Phase 1 cohort expansion study of LY3023414, a dual PI3K/mTOR inhibitor, in patients with advanced mesothelioma

Marjorie G Zauderer,Enrica Capelletto,Melinda D Willard,Anna M Szpurka,Johanna Bendell,Evan W Alley,Todd M Bauer,Anna M Varghese,Sophie Callies,Volker Wacheck,Suhyun Kang

doi:10.1007/s10637-021-01086-6

Abstract

SummaryBACKGROUND LY3023414 is a selective, ATP competitive inhibitor of class I PI3K isoforms, mTORC1/2 and DNA-PK. A Phase 1 dose escalation, 200 mg twice daily (BID) of LY3023414 was the determined recommended phase 2 dose (RP2D). We report the antitumor activity and safety of LY3023414 monotherapy in patients with advanced mesothelioma.METHODS Patients enrolled had advanced malignant pleural or peritoneal mesothelioma with measurable disease, ECOG PS 0–1, were refractory or ineligible to receive standard therapies. Patients received LY3023414 200 mg BID. This dose expansion cohort is intended to evaluate preliminary antitumor activity of LY3023414 by overall response rate. Safety, tolerability and pharmacokinetics were assessed. Biomarkers associated with treatment response was an exploratory endpoint. RESULTS Forty-two patients received LY3023414 for a median duration of 11.2 weeks (range: 1.1–53.0). One patient had a confirmed partial response (PR) (ORR 2.4%). Three patients had an unconfirmed PR. Seventeen patients had stable disease (SD) (DCR 43%). Most common adverse events (AEs) included fatigue (43%), nausea (43%), decreased appetite (38%), vomiting (33%), and diarrhea (29%). AEs were mostly mild or moderate. Grade ≥ 3 AEs were reported for 21% of patients with fatigue as the most frequent event (10%). Alterations of BAP1 were identified in 11/19 patients as the most common molecular aberration, followed by SETD2 and NF2 alterations. No obvious pattern of genetic changes/mutations in single genes or pathways was associated with anti-tumor activity. CONCLUSION LY3023414 monotherapy (200 mg BID) demonstrated an acceptable and manageable safety profile with limited single-agent activity in patients with advanced mesothelioma. ClinicalTrials.gov identifier: NCT01655225; Date of registration: 19 July 2012.

Highlights

The phosphatidylinositol 3-kinase/mammalian target of rapamycin (PI3K/mTOR) pathway is vital in regulating physiological processes such as cell growth and proliferation
A total of 42 patients diagnosed with advanced mesothelioma were enrolled and received at least one dose of the study drug
As mTOR activity is aberrantly upregulated in the case of NF2 inactivation, suppressing mTOR activity by LY3023414 might be considered beneficial for treatment of malignant mesothelioma

Summary

Introduction

The phosphatidylinositol 3-kinase/mammalian target of rapamycin (PI3K/mTOR) pathway is vital in regulating physiological processes such as cell growth and proliferation. In. Nashville, TN, USA 5 University of Turin, Torino, TO, Italy 6 Eli Lilly and Company, Indianapolis, IN, USA the development of malignant disease, its activation has been reported in >30% of various solid tumor types [1, 2]. Pharmacological inhibition of PI3K/mTOR blocks tumor growth and survival signaling in different tumor xenograft models [3]. Several dual PI3K/mTOR inhibitors are currently under investigation as monotherapy or in combination with standard of care therapies. Besides allosteric mTOR inhibitors (everolimus and temsirolimus), delta isoform specific PI3K inhibitors are currently approved for clinical use [4]. For solid tumors with a high incidence of aberrant PI3K pathway activation, PI3K/mTOR inhibitor monotherapy could be employed in larger patient populations [5, 6]

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