Sorafenib and everolimus in patients with advanced solid tumors and KRAS-mutated NSCLC: A phase I trial with early pharmacodynamic FDG-PET assessment.

Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Lung Cancer Group, University of Cologne, Cologne, Germany. Onkologische Praxis Moers, Moers, Germany. Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany. Faculty of Medicine and University Hospital Cologne, Institute for Diagnostics und Intervention Radiology, University of Cologne, Cologne, Germany. Faculty of Medicine and University Hospital Cologne, Department for Nuclear Medicine, University of Cologne, Cologne, Germany. Faculty of Medicine and University Hospital Cologne, Institute for Pathology, University of Cologne, Cologne, Germany. Faculty of Medicine, Institute for Medical Statistics and Bioinformatics, University of Cologne, Cologne, Germany. Max Planck Institute for Metabolism Research, Cologne, Germany. Praxis for Medical Oncology and Haematology (PIOH), Frechen, Germany. Heamatology and Oncology, Augusta Hospital, Bochum, Germany. Bethanien Hospital, Solingen, Germany. Medical Oncology and Haematology, St. Marien Hospital, Düren, Germany. Institute for Biomedical and Pharmaceutical Research (IBMP), Nürnberg, Germany. Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China. Hunan Key Laboratory for Bioanalysis of Complex Matrix Samples, Changsha, China.

Cancer medicine. 2020;(14):4991-5007
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Abstract

BACKGROUND Treatment of patients with solid tumors and KRAS mutations remains disappointing. One option is the combined inhibition of pathways involved in RAF-MEK-ERK and PI3K-AKT-mTOR. METHODS Patients with relapsed solid tumors were treated with escalating doses of everolimus (E) 2.5-10.0 mg/d in a 14-day run-in phase followed by combination therapy with sorafenib (S) 800 mg/d from day 15. KRAS mutational status was assessed retrospectively in the escalation phase. Extension phase included KRAS-mutated non-small-cell lung cancer (NSCLC) only. Pharmacokinetic analyses were accompanied by pharmacodynamics assessment of E by FDG-PET. Efficacy was assessed by CT scans every 6 weeks of combination. RESULTS Of 31 evaluable patients, 15 had KRAS mutation, 4 patients were negative for KRAS mutation, and the KRAS status remained unknown in 12 patients. Dose-limiting toxicity (DLT) was not reached. The maximum tolerated dose (MTD) was defined as 7.5 mg/d E + 800 mg/d S due to toxicities at previous dose level (10 mg/d E + 800 mg/d S) including leucopenia/thrombopenia III° and pneumonia III° occurring after the DLT interval. The metabolic response rate in FDG-PET was 17% on day 5 and 20% on day 14. No patient reached partial response in CT scan. Median progression free survival (PFS) and overall survival (OS) were 3.25 and 5.85 months, respectively. CONCLUSIONS Treatment of patients with relapsed solid tumors with 7.5 mg/d E and 800 mg/d S is safe and feasible. Early metabolic response in FDG-PET was not confirmed in CT scan several weeks later. The combination of S and E is obviously not sufficient to induce durable responses in patients with KRAS-mutant solid tumors.

Methodological quality

Publication Type : Clinical Trial

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