Selective Oral MEK1/2 Inhibitor Pimasertib in Metastatic Melanoma: Antitumor Activity in a Phase I, Dose-Escalation Trial.


Journal

Targeted oncology
ISSN: 1776-260X
Titre abrégé: Target Oncol
Pays: France
ID NLM: 101270595

Informations de publication

Date de publication:
01 2021
Historique:
pubmed: 20 11 2020
medline: 15 10 2021
entrez: 19 11 2020
Statut: ppublish

Résumé

Pimasertib is a selective, potent mitogen-activated protein kinase kinase (MEK) 1/2 inhibitor. The aim of this study was to describe the efficacy, safety, and pharmacodynamics of pimasertib at pharmacologically active doses in a cohort of patients with locally advanced/metastatic melanoma from a first-in-human study of pimasertib. This was a phase I, open-label, two-part, dose-escalation study. Part 1 was conducted in patients with solid tumors and identified the maximum tolerated dose, while Part 2 was restricted to patients with advanced/metastatic melanoma. Endpoints included safety, pharmacodynamics, and antitumor activity. We present data for patients with melanoma only from both parts of the study. In total, 93 patients with melanoma received pimasertib, 89 of whom received pharmacologically active doses (28-255 mg/day) across four dose regimens in the two parts of the study. The objective response rate was 12.4% (11/89): complete response (n = 1) and partial response (PR; n = 10). Six patients responded for > 24 weeks. Nine of the 11 responders had tumors with B-Raf Proto-Oncogene, Serine/Threonine Kinase (BRAF; n = 6) and/or NRAS Proto-Oncogene, GTPase (NRAS; n = 3) mutations. Forty-six patients had stable disease (SD). In patients with ocular melanoma (n = 13), best overall response was PR (n = 1), SD (n = 11), and disease progression (n = 1). Phosphorylated extracellular signal-regulated kinase (pERK) levels were substantially reduced within 2 h of treatment and inhibition was sustained with continuous twice-daily dosing. Treatment-related, recurrent, grade 3 or higher adverse events were reported in eight patients, including diarrhea, and skin and ocular events. Results from this phase I study indicate that pimasertib has clinical activity in patients with locally advanced/metastatic melanoma, particularly BRAF- and NRAS-mutated tumors, at clinically relevant doses associated with pERK inhibition in peripheral blood mononuclear cells. ClinicalTrials.gov, NCT00982865.

Sections du résumé

BACKGROUND
Pimasertib is a selective, potent mitogen-activated protein kinase kinase (MEK) 1/2 inhibitor.
OBJECTIVES
The aim of this study was to describe the efficacy, safety, and pharmacodynamics of pimasertib at pharmacologically active doses in a cohort of patients with locally advanced/metastatic melanoma from a first-in-human study of pimasertib.
METHODS
This was a phase I, open-label, two-part, dose-escalation study. Part 1 was conducted in patients with solid tumors and identified the maximum tolerated dose, while Part 2 was restricted to patients with advanced/metastatic melanoma. Endpoints included safety, pharmacodynamics, and antitumor activity. We present data for patients with melanoma only from both parts of the study.
RESULTS
In total, 93 patients with melanoma received pimasertib, 89 of whom received pharmacologically active doses (28-255 mg/day) across four dose regimens in the two parts of the study. The objective response rate was 12.4% (11/89): complete response (n = 1) and partial response (PR; n = 10). Six patients responded for > 24 weeks. Nine of the 11 responders had tumors with B-Raf Proto-Oncogene, Serine/Threonine Kinase (BRAF; n = 6) and/or NRAS Proto-Oncogene, GTPase (NRAS; n = 3) mutations. Forty-six patients had stable disease (SD). In patients with ocular melanoma (n = 13), best overall response was PR (n = 1), SD (n = 11), and disease progression (n = 1). Phosphorylated extracellular signal-regulated kinase (pERK) levels were substantially reduced within 2 h of treatment and inhibition was sustained with continuous twice-daily dosing. Treatment-related, recurrent, grade 3 or higher adverse events were reported in eight patients, including diarrhea, and skin and ocular events.
CONCLUSION
Results from this phase I study indicate that pimasertib has clinical activity in patients with locally advanced/metastatic melanoma, particularly BRAF- and NRAS-mutated tumors, at clinically relevant doses associated with pERK inhibition in peripheral blood mononuclear cells.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT00982865.

