Phase Ib study of the MEK inhibitor cobimetinib (GDC-0973) in combination with the PI3K inhibitor pictilisib (GDC-0941) in patients with advanced solid tumors
Abstract
Purpose We investigated the combination of the MEK inhibitor, cobimetinib, and the pan-PI3K inhibitor, pictilisib, in an open-label, phase Ib study. Experimental Design Patients with advanced solid tumors were enrolled in 3 dose escalation schedules: (1) both agents once-daily for 21-days-on 7-days-off ("21/7"); (2) intermittent cobimetinib and 21/7 pictilisib ("intermittent"); or (3) both agents once-daily for 7-days-on 7-days-off ("7/7"). Starting doses for the 21/7, intermittent, and 7/7 schedules were 20/80, 100/130, and 40/130 mg of cobimetinib/pictilisib, respectively. Nine indication-specific expansion cohorts interrogated the recommended phase II dose and schedule. Results Of 178 enrollees (dose escalation: n = 98), 177 patients were dosed. The maximum tolerated doses for cobimetinib/pictilisib (mg) were 40/100, 125/180, and not reached, for the 21/7, intermittent, and 7/7 schedules, respectively. Six dose-limiting toxicities included grade 3 (G3) elevated lipase, G4 elevated creatine phosphokinase, and G3 events including fatigue concurrent with a serious adverse event (SAE) of diarrhea, decreased appetite, and SAEs of hypersensitivity and dehydration. Common drug-related adverse events included nausea, fatigue, vomiting, decreased appetite, dysgeusia, rash, and stomatitis. Pharmacokinetic parameters of the drugs used in combination were unaltered compared to monotherapy exposures. Confirmed partial responses were observed in patients with BRAF-mutant melanoma (n = 1) and KRAS-mutant endometrioid adenocarcinoma (n = 1). Eighteen patients remained on study ≥6 months. Biomarker data established successful blockade of MAP kinase (MAPK) and PI3K pathways. The metabolic response rate documented by FDG-PET was similar to that observed with cobimetinib monotherapy. Conclusions Cobimetinib and pictilisib combination therapy in patients with solid tumors had limited tolerability and efficacy.
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Despite attempts to verify the efficacy of combined PI3K and MEK inhibition, no desirable clinical result has been achieved for mutant-RAS tumors, and none of the approved PI3K inhibitors is adapted to treat them.
“Despite attempts to verify the efficacy of combined inhibition of PI3K and MEK, no desirable clinical result has been achieved for mutant-RAS tumors, and none of the approved PI3K inhibitors is adapted to treat them.620–622”
From Recent advances in targeting the “undruggable” proteins: from drug discovery to clinical trials (2023) · cites this paper as [620]
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eEF2K Activity Determines Synergy to Cotreatment of Cancer Cells With PI3K and MEK Inhibitors
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“Consequently, several clinical trials have been designed to evaluate combination therapies that simultaneously target PI3K and MAPK pathway members in order to prevent the occurrence of therapeutic resistance (40).”
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“When Pictilisib was used in combination with Cobimetinib (a MEK inhibitor), the recommended dose was not found due to minimal effieciency with tolerable dosage and the study was discontinued [64].”
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Melanoma: Pathogenesis and Targeted Therapy
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“The efficacy and tolerability of pan-PI3K inhibitor (pictilisib) plus MEK inhibitor (cobimetinib) were also disappointing in patients with solid tumors in the NCT00996892 study [ 227 ].”
TAS0612, a Novel RSK, AKT, and S6K Inhibitor, Exhibits Antitumor Effects in Preclinical Tumor Models
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Oncogenic stress response mechanisms as new therapeutic targets in cancer treatment: A review
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“Current strategies target mutant RAS proteins either directly [108] or by identifying vulnerabilities in oncogene-addicted tumor cells.”
Colon cancer cells evade drug action by enhancing drug metabolism
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YB-1 activating cascades as potential targets in KRAS-mutated tumors
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Towards Targeting Endothelial Rap1B to Overcome Vascular Immunosuppression in Cancer
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“Combining PI3K and MEK inhibitors has shown preclinical success [182,183], but clinical trials face toxicity issues [184,185].”
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“The theoretically promising approach of combination therapy with MAPK and PI3K inhibitors was toxic in clinical trials [142,143].”
