TY - JOUR
T1 - Pre-surgical trial of the AKT inhibitor MK-2206 in patients with operable invasive breast cancer
T2 - a New York Cancer Consortium trial
AU - Kalinsky, K.
AU - Sparano, J. A.
AU - Zhong, X.
AU - Andreopoulou, E.
AU - Taback, B.
AU - Wiechmann, L.
AU - Feldman, S. M.
AU - Ananthakrishnan, P.
AU - Ahmad, A.
AU - Cremers, S.
AU - Sireci, A. N.
AU - Cross, J. R.
AU - Marks, D. K.
AU - Mundi, P.
AU - Connolly, E.
AU - Crew, K. D.
AU - Maurer, M. A.
AU - Hibshoosh, H.
AU - Lee, S.
AU - Hershman, D. L.
N1 - Publisher Copyright:
© 2018, Federación de Sociedades Españolas de Oncología (FESEO).
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Introduction: The PI3K/AKT/mTOR pathway is an oncogenic driver in breast cancer (BC). In this multi-center, pre-surgical study, we evaluated the tissue effects of the AKT inhibitor MK-2206 in women with stage I–III BC. Materials and methods: Two doses of weekly oral MK2206 were administered at days − 9 and − 2 before surgery. The primary endpoint was reduction of pAktSer473 in breast tumor tissue from diagnostic biopsy to surgery. Secondary endpoints included changes in PI3K/AKT pathway tumor markers, tumor proliferation (ki-67), insulin growth factor pathway blood markers, pharmacokinetics (PK), genomics, and MK-2206 tolerability. Paired t tests were used to compare biomarker changes in pre- and post-MK-2206, and two-sample t tests to compare with prospectively accrued untreated controls. Results: Despite dose reductions, the trial was discontinued after 12 patients due to grade III rash, mucositis, and pruritus. While there was a trend to reduction in pAKT after MK-2206 (p = 0.06), there was no significant change compared to controls (n = 5, p = 0.65). After MK-2206, no significant changes in ki-67, pS6, PTEN, or stathmin were observed. There was no significant association between dose level and PK (p = 0.11). Compared to controls, MK-2206 significantly increased serum glucose (p = 0.02), insulin (p < 0.01), C-peptide (p < 0.01), and a trend in IGFBP-3 (p = 0.06). Conclusion: While a trend to pAKT reduction after MK-2206 was observed, there was no significant change compared to controls. However, the accrued population was limited, due to toxicity being greater than expected. Pre-surgical trials can identify in vivo activity in the early drug development, but side effects must be considered in this healthy population.
AB - Introduction: The PI3K/AKT/mTOR pathway is an oncogenic driver in breast cancer (BC). In this multi-center, pre-surgical study, we evaluated the tissue effects of the AKT inhibitor MK-2206 in women with stage I–III BC. Materials and methods: Two doses of weekly oral MK2206 were administered at days − 9 and − 2 before surgery. The primary endpoint was reduction of pAktSer473 in breast tumor tissue from diagnostic biopsy to surgery. Secondary endpoints included changes in PI3K/AKT pathway tumor markers, tumor proliferation (ki-67), insulin growth factor pathway blood markers, pharmacokinetics (PK), genomics, and MK-2206 tolerability. Paired t tests were used to compare biomarker changes in pre- and post-MK-2206, and two-sample t tests to compare with prospectively accrued untreated controls. Results: Despite dose reductions, the trial was discontinued after 12 patients due to grade III rash, mucositis, and pruritus. While there was a trend to reduction in pAKT after MK-2206 (p = 0.06), there was no significant change compared to controls (n = 5, p = 0.65). After MK-2206, no significant changes in ki-67, pS6, PTEN, or stathmin were observed. There was no significant association between dose level and PK (p = 0.11). Compared to controls, MK-2206 significantly increased serum glucose (p = 0.02), insulin (p < 0.01), C-peptide (p < 0.01), and a trend in IGFBP-3 (p = 0.06). Conclusion: While a trend to pAKT reduction after MK-2206 was observed, there was no significant change compared to controls. However, the accrued population was limited, due to toxicity being greater than expected. Pre-surgical trials can identify in vivo activity in the early drug development, but side effects must be considered in this healthy population.
KW - AKT inhibitor
KW - Breast cancer
KW - MK-2206
KW - Phase 0
KW - Pre-surgical
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U2 - 10.1007/s12094-018-1888-2
DO - 10.1007/s12094-018-1888-2
M3 - Article
C2 - 29736694
AN - SCOPUS:85046531888
SN - 1699-048X
VL - 20
SP - 1474
EP - 1483
JO - Clinical and Translational Oncology
JF - Clinical and Translational Oncology
IS - 11
ER -