Identifiants

pubmed: 33211315
doi: 10.1007/s11523-020-00767-1
pii: 10.1007/s11523-020-00767-1
doi:

Substances chimiques

MAS1 protein, human 0
N-(2,3-dihydroxypropyl)-1-((2-fluoro-4-iodophenyl)amino)isonicotinamide 0
Protein Kinase Inhibitors 0
Proto-Oncogene Mas 0
Niacinamide 25X51I8RD4

Banques de données

ClinicalTrials.gov
['NCT00982865']

Types de publication

Clinical Trial, Phase I Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

47-57

Références

Chapman PB, Hauschild A, Robert C, Haanen JB, Ascierto P, Larkin J. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med. 2011;364:2507–16.
doi: 10.1056/NEJMoa1103782
Hauschild A, Grob JJ, Demidov LV, Jouary T, Gutzmer R, Millward M, et al. Dabrafenib in BRAF-mutated metastatic melanoma: a multicentre, open-label, phase 3 randomised controlled trial. Lancet. 2012;380:358–65.
doi: 10.1016/S0140-6736(12)60868-X
Rossi A, Roberto M, Panebianco M, Botticelli A, Mazzuca F, Marchetti P. Drug resistance of BRAF-mutant melanoma: review of up-to-date mechanisms of action and promising targeted agents. Eur J Pharmacol. 2019;862:172621.
doi: 10.1016/j.ejphar.2019.172621
Ascierto PA, McArthur GA, Dréno B, Atkinson V, Liszkay G, Di Giacomo AM, et al. Cobimetinib combined with vemurafenib in advanced BRAF(V600)-mutant melanoma (coBRIM): updated efficacy results from a randomised, double-blind, phase 3 trial. Lancet Oncol. 2016;17:1248–60.
doi: 10.1016/S1470-2045(16)30122-X
Larkin J, Ascierto PA, Dréno B, Atkinson V, Liszkay G, Maio M, et al. Combined vemurafenib and cobimetinib in BRAF-mutated melanoma. N Engl J Med. 2014;371:1867–76.
doi: 10.1056/NEJMoa1408868
Robert C, Grob JJ, Stroyakovskiy D, Karaszewska B, Hauschild A, Levchenko E, et al. Five-year outcomes with dabrafenib plus trametinib in metastatic melanoma. N Engl J Med. 2019;381:626–36.
doi: 10.1056/NEJMoa1904059
Long GV, Flaherty KT, Stroyakovskiy D, Gogas H, Levchenko E, de Braud F, et al. Dabrafenib plus trametinib versus dabrafenib monotherapy in patients with metastatic BRAF V600E/K-mutant melanoma: long-term survival and safety analysis of a phase 3 study. Ann Oncol. 2018;28:1631–9.
doi: 10.1093/annonc/mdx176
Dummer R, Ascierto PA, Gogas HJ, Arance A, Mandala M, Liszkay G, et al. Encorafenib plus binimetinib versus vemurafenib or encorafenib in patients with BRAF-mutant melanoma (COLUMBUS): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2018a;19:603–15.
doi: 10.1016/S1470-2045(18)30142-6
Dummer R, Ascierto PA, Gogas HJ, Arance A, Mandala M, Liszkay G, et al. Overall survival in patients with BRAF-mutant melanoma receiving encorafenib plus binimetinib versus vemurafenib or encorafenib (COLUMBUS): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2018b;19:1315–27.
doi: 10.1016/S1470-2045(18)30497-2
Hamid O, Puzanov I, Dummer R, Schachter J, Daud A, Schadendorf D, et al. Final analysis of a randomised trial comparing pembrolizumab versus investigator-choice chemotherapy for ipilimumab-refractory advanced melanoma. Eur J Cancer. 2017;86:37–45.
doi: 10.1016/j.ejca.2017.07.022
Schachter J, Ribas A, Long GV, Arance A, Grob JJ, Mortier L, et al. Pembrolizumab versus ipilimumab for advanced melanoma: final overall survival results of a multicentre, randomised, open-label phase 3 study (KEYNOTE-006). Lancet. 2017;390:1853–62.
doi: 10.1016/S0140-6736(17)31601-X
Larkin J, Minor D, D’Angelo S, Neyns B, Smylie M, Miller WH Jr, et al. Overall survival in patients with advanced melanoma who received nivolumab versus investigator’s choice chemotherapy in Checkmate 037: a randomized, controlled, open-label Phase III trial. J Clin Oncol. 2018;36:383–90.
doi: 10.1200/JCO.2016.71.8023
Hodi FS, Chiarion-Sileni V, Gonzalez R, Grob JJ, Rutkowski P, Cowey CL, et al. Nivolumab plus ipilimumab or nivolumab alone versus ipilimumab alone in advanced melanoma (CheckMate 067): 4-year outcomes of a multicentre, randomised, phase 3 trial. Lancet Oncol. 2018;19:1480–92.
doi: 10.1016/S1470-2045(18)30700-9
Hodi FS, O’Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010;363:711–2.
doi: 10.1056/NEJMoa1003466
Wolchok JD, Chiarion-Sileni V, Gonzalez R, Rutkowski P, Grob JJ, Cowey CL, et al. Overall survival with combined nivolumab and ipilimumab in advanced melanoma. N Engl J Med. 2017;377:1345–56.
doi: 10.1056/NEJMoa1709684
Conry RM, Westbrook B, McKee S, Norwood TG. Talimogene laherparepvec: first in class oncolytic virotherapy. Hum Vaccin Immunother. 2018;14:839–46.
doi: 10.1080/21645515.2017.1412896
Keilholz U, Mehnert JM, Bauer S, Bourgeois H, Patel MR, Gravenor D, et al. Avelumab in patients with previously treated metastatic melanoma: phase 1b results from the JAVELIN Solid Tumor trial. J Immunother Cancer. 2019;7:12.
doi: 10.1186/s40425-018-0459-y
