined from the dose-escalation phase, in biomarker-selected patients. The primary endpoints were the recommended phase 2 dose at which no more than one out of six patients had a treatment-related dose-limiting toxicity, and the safety and toxicity profile of each dosing schedule. The key secondary endpoint was investigator-assessed response rate in the dose-expansion phase. Patients who received at least one dose of the study drug were evaluable for safety and patients who received one cycle of the study drug and underwent baseline disease assessment were evaluable for response. This trial is registered with ClinicalTrials.gov, NCT02407509. FINDINGS Between June 5, 2013, and Jan 10, 2019, 58 eligible patients were enrolled to the study: 29 patients with solid tumours were included in the dose-escalation cohort and 29 patients with solid tumours or multiple myeloma were included in the basket dose-expansion cohort (12 non-small-cell lung cancer, five gynaecological malignancy, four colorectal cancer, one melanoma, and seven multiple myeloma). Median follow-up at the time of data cutoff was 2·3 months (IQR 1·6-3·5). Dose-limiting toxicities included grade 3 bilateral retinal pigment epithelial detachment in one patient who received 4·0 mg CH5126766 three times per week, and grade 3 rash (in two patients) and grade 3 creatinine phosphokinase elevation (in one patient) in those who received 3·2 mg CH5126766 three times per week. 4·0 mg CH5126766 twice per week (on Monday and Thursday or Tuesday and Friday) was established as the recommended phase 2 dose. The most common grade 3-4 treatment-related adverse events were rash (11 [19%] patients), creatinine phosphokinase elevation (six [11%]), hypoalbuminaemia (six [11%]), and fatigue (four [7%]). Five (9%) patients had serious treatment-related adverse events. There were no treatment-related deaths. Eight (14%) of 57 patients died during the trial due to disease progression. Seven (27% [95% CI 11·6-47·8]) of 26 response-evaluable patients in the basket expansion achieved objective responses. INTERPRETATION To our knowledge, this is the first study to show that highly intermittent schedules of a RAF-MEK inhibitor has antitumour activity across various cancers with RAF-RAS-MEK pathway mutations, and that this inhibitor is tolerable. CH5126766 used as a monotherapy and in combination regimens warrants further evaluation. FUNDING Chugai Pharmaceutical.
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Affiliation(s)
- Christina Guo
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Maxime Chénard-Poirier
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Desamparados Roda
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Maria de Miguel
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Samuel J Harris
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Irene Moreno Candilejo
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Priya Sriskandarajah
- Division of Cancer Therapeutics, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Wen Xu
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Mariana Scaranti
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Anastasia Constantinidou
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Jenny King
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Mona Parmar
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Alison J Turner
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | | | - Ruth Riisnaes
- Cancer Biomarkers, The Institute of Cancer Research, London, UK
| | - Laura Finneran
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Yuji Ishikawa
- Translational Research Division, Chugai Pharmaceutical, Tokyo, Japan
| | - Kiyohiko Nakai
- Translational Research Division, Chugai Pharmaceutical, Tokyo, Japan
| | - Nina Tunariu
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Bristi Basu
- Department of Oncology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Martin Kaiser
- Division of Molecular Pathology and Myeloma Molecular Therapy Group, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Juanita Suzanne Lopez
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Anna Minchom
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Johann S de Bono
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Udai Banerji
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK.
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Yap TA, Kristeleit R, Michalarea V, Pettitt SJ, Lim JSJ, Carreira S, Roda D, Miller R, Riisnaes R, Miranda S, Figueiredo I, Rodrigues DN, Ward S, Matthews R, Parmar M, Turner A, Tunariu N, Chopra N, Gevensleben H, Turner NC, Ruddle R, Raynaud FI, Decordova S, Swales KE, Finneran L, Hall E, Rugman P, Lindemann JPO, Foxley A, Lord CJ, Banerji U, Plummer R, Basu B, Lopez JS, Drew Y, de Bono JS. Phase I Trial of the PARP Inhibitor Olaparib and AKT Inhibitor Capivasertib in Patients with BRCA1/2- and Non- BRCA1/2-Mutant Cancers. Cancer Discov 2020; 10:1528-1543. [PMID: 32532747 PMCID: PMC7611385 DOI: 10.1158/2159-8290.cd-20-0163] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/20/2020] [Accepted: 06/09/2020] [Indexed: 11/16/2022]
Abstract
Preclinical studies have demonstrated synergy between PARP and PI3K/AKT pathway inhibitors in BRCA1 and BRCA2 (BRCA1/2)-deficient and BRCA1/2-proficient tumors. We conducted an investigator-initiated phase I trial utilizing a prospective intrapatient dose- escalation design to assess two schedules of capivasertib (AKT inhibitor) with olaparib (PARP inhibitor) in 64 patients with advanced solid tumors. Dose expansions enrolled germline BRCA1/2-mutant tumors, or BRCA1/2 wild-type cancers harboring somatic DNA damage response (DDR) or PI3K-AKT pathway alterations. The combination was well tolerated. Recommended phase II doses for the two schedules were: olaparib 300 mg twice a day with either capivasertib 400 mg twice a day 4 days on, 3 days off, or capivasertib 640 mg twice a day 2 days on, 5 days off. Pharmacokinetics were dose proportional. Pharmacodynamic studies confirmed phosphorylated (p) GSK3β suppression, increased pERK, and decreased BRCA1 expression. Twenty-five (44.6%) of 56 evaluable patients achieved clinical benefit (RECIST complete response/partial response or stable disease ≥ 4 months), including patients with tumors harboring germline BRCA1/2 mutations and BRCA1/2 wild-type cancers with or without DDR and PI3K-AKT pathway alterations. SIGNIFICANCE: In the first trial to combine PARP and AKT inhibitors, a prospective intrapatient dose- escalation design demonstrated safety, tolerability, and pharmacokinetic-pharmacodynamic activity and assessed predictive biomarkers of response/resistance. Antitumor activity was observed in patients harboring tumors with germline BRCA1/2 mutations and BRCA1/2 wild-type cancers with or without somatic DDR and/or PI3K-AKT pathway alterations.This article is highlighted in the In This Issue feature, p. 1426.
