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Harris SJ, de Miguel Luken MJ, Roda Perez D, Perez Lopez R, Parmar M, Prathapan V, Hassam H, Turner AJ, Serrano Fandos S, Hall E, Tovey H, Tunariu N, Lopez JS, Yap TA, De Bono JS, Banerji U. Updated efficacy and safety results from the phase I study of intermittent dosing of the dual MEK/RAF inhibitor, RO5126766 in patients (pts) with RAS/RAF mutated advanced solid tumours. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.2582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Mona Parmar
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | | | - Hasina Hassam
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | | | | | - Emma Hall
- The Institute of Cancer Research Clinical Trials and Statistics Unit, Sutton, United Kingdom
| | - Holly Tovey
- The Institute of Cancer Research Clinical Trials and Statistics Unit, Sutton, United Kingdom
| | - Nina Tunariu
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | | | | | - Johann S. De Bono
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Udai Banerji
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
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Michalarea V, Lopez J, Lorente D, Carreira S, Hassam H, Parmar M, Turner A, Hall E, Fandos SS, Decordova S, Swales K, Ruddle R, Raynaud F, Tunariu N, Stephens C, Molife L, Banerji U, Plummer R, Bono JD, Yap T. 343 Translational phase I trial combining the AKT inhibitor AZD5363 (AZD) and PARP inhibitor Olaparib (Ola) in advanced cancer patients (pts). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30206-4] [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: 10/22/2022]
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Michalarea V, Lorente D, Lopez J, Carreira S, Hassam H, Parmar M, Sathiyayogan N, Turner A, Hall E, Serrano Fandos S, Seeramreddi S, Decordova S, Swales K, Ruddle R, Raynaud F, Tunariu N, Attard G, Molife LR, Banerji U, Plummer R, de Bono JS, Yap TA. Abstract CT323: Accelerated phase I trial of two schedules of the combination of the PARP inhibitor olaparib and AKT inhibitor AZD5363 using a novel intrapatient dose escalation design in advanced cancer patients. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-ct323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: There is an urgent need for better trial designs to assess targeted drug combinations. We proposed a novel intrapatient (intrapt) dose escalation trial design to optimize drug exposures, minimize pharmacokinetic (PK) variability and reduce patient (pt) numbers needed (Yap et al, JCO 2013). In vivo synergy between PARP and PI3K pathway inhibition was seen in BRCA1-related and sporadic cancers (Juvekar et al; Ibrahim et al, Cancer Discov 2012), providing rationale for this study.
Methods: Two-stage investigator initiated phase I trial: a) Intrapt dose escalation; b) Recommended phase II combination dose (RP2CD) expansion. Advanced cancer pts received escalating doses of AZD5363 (AZD) BID in 2 parallel arms (4 days on 3 days off [4/7 arm] at 320, 400, 480mg; 2 days on 5 days off [2/7 arm] at 480, 560, 640mg) with Olaparib (Ola) at 300mg BID in 3 weekly cycles. AZD was escalated after each cycle in each pt if drug related toxicities were ≤CTCAE G2. Dose limiting toxicities (DLT) were assessed during the 1st cycle of each dose level (DL). ≥6 evaluable pts were required at each DL. RECIST assessment was done every 3 cycles. Prior PARP or PI3K/AKT inhibitor use was allowed. PK and pharmacodynamics (PD) were assessed in tumor and normal tissue. Targeted +/- whole exome next generation sequencing was assessed in tumor and serial plasma DNA samples in all pts for predictive biomarkers of response.
Results: Dose escalation was completed in 7.5 months (m) in 20 pts in 1 center; ≥6 evaluable pts were treated at each of the 3 DLs in both arms. Common (>15%) G1-2 toxicities were nausea, vomiting, fatigue, diarrhea and anemia. A DLT of G3 rash was seen at 480mg BID 4/7 AZD + 300mg BID Ola. Non DLT G3 anemia (n = 2), diarrhea (n = 2), fatigue (n = 1) and vomiting (n = 1) were seen in 4/7 arm; G3 hyperglycemia (n = 1), transaminitis (n = 1) and fatigue (n = 2) in 2/7 arm. No significant PK interactions were seen between Ola and AZD. Intrapt dose escalation of AZD showed dose dependent increases in PK exposures. Platelet-rich plasma PD showed significant decreases in pSer9 GSK3β post-therapy at all DLs (mean ≥55% [p<0.002] in 4/7 arm and ≥70% [p<0.0001] in 2/7 arm). Confirmed partial responses (PR) were seen in a BRCA wild type PTEN LOH platinum resistant ovarian cancer (PROC) pt for 6m and a BRCA1 mutant (mut) PROC pt for 5.5m+. Unconfirmed PR was seen in a BRCA1 mut breast cancer pt (2.5m+). A BRCA1 mut castration resistant prostate cancer pt has PCWG2 response (PSA 14 to 0.7 μg/L) and tumor response on DW-MRI (8m+). A PI3K/mTOR inhibitor resistant peritoneal mesothelioma pt has stable disease for 9m+ with 66% CA125 decline (202 to 69 U/mL). RP2CD was established at 640mg BID 2/7 AZD + 300mg BID Ola based on tolerability.
