A Phase II Trial of Rivoceranib, an Oral Vascular Endothelial Growth Factor Receptor 2 Inhibitor, for Recurrent or Metastatic Adenoid Cystic Carcinoma

PURPOSE

This open-label, single-arm, phase II study evaluated the vascular endothelial growth factor receptor 2 (VEGFR2) tyrosine kinase inhibitor (TKI) rivoceranib in patients with recurrent or metastatic (R/M) adenoid cystic carcinoma (ACC).

PATIENTS AND METHODS

Eligible patients had confirmed disease progression per Response Evaluation Criteria in Solid Tumors (RECIST) with ≥20% increase in radiologically or clinically measurable lesions or appearance of new lesions within the preceding 6 months. Patients received oral rivoceranib 700 mg once daily. Primary outcomes were objective response rate (ORR) by investigator review and by blinded independent review committee (BIRC).

RESULTS

Eighty patients were enrolled and 72 were efficacy evaluable. Seventy-four patients had distant metastases and 49 received prior systemic treatment (14 received VEGFR TKIs). Per investigator and BIRC, respectively, ORR was 15.3% [95% confidence interval (95% CI), 7.9-25.7] and 9.7% (95% CI, 4.0-19.0); median duration of response was 14.9 months (95% CI, 4.9-17.3) and 7.2 months (95% CI, 3.5-8.4); and median progression-free survival was 9.0 months (95% CI, 7.3-11.5) and 9.0 months (95% CI, 7.7-11.5). Grade ≥3 treatment-related adverse events occurred in 56 patients (70.0%); the most common were hypertension (34, 42.5%) and stomatitis (6, 7.5%). Four grade 5 events occurred with one attributed to rivoceranib (epistaxis). Sixty-eight patients (85.0%) had ≥1 dose modifications and 16 patients (20.0%) discontinued rivoceranib for toxicity.

CONCLUSIONS

In patients with progressing R/M ACC, rivoceranib demonstrated antitumor activity and a manageable safety profile consistent with other VEGFR TKIs.

A randomized phase II study of SM-88 plus methoxsalen, phenytoin, and sirolimus in patients with metastatic pancreatic cancer treated in the second line and beyond

BACKGROUND

This trial explores SM-88 used with methoxsalen, phenytoin, and sirolimus (MPS) in pretreated metastatic pancreatic ductal adenocarcinoma (mPDAC) METHODS: Forty-nine patients were randomized to daily 460 or 920 mg oral SM-88 with MPS (SM-88 Regimen). The primary endpoint was objective response rate (RECIST 1.1).

RESULTS

Thirty-seven patients completed ≥ one cycle of SM-88 Regimen (response evaluable population). Disease control rate (DCR), overall survival (OS), and progression-free survival (PFS) did not differ significantly between dose levels. Stable disease was achieved in 9/37 patients (DCR, 24.3%); there were no complete or partial responses. Quality-of-life (QOL) was maintained and trended in favor of 920 mg. SM-88 Regimen was well tolerated; a single patient (1/49) had related grade 3 and 4 adverse events, which later resolved. In the intention-to-treat population of 49 patients, the median overall survival (mOS) was 3.4 months (95% CI: 2.7-4.9 months). Those treated in the second line had an mOS of 8.1 months and a median PFS of 3.8 months. Survival was higher for patients with stable versus progressive disease (any line; mOS: 10.6 months vs. 3.9 months; p = 0.01).

CONCLUSIONS

SM-88 Regimen has a favorable safety profile with encouraging QOL effects, disease control, and survival trends. This regimen should be explored in the second-line treatment of patients with mPDAC.

CLINICALTRIALS

gov Identifier: NCT03512756.

A first in man, dose-finding study of the mTORC1/mTORC2 inhibitor OSI-027 in patients with advanced solid malignancies

BACKGROUND

The kinase activity of mTOR involves 2 multiprotein complexes, (mTORC1-mTORC2). Targeting mTORC1 with rapalogues induces compensatory feedback loops resulting in AKT/ERK activation, which may be abrogated by mTORC2 inhibition. A first-in-human trial evaluating tolerability, pharmacokinetics and pharmacodynamics of the dual TORC1/TORC2 inhibitor OSI-027 was conducted.

METHODS

Dose escalation was pursued for three schedules of administration (three consecutive days per week (S1), once a week (S2) and daily dosing (S3)), until dose-limiting toxicities (DLT) were identified. Expansion cohorts with paired tumour biopsies were initiated based on tolerability and pharmacodynamics.

RESULTS

One hundred and twenty eight patients with advanced cancer were enrolled. DLT consisted predominantly of fatigue, renal function disturbances and cardiac events. OSI-027 exposure was dose proportional, with Tmax within 4 h and a half-life of ∼14 h. Expansion cohorts were initiated for S1 and S2, as MTD for S3 was overall considered suboptimal. Target modulation in peripheral blood mononuclear cells were observed from 30 mg, but in tumour biopsies 120 mg QD were needed, which was a non-tolerable dose due to renal toxicity. No RECIST responses were recorded, with stable disease >6 months in six (5%) patients.

CONCLUSIONS

OSI-027 inhibits mTORC1/2 in patients with advanced tumour s in a dose-dependent manner but doses above the tolerable levels in S1 and S3 are required for a sustained biological effect in tumour biopsies.

Abstract B187: Pharmacodynamics of OSI-027, a dual mTORC1/mTORC2 inhibitor, in tumor and surrogate tissues: Results from the expansion phase of a first-in-man study

Background: The kinase activity of the mammalian target of rapamycin (mTOR) involves 2 multiprotein complexes, mTORC1 and mTORC2, regulating distinct signaling pathways. We conducted a first-in-human study of OSI-027, an orally bio-available inhibitor of both mTORC1 and mTORC2, with the aim of evaluating its safety, pharmacokinetics (PK), maximum tolerated dose (MTD) and pharmacodynamics (PD). We present final results, focusing on expansion cohorts for biomarker assessments at different dose levels.

Material and Methods: Three dose-escalation arms evaluated different schedules (S) of administration; S1: once daily for 3 of every 7 days (qd 3/7d), S2: once weekly (qwk) or S3: continuous qd, in 21-day cycles. Dose limiting toxicities (DLT) were assessed in cycle 1 (CTCAE v3). Safety and PK were studied after single and multiple dosing. Expansion cohorts for biomarker assessment were initiated at different dose levels based on safety data, collecting PBMC samples and paired pre/post-treatment tumor and skin biopsies.

Results: 123 patients (pts) were treated. Overall, DLTs (n=11) were fatigue (4), elevated serum creatinine (2), cardiomyopathy (1), decreased left ventricular ejection fraction (1), hyperglycemia (1), rash (1) and bone pain (1). S3 was discontinued (MTD 35mg qd) due to renal toxicity. Based on safety data, expansion cohorts were initiated to assess PD at 90mg qd 3/7d, 120mg qd 3/7d (MTD for S1) and 240mg qwk (maximum administered dose on S2 due to high number of capsules required; MTD for S2 not reached). Cmax and AUC were dose-linear. PD inhibition in PBMC was associated with OSI-027 exposure; results of tumor and skin biopsies are presented in table 1. Stable disease (RECIST 1.0) after 24 weeks was observed in 5 pts.

Conclusions: OSI-027 modulates mTORC1/mTORC2 in a dose-dependent manner. PD in skin samples did not predict PD in tumor. While 90mg qd 3/7d inhibited target in PBMC and skin, 120mg qd 3/7d was required to achieve substantial effect in tumor but this dose was not well tolerated: 1/3 of pts required dose-reductions due to adverse events.