Cited by 92PI3K/AKT/mTOR signaling in cancerMelanoma and MAPK PathwaysAdvanced Breast Cancer Therapies

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

Shapiro, Geoffrey I., LoRusso, Patricia, Kwak, Eunice, Pandya, Susan, Rudin, Charles M., Kurkjian, Carla, Cleary, James M., Pilat, Mary Jo +10 more·2020·Investigational New Drugs

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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Crossref · 10.1007/s10637-019-00776-6

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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”

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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.
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
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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