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Affiliation(s)
- Timothy A Yap
- Royal Marsden Hospital, London, United Kingdom.
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Stephen J Pettitt
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
- The CRUK Gene Function Laboratory, The Institute of Cancer Research, London, United Kingdom
| | | | | | - Desamparados Roda
- Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Rowan Miller
- University College London, London, United Kingdom
| | - Ruth Riisnaes
- The Institute of Cancer Research, London, United Kingdom
| | - Susana Miranda
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Sarah Ward
- Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Ruth Matthews
- Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Mona Parmar
- Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Alison Turner
- Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | | | - Neha Chopra
- Royal Marsden Hospital, London, United Kingdom
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | | | - Nicholas C Turner
- Royal Marsden Hospital, London, United Kingdom
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Ruth Ruddle
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Karen E Swales
- The Institute of Cancer Research, London, United Kingdom
| | - Laura Finneran
- The Institute of Cancer Research, London, United Kingdom
| | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
| | - Paul Rugman
- Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | | | - Andrew Foxley
- Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Christopher J Lord
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
- The CRUK Gene Function Laboratory, The Institute of Cancer Research, London, United Kingdom
| | - Udai Banerji
- Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Ruth Plummer
- Clinical and Translational Research Institute, Newcastle University, Newcastle, United Kingdom
| | - Bristi Basu
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Juanita S Lopez
- Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Yvette Drew
- Clinical and Translational Research Institute, Newcastle University, Newcastle, United Kingdom
| | - Johann S de Bono
- Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
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Yap TA, O’Carrigan B, Penney MS, Lim JS, Brown JS, de Miguel Luken MJ, Tunariu N, Perez-Lopez R, Rodrigues DN, Riisnaes R, Figueiredo I, Carreira S, Hare B, McDermott K, Khalique S, Williamson CT, Natrajan R, Pettitt SJ, Lord CJ, Banerji U, Pollard J, Lopez J, de Bono JS. Phase I Trial of First-in-Class ATR Inhibitor M6620 (VX-970) as Monotherapy or in Combination With Carboplatin in Patients With Advanced Solid Tumors. J Clin Oncol 2020; 38:3195-3204. [PMID: 32568634 PMCID: PMC7499606 DOI: 10.1200/jco.19.02404] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Preclinical studies demonstrated that ATR inhibition can exploit synthetic lethality (eg, in cancer cells with impaired compensatory DNA damage responses through ATM loss) as monotherapy and combined with DNA-damaging drugs such as carboplatin. PATIENTS AND METHODS This phase I trial assessed the ATR inhibitor M6620 (VX-970) as monotherapy (once or twice weekly) and combined with carboplatin (carboplatin on day 1 and M6620 on days 2 and 9 in 21-day cycles). Primary objectives were safety, tolerability, and maximum tolerated dose; secondary objectives included pharmacokinetics and antitumor activity; exploratory objectives included pharmacodynamics in timed paired tumor biopsies. RESULTS Forty patients were enrolled; 17 received M6620 monotherapy, which was safe and well tolerated. The recommended phase II dose (RP2D) for once- or twice-weekly administration was 240 mg/m2. A patient with metastatic colorectal cancer harboring molecular aberrations, including ATM loss and an ARID1A mutation, achieved RECISTv1.1 complete response and maintained this response, with a progression-free survival of 29 months at last assessment. Twenty-three patients received M6620 with carboplatin, with mechanism-based hematologic toxicities at higher doses, requiring dose delays and reductions. The RP2D for combination therapy was M6620 90 mg/m2 with carboplatin AUC5. A patient with advanced germline BRCA1 ovarian cancer achieved RECISTv1.1 partial response and Gynecologic Cancer Intergroup CA125 response despite being platinum refractory and PARP inhibitor resistant. An additional 15 patients had RECISTv1.1 stable disease as best response. Pharmacokinetics were dose proportional and exceeded preclinical efficacious levels. Pharmacodynamic studies demonstrated substantial inhibition of phosphorylation of CHK1, the downstream ATR substrate. CONCLUSION To our knowledge, this report is the first of an ATR inhibitor as monotherapy and combined with carboplatin. M6620 was well tolerated, with target engagement and preliminary antitumor responses observed.
