A phase II study of sapanisertib (TAK-228) a mTORC1/2 inhibitor in rapalog-resistant advanced pancreatic neuroendocrine tumors (PNET): ECOG-ACRIN EA2161
0301 basic medicine
PNET
Sapanisertib
Clinical Sciences
Oncology and Carcinogenesis
Clinical Trials and Supportive Activities
Neuroectodermal Tumors
Mechanistic Target of Rapamycin Complex 1
03 medical and health sciences
Clinical Research
Primitive
Humans
Neuroectodermal Tumors, Primitive
Oncology & Carcinogenesis
mTORC1/2 inhibitor
Protein Kinase Inhibitors
Cancer
Sirolimus
Biomedical and Clinical Sciences
Evaluation of treatments and therapeutic interventions
Oncology and carcinogenesis
Pharmacology and Pharmaceutical Sciences
MTOR Inhibitors
3. Good health
Pancreatic Neoplasms
Neuroendocrine Tumors
Pharmacology and pharmaceutical sciences
6.1 Pharmaceuticals
DOI:
10.1007/s10637-022-01311-w
Publication Date:
2022-10-20T06:02:31Z
AUTHORS (9)
ABSTRACT
This was a two-stage phase II trial of a mTORC1/2 inhibitor (mTORC: mammalian target of rapamycin complex) Sapanisertib (TAK228) in patients with rapalog-resistant pancreatic neuroendocrine tumors (PNETs) (NCT02893930). Approved rapalogs such as everolimus inhibit mTORC1 and have limited clinical activity, possibly due to compensatory feedback loops. Sapanisertib addresses the potential for incomplete inhibition of the mTOR pathway through targeting of both mTORC1 and mTORC2, and thus to reverse resistance to earlier rapamycin analogues. In stage 1, patients received sapanisertib 3 mg by mouth once daily on a continuous dosing schedule in 28-day cycle. This trial adopted a two-stage design with the primary objective of evaluating objective tumor response. The first stage would recruit 13 patients in order to accrue 12 eligible and treated patients. If among the 12 eligible patients at least 1 patient had an objective response to therapy, the study would move to the second stage of accrual where 25 eligible and treated patients would be enrolled. This study activated on February 1, 2017, the required pre-determined number of patients (n = 13) had entered by November 5, 2018 for the first stage response evaluation. The accrual of this trial was formally terminated on December 27, 2019 as no response had been observed after the first stage accrual. Treatment-related grade 3 adverse events were reported in eight (61%) patients with hyperglycemia being the most frequent, in three patients (23%). Other toxicities noted in the trial included fatigue, rash diarrhea, nausea, and vomiting. The median PFS was 5.19 months (95% CI [3.84, 9.30]) and the median OS was 20.44 months (95% CI [5.65, 22.54]). Due to the lack of responses in Stage 1 of the study, the study did not proceed to stage 2. Thus the potential to reverse resistance was not evident.
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