Timothy S Fenske1, Namrata M Shah1, Kyung Mann Kim2, Sandeep Saha2, Chong Zhang2, Arielle E Baim1, John P Farnen3, Adedayo A Onitilo4, Jules H Blank5, Harish Ahuja6, Tim Wassenaar7, Rubina Qamar8, Patrick Mansky9, Anne M Traynor10, Ryan J Mattison10, Brad S Kahl10. 1. Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin. 2. Department of Biostatistics and Medical Informatics, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin. 3. Gundersen Lutheran Health System, La Crosse, Wisconsin. 4. Marshfield Clinic, Weston, Wisconsin. 5. St. Vincent Regional Cancer Center, Green Bay, Wisconsin. 6. Aspirus Regional Cancer Center, Wausau, Wisconsin. 7. ProHealth Care Cancer Center, Waukesha, Wisconsin. 8. Aurora Cancer Care, Wauwatosa, Wisconsin. 9. Bellin Health, Green Bay, Wisconsin. 10. Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.
Abstract
BACKGROUND: Proteasome inhibitors and mammalian target of rapamycin inhibitors each have activity in various B-cell malignancies and affect distinct cellular pathways. Their combination has demonstrated synergy in vitro and in mouse models. METHODS: The authors conducted a single-arm, phase 2 trial of combined temsirolimus and bortezomib in patients with relapsed and refractory B-cell non-Hodgkin lymphoma (NHL) using a dosing scheme that was previously tested in multiple myeloma. The patients received bortezomib and temsirolimus weekly on days 1, 8, 15, and 22 of a 35-day cycle. RESULTS: Of 39 patients who received treatment, 3 achieved a complete response (7.7%; 95% confidence interval [CI], 1.6%-21%), and 9 had a partial response (PR) (23%; 95% CI, 11%-39%). Thus, the overall response rate (12 of 39 patients) was 31% (95% CI, 17%-48%), and the median progression-free survival was 4.7 months (95% CI, 2.1-7.8 months; 2 months for patients with diffuse large B-cell lymphoma [n = 18], 7.5 months for those with mantle cell lymphoma [n = 7], and 16.5 months for those with follicular lymphoma [n = 9]). Two extensively treated patients with diffuse large B-cell lymphoma achieved a complete response. There were no unexpected toxicities from the combination. CONCLUSIONS: The current results demonstrate that the combination of a mammalian target of rapamycin inhibitor and a proteasome inhibitor is safe and has activity in patients with heavily pretreated B-cell NHL. Further studies with this combination are warranted in specific subtypes of NHL.
BACKGROUND: Proteasome inhibitors and mammalian target of rapamycin inhibitors each have activity in various B-cell malignancies and affect distinct cellular pathways. Their combination has demonstrated synergy in vitro and in mouse models. METHODS: The authors conducted a single-arm, phase 2 trial of combined temsirolimus and bortezomib in patients with relapsed and refractory B-cell non-Hodgkin lymphoma (NHL) using a dosing scheme that was previously tested in multiple myeloma. The patients received bortezomib and temsirolimus weekly on days 1, 8, 15, and 22 of a 35-day cycle. RESULTS: Of 39 patients who received treatment, 3 achieved a complete response (7.7%; 95% confidence interval [CI], 1.6%-21%), and 9 had a partial response (PR) (23%; 95% CI, 11%-39%). Thus, the overall response rate (12 of 39 patients) was 31% (95% CI, 17%-48%), and the median progression-free survival was 4.7 months (95% CI, 2.1-7.8 months; 2 months for patients with diffuse large B-cell lymphoma [n = 18], 7.5 months for those with mantle cell lymphoma [n = 7], and 16.5 months for those with follicular lymphoma [n = 9]). Two extensively treated patients with diffuse large B-cell lymphoma achieved a complete response. There were no unexpected toxicities from the combination. CONCLUSIONS: The current results demonstrate that the combination of a mammalian target of rapamycin inhibitor and a proteasome inhibitor is safe and has activity in patients with heavily pretreated B-cell NHL. Further studies with this combination are warranted in specific subtypes of NHL.
Authors: Arati A Inamdar; Andre Goy; Nehad M Ayoub; Christen Attia; Lucia Oton; Varun Taruvai; Mark Costales; Yu-Ting Lin; Andrew Pecora; K Stephen Suh Journal: Oncotarget Date: 2016-07-26