CTEP 9557: A dose-escalation trial of combination dabrafenib, trametinib, and AT13387 in patients with BRAF mutant solid tumors.

Authors

null

Meghan Mooradian

Massachusetts General Hospital Cancer Center, Boston, MA

Meghan Mooradian , James M. Cleary , Justine Vanessa Cohen , Donald P. Lawrence , Elizabeth Iannotti Buchbinder , Anita Giobbie-Hurder , Aparna Raj Parikh , Geoffrey Shapiro , Lancia Darville , Keiran Smalley , John M Koomen , Amber Newton , Harold N. Keer , S. Percy Ivy , Helen X. Chen , Ryan J. Sullivan

Organizations

Massachusetts General Hospital Cancer Center, Boston, MA, Dana Farber Cancer Institute, Boston, MA, Massachusetts General Hospital, Boston, MA, Massachusetts General Hospital and Dana-Farber Cancer Institute, Boston, MA, Beth Israel Deaconess Medical Center, Boston, MA, Dana-Farber Cancer Institute, Boston, MA, University of California San Francisco, San Francisco, CA, Moffitt Cancer Center, Tampa, FL, Departments of Molecular Oncology and Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, Astex Pharmaceuticals, Pleasanton, CA, National Cancer Institute at the National Institutes of Health, Rockville, MD, CTEP National Cancer Institute, Rockville, MD

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health

Background: Combination BRAF and MEK inhibitor therapy is associated with response in patients (pts) with BRAF mutant (mut) solid tumors; however critical limitations for the durable activity of these agents remains. Preclinically, the addition of heat shock protein 90 (HSP90) inhibitors improves the efficacy of BRAF inhibitor (BRAFi) therapy in both BRAFi-sensitive and resistant mutant cell lines. Methods: CTEP study 9557 (NCT02097225) is a phase I study designed to determine the safety and efficacy of the small molecule HSP90inhibitor, AT13387, in combination with dabrafenib (dab) and trametinib (tram) in patients with BRAFV600E/K mut solid tumors. Prior chemotherapy, immunotherapy, BRAF and/or MEK exposure was permitted. The primary objective was to determine the maximum tolerated dose (MTD). Results: From July 2015 to June 2018, 22 patients with previously treated, metastatic BRAF V600E/K mut solid tumors were enrolled using a 3 + 3 design at four dose levels (DL) (Table). Pts were predominantly female (59%) with a median age of 57.5yrs (37 -75). The most common tumor type was BRAFV600Emut colon cancer (N=12). Dose limiting toxicities (DLTs) occurred in one patient in DL3 and one in DL4, specifically grade 3 myelosuppression and fatigue, respectively. The MTD was Dab 150mg [BID/PO], Tram 2mg [QD/PO] and AT1187 260mg/m2 [D1,8,15/IV]. Twenty-one of 22 pts were eligible for efficacy assessment. Best response, per RECIST 1.1, was partial response (PR) in 2 pts – one with colon ca (TKI-naïve), one with melanoma (TKI-resistant) - stable disease (SD) in 8 pts, and disease progression (PD) in 11 with a disease control rate (PR + SD) of 47.6% (90% CI: 29% - 67%). Median time to progression was significantly longer in DL3 (3.9 mths; 1.8-9.2) compared to DL1 (1.6mths; 0.9-1.7) or DL2 (1.5; 0.6-3.6). Median PFS and OS were 1.8mths (90% CI: 1.6 – 3.7mths) and 5.1 mths (90% CI: 2.5 -10.6mths), respectively. Median OS was not reached in DL3/4. Correlative data on the expression of the key signaling proteins relating to response will be presented at the meeting. Conclusions: HSP90 inhibition combined with BRAF/MEK inhibition was determined to be safe with evidence of disease control in a heavily pre-treated population of pts with BRAF V600E/K mut solid tumors. Clinical trial information: NCT02097225.

Dose level cohorts.

DOSE LEVELDABRAFENIB [BID/PO]TRAMETINIB [QD/PO]AT13387 [D1,8,15/IV]
-175 mg1 mg180 mg/m2
1150 mg1 mg180 mg/m2
2150 mg2 mg180 mg/m2
3150 mg2 mg220 mg/m2
4150 mg2 mg260 mg/m2

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Abstract Details

Meeting

2020 ASCO Virtual Scientific Program

Session Type

Poster Session

Session Title

Developmental Therapeutics—Molecularly Targeted Agents and Tumor Biology

Track

Developmental Therapeutics—Molecularly Targeted Agents and Tumor Biology

Sub Track

Small Molecules

Clinical Trial Registration Number

NCT02097225

Citation

J Clin Oncol 38: 2020 (suppl; abstr 3609)

DOI

10.1200/JCO.2020.38.15_suppl.3609

Abstract #

3609

Poster Bd #

339

Abstract Disclosures

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