Sullivan RJ, Hamid O, Gonzalez R, Infante JR, Patel MR, Hodi FS, et al. Atezolizumab plus cobimetinib and vemurafenib in BRAF-mutated melanoma patients. Nat Med. 2019;25:929–35.
doi: 10.1038/s41591-019-0474-7
Ascierto PA, Ferrucci PF, Fisher R, Del Vecchio M, Atkinson V, Schmidt H, et al. Dabrafenib, trametinib and pembrolizumab or placebo in BRAF-mutant melanoma. Nat Med. 2019;25:941–6.
doi: 10.1038/s41591-019-0448-9
Dummer R, Schadendorf D, Ascierto PA, Arance A, Dutriaux C, Di Giacomo AM, et al. Binimetinib versus dacarbazine in patients with advanced NRAS-mutant melanoma (NEMO): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2017;18:435–45.
doi: 10.1016/S1470-2045(17)30180-8
Muñoz-Couselo E, Adelantado EZ, Ortiz C, García JS, Perez-Garcia J. NRAS-mutant melanoma: current challenges and future prospect. Onco Targets Ther. 2017;10:3941–7.
doi: 10.2147/OTT.S117121
Boespflug A, Caramel J, Stephane Dalle S, Thomas L. Treatment of NRAS-mutated advanced or metastatic melanoma: rationale, current trials and evidence to date. Ther Adv Med Oncol. 2017;9:481–92.
doi: 10.1177/1758834017708160
Kim K, Kong SY, Fulciniti M, Li X, Song W, Nahar S, et al. Blockade of the MEK/ERK signalling cascade by AS703026, a novel selective MEK1/2 inhibitor, induces pleiotropic anti-myeloma activity in vitro and in vivo. Br J Haematol. 2010;149:537–49.
doi: 10.1111/j.1365-2141.2010.08127.x
Yoon J, Koo K-H, Choi K-Y. MEK1/2 Inhibitors AS703026 and AZD6244 may be potential therapies for KRAS mutated colorectal cancer that is resistant to EGFR monoclonal antibody therapy. Cancer Res. 2010;71:445–53.
doi: 10.1158/0008-5472.CAN-10-3058
Park SJ, Hong S-W, Moon J-H, Jin DH, Kim JS, Lee CK, et al. The MEK1/2 inhibitor AS703026 circumvents resistance to the BRAF inhibitor PLX4032 in human malignant melanoma cells. Am J Med Sci. 2013;346:494–8.
doi: 10.1097/MAJ.0b013e318298a185
von Richter O, Massimini G, Scheible H, Udvaros I, Johne A. Pimasertib, a selective oral MEK1/2 inhibitor: absolute bioavailability, mass balance, elimination route, and metabolite profile in cancer patients. Br J Clin Pharmacol. 2016;82:1498–508.
doi: 10.1111/bcp.13078
Delord J-P, Houédé N, Awada A, Lebbe C, Lesimple T, Schellens JHM, et al. 616 Pimasertib (MSC1936369B), a selective oral MEK1/2 inhibitor, shows clinical activity in melanoma. Eur J Cancer. 2012;48(Suppl 6):190.
doi: 10.1016/S0959-8049(12)72413-9
Delord J-P, Italiano A, Awada A, Aftimos P, Houédé N, Lebbe C, et al. Selective oral MEK 1/2 inhibitor pimasertib: a phase I trial in patients with advanced solid tumors. Target Oncol. https://doi.org/10.1007/s11523-020-00768-0
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
Falchook GS, Lewis KD, Infante JR, Gordon MS, Vogelzang NJ, DeMarini DJ, et al. Activity of the oral MEK inhibitor trametinib in patients with advanced melanoma: a phase 1 dose-escalation trial. Lancet Oncol. 2012;13:782–9.
doi: 10.1016/S1470-2045(12)70269-3
Flaherty KT, Robert C, Hersey P, Nathan P, Garbe C, Milhem M, et al. Improved survival with MEK inhibition in BRAF-mutated melanoma. N Engl J Med. 2012;367:107–14.
doi: 10.1056/NEJMoa1203421
Ravandi F, Pigneux A, DeAngelo DJ, Raffoux E, Delaunay J, Thomas X, et al. Clinical, pharmacokinetic and pharmacodynamic data for the MEK1/2 inhibitor pimasertib in patients with advanced hematologic malignancies. Blood Cancer J. 2015;5:e375.
doi: 10.1038/bcj.2015.103
Macarulla T, Cervantes A, Tabernero J, Roselló S, Van Cutsem E, Tejpar S, et al. Phase I study of FOLFIRI plus pimasertib as second-line treatment for KRAS-mutated metastatic colorectal cancer. Br J Cancer. 2015;112:1874–81.
doi: 10.1038/bjc.2015.144
Ascierto PA, Schadendorf D, Berking C, Agarwala SS, van Herpen CM, Queirolo P, et al. MEK162 for patients with advanced melanoma harbouring NRAS or Val600 BRAF mutations: a non-randomised, open-label phase 2 study. Lancet Oncol. 2013;14:249–56.
doi: 10.1016/S1470-2045(13)70024-X
Heinzerling L, Eigentler TK, Fluck M, Hassel JC, Heller-Schenck D, Leipe J, et al. Tolerability of BRAF/MEK inhibitor combinations: adverse event evaluation and management. ESMO Open. 2019;4:e000491.
doi: 10.1136/esmoopen-2019-000491
Kim KB, Kefford R, Pavlick AC, Infante JR, Ribas A, Sosman JA, et al. Phase II study of the MEK1/MEK2 inhibitor trametinib in patients with metastatic BRAF-mutant cutaneous melanoma previously treated with or without a BRAF inhibitor. J Clin Oncol. 2013;31:482–9.
doi: 10.1200/JCO.2012.43.5966
Lebbe C, Dutriaux C, Lesimple T, Kruit W, Kerger J, Thomas L, et al. Pimasertib (PIM) versus dacarbazine (DTIC) in patients (pts) with cutaneous NRAS melanoma: a controlled, open-label phase II trial with crossover. Ann Oncol. 2016;27(Suppl 6):1136P.
Savoia P, Fava P, Casoni F, Cremona O. Targeting the ERK signaling pathway in melanoma. Int J Mol Sci. 2019;20:1483.
doi: 10.3390/ijms20061483

