A S Fung1, D M Graham2, E X Chen3, T L Stockley4, T Zhang5, L W Le6, H Albaba6, K M Pisters7, P A Bradbury3, M Trinkaus8, M Chan9, S Arif9, U Zurawska10, J Rothenstein11, D Zawisza6, S Effendi6, S Gill6, M Sawczak6, J H Law6, N B Leighl12. 1. Department of Oncology, Queen's University, Canada; Princess Margaret Cancer Centre, University Health Network, Canada. 2. Princess Margaret Cancer Centre, University Health Network, Canada; Division of Medical Oncology, University of Toronto, Canada; The Christie NHSFoundation Trust, Manchester, UK. 3. Princess Margaret Cancer Centre, University Health Network, Canada; Division of Medical Oncology, University of Toronto, Canada. 4. Division of Clinical Laboratory Genetics, University Health Network, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada; Advanced Molecular Diagnostics Laboratory, University Health Network, Canada. 5. Division of Clinical Laboratory Genetics, University Health Network, Canada; Advanced Molecular Diagnostics Laboratory, University Health Network, Canada. 6. Princess Margaret Cancer Centre, University Health Network, Canada. 7. Princess Margaret Cancer Centre, University Health Network, Canada; MD Anderson Cancer Centre, Houston, TX, United States. 8. Division of Medical Oncology, University of Toronto, Canada; Markham Stouffville Hospital, Markham, Canada. 9. Division of Medical Oncology, University of Toronto, Canada; Trillium Health Partners, Mississauga, Canada. 10. Division of Medical Oncology, University of Toronto, Canada; St. Joseph's Health Centre, Toronto, Canada. 11. Division of Medical Oncology, University of Toronto, Canada; RS McLaughlin Durham Cancer Centre, Oshawa, Canada. 12. Princess Margaret Cancer Centre, University Health Network, Canada; Division of Medical Oncology, University of Toronto, Canada. Electronic address: Natasha.Leighl@uhn.ca.
Abstract
INTRODUCTION: MEK inhibition is a potential therapeutic strategy in non-small cell lung cancer (NSCLC). This phase I study evaluates the MEK inhibitor binimetinib plus carboplatin and pemetrexed in stage IV non-squamous NSCLC patients (NCT02185690). METHODS: A standard 3 + 3 dose-escalation design was used. Binimetinib 30 mg BID (dose level 1 [DL1]) or 45 mg BID (dose level 2 [DL2]) was given with standard doses of carboplatin and pemetrexed using an intermittent dosing schedule. The primary outcome was determination of the recommended phase II dose (RP2D) and safety of binimetinib. Secondary outcomes included efficacy, pharmacokinetics, and an exploratory analysis of response based on mutation subtype. RESULTS: Thirteen patients (6 DL1, 7 DL2) were enrolled: 7 KRAS, 5 EGFR, and 1 NRAS mutation. The RP2D was binimetinib 30 mg BID. Eight patients (61.5%) had grade 3/4 adverse events, with dose limiting toxicities in 2 patients at DL2. Twelve patients were evaluated for response, with an investigator-assessed objective response rate (ORR) of 50% (95% CI 21.1%-78.9%; ORR 33.3% by independent-review, IR), and disease control rate 83.3% (95% CI 51.6%-97.9%). Median progression free survival (PFS) was 4.5 months (95% CI 2.6 months-NA), with a 6-month and 12-month PFS rate of 38.5% (95% CI 19.3%-76.5%) and 25.6% (95% CI 8.9%-73.6%), respectively. In an exploratory analysis, KRAS/NRAS-mutated patients had an ORR of 62.5% (ORR 37.5% by IR) vs. 25% in KRAS/NRAS wild-type patients. In MAP2K1-mutated patients, the ORR was 42.8%. CONCLUSION: The addition of binimetinib to carboplatin and pemetrexed appears to have manageable toxicity with evidence of activity in advanced non-squamous NSCLC.
INTRODUCTION:MEK inhibition is a potential therapeutic strategy in non-small cell lung cancer (NSCLC). This phase I study evaluates the MEK inhibitor binimetinib plus carboplatin and pemetrexed in stage IV non-squamous NSCLCpatients (NCT02185690). METHODS: A standard 3 + 3 dose-escalation design was used. Binimetinib 30 mg BID (dose level 1 [DL1]) or 45 mg BID (dose level 2 [DL2]) was given with standard doses of carboplatin and pemetrexed using an intermittent dosing schedule. The primary outcome was determination of the recommended phase II dose (RP2D) and safety of binimetinib. Secondary outcomes included efficacy, pharmacokinetics, and an exploratory analysis of response based on mutation subtype. RESULTS: Thirteen patients (6 DL1, 7 DL2) were enrolled: 7 KRAS, 5 EGFR, and 1 NRAS mutation. The RP2D was binimetinib 30 mg BID. Eight patients (61.5%) had grade 3/4 adverse events, with dose limiting toxicities in 2 patients at DL2. Twelve patients were evaluated for response, with an investigator-assessed objective response rate (ORR) of 50% (95% CI 21.1%-78.9%; ORR 33.3% by independent-review, IR), and disease control rate 83.3% (95% CI 51.6%-97.9%). Median progression free survival (PFS) was 4.5 months (95% CI 2.6 months-NA), with a 6-month and 12-month PFS rate of 38.5% (95% CI 19.3%-76.5%) and 25.6% (95% CI 8.9%-73.6%), respectively. In an exploratory analysis, KRAS/NRAS-mutated patients had an ORR of 62.5% (ORR 37.5% by IR) vs. 25% in KRAS/NRAS wild-type patients. In MAP2K1-mutated patients, the ORR was 42.8%. CONCLUSION: The addition of binimetinib to carboplatin and pemetrexed appears to have manageable toxicity with evidence of activity in advanced non-squamous NSCLC.
Authors: Alexander Scheiter; Frederik Hierl; Ingrid Winkel; Felix Keil; Margit Klier-Richter; Cédric Coulouarn; Florian Lüke; Arne Kandulski; Matthias Evert; Wolfgang Dietmaier; Diego F Calvisi; Kirsten Utpatel Journal: J Pers Med Date: 2022-08-01