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Affiliation(s)
- Timothy A. Yap
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Brent O’Carrigan
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
| | | | - Joline S. Lim
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
| | - Jessica S. Brown
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
| | | | - Nina Tunariu
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
| | | | | | - Ruth Riisnaes
- The Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | - Saira Khalique
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Chris T. Williamson
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
- CRUK Gene Function Laboratory, The Institute of Cancer Research, London, United Kingdom
| | - Rachael Natrajan
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Stephen J. Pettitt
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
- CRUK Gene Function Laboratory, The Institute of Cancer Research, London, United Kingdom
| | - Christopher J. Lord
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
- CRUK Gene Function Laboratory, The Institute of Cancer Research, London, United Kingdom
| | - Udai Banerji
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - John Pollard
- Vertex Pharmaceuticals, Oxfordshire, United Kingdom
| | - Juanita Lopez
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
| | - Johann S. de Bono
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
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42
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McLeod R, Kumar R, Papadatos-Pastos D, Mateo J, Brown JS, Garces AHI, Ruddle R, Decordova S, Jueliger S, Ferraldeschi R, Maiques O, Sanz-Moreno V, Jones P, Traub S, Halbert G, Mellor S, Swales KE, Raynaud FI, Garrett MD, Banerji U. First-in-Human Study of AT13148, a Dual ROCK-AKT Inhibitor in Patients with Solid Tumors. Clin Cancer Res 2020; 26:4777-4784. [PMID: 32616501 PMCID: PMC7611345 DOI: 10.1158/1078-0432.ccr-20-0700] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/29/2020] [Accepted: 06/30/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE AT13148 is an oral AGC kinase inhibitor, which potently inhibits ROCK and AKT kinases. In preclinical models, AT13148 has been shown to have antimetastatic and antiproliferative activity. PATIENTS AND METHODS The trial followed a rolling six design during dose escalation. An intrapatient dose escalation arm to evaluate tolerability and a biopsy cohort to study pharmacodynamic effects were later added. AT13148 was administered orally three days a week (Mon-Wed-Fri) in 28-day cycles. Pharmacokinetic profiles were assessed using mass spectrometry and pharmacodynamic studies included quantifying p-GSK3β levels in platelet-rich plasma (PRP) and p-cofilin and p-MLC2 levels in tumor biopsies. RESULTS Fifty-one patients were treated on study. The safety of 5-300 mg of AT13148 was studied. Further, the doses of 120-180-240 mg were studied in an intrapatient dose escalation cohort. The dose-limiting toxicities included hypotension (300 mg), pneumonitis, and elevated liver enzymes (240 mg), and skin rash (180 mg). The most common side effects were fatigue, nausea, headaches, and hypotension. On the basis of tolerability, 180 mg was considered the maximally tolerated dose. At 180 mg, mean C max and AUC were 400 nmol/L and 13,000 nmol/L/hour, respectively. At 180 mg, ≥50% reduction of p-cofilin was observed in 3 of 8 posttreatment biopsies. CONCLUSIONS AT13148 was the first dual potent ROCK-AKT inhibitor to be investigated for the treatment of solid tumors. The narrow therapeutic index and the pharmacokinetic profile led to recommend not developing this compound further. There are significant lessons learned in designing and testing agents that simultaneously inhibit multiple kinases including AGC kinases in cancer.
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Affiliation(s)
| | - Rajiv Kumar
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Joaquin Mateo
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jessica S Brown
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Ruth Ruddle
- The Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Oscar Maiques
- Bart's Cancer Centre, Queen Mary University of London, London, United Kingdom
| | | | - Paul Jones
- Cancer Research UK, London, United Kingdom
| | | | - Gavin Halbert
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow, United Kingdom
| | | | - Karen E Swales
- The Institute of Cancer Research, London, United Kingdom
| | | | - Michelle D Garrett
- The Institute of Cancer Research, London, United Kingdom
- University of Kent, Canterbury, United Kingdom
| | - Udai Banerji
- The Royal Marsden NHS Foundation Trust, London, United Kingdom.
