A phase Ib study of sotrastaurin, a PKC inhibitor, and alpelisib, a PI3Kα inhibitor, in patients with metastatic uveal melanoma Journal Article


Authors: Shoushtari, A. N.; Khan, S.; Komatsubara, K.; Feun, L.; Acquavella, N.; Singh-Kandah, S.; Negri, T.; Nesson, A.; Abbate, K.; Cremers, S.; Musi, E.; Ambrosini, G.; Lee, S.; Schwartz, G. K.; Carvajal, R. D.
Article Title: A phase Ib study of sotrastaurin, a PKC inhibitor, and alpelisib, a PI3Kα inhibitor, in patients with metastatic uveal melanoma
Abstract: Simple Summary: Uveal melanoma is a rare subset of melanoma characterized by the presence of early initiating GNAQ/11 mutations, with downstream activation of several pathways which are thought to contribute to cell growth. Based on clinical and preclinical data supporting targeting of protein kinase C (PKC) and the phosphatidylinositol 3-kinase (PI3K) pathway, we conducted a phase Ib study to assess the safety of combined sotrastaurin, a PKC inhibitor, and alpelisib, a PI3K inhibitor. We found that sotrastaurin and alpelisib can be safely administered, however there was no evidence of clinical efficacy.Uveal melanoma (UM) is a rare subset of melanoma characterized by the presence of early initiating GNAQ/11 mutations, with downstream activation of the PKC, MAPK, and PI3Ka pathways. Activity has been observed with the PKC inhibitors sotrastaurin (AEB071) and darovasertib (IDE196) in patients with UM. Inhibition of the PI3K pathway enhances PKC inhibition in in vivo models. We therefore conducted a phase Ib study of sotrastaurin in combination with the PI3Ka inhibitor alpelisib to identify a tolerable regimen that may enhance the activity of PKC inhibition alone. Patients with metastatic uveal melanoma (n = 24) or GNAQ/11 mutant cutaneous melanoma (n = 1) were enrolled on escalating dose levels of sotrastaurin (100-400 mg BID) and alpelisib (200-350 mg QD). The primary objective was to identify the maximum tolerated dose (MTD) of these agents when administered in combination. Treatment-related adverse events (AE) occurred in 86% (any grade) and 29% (Grade 3). No Grade 4-5-related AEs occurred. Dose Level 4 (sotrastaurin 200 mg BID and alpelisib 350 mg QD) was identified as the maximum tolerated dose. Pharmacokinetic analysis demonstrated increasing concentration levels with increasing doses of sotrastaurin and alpelisib, without evidence of interaction between agents. Pharmacodynamic assessment of pMARCKS and pAKT protein expression with drug exposure suggested modest target inhibition that did not correlate with clinical response. No objective responses were observed, and median progression-free survival was 8 weeks (range, 3-51 weeks). Although a tolerable dose of sotrastaurin and alpelisib was identified with pharmacodynamic evidence of target inhibition and without evidence of a corresponding immunosuppressive effect, limited clinical activity was observed.
Keywords: targeted therapy; pi3k; family; pkc; mutations; gnaq; uveal melanoma; alpelisib; sotrastaurin; aeb071
Journal Title: Cancers
Volume: 13
Issue: 21
ISSN: 2072-6694
Publisher: MDPI  
Date Published: 2021-11-01
Start Page: 5504
Language: English
ACCESSION: WOS:000719497700001
DOI: 10.3390/cancers13215504
PROVIDER: wos
PMCID: PMC8583628
PUBMED: 34771668
Notes: Article -- Source: Wos
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  1. Kelly Teresa Abbate
    14 Abbate