Auteurs

Céleste Lebbé (C)

Dermatology and CIC, AP-HP, Saint Louis Hospital, and Université de Paris, INSERM U976, Paris, France. celeste.lebbe@aphp.fr.

Antoine Italiano (A)

Early Phase Trials and Sarcoma Units, Institut Bergonié, Bordeaux, France.
University of Bordeaux, Bordeaux, France.

Nadine Houédé (N)

Medical Oncology, Institut de Cancérologie du Gard, CHU Caremeau, Nîmes, France.

Ahmad Awada (A)

Oncology Médicine Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.

Philippe Aftimos (P)

Oncology Médicine Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.

Thierry Lesimple (T)

Medical Oncology Department, Comprehensive Cancer Center Eugène Marquis, Rennes, France.

Monica Dinulescu (M)

Department of Dermatology, Rennes University Hospital, Rennes, France.

Jan H M Schellens (JHM)

Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, The Netherlands.

Suzanne Leijen (S)

Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.

Sylvie Rottey (S)

Department of Medical Oncology, Ghent University Hospital and Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.

Vibeke Kruse (V)

Department of Medical Oncology, Ghent University Hospital and Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.

Richard Kefford (R)

Crown Princess Mary Cancer Centre Westmead Hospital, Faculty of Medicine and Health Sciences, Macquarie University, and Melanoma Institute Australia, Sydney, NSW, Australia.

Eric Raymond (E)

Medical Oncology, Groupe Hospitalier Paris St Joseph, Paris, France.

Sandrine Faivre (S)

Medical Oncology, Beaujon University Hospital, Clichy, France.

Celine Pages (C)

Dermatology and CIC, AP-HP, Saint Louis Hospital, and Université de Paris, INSERM U976, Paris, France.

Carlos Gomez-Roca (C)

Clinical Research Unit, Institut Universitaire du Cancer, Oncopole, Toulouse, France.

Armin Schueler (A)

Global Biostatistics and Epidemiology, EMD Serono Research and Development Institute, Inc. (an affiliate of Merck KGaA, Darmstadt, Germany), Billerica, MA, USA.

Samantha Goodstal (S)

Translational Research, EMD Serono Research and Development Institute, Inc. (an affiliate of Merck KGaA, Darmstadt, Germany), Billerica, MA, USA.

Giorgio Massimini (G)

Early Clinical Oncology Global Clinical Development Biopharma, Merck KGaA, Darmstadt, Germany.

Jean-Pierre Delord (JP)

Clinical Research Unit, Institut Universitaire du Cancer, Oncopole, Toulouse, France.

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