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“The combinations of alpelisib with binimetinib, cobimetinib with pictilisib, and pimasertinib with voxtalisib have shown a 10%, 3%, and 8% ORR in 58,178 and 53 patients with unselected neoplasms, respectively [150–152].”
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“…20–22 B-cell lym-phoma-extra large (BCL-XL) inhibitors, 23 cyclin-dependent kinase 4/6 (CDK4/6) inhibitors, 24,25 and autophagy inhibitors 26,27 with MEK inhibitors have entered clinical trials, some combinations have failed due to enhanced toxicity, 20–22 and the results for others are awaited.”
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“…of p110 α and MEK requires further investigation as tolerability remains a challenge, but this could potentially be addressed by intermittent treatment with the MEK inhibitor (49) or the use of mutant-specific KRAS inhibitors (38, 50), which are currently at various stages of clinical development.”
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Additional file 1 of Identification of SUMOylation-related biomarkers in papillary thyroid carcinoma
Li, X., Ding, Z., & Tong, Y. (2024) · Figshare · doi:10.6084/m9.figshare.25706142
Additional file 2 of Identification of SUMOylation-related biomarkers in papillary thyroid carcinoma
Li, X., Ding, Z., & Tong, Y. (2024) · Figshare · doi:10.6084/m9.figshare.26713370
Emerging therapeutic strategies for mitochondrial DNA-related diseases
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“…already approved for clinical use in other indications 139 and has shown preclinical efficacy in vitro in a different mtDNA mutation, m.11778G>A. 64 142 Nevertheless, further validation across other mtDNA mutations is required, as current data suggest that heteroplasmy modulation may be mutation…”
Zhang, H.-H., Liu, M., Chen, Y.-N., Ming-ru, Z., Zhang, J., & He, J. (2026) · BMC Cancer · doi:10.1186/s12885-026-16571-5
“Cobimetinib (GDC-0973), a highly selective MEK1/2 inhibitor already approved for melanoma and other cancer types [38], emerges as a potential candidate drug that targets pathways related to CLIC4 , EZR , and MAOA .”
- Authors
- Shapiro, G. I., LoRusso, P., Kwak, E., Pandya, S., Rudin, C. M., Kurkjian, C., Cleary, J. M., Pilat, M. J., Jones, S., de Crespigny, A., Fredrickson, J., Musib, L., Yan, Y., Wongchenko, M., Hsieh, H.-J., Gates, M. R., Chan, I. T., & Bendell, J.
- Affiliations
- Dana-Farber Cancer Institute (US)
- Yale Cancer Center (US)
- Massachusetts General Hospital (US)
- Beth Israel Deaconess Medical Center (US)
- Memorial Sloan Kettering Cancer Center (US)
- OU Health Stephenson Cancer Center (US)
- Wayne State University (US)
- Sarah Cannon (US)
- Genentech (US)
- Corresponding author
- Shapiro, Geoffrey I.
- ORCID
- Venue
- Investigational New Drugs
- Published
- 2019-04-24
- Volume
- 38
- Issue
- 2
- Pages
- 419-432
- ISSN
- 0167-6997 (ISSN-L)
- 1573-0646
- OpenAlex
- W2940793077
- Cited by
- 90
- References
- 34
- Citations by year
- 2026: 8 · 2025: 15 · 2024: 17 · 2023: 13 · 2022: 9 · 2021: 18 · 2020: 7 · 2019: 3
- FWCI
- 3.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Investigational New Drugs (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Genentech
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › PI3K/AKT/mTOR signaling in cancer
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Melanoma and MAPK Pathways
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Advanced Breast Cancer Therapies
- Keywords
- cobimetinib, pictilisib, MEK inhibitors, PI3K inhibitors, combination therapy, advanced solid tumors, dose escalation, maximum tolerated dose, dose-limiting toxicity, BRAF-mutant melanoma, pharmacokinetics
- MeSH terms
- Phosphoinositide-3 Kinase Inhibitors, Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Azetidines, Female, Humans, Indazoles, Male, Membrane Proteins, Middle Aged, Neoplasms, Piperidines, Sulfonamides, Proto-Oncogene Proteins p21(ras), Treatment Outcome, GTP Phosphohydrolases, Mitogen-Activated Protein Kinase Kinases, Protein Kinase Inhibitors, Young Adult, Class I Phosphatidylinositol 3-Kinases
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