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Hong DS, Bauer TM, Lee JJ, Dowlati A, Brose MS, Farago AF, Taylor M, Shaw AT, Montez S, Meric-Bernstam F, Smith S, Tuch BB, Ebata K, Cruickshank S, Cox MC, Burris HA, Doebele RC. Larotrectinib in adult patients with solid tumours: a multi-centre, open-label, phase I dose-escalation study. Ann Oncol 2019; 30:325-331. [PMID: 30624546 PMCID: PMC6386027 DOI: 10.1093/annonc/mdy539] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [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] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND NTRK1, NTRK2 and NTRK3 gene fusions (NTRK gene fusions) occur in a range of adult cancers. Larotrectinib is a potent and highly selective ATP-competitive inhibitor of TRK kinases and has demonstrated activity in patients with tumours harbouring NTRK gene fusions. PATIENTS AND METHODS This multi-centre, phase I dose escalation study enrolled adults with metastatic solid tumours, regardless of NTRK gene fusion status. Key inclusion criteria included evaluable and/or measurable disease, Eastern Cooperative Oncology Group performance status 0-2, and adequate organ function. Larotrectinib was administered orally once or twice daily, on a continuous 28-day schedule, in increasing dose levels according to a standard 3 + 3 dose escalation scheme. The primary end point was the safety of larotrectinib, including dose-limiting toxicity. RESULTS Seventy patients (8 with tumours with NTRK gene fusions; 62 with tumours without a documented NTRK gene fusion) were enrolled to 6 dose cohorts. There were four dose-limiting toxicities; none led to study drug discontinuation. The maximum tolerated dose was not reached. Larotrectinib-related adverse events were predominantly grade 1; none were grade 4 or 5. The most common grade 3 larotrectinib-related adverse event was anaemia [4 (6%) of 70 patients]. A dose of 100 mg twice daily was recommended for phase II studies based on tolerability and antitumour activity. In patients with evaluable TRK fusion cancer, the objective response rate by independent review was 100% (eight of the eight patients). Eight (12%) of the 67 assessable patients overall had an objective response by investigator assessment. Median duration of response was not reached. Larotrectinib had limited activity in tumours with NTRK mutations or amplifications. Pharmacokinetic analysis showed exposure was generally proportional to administered dose. CONCLUSIONS Larotrectinib was well tolerated, demonstrated activity in all patients with tumours harbouring NTRK gene fusions, and represents a new treatment option for such patients. CLINCALTRIALS.GOV NUMBER NCT02122913.
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Affiliation(s)
- D S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - T M Bauer
- Medical Oncology, Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, USA
| | - J J Lee
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - A Dowlati
- Department of Medicine-Hematology and Oncology, UH Cleveland Medical Center, Cleveland, USA
| | - M S Brose
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, USA
| | - A F Farago
- Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - M Taylor
- The Knight Cancer Institute, Oregon Health & Science University, Portland, USA
| | - A T Shaw
- Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - S Montez
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S Smith
- Loxo Oncology, South San Francisco, USA
| | - B B Tuch
- Loxo Oncology, South San Francisco, USA
| | - K Ebata
- Loxo Oncology, South San Francisco, USA
| | | | - M C Cox
- Loxo Oncology, South San Francisco, USA
| | - H A Burris
- Medical Oncology, Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, USA
| | - R C Doebele
- Department of Medicine, University of Colorado Cancer Center, Aurora, USA
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Subbiah V, Velcheti V, Tuch BB, Ebata K, Busaidy NL, Cabanillas ME, Wirth LJ, Stock S, Smith S, Lauriault V, Corsi-Travali S, Henry D, Burkard M, Hamor R, Bouhana K, Winski S, Wallace RD, Hartley D, Rhodes S, Reddy M, Brandhuber BJ, Andrews S, Rothenberg SM, Drilon A. Selective RET kinase inhibition for patients with RET-altered cancers. Ann Oncol 2018; 29:1869-1876. [PMID: 29912274 PMCID: PMC6096733 DOI: 10.1093/annonc/mdy137] [Citation(s) in RCA: 276] [Impact Index Per Article: 46.0] [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] [Indexed: 02/02/2023] Open
Abstract
Background Alterations involving the RET kinase are implicated in the pathogenesis of lung, thyroid and other cancers. However, the clinical activity of multikinase inhibitors (MKIs) with anti-RET activity in RET-altered patients appears limited, calling into question the therapeutic potential of targeting RET. LOXO-292 is a selective RET inhibitor designed to inhibit diverse RET fusions, activating mutations and acquired resistance mutations. Patients and methods Potent anti-RET activity, high selectivity, and central nervous system coverage were confirmed preclinically using a variety of in vitro and in vivo RET-dependent tumor models. Due to clinical urgency, two patients with RET-altered, MKI-resistant cancers were treated with LOXO-292, utilizing rapid dose-titration guided by real-time pharmacokinetic assessments to achieve meaningful clinical exposures safely and rapidly. Results LOXO-292 demonstrated potent and selective anti-RET activity preclinically against human cancer cell lines harboring endogenous RET gene alterations; cells engineered to express a KIF5B-RET fusion protein -/+ the RET V804M gatekeeper resistance mutation or the common RET activating mutation M918T; and RET-altered human cancer cell line and patient-derived xenografts, including a patient-derived RET fusion-positive xenograft injected orthotopically into the brain. A patient with RET M918T-mutant medullary thyroid cancer metastatic to the liver and an acquired RET V804M gatekeeper resistance mutation, previously treated with six MKI regimens, experienced rapid reductions in tumor calcitonin, CEA and cell-free DNA, resolution of painful hepatomegaly and tumor-related diarrhea and a confirmed tumor response. A second patient with KIF5B-RET fusion-positive lung cancer, acquired resistance to alectinib and symptomatic brain metastases experienced a dramatic response in the brain, and her symptoms resolved. Conclusions These results provide proof-of-concept of the clinical actionability of RET alterations, and identify selective RET inhibition by LOXO-292 as a promising treatment in heavily pretreated, multikinase inhibitor-experienced patients with diverse RET-altered tumors.
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Affiliation(s)
- V Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - V Velcheti
- The Cleveland Clinic Foundation, Cleveland, USA
| | - B B Tuch
- Loxo Oncology, Inc., Stamford, USA
| | - K Ebata
- Loxo Oncology, Inc., Stamford, USA
| | - N L Busaidy
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M E Cabanillas
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L J Wirth
- Massachusetts General Hospital Cancer Center, Boston, USA
| | - S Stock
- The Cleveland Clinic Foundation, Cleveland, USA
| | - S Smith
- Loxo Oncology, Inc., Stamford, USA
| | | | | | - D Henry
- Loxo Oncology, Inc., Stamford, USA
| | | | - R Hamor
- Array BioPharma, Inc., Boulder, USA
| | | | - S Winski
- Array BioPharma, Inc., Boulder, USA
| | | | | | - S Rhodes
- Array BioPharma, Inc., Boulder, USA
| | - M Reddy
- Array BioPharma, Inc., Boulder, USA
| | | | | | | | - A Drilon
- Memorial Sloan Kettering Cancer Center, New York, USA.
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