- The Institute of Cancer Research, London, United Kingdom
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Terbuch A, Tiu C, Candilejo IM, Scaranti M, Curcean A, Bar D, Estevez Timon M, Ameratunga M, Ang JE, Ratoff J, Minchom AR, Banerji U, de Bono JS, Tunariu N, Lopez JS. Radiological Patterns of Drug-induced Interstitial Lung Disease (DILD) in Early-phase Oncology Clinical Trials. Clin Cancer Res 2020; 26:4805-4813. [PMID: 32332017 DOI: 10.1158/1078-0432.ccr-20-0454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Drug-induced interstitial lung disease (DILD) is a rare, but potentially fatal toxicity. Clinical and radiological features of DILD in the early experimental setting are poorly described. PATIENTS AND METHODS A total of 2,499 consecutive patients with advanced cancer on phase I clinical trials were included. DILD was identified by a dedicated radiologist and investigators, categorized per internationally recognized radiological patterns, and graded per Common Terminology Criteria for Adverse Events (CTCAE) and the Royal Marsden Hospital (RMH) DILD score. Clinical and radiological features of DILD were analyzed. RESULTS Sixty patients overall (2.4%) developed DILD. Median time to onset of DILD was 63 days (range, 14-336 days). A total of 45% of patients who developed DILD were clinically asymptomatic. Incidence was highest in patients receiving drug conjugates (7.4%), followed by inhibitors of the PI3K/AKT/mTOR pathway (3.9%). The most common pattern seen was hypersensitivity pneumonitis (33.3%), followed by nonspecific interstitial pneumonia (30%), and cryptogenic organizing pneumonia (26.7%). A higher DILD score [OR, 1.47, 95% confidence interval (CI), 1.19-1.81; P < 0.001] and the pattern of DILD (OR, 5.83 for acute interstitial pneumonia; 95% CI, 0.38-90.26; P = 0.002) were significantly associated with a higher CTCAE grading. The only predictive factor for an improvement in DILD was an interruption of treatment (OR, 0.05; 95% CI, 0.01-0.35; P = 0.01). CONCLUSIONS DILD in early-phase clinical trials is a toxicity of variable onset, with diverse clinical and radiological findings. Radiological findings precede clinical symptoms. The extent of the affected lung parenchyma, scored by the RMH DILD score, correlates with clinical presentation. Most events are low grade, and improve with treatment interruption, which should be considered early.
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Affiliation(s)
- Angelika Terbuch
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Crescens Tiu
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Irene Moreno Candilejo
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Division of Medical Oncology, START Madrid-HM Sanchinarro CIOCC Early Phase Program, Medical University Hospital of Sanchinarro, Madrid, Spain
| | - Mariana Scaranti
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Andra Curcean
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Dan Bar
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Miriam Estevez Timon
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Malaka Ameratunga
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Monash University, Melbourne, Australia
| | - Joo Ern Ang
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jonathan Ratoff
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Epsom and St. Helier University Hospitals NHS Trust, Epsom, United Kingdom
| | - Anna R Minchom
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Udai Banerji
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Johann S de Bono
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Nina Tunariu
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Juanita S Lopez
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom.
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Pal A, Stapleton S, Lai-Kwon J, Simoes N, Minchom A, Banerji U, de Bono J, Karikios D, Boyle F, Lopez J. 1886P Quantifying quality of informed consent (IC) in patients enrolled in phase I (ph I) oncology clinical trials with a validated instrument (QuIC Parts A, B) in a large United Kingdom phase I trials unit. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Papadatos-Pastos D, Pal A, Akay M, Ameratunga M, Mithra S, Ang JE, Levva S, Caldwell R, Riisnaes R, Crespo M, Yuan W, Seed G, Gurel B, Figueiredo I, Pereira R, Miranda S, Ferreira A, Carreira S, Bertan C, Baker C, Morilla R, Brown R, Masrour N, Prout T, Zachariou A, Turner A, Parmar M, Van de Velde M, Jenkins B, Yap C, Tunariu N, Banerji U, Lopez J, Minchom A, De Bono J. Abstract CT129: HyPeR: A phase 1, dose escalation and expansion trial of guadecitabine (SGI-110), a second-generation hypomethylating agent in combination with pembrolizumab (MK3475) in patients with refractory solid tumors. