Summary
Introduction This Phase Ib trial investigated the safety, tolerability, and recommended phase 2 dose for the pan-PI3K/mTOR inhibitor, GSK2126458 (GSK458), and trametinib combination when administered to patients with advanced solid tumors. Patients and Methods Patients with advanced solid tumors received escalating doses of GSK458 (once or twice daily, and continuous or intermittent) and trametinib following a zone-based 3 + 3 design to determine the maximum tolerated dose (MTD). Assessments included monitoring for adverse events and response, and evaluating pharmacokinetic (PK) measures. Archival tissue and circulating free DNA samples were collected to assess biomarkers of response in the PI3K and RAS pathways. Results 57 patients were enrolled onto the continuous dosing cohort and 12 patients onto an intermittent BID dosing cohort. Two MTDs were established for the continuous daily dosing: 2 mg of GSK458 with 1.0 mg of trametinib or 1.0 mg of GSK458 with 1.5 mg of trametinib; no MTD was determined in the intermittent dosing cohort. The most frequent adverse events were rash (74 %) and diarrhea (61 %). Dose interruptions due to adverse events occurred in 42 % of patients. No significant PK interaction was observed. One patient achieved partial response and 12 patients had stable disease >16 weeks. Mutations in RAS/RAF/PI3K were detected in 70 % of patients, but no pattern emerged between response and mutational status. Conclusion GSK458 plus trametinib is poorly tolerated, due to skin and GI-related toxicities. Responses were minimal, despite enrichment for PI3K/RAS pathway driven tumors, which may be due to overlapping toxicities precluding sufficient dose exposure.
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The authors would like to thank the patients who participated in the study.
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This study was funded by GlaxoSmithKline. Rajendra Singh and Yuehui Wu are current employees/stockholders of GlaxoSmithKline. Leanne Cartee is a former employee and current stockholder of GlaxoSmithKline. Philippe Bedard has received research funding from GlaxoSmithKine and Novartis. Albiruni Razak has received travel funding from GlaxoSmithKline, Novartis, BristolMyersSquibb, Boehringer, Karyopharm, and Deciphera. All remaining authors declare no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Written informed consent was obtained from all participants included in the study.
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J. E. Grilley-Olson and P. L. Bedard contributed equally to this article.
Highlights
•We report a phase Ib study of the PI3K/mTOR inhibitor, GSK2126458, and trametinib
•The combination is poorly tolerated, due to overlapping skin and GI toxicities
•Efficacy was limited, possibly due to dosing limitations
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Grilley-Olson, J.E., Bedard, P.L., Fasolo, A. et al. A phase Ib dose-escalation study of the MEK inhibitor trametinib in combination with the PI3K/mTOR inhibitor GSK2126458 in patients with advanced solid tumors. Invest New Drugs 34, 740–749 (2016). https://doi.org/10.1007/s10637-016-0377-0
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DOI: https://doi.org/10.1007/s10637-016-0377-0