Journal article
A phase I study of tivantinib in combination with temsirolimus in patients with advanced solid tumors
Investigational new drugs, Vol.35(3), pp.290-297
06/01/2017
DOI: 10.1007/s10637-016-0418-8
PMCID: PMC5809175
PMID: 28004284
Abstract
Background A wide variety of human cancers exhibit dysregulated c-Met activity that has implications in oncogenesis. Phosphorylation of c-Met results in activation of the PI3K/AKT/mTOR pathway. Combined blockade of c-Met and mTOR pathways has shown efficacy in preclinical studies. Tivantinib is a c-Met inhibitor and temsirolimus is a selective mTOR inhibitor. We aimed to determine the maximum tolerated dose (MTD) and the recommended phase II dose (RP2D), dose-limiting toxicities (DLT), adverse events (AEs), clinical activity and pharmacokinetic (PK) parameters of the combination. Methods This open-label phase I study used a 3 + 3 dose escalation design. Patients (pts) were treated with escalating doses of tivantinib (120-360 mg tablets orally twice daily) and temsirolimus (20 mg IV weekly) followed by dose expansion at the MTD. Separate cohorts were planned for extensive (normal) and poor tivantinib metabolizers based on CYP2C19 genotypes. Cycles were 28 days besides cycle 1 that was 35 days to allow for PK analysis. Results Twenty-nine pts. [median age 58 (range 28-77)] were enrolled (21 in dose escalation and 8 in dose expansion). All were extensive CYP2C19 metabolizers. The most common types of cancer were colorectal, ovarian and non-small cell lung. Sixteen out of 21 and 6 out of 8 pts. were evaluable for DLT evaluation per protocol in the dose escalation and dose expansion phases, respectively. Pts remained on study for a median of 71 days (range 18-296). The MTD and RP2D was tivantinib 240 mg twice daily and temsirolimus 20 mg weekly. DLTs included grade (gr) 4 neutropenia (2 pts.; 1 with gr 3 febrile neutropenia), gr 3 abdominal pain (1 pt) and gr 2 mucositis resulting in inadequate drug delivery. The most common treatment related AEs grade ≥ 2 included: anemia (gr 2 in 9 pts., gr 3 in 3 pts), fatigue (gr 2 in 10 pts), anorexia (gr 2 in 9 pts), hypoalbuminemia (gr 2 in 6 pts., gr 3 in 2 pts), hypophosphatemia (gr 2 in 2 pts., gr 3 in 5 pts) and nausea (gr 2 in 6 pts., gr 3 in 1 pt). One pt. with ovarian cancer had a confirmed partial response and remained on study for 10 months, a second patient with ovarian cancer had stable disease and remained on study for 6 months and a third pt. with squamous cell carcinoma of the tongue had stable disease and remained on study for 7 months. Pharmacokinetic analysis showed that there is no interaction in the plasma concentrations between tivantinib and temsirolimus. Conclusions The combination of tivantinib with temsirolimus appears to be well tolerated with evidence of clinical activity.
Details
- Title: Subtitle
- A phase I study of tivantinib in combination with temsirolimus in patients with advanced solid tumors
- Creators
- Christos E Kyriakopoulos - University of Wisconsin Carbone Cancer CenterAmy M Braden - University of Wisconsin–MadisonJill M Kolesar - University of Wisconsin Carbone Cancer CenterJens C Eickhoff - University of Wisconsin–MadisonHoward H Bailey - University of Wisconsin Carbone Cancer CenterJennifer Heideman - University of Wisconsin Carbone Cancer CenterGlenn Liu - University of Wisconsin Carbone Cancer CenterKari B Wisinski - University of Wisconsin Carbone Cancer Center
- Resource Type
- Journal article
- Publication Details
- Investigational new drugs, Vol.35(3), pp.290-297
- DOI
- 10.1007/s10637-016-0418-8
- PMID
- 28004284
- PMCID
- PMC5809175
- ISSN
- 0167-6997
- eISSN
- 1573-0646
- Grant note
- UM1 CA186716 / NCI NIH HHS U01 CA062491 / NCI NIH HHS P30 CA014520 / NCI NIH HHS
- Language
- English
- Date published
- 06/01/2017
- Academic Unit
- Pharmacy; Pharmaceutical Sciences and Experimental Therapeutics
- Record Identifier
- 9984695789202771
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