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Methylation is reported to support cancer immune tolerance. We conducted a phase 1 dose-escalation trial [NCT02998567] of combination guadecitabine (G; DNA hypomethylating agent) and pembrolizumab (P) in patients (pts) with advanced cancers. We hypothesized that G can normalize the expression of epigenetically suppressed immune genes, increase interferon producing tumor-infiltrating lymphocytes (TILs), and enhance the anticancer activity of P. Methods: In dose escalation (Es), pts received G (45 mg/m2 or 30 mg/m2, administered SC on days 1-4) with P (200 mg, administered IV starting from cycle 2 onwards) as outpatient Q3W; in expansion (Ex), the RP2D of G (30 mg/m2) with P (200 mg) Q3W was administered. Pre-treatment and on-treatment tumor biopsies were evaluated for PD-L1 expression, tumor infiltrating lymphocytes, gene expression by RNAseq and methylome studies. Longitudinal analyses of peripheral blood CD3, CD4 and CD8 lymphocytes by flow cytometry were performed. Results: Overall, 34 pts (Es, n = 14; Ex, n = 20) were evaluable for safety. The most common treatment-related adverse events (TRAEs) were neutropenia (n = 21), fatigue (n = 6) and thrombocytopenia (n = 3), diarrhea (n = 2). G3+ TRAEs were neutropenia (n = 14), febrile neutropenia (n = 4), raised ALP (n = 1), raised AST (n=1), colitis (n = 1), diarrhoea (n = 1) and lung infection (n = 1). Two DLTs (neutropenia, febrile neutropenia) were reported at G 45mg/m2 with none reported at G 30mg/m2. There were no treatment-related deaths. In total, 28 pts (Es, n = 12; Ex, n = 16) were evaluable for antitumor activity studies (≥2 scans); ORR (CR+PR) and DCR (CR+PR+SD) were 3% and 57%; 10/15 pts with non-small cell lung cancer (13 pts resistant/refractory to PD-1/PD-L1 targeting agents) were evaluable, with a DCR of 80% and 5 pts having DCR > 6 months with 8 pts remaining on study treatment. Overall, 25 paired biopsies were obtained. Using LINE1 sequences to study global methylation, both tumor biopsies and peripheral blood showed reduced methylation post-G treatment. Preliminary data on tumor-infiltrating lymphocytes assessed by multicolor immunofluorescence in 9 paired biopsies showed a numerical increase in median values of T-helper (CD4+FOXP3-) (10.20 to 19.70, p = 0.5469), T-regulatory (CD4+FOXP3+) (5.1 to 6.7, p=0.8438), and T-cytotoxic (CD8+) cell densities (2.7 to 7.4, p=0.6523) . Comparing with matched pre-treatment, on treatment tumor had numerical increases in interferon alpha and gamma response pathway activation in serial biopsy RNAseq analyses but did not reach significance. Conclusions: G plus P resulted in no unexpected toxicities with evidence suggestive of biological and anti-cancer activity.
Citation Format: Dionysis Papadatos-Pastos, Abhijit Pal, Melek Akay, Malaka Ameratunga, Sanjena Mithra, Joo-Ern Ang, Sofia Levva, Reece Caldwell, Ruth Riisnaes, Mateus Crespo, Wei Yuan, George Seed, Bora Gurel, Ines Figueiredo, Rita Pereira, Susana Miranda, Anna Ferreira, Suzanne Carreira, Claudia Bertan, Chloe Baker, Ricardo Morilla, Robert Brown, Nahal Masrour, Toby Prout, Anna Zachariou, Alison Turner, Mona Parmar, Mark Van de Velde, Ben Jenkins, Christina Yap, Nina Tunariu, Udai Banerji, Juanita Lopez, Anna Minchom, Johann De Bono. HyPeR: A phase 1, dose escalation and expansion trial of guadecitabine (SGI-110), a second-generation hypomethylating agent in combination with pembrolizumab (MK3475) in patients with refractory solid tumors [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT129.
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Affiliation(s)
| | | | - Melek Akay
- 1University College London Hospitals, London, United Kingdom
| | - Malaka Ameratunga
- 3The Royal Marsden and Institute of Cancer Research, London, United Kingdom
| | - Sanjena Mithra
- 1University College London Hospitals, London, United Kingdom
| | - Joo-Ern Ang
- 3The Royal Marsden and Institute of Cancer Research, London, United Kingdom
| | - Sofia Levva
- 1University College London Hospitals, London, United Kingdom
| | - Reece Caldwell
- 4The Institute of Cancer Research, London, United Kingdom
| | - Ruth Riisnaes
- 4The Institute of Cancer Research, London, United Kingdom
| | - Mateus Crespo
- 4The Institute of Cancer Research, London, United Kingdom
| | - Wei Yuan
- 4The Institute of Cancer Research, London, United Kingdom
| | - George Seed
- 4The Institute of Cancer Research, London, United Kingdom
| | - Bora Gurel
- 4The Institute of Cancer Research, London, United Kingdom
| | | | - Rita Pereira
- 4The Institute of Cancer Research, London, United Kingdom
| | - Susana Miranda
- 4The Institute of Cancer Research, London, United Kingdom
| | - Anna Ferreira
- 4The Institute of Cancer Research, London, United Kingdom
| | | | - Claudia Bertan
- 4The Institute of Cancer Research, London, United Kingdom
| | - Chloe Baker
- 4The Institute of Cancer Research, London, United Kingdom
| | - Ricardo Morilla
- 3The Royal Marsden and Institute of Cancer Research, London, United Kingdom
| | - Robert Brown
