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A phase 1b/2 study of LEE011 in combination with binimetinib (MEK162) in patients with NRAS-mutant melanoma: Early encouraging clinical activity.
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).
Background: NRAS-mutant melanoma has poor prognosis with no approved targeted therapies. Enhanced MAPK pathway signaling and cell cycle checkpoint dysregulation are frequent in NRAS-mutant melanoma. Thus, simultaneous inhibition of MEK and CDK4/6 could further suppress pathway activation. The MEK inhibitor binimetinib (MEK162) showed clinical activity in patients (pts) with NRAS-mutant melanoma. In preclinical studies, the selective CDK4/6 inhibitor LEE011 demonstrated tumor growth inhibition, and in combination with binimetinib led to regressions in NRAS-mutant melanoma models, warranting clinical study. Methods: This is a phase 1b/2, open-label study of LEE011 + binimetinib in pts with NRAS-mutant melanoma. The primary objective of the phase 1b part is to estimate the MTD/RP2D of the combination, using a Bayesian logistic regression model (BLRM) with overdose control. Secondary objectives include safety, pharmacokinetics (PK), and preliminary efficacy. LEE011 is administered once daily for 21 days of each 28-day cycle and binimetinib is administered twice daily continuously. Results: As of Dec 20, 2013, 14 pts were enrolled (93% stage M1c; ECOG PS 0/1/2 [43%/50%/7%]; median 2 prior lines) and were treated with LEE011 at 200 mg (dose level [DL] 1, n = 8) or 300 mg (DL 2, n = 6) and with binimetinib 45 mg. DLTs occurred at DL 1 (grade 3 acute renal injury, n = 1) and DL 2 (grade 4 asymptomatic creatine phosphokinase [CPK] elevation and grade 3 edema plus grade 4 atrial fibrillation, 1 pt each). Common treatment-related toxicities included CPK elevation, rash, edema, anemia, nausea, diarrhea, and fatigue. Preliminary PK was consistent with single-agent data for either drug, with no evidence of drug-drug interaction. Six pts achieved partial response (43%; 1 confirmed, 5 unconfirmed) and 6 had stable disease (4 with tumor shrinkage > 20%). Several pts experienced early tumor shrinkage with major symptomatic improvement; 8 pts remain on treatment (duration 2-8 mo). Conclusions: Combined LEE011 + binimetinib shows promising preliminary antitumor activity in pts with NRAS-mutant melanoma. Determination of a phase 2 dose and schedule and PD effects are ongoing. Clinical trial information: NCT01719380.
Abstracts by Jeffrey Alan Sosman:
CheckMate 025 phase III trial: Outcomes by key baseline factors and prior therapy for nivolumab (NIVO) versus everolimus (EVE) in advanced renal cell carcinoma (RCC).Meeting: 2016 Genitourinary Cancers Symposium | Abstract No: 498Category: Genitourinary Cancer - Renal Cell Cancer
BRAF inhibitor acquired resistance: A multicenter meta-analysis of the spectrum and clinical implications of resistance mechanisms.Meeting: 2015 ASCO Annual Meeting | Abstract No: 9008
Dose escalation stage of a first-in-class phase I study of the novel oral ERK 1/2 kinase inhibitor BVD-523 (ulixertinib) in patients with advanced solid tumors.Meeting: 2015 ASCO Annual Meeting | Abstract No: 2506
Presentations by Jeffrey Alan Sosman:
Meeting: 2012 Markers in Cancer
Session: General Session IV: Mechanism-Based Markers of Resistance and Toxicity (General Session)
Analysis of molecular mechanisms of response and resistance to vemurafenib (vem) in BRAFV600E melanoma.Meeting: 2012 ASCO Annual Meeting Abstract No: 8503^Session: Melanoma/Skin Cancers (Oral Abstract Session)