A Phase I Trial of the IGFa??1R Antibody Ganitumab (AMG 479) in Combination with Everolimus (RAD001) and Panitumumab in Patients with Advanced Cancer

摘要

Purpose. This study evaluated the maximum tolerated dose or recommended phase II dose (RPTD) and safety and tolerability of the ganitumab and everolimus doublet regimen followed by the ganitumab, everolimus, and panitumumab triplet regimen. Materials and Methods. This was a standard 3a??+a??3 dose escalation trial. Doublet therapy consisted of ganitumab at 12 mg/kg every 2 weeks; doses of everolimus were adjusted according to dosea??limiting toxicities (DLTs). Panitumumab at 4.8 mg/kg every 2 weeks was added to the RPTD of ganitumab and everolimus. DLTs were assessed in cycle 1; toxicity evaluation was closely monitored throughout treatment. Treatment continued until disease progression or undesirable toxicity. Pretreatment and ona??treatment skin biopsies were collected to assess insulina??like growth factor 1 receptor and mammalian target of rapamycin (mTOR) target modulation. Results. Fortya??three subjects were enrolled. In the doublet regimen, two DLTs were observed in cohort 1, no DLTs in cohort a??1, and one in cohort a??1B. The triplet combination was discontinued because of unacceptable toxicity. Common adverse events were thrombocytopeniaeutropenia, skin rash, mucositis, fatigue, and hyperglycemia. In the doublet regimen, two patients with refractory nona??small cell lung cancer (NSCLC) achieved prolonged complete responses ranging from 18 to 60 months; one treatmenta??na?ˉve patient with chondrosarcoma achieved prolonged stable disease 24 months. In dermal granulation tissue, the insulina??like growth factor receptor and mTOR pathways were potently and specifically inhibited by ganitumab and everolimus, respectively. Conclusion. The triplet regimen of ganitumab, everolimus, and panitumumab was associated with unacceptable toxicity. However, the doublet of ganitumab at 12 mg/kg every 2 weeks and everolimus five times weekly had an acceptable safety profile and demonstrated notable clinical activity in patients with refractory NSCLC and sarcoma. Implications for Practice. This trial evaluated the maximum tolerated dose or recommended phase II dose and safety and tolerability of the ganitumab and everolimus doublet regimen followed by the ganitumab, everolimus, and panitumumab triplet regimen. Although the triplet regimen of ganitumab, everolimus, and panitumumab was associated with unacceptable toxicity, the doublet of ganitumab at 12 mg/kg every 2 weeks and everolimus at five times weekly had an acceptable safety profile and demonstrated notable clinical activity in patients with refractory nona??small cell lung cancer and sarcoma.