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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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