A phase I study of single-agent perifosine for recurrent or refractory pediatric CNS and solid tumors Journal Article


Authors: Becher, O. J.; Millard, N. E.; Modak, S.; Kushner, B. H.; Haque, S.; Spasojevic, I.; Trippett, T. M.; Gilheeney, S. W.; Khakoo, Y.; Lyden, D. C.; De Braganca, K. C.; Kolesar, J. M.; Huse, J. T.; Kramer, K.; Cheung, N. K. V.; Dunkel, I. J.
Article Title: A phase I study of single-agent perifosine for recurrent or refractory pediatric CNS and solid tumors
Abstract: The PI3K/Akt/mTOR signaling pathway is aberrantly activated in various pediatric tumors. We conducted a phase I study of the Akt inhibitor perifosine in patients with recurrent/refractory pediatric CNS and solid tumors. This was a standard 3+3 open-label dose-escalation study to assess pharmacokinetics, describe toxicities, and identify the MTD for single-agent perifosine. Five dose levels were investigated, ranging from 25 to 125 mg/m2/day for 28 days per cycle. Twenty-three patients (median age 10 years, range 4±18 years) with CNS tumors (DIPG [n = 3], high-grade glioma [n = 5], medulloblastoma [n = 2], ependymoma [n = 3]), neuroblastoma (n = 8), Wilms tumor (n = 1), and Ewing sarcoma (n = 1) were treated. Only one DLT occurred (grade 4 hyperuricemia at dose level 4). The most common grade 3 or 4 toxicity at least possibly related to perifosine was neutropenia (8.7%), with the remaining grade 3 or 4 toxicities (fatigue, hyperglycemia, fever, hyperuricemia, and catheter- related infection) occurring in one patient each. Pharmacokinetics was dose-saturable at doses above 50 mg/m2/day with significant inter-patient variability, consistent with findings reported in adult studies. One patient with DIPG (dose level 5) and 4 of 5 patients with highgrade glioma (dose levels 2 and 3) experienced stable disease for two months. Five subjects with neuroblastoma (dose levels 1 through 4) achieved stable disease which was prolonged (≥11 months) in three. No objective responses were noted. In conclusion, the use of perifosine was safe and feasible in patients with recurrent/refractory pediatric CNS and solid tumors. An MTD was not defined by the 5 dose levels investigated. Our RP2D is 50 mg/m2/day. © 2017 Becher et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Journal Title: PLoS ONE
Volume: 12
Issue: 6
ISSN: 1932-6203
Publisher: Public Library of Science  
Date Published: 2017-06-05
Start Page: e0178593
Language: English
DOI: 10.1371/journal.pone.0178593
PROVIDER: scopus
PMCID: PMC5459446
PUBMED: 28582410
DOI/URL:
Notes: Article -- Export Date: 3 July 2017 -- Source: Scopus
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MSK Authors
  1. Brian Kushner
    272 Kushner
  2. Tanya M Trippett
    120 Trippett
  3. Nai-Kong Cheung
    585 Cheung
  4. Ira J Dunkel
    322 Dunkel
  5. David C Lyden
    85 Lyden
  6. Kim Kramer
    206 Kramer
  7. Shakeel Modak
    213 Modak
  8. Yasmin Khakoo
    131 Khakoo
  9. Sofia S Haque
    123 Haque
  10. Jason T Huse
    133 Huse
  11. Oren Josh Becher
    25 Becher