Oral MEK1/MEK2 inhibitor trametinib (GSK1120212) in combination with docetaxel in KRAS-mutant and wild-type (WT) advanced non-small cell lung cancer (NSCLC): A phase I/Ib trial

Autor: David R. Gandara, Sandrine Hiret, George R. Blumenschein, Fabrice Barlesi, Jean-Pierre Delord, Jeannick Madelaine, Jeffrey R. Infante, Karen L. Reckamp, Primo Lara, Christine Audebert, Byoung Chul Cho, Keunchil Park, Fadi S. Braiteh, Robert M. Jotte, Yuehui Wu, Daniel J. Schramek, Alexandra M. Piepszak, Olivia S. Gardner, Vijay Gopal Reddy Peddareddigari, Natasha B. Leighl
Rok vydání: 2013
Předmět:
Zdroj: Journal of Clinical Oncology. 31:8028-8028
ISSN: 1527-7755
0732-183X
DOI: 10.1200/jco.2013.31.15_suppl.8028
Popis: 8028 Background: KRAS-mutant NSCLC, usually reflecting tobacco-related carcinogenesis, represents an unmet medical need in lung cancer therapy. Trametinib plus docetaxel (doc) enhances growth inhibition and apoptosis of NSCLC cell lines in vitro with and without RAS/RAF mutations when compared with either agent alone. Methods: This 2-part, multiarm, phase I/Ib, open-label study evaluated the safety and efficacy of trametinib plus chemotherapy (NCT01192165). Part 1 determined the recommended phase II dose (RP2D) for trametinib+doc in patients (pts) with advanced solid tumors. In part 2, NSCLC pts were stratified as KRAS WT or mutation unknown (WT) or KRAS-mutant (KRAS) and were treated with trametinib + doc at the RP2D. Primary study objectives were safety and tolerability; secondary objectives were efficacy and pharmacokinetics (PK). Exploratory mutational profiling was done using circulating-free DNA from plasma and available archival tumor tissue. Results: As of January 2013, 46 NSCLC pts (24 WT [67% had ≥ 2 prior therapies] and 22 KRAS [41% had ≥ 2 prior therapies]) have been treated at the trametinib + doc RP2D (2.0 mg + 75 mg/m2 + growth factors). Diarrhea, fatigue, asthenia, and nausea were the 4 most frequent toxicities. Dose reduction occurred in 10 pts (22%), mostly for diarrhea, fatigue, mucositis, neutropenia, and skin fissures (all 4%). Preliminary PK suggests no drug-drug interaction. In KRAS pts, the best investigator-assessed response (confirmed + unconfirmed) was 3 partial response (PR; RR = 17%) and 8 stable disease (SD; 44%); additionally, 4 pts had > 20% tumor shrinkage. The current disease control rate (DCR) is 61%; 4 pts have not had postbaseline scans. In WT pts, 5 PR (RR=21%) and 11 SD (46%) were observed (67% DCR). Final response and progression-free survival data will be reported upon maturity. Biomarker analyses, including assessment of KRAS mutation subtype vs efficacy, are ongoing. Conclusions: MEK inhibition with trametinib + doc (+ growth factors) demonstrates tolerability and clinical activity in both KRAS-mutant and WT NSCLC, exceeding expectations for each drug alone and warranting further study. Clinical trial information: NCT01192165.
Databáze: OpenAIRE
Externí odkaz: