B H O'Neil1, A J Scott2, W W Ma3, S J Cohen4, D L Aisner2, A R Menter5, M A Tejani6, J K Cho7, J Granfortuna8, L Coveler9, O O Olowokure10, J C Baranda11, M Cusnir12, P Phillip13, J Boles14, R Nazemzadeh15, M Rarick16, D J Cohen17, J Radford18, L Fehrenbacher19, R Bajaj20, V Bathini21, P Fanta22, J Berlin23, A J McRee24, R Maguire25, F Wilhelm25, M Maniar25, A Jimeno2, C L Gomes26, W A Messersmith27. 1. Simon Cancer Center, Indiana University School of Medicine, Indianapolis. 2. University of Colorado, Denver, Aurora. 3. Roswell Park Cancer Institute, Buffalo. 4. Fox Chase Cancer Center, Philadelphia. 5. Kaiser Permanente, Lone Tree. 6. University of Rochester Medical Center, Rochester. 7. Oncare Hawaii, Honolulu. 8. Cone Health Cancer Center, Greensboro. 9. University of Washington, Seattle. 10. University of Cincinnati Cancer Institute, Cincinnati. 11. University of Kansas Medical Center, Westwood. 12. Mount Sinai Medical Center, Miami Beach. 13. Karmanos Cancer Institute, Detroit. 14. Rex Cancer Center UNC Healthcare, Raleigh. 15. Carolinas Health Care, Charlotte. 16. Kaiser Permanante Northwest, Portland. 17. NYU Clinical Cancer Center, New York. 18. Hendersonville Hematology and Oncology at Pardee, Hendersonville. 19. Kaiser Permanante Medical Center, Vallejo. 20. McLeod Regional Medical Center, Florence. 21. University of Massachusetts Memorial, Worcester. 22. UCSD Moores Cancer Center, La Jolla. 23. Vanderbilt-Ingram Cancer Center, Nashville. 24. UNC Lineberger Comprehensive Cancer Center, Chapel Hill. 25. Onconova Therapeutics Inc., Newtown. 26. Oncology Consortia of Criterium Inc., Saratoga Springs, USA. 27. University of Colorado, Denver, Aurora. Electronic address: wells.messersmith@ucdenver.edu.
Abstract
BACKGROUND: Rigosertib (ON 01910.Na), a first-in-class Ras mimetic and small-molecule inhibitor of multiple signaling pathways including polo-like kinase 1 (PLK1) and phosphoinositide 3-kinase (PI3K), has shown efficacy in preclinical pancreatic cancer models. In this study, rigosertib was assessed in combination with gemcitabine in patients with treatment-naïve metastatic pancreatic adenocarcinoma. MATERIALS AND METHODS:Patients with metastatic pancreatic adenocarcinoma were randomized in a 2:1 fashion to gemcitabine 1000 mg/m(2) weekly for 3 weeks of a 4-week cycle plus rigosertib 1800 mg/m(2) via 2-h continuous IV infusions given twice weekly for 3 weeks of a 4-week cycle (RIG + GEM) versus gemcitabine 1000 mg/m(2) weekly for 3 weeks in a 4-week cycle (GEM). RESULTS: A total of 160 patients were enrolled globally and randomly assigned to RIG + GEM (106 patients) or GEM (54). The most common grade 3 or higher adverse events were neutropenia (8% in the RIG + GEM group versus 6% in the GEM group), hyponatremia (17% versus 4%), and anemia (8% versus 4%). The median overall survival was 6.1 months for RIG + GEM versus 6.4 months for GEM [hazard ratio (HR), 1.24; 95% confidence interval (CI) 0.85-1.81]. The median progression-free survival was 3.4 months for both groups (HR = 0.96; 95% CI 0.68-1.36). The partial response rate was 19% versus 13% for RIG + GEM versus GEM, respectively. Of 64 tumor samples sent for molecular analysis, 47 were adequate for multiplex genetic testing and 41 were positive for mutations. The majority of cases had KRAS gene mutations (40 cases). Other mutations detected included TP53 (13 cases) and PIK3CA (1 case). No correlation between mutational status and efficacy was detected. CONCLUSIONS: The combination of RIG + GEM failed to demonstrate an improvement in survival or response compared with GEM in patients with metastatic pancreatic adenocarcinoma. Rigosertib showed a similar safety profile to that seen in previous trials using the IV formulation.
RCT Entities:
BACKGROUND:Rigosertib (ON 01910.Na), a first-in-class Ras mimetic and small-molecule inhibitor of multiple signaling pathways including polo-like kinase 1 (PLK1) and phosphoinositide 3-kinase (PI3K), has shown efficacy in preclinical pancreatic cancer models. In this study, rigosertib was assessed in combination with gemcitabine in patients with treatment-naïve metastatic pancreatic adenocarcinoma. MATERIALS AND METHODS:Patients with metastatic pancreatic adenocarcinoma were randomized in a 2:1 fashion to gemcitabine 1000 mg/m(2) weekly for 3 weeks of a 4-week cycle plus rigosertib 1800 mg/m(2) via 2-h continuous IV infusions given twice weekly for 3 weeks of a 4-week cycle (RIG + GEM) versus gemcitabine 1000 mg/m(2) weekly for 3 weeks in a 4-week cycle (GEM). RESULTS: A total of 160 patients were enrolled globally and randomly assigned to RIG + GEM (106 patients) or GEM (54). The most common grade 3 or higher adverse events were neutropenia (8% in the RIG + GEM group versus 6% in the GEM group), hyponatremia (17% versus 4%), and anemia (8% versus 4%). The median overall survival was 6.1 months for RIG + GEM versus 6.4 months for GEM [hazard ratio (HR), 1.24; 95% confidence interval (CI) 0.85-1.81]. The median progression-free survival was 3.4 months for both groups (HR = 0.96; 95% CI 0.68-1.36). The partial response rate was 19% versus 13% for RIG + GEM versus GEM, respectively. Of 64 tumor samples sent for molecular analysis, 47 were adequate for multiplex genetic testing and 41 were positive for mutations. The majority of cases had KRAS gene mutations (40 cases). Other mutations detected included TP53 (13 cases) and PIK3CA (1 case). No correlation between mutational status and efficacy was detected. CONCLUSIONS: The combination of RIG + GEM failed to demonstrate an improvement in survival or response compared with GEM in patients with metastatic pancreatic adenocarcinoma. Rigosertib showed a similar safety profile to that seen in previous trials using the IV formulation.
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