Everolimus and pazopanib (E/P) benefit genomically selected patients with metastatic urothelial carcinoma

Joaquim Bellmunt, Aly-Khan A Lalani, Sussana Jacobus, Stephanie A Wankowicz, Laura Polacek, David Y Takeda, Lauren C Harshman, Nikhil Wagle, Irene Moreno, Kevin Lundgren, Dominick Bossé, Eliezer M Van Allen, Toni K Choueiri, Jonathan E Rosenberg, Joaquim Bellmunt, Aly-Khan A Lalani, Sussana Jacobus, Stephanie A Wankowicz, Laura Polacek, David Y Takeda, Lauren C Harshman, Nikhil Wagle, Irene Moreno, Kevin Lundgren, Dominick Bossé, Eliezer M Van Allen, Toni K Choueiri, Jonathan E Rosenberg

Abstract

Background: Metastatic urothelial carcinoma (mUC) is a genomically diverse disease with known alterations in the mTOR pathway and tyrosine kinases including FGFR. We investigated the efficacy and safety of combination treatment with everolimus and pazopanib (E/P) in genomically profiled patients with mUC.

Methods: mUC patients enrolled on a Phase I dose escalation study and an expansion cohort treated with E/P were included. The primary end point was objective response rate (ORR); secondary end points were safety, duration of response (DOR), progression-free survival (PFS) and overall survival (OS). Patients were assessed for mutations and copy number alterations in 300 relevant cancer-associated genes using next-generation sequencing and findings were correlated with outcomes. Time-to-event data were estimated with Kaplan-Meier methods.

Results: Of the 23 patients enrolled overall, 19 had mUC. ORR was 21% (one complete response (CR), three partial responses (PR), eight with stable disease (SD). DOR, PFS and OS were 6.5, 3.6, and 9.1 months, respectively. Four patients with clinical benefit (one CR, two PR, one SD) had mutations in TSC1/TSC2 or mTOR and a 5th patient with PR had a FGFR3-TACC3 fusion.

Conclusions: Combination therapy with E/P is safe in mUC and select patients with alterations in mTOR or FGFR pathways derive significant clinical benefit.

Trial registration: ClinicalTrials.gov NCT01184326.

Conflict of interest statement

J.B.: Honoraria/consulting from Astellas, Genentech, Merck, Novartis, Pfizer, Pierre Fabre; institutional research funding/support from Millenium, Sanofi, MSD Oncology, Pfizer. A.A.L.: Honoraria/consulting from Novartis; travel expenses from Pfizer. L.C.H.: Honoraria/consulting from Genentech, Pfizer, Dendreon, NCCN, Medivation/Astellas, KEW; institutional research funding/support from Bayer, Medivation/Astellas, Pfizer, Dendreon, Sotio, Genentech, Merck, BMS, Jannsen. E.M.V.A.: Honoraria/consulting from Genome Medical, Novartis, Roche, Syapse, Takeda, Third Rock Ventures; institutional research funding/support from Bristol-Myers Squibb, Novartis. T.K.C.: Honoraria/consulting from Alligent, AstraZeneca, Bayer, Bristol-Myers Squibb, Cerulean Pharma, Eisai, Exelixis, Foundation Medicine, GlaxoSmithKline, Merck, Novartis, Peloton, Pfizer, Prometheus, Roche/Genentech; institutional research funding/support from Pfizer, Exelixis, Bristol-Myers Squibb, Novartis, Peloton, AstraZeneca, Agensys, TRACON. J.E.R.: Honoraria/consulting from Agensys, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol- Myers Squibb, EMD Serono, Lilly, Merck, Oncogenex, Roche/Genentech, Sanofi, Seattle Genetics; institutional research funding/support from Agensys, Genentech/Roche, Mirati Therapeutics, Novartis, Oncogenex, Viralytics. The remaining authors declare no competing interests.

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