Conclusion: This novel trial design led to rapid completion of dose escalation. RP2CD expansion (n = 40) is ongoing in: a) germline BRCA mut cancers; b) sporadic cancers with relevant somatic mutations.
Citation Format: Vasiliki Michalarea, David Lorente, Juanita Lopez, Suzanne Carreira, Hasina Hassam, Mona Parmar, Nitharsan Sathiyayogan, Alison Turner, Emma Hall, Sonia Serrano Fandos, Satyanarayana Seeramreddi, Shaun Decordova, Karen Swales, Ruth Ruddle, Florence Raynaud, Nina Tunariu, Gerhardt Attard, L. Rhoda Molife, Udai Banerji, Ruth Plummer, Johann S. de Bono, Timothy A. Yap. Accelerated phase I trial of two schedules of the combination of the PARP inhibitor olaparib and AKT inhibitor AZD5363 using a novel intrapatient dose escalation design in advanced cancer patients. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr CT323. doi:10.1158/1538-7445.AM2015-CT323
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Affiliation(s)
- Vasiliki Michalarea
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - David Lorente
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Juanita Lopez
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | | | - Hasina Hassam
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Mona Parmar
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | | | - Alison Turner
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Emma Hall
- 2The Institute of Cancer Research, London, United Kingdom
| | - Sonia Serrano Fandos
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | | | | | - Karen Swales
- 2The Institute of Cancer Research, London, United Kingdom
| | - Ruth Ruddle
- 2The Institute of Cancer Research, London, United Kingdom
| | | | - Nina Tunariu
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Gerhardt Attard
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - L. Rhoda Molife
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Udai Banerji
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Ruth Plummer
- 3Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Johann S. de Bono
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Timothy A. Yap
- 1Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
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de Miguel Luken MJ, Roda D, Perez Lopez R, Jimenez B, Hassam H, Sathiyayogan N, Parmar M, Turner AJ, Hall E, Tunariu N, Molife LR, Yap TA, De Bono JS, Banerji U. A pharmacokinetic (PK) and pharmacodynamic (PD) biomarker-driven phase I study of intermittent, low dose intensity schedules of the dual MEK/RAF inhibitor, RO5126766 (RO) in patients (pts) with advanced solid tumors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Desamparados Roda
- The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | - Raquel Perez Lopez
- The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | - Begona Jimenez
- The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | - Hasina Hassam
- The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | | | - Mona Parmar
- The Institute of Cancer Research, London, United Kingdom
| | | | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - L Rhoda Molife
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Timothy Anthony Yap
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Jimenez Rodriguez B, Michie CO, Lorente D, Hassam H, Toloui HN, Lovosgaldeano J, Goswami D, De Bono JS, Kaye SB, Banerji U, Molife LR. Long-term survivors in phase I clinical trials: Who are they and what predicts their survival? J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Begona Jimenez Rodriguez
- Drug Development Unit at The institute of Cancer Research and The Royal Marsden NHS Fundation Trust, London, United Kingdom
| | - Caroline Ogilvie Michie
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - David Lorente
- Division of Cancer Therapeutics and Division of Clinical Studies, The Institute of Cancer Research; Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Hasina Hassam
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust,, London, United Kingdom
| | - Helen Nicole Toloui
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden Foundation Trust, Sutton, United Kingdom
| | - Jimena Lovosgaldeano
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Debarati Goswami
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust,, Sutton, United Kingdom
| | | | - Stan B Kaye
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Udai Banerji
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden Foundation Trust, London, United Kingdom
| | - L Rhoda Molife
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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