Phase Ib Trial of the PI3K Inhibitor Copanlisib Combined with the Allosteric MEK Inhibitor Refametinib in Patients with Advanced Cancer

Ramesh K. Ramanathan, Daniel D. Von Hoff, Ferry Eskens, George Blumenschein, Donald Richards, Isabelle Genvresse, Susanne Reschke, Camille Granvil, Adam Skubala, Carol Peña, Klaus Mross

Research output: Contribution to journalArticle

Abstract

Background: Dual inhibition of PI3K and MAPK signaling is conceptually a promising anticancer therapy. Objective: This phase 1b trial investigated the safety, maximum tolerated dose (MTD), recommended phase II dose, pharmacokinetics, tumor response, fluorodeoxyglucose positron emission tomography (FDG-PET) pharmacodynamics, and biomarker explorations for the combination of pan-PI3K inhibitor copanlisib and allosteric MEK inhibitor refametinib in patients with advanced solid tumors. Patients and methods: This was an adaptive trial with eight dose cohorts combining dose escalation and varying schedules in repeated 28-day cycles. Patients received copanlisib (0.2–0.8 mg/kg intravenously) intermittently (days 1, 8, 15) or weekly (days 1, 8, 15, 22) each cycle, and refametinib (30–50 mg twice daily orally) continuously or 4 days on/3 days off. Patients with KRAS, NRAS, BRAF, or PI3KCA mutations were eligible for the expansion cohort. Results: In the dose-escalation (n = 49) and expansion (n = 15) cohorts, the most common treatment-emergent adverse events included diarrhea (59.4%), nausea, acneiform rash, and fatigue (51.6% each). Dose-limiting toxicities included oral mucositis (n = 4), increased alanine aminotransferase/aspartate aminotransferase (n = 3), rash acneiform, hypertension (n = 2 each), and diarrhea (n = 1). MTD was copanlisib 0.4 mg/kg weekly and refametinib 30 mg twice daily. No pharmacokinetic interactions were identified. Decreased tumor FDG uptake and MEK-ERK signaling inhibition were demonstrated during treatment. Best response was stable disease (n = 21); median treatment duration was 6 weeks. Conclusions: Despite sound rationale and demonstrable pharmacodynamic tumor activity in relevant tumor populations, a dose and schedule could not be identified for this drug combination that was both tolerable and offered clear efficacy in the population assessed. Clinicaltrials.gov identifier: NCT01392521.

Original languageEnglish (US)
Pages (from-to)163-174
Number of pages12
JournalTargeted Oncology
Volume15
Issue number2
DOIs
StatePublished - Apr 1 2020

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Pharmacology (medical)

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    Ramanathan, R. K., Von Hoff, D. D., Eskens, F., Blumenschein, G., Richards, D., Genvresse, I., Reschke, S., Granvil, C., Skubala, A., Peña, C., & Mross, K. (2020). Phase Ib Trial of the PI3K Inhibitor Copanlisib Combined with the Allosteric MEK Inhibitor Refametinib in Patients with Advanced Cancer. Targeted Oncology, 15(2), 163-174. https://doi.org/10.1007/s11523-020-00714-0