- 5Imperial College London, London, United Kingdom
| | | | - Toby Prout
- 4The Institute of Cancer Research, London, United Kingdom
| | - Anna Zachariou
- 4The Institute of Cancer Research, London, United Kingdom
| | - Alison Turner
- 4The Institute of Cancer Research, London, United Kingdom
| | - Mona Parmar
- 4The Institute of Cancer Research, London, United Kingdom
| | | | - Ben Jenkins
- 4The Institute of Cancer Research, London, United Kingdom
| | - Christina Yap
- 4The Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- 3The Royal Marsden and Institute of Cancer Research, London, United Kingdom
| | - Udai Banerji
- 3The Royal Marsden and Institute of Cancer Research, London, United Kingdom
| | - Juanita Lopez
- 3The Royal Marsden and Institute of Cancer Research, London, United Kingdom
| | - Anna Minchom
- 3The Royal Marsden and Institute of Cancer Research, London, United Kingdom
| | - Johann De Bono
- 3The Royal Marsden and Institute of Cancer Research, London, United Kingdom
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Spicer J, Basu B, Montes A, Banerji U, Kristeleit R, Veal GJ, Corrigan C, Till S, Nintos G, Brier T, Funingana IG, Ang JE, Zaki K, Griffin A, Barton C, Jones P, Mellor S, Brook S, Stoddart K, Selkirk C, Carroll S, Lentfer H, Woodman N, Pope A, Pellizzari G, Nakamura M, Ilieva KM, Khiabany A, Stavraka C, Gould H, Chauhan J, Bax H, Pinder S, Josephs D, Karagiannis S. Abstract CT141: Phase 1 trial of MOv18, a first-in-class IgE antibody therapy for cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: All antibodies approved for the treatment of cancer are monoclonal IgGs, and no IgE therapy has yet been tested in humans. The biology of IgE, compared with IgG, offers potential for enhanced immune surveillance and superior effector cell potency against tumor cells. IgE antibodies in preclinical cancer models are not associated with allergic toxicity even in immunocompetent animals, and in vivo efficacy compares favorably with equivalent IgGs.
Methods: We conducted a first-in-human first-in-class trial of MOv18, a chimeric monoclonal IgE, in patients with solid tumors expressing folate receptor-alpha, the antigen recognized by this antibody. Antigen expression was deemed positive in the presence of >5% membrane staining of any intensity using the mouse clone BN3.2. Intravenous treatment was administered weekly for 6 weeks, then two-weekly. The trial incorporated pre-treatment skin prick testing with MOv18 IgE, and an ex vivo basophil activation test (BAT) using patient whole blood, with the aim of predicting systemic allergic toxicity and excluding patients at potential risk. Safety, efficacy, markers of immune response, and pharmacokinetics have been evaluated in 24 patients to date, at total doses ranging from 0.07 to 3.0mg.
Results: Treatment was well tolerated in almost all patients. The most common toxicity was readily manageable urticaria, without systemic symptoms, signs or tryptase elevation. One patient treated at the 0.5mg dose experienced anaphylaxis, with tryptase elevation, despite a negative pre-dose skin prick test. This was the only patient in the trial with baseline circulating basophils that could be activated by ex vivo exposure to MOv18 IgE. This BAT assay was subsequently used to ensure no further patient with reactive basophils was exposed. Maximum tolerated dose has not yet been reached. Dose-dependent increases in Cmax were observed, and plasma concentrations of 70-100ng/mL achieved at the 1.5mg dose are comparable to typical levels of endogenous IgE. No consistent anti-drug antibody response has been detected. Preliminary evidence of anti-tumor activity was seen in a patient with ovarian cancer at a total MOv18 IgE dose of 0.7mg. Shrinkage of peritoneal metastases was accompanied by a tumor marker reduction meeting Gynecologic Cancer InterGroup criteria for response.
Conclusions: These results support for the first time the safety of IgE as a treatment for cancer, and provide preliminary evidence for anti-tumor efficacy of this new therapeutic class. The mechanism of cutaneous toxicity is being investigated. Clinical testing of class-switched IgE versions of approved IgG-based therapeutic antibodies is warranted.
Citation Format: James Spicer, Bristi Basu, Ana Montes, Udai Banerji, Rebecca Kristeleit, Gareth J. Veal, Christopher Corrigan, Stephen Till, George Nintos, Timothy Brier, Ionut G. Funingana, Joo Ern Ang, Kam Zaki, Annie Griffin, Claire Barton, Paul Jones, Sarah Mellor, Susan Brook, Katie Stoddart, Christopher Selkirk, Simon Carroll, Heike Lentfer, Natalie Woodman, Amy Pope, Giulia Pellizzari, Mano Nakamura, Kristina M. Ilieva, Atousa Khiabany, Chara Stavraka, Hannah Gould, Jitesh Chauhan, Heather Bax, Sarah Pinder, Debra Josephs, Sophia Karagiannis. Phase 1 trial of MOv18, a first-in-class IgE antibody therapy for cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT141.
