91 Background: Resistance to EGFR therapy is poorly understood. We performed a phase I study in which pre- and post-treatment biopsies were profiled to assess the impact of CTX and LPT on downstream pathways that drive cancer progression. Methods: Between 10/2010 and 5/2012, 16 patients (pts) were enrolled in a 3+3 dose escalation trial, including: colon (7), lung (4), head and neck (3), and anal cancers (2). Prior EGFR therapy was allowed. CTX was 400mg/m2 on D1, then 250 mg/m2 weekly. LPT dose levels were 750 mg, 1000 mg, and 1250 mg daily. Cycles were 21 days in length; pts were assessed for response every 2 cycles. Pts underwent pre- and post-cycle 1 tumor biopsies. Biopsies were evaluated with a Reverse Phase MicroArray (RPMA) platform. Protein lysates were robotically immobilized in defined spots on nitrocellulose-coated slides; each printed array was then interrogated with a highly specific antibody. A total of 36 different proteins were analyzed, including total and phosphorylated EGFR, ErbB2, ErbB3, MET, IGF, MAPK, PI3K, Jak-Stat, and other subpathways. Relative baseline expression levels were determined, as were percent change in matched samples. Results: Of 12 pts evaluable for response, 2 had a partial response (PR), 5 had stable disease (SD), and 5 had disease progression (DP). Baseline tumor measurements of total ERK, p90RSK, and p38MAPK correlated with response (p<0.05), with a trend towards significance between response and expression of pEGFR, pMEK, pNFKB, and p4EBP1 (p<0.10). Nine patients had paired pre- and post-treatment biopsies. In tumors from pts with PR and SD, consistent down regulation of the EGFR pathway was detected. In the four patients with DP, up-regulation of distinct pathway components was detected, including of IGF (1 pt), Mek1/Erk (2 pts), mTOR (2 pts), and STAT3 (3 pts). Conclusions: A tumor profile was defined that correlated with clinical benefit to LPT+CTX. Resistance to this combination was due to upregulation of EGFR pathway components, components that are druggable. This analysis highlights the potential of personalizing therapy with combined EGFR therapies, and for adding additional targeted therapies to patients with resistant tumors.
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