Phase I study of temsirolimus in combination with EKB-569 in patients with advanced solid tumors.

Abstract

Purpose Activation of EGFR can stimulate proliferative and survival signaling through mTOR. Preclinical data demonstrates synergistic activity of combined EGFR and mTOR inhibition. We undertook a phase I trial of temsirolimus (T, an mTOR inhibitor) and EKB-569 (E, an EGFR inhibitor) to determine the safety and tolerability. Methods The primary aim was to determine the maximally tolerated dose (MTD) of this combination in adults with solid tumors. Following the dose-escalation phase, (Cohort A), two subsequent cohorts were used to assess any pharmacokinetic (PK) interaction between the agents. Results Forty eight patients were enrolled. The MTD of this combination was E, 35 mg daily and T, 30 mg on days 1-3 and 15-17 using a 28-day cycle. The most common toxicities were nausea, diarrhea, fatigue, anorexia, stomatitis, rash, anemia, neutropenia, thrombocytopenia, and hypertriglyceridemia. Sixteen patients (36%) had at least one grade 3 toxicity. The most frequent grade 3/4 toxicities were diarrhea, dehydration, and nausea and vomiting (19% each). No grade 5 events were seen. Four patients had a partial response and 15 had stable disease. Clinical benefit was seen across a range of tumor types and in all cohorts. PK analysis revealed no significant interaction between E and T. Conclusions This combination of agents is associated with tolerable toxicities at doses that induced responses. PK studies revealed no interaction between the drugs. Further investigations of this targeting strategy may be attractive in renal cell carcinoma, non-small cell lung cancer, alveolar sarcoma, and carcinoid tumor.

• Authors: Alan H Bryce, Ravi Rao, Jann Sarkaria, Joel M Reid, Yingwei Qi, Rui Qin, C David James, Robert B Jenkins, Joseph Boni, Charles Erlichman, Paul Haluska
• Journal: Investigational new drugs (Invest New Drugs) Vol. 30 Issue 5 Pg. 1934-41 (Oct 2012) ISSN: 1573-0646 [Electronic] United States
• PMID: 21881915 (Publication Type: Clinical Trial, Phase I, Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Aminoquinolines
• Aniline Compounds
• temsirolimus
• MTOR protein, human
• EGFR protein, human
• ErbB Receptors
• TOR Serine-Threonine Kinases
• Sirolimus
• EKB 569

Topics

• Adult
• Aged
• Aged, 80 and over
• Aminoquinolines (administration & dosage, adverse effects, pharmacokinetics)
• Aniline Compounds (administration & dosage, adverse effects, pharmacokinetics)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, pharmacokinetics, therapeutic use)
• Cohort Studies
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Drug Synergism
• ErbB Receptors (antagonists & inhibitors, metabolism)
• Female
• Follow-Up Studies
• Humans
• Male
• Maximum Tolerated Dose
• Middle Aged
• Neoplasms (drug therapy, metabolism)
• Sirolimus (administration & dosage, adverse effects, analogs & derivatives, pharmacokinetics)
• TOR Serine-Threonine Kinases (antagonists & inhibitors, metabolism)
• Young Adult