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Affiliation(s)
| | - Bristi Basu
- 2University of Cambridge, Cambridge, United Kingdom
| | - Ana Montes
- 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Udai Banerji
- 4The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | | | - Gareth J. Veal
- 6Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | | | - George Nintos
- 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Timothy Brier
- 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ionut G. Funingana
- 7Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Joo Ern Ang
- 4The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | - Kam Zaki
- 8University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Annie Griffin
- 9University of Southampton, Southampton, United Kingdom
| | | | - Paul Jones
- 11Cancer Research UK, London, United Kingdom
| | | | - Susan Brook
- 11Cancer Research UK, London, United Kingdom
| | | | | | | | | | | | - Amy Pope
- 1King's College London, London, United Kingdom
| | | | | | | | | | | | | | | | - Heather Bax
- 1King's College London, London, United Kingdom
| | - Sarah Pinder
- 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Debra Josephs
- 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Lopez JS, Biondo A, Tiu C, Scaranti M, Ameratunga M, Zachariou A, Turner A, Tunariu N, Prout T, Parmar M, Badham H, Swales K, Yuan W, Morilla R, Crespo M, Daly R, Figueiredo I, Gurel B, Pereira R, Riisnaes R, Vivanco I, Minchom A, Jenkins B, Yap C, Banerji U, De Bono J. Abstract CT140: Proof-of-concept evidence of immune modulation by blockade of the phosphatidylinositol 3-kinase (PI3K)-AKT signaling pathway in the phase I dose escalation study of Ipatasertib (Ipa) in combination with atezolizumab (A) in patients (pts) with advanced solid tumors (Ice-CAP). Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Hyperactivation of the PI3K/AKT pathway correlates with impaired anti-tumor responses, including reduced T cell infiltration into tumor, and reduced efficacy of immune checkpoint inhibitors. Blockade of this pathway synergizes with PD-L1/PD-1 axis blockade preclinically.
Methods: This Phase I clinical trial (NCT03673787) assessed the safety, pharmacodynamic, and preliminary clinical activity of Ipa (200mg or 400mg OD) given in combination with A 1200mg q3 wk in refractory pts. Serial paired blood and tumor samples were analysed to interrogate the effect of Ipa on the tumor micro-environment and host immune system prior to the addition of the immune check point inhibitor, A.
Results: 18 adult pts were treated in dose escalation. Median age 49 yrs. All pts had ECOG PS 0-1 and median 7 prior therapies. Most common TRAEs (>15%) were mild Gr1-2 diarrhea (56%), rash (50%), fatigue (33%), nausea (33%), raised ALT/AST (33%), headache (28%) and arthralgia (22%). 1 pt had G2 systemic immune activation; 2 pts had G3 rash, both rapidly reversible. 1 DLT of G3 raised ALT seen at 200mg (1 DLT/9 evaluable pts) but none at 400mg (0 DLT/6). Of 14 RECIST evaluable patients, there were 2 confirmed PRs, and 5 SD (clinical benefit rate 50%). Reductions of CD4+FOXP3+ Tregs in tumor microenvironment were seen after 2wks of single agent Ipa, regardless of PIK3/AKT somatic mutation status (Table 1). Responding pts had a >400% median increase in intra-tumoral CD8+ Teff cell infiltration, effectively switching from a desert phenotype to an inflamed phenotype. Paired changes in FACS, transcriptome and cytokine will also be presented.Conclusions: The RP2D of Ipa 400mg OD combination with A was well tolerated with early efficacy signals. Further biomarker work is ongoing and will be evaluated in expansion cohorts.
Table 1:Changes in immune cell populations as assessed by multicolour Immunofluorescence in paired biopsies of breast/gynae patients, % change in cell number/mm2 from baseline (median [min,max$])&Post 2 weeks single agent Ipatasertib(n=9)Post 1 cycle of combination Ipatasertib and Atezolizumab(n=7)CD4+FOXP3+Tregs cellsCD 8+ Teff cellsCD4+FOXP3+Tregs cellsCD 8+ Teff cellsIntra-tumourstromaIntra-tumourstromaIntra-tumourstromaIntra-tumourstromaAll patients-23.9*[-89.7, BL0]-30.0*[-91.6, BL0]-37.7*[-84.4, -24.5]-28.4[-92.4, 259.8]335.9[-44.0,BL0]45.4[-51.0, BL0]59.6[-60.6,493.3]64.7[-51.7,293.3]Stratified by somatic PI3K/AKT/PTEN mutational statusPathogenic mutations (mt)11.1[-82.2, BL0]#-10.7[-91.6, BL0]Φnsnsnsns-30.5[-60.6,-0.5]11.3[-51.7,50.0]Wildtype (wt)-63.1[-89.7,19.0]#-47.5[-77.0,11.1]Φnsnsnsns426.5[59.6,493.3]126.7[79.4,293.3]Stratified by responseResponders (PR + SD>4 cycles). 1 ER+ HER2+ breast cancer (wt), 1 ER+ HER2- breast cancer (wt)459.9[426.5,493.3]@103.1[79.4,126.7]Non-responders (PD at 4 cycles) 1 cervical cancer, 4 ER+ breast cancer-0.5[-60.6, 59.6]@30.6[-51.7,293.3]*significant change (p≤0.05; Wilcoxon sign-rank test) from baseline, $maximum values denoted by BL0indicate that the baseline value was zero, and so percentage change from baseline is not defined. For the analysis, the baseline value has been replaced by a nominal value of 0.1 so that a large percentage increase is associated with these cases. Note that these large percentage increases do not affect the non-parametric statistical tests used.#no significant difference in distribution of reduction in intra-tumoural CD4+ FOXP3+Tregsbetween pts with pathogenic mutations in PI3K/AKT and those without (p=0.30; Wilcoxon rank-sum test)Φno significant difference in distribution of reduction in stromal CD4+FOXP3+Tregsbetween pts with pathogenic mutations in PI3K/AKT and those without (p=0.44; Wilcoxon rank-sum test) @ difference between responders and non-responders p=0.083; Wilcoxon rank-sum test)mt pathogenic mutations in PI3K/AKT and PTEN as per COSMIC database present in tumour or PTEN loss by IHC. wt no pathogenic mutations in PI3K/AKT and PTEN as per COSMIC database detected in tumour and intact PTEN expression by IHC. &exploratory analyses with no adjustment for multiple testing
Citation Format: Juanita S. Lopez, Andrea Biondo, Crescens Tiu, Mariana Scaranti, Malaka Ameratunga, Anna Zachariou, Alison Turner, Nina Tunariu, Toby Prout, Mona Parmar, Hannah Badham, Karen Swales, Wei Yuan, Ricardo Morilla, Mateus Crespo, Rob Daly, Ines Figueiredo, Bora Gurel, Rita Pereira, Ruth Riisnaes, Igor Vivanco, Anna Minchom, Ben Jenkins, Christina Yap, Udai Banerji, Johann De Bono. Proof-of-concept evidence of immune modulation by blockade of the phosphatidylinositol 3-kinase (PI3K)-AKT signaling pathway in the phase I dose escalation study of Ipatasertib (Ipa) in combination with atezolizumab (A) in patients (pts) with advanced solid tumors (Ice-CAP) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT140.
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Affiliation(s)
- Juanita S. Lopez
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Andrea Biondo
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Crescens Tiu
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Mariana Scaranti
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Malaka Ameratunga
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Anna Zachariou
- 2The Institute of Cancer Research, London, United Kingdom
| | - Alison Turner
- 2The Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Toby Prout
- 2The Institute of Cancer Research, London, United Kingdom
| | - Mona Parmar
- 2The Institute of Cancer Research, London, United Kingdom
| | - Hannah Badham
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Karen Swales
- 2The Institute of Cancer Research, London, United Kingdom
| | - Wei Yuan
- 2The Institute of Cancer Research, London, United Kingdom
| | - Ricardo Morilla
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Mateus Crespo
- 2The Institute of Cancer Research, London, United Kingdom
| | - Rob Daly
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | | | - Bora Gurel
- 2The Institute of Cancer Research, London, United Kingdom
| | - Rita Pereira
- 2The Institute of Cancer Research, London, United Kingdom
| | - Ruth Riisnaes
- 2The Institute of Cancer Research, London, United Kingdom
| | - Igor Vivanco
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Anna Minchom
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Ben Jenkins
- 2The Institute of Cancer Research, London, United Kingdom
| | - Christina Yap
- 2The Institute of Cancer Research, London, United Kingdom
| | - Udai Banerji
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Johann De Bono
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
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Shinde R, Terbuch A, Little M, Caldwell R, Kurup R, Riisnaes R, Crespo M, Ruddle R, Gurel B, Stewart A, King J, Parmar M, Turner A, Raynaud F, Mahmud M, Yap C, Pachter JA, Mills GB, Minchom A, Lopez J, Banerjee SN, de Bono JS, Krebs M, Banerji U. Abstract CT143: Phase I study of the combination of a RAF-MEK inhibitor CH5126766 and FAK inhibitor defactinib in an intermittent dosing schedule with expansions inKRASmutant cancers. Tumour Biol 2020. [DOI: 10.1158/1538-7445.am2020-ct143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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50
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Tiu C, Shinde R, Yap C, Rao Baikady B, Banerji U, Minchom AR, de Bono JS, Lopez JS. A risk-based approach to experimental early phase clinical trials during the COVID-19 pandemic. Lancet Oncol 2020; 21:889-891. [PMID: 32615107 PMCID: PMC7324104 DOI: 10.1016/s1470-2045(20)30339-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Crescens Tiu
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, UK
| | - Rajiv Shinde
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, UK
| | - Christina Yap
- Institute of Cancer Research's Clinical Trials and Statistics Unit, Sutton, UK
| | - Bindumalini Rao Baikady
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, UK
| | - Udai Banerji
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, UK
| | - Anna R Minchom
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, UK
| | - Johann S de Bono
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, UK
| | - Juanita S Lopez
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, UK.
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