Phase II study of selumetinib, an orally active inhibitor of MEK1 and MEK2 kinases, in KRASG12R-mutant pancreatic ductal adenocarcinoma

Cara Kenney, Tricia Kunst, Santhana Webb, Devisser Christina Jr, Christy Arrowood, Seth M Steinberg, Niharika B Mettu, Edward J Kim, Udo Rudloff, Cara Kenney, Tricia Kunst, Santhana Webb, Devisser Christina Jr, Christy Arrowood, Seth M Steinberg, Niharika B Mettu, Edward J Kim, Udo Rudloff

Abstract

Background Preclinical evidence has suggested that a subset of pancreatic cancers with the G12R mutational isoform of the KRAS oncogene is more sensitive to MAPK pathway blockade than pancreatic tumors with other KRAS isoforms. We conducted a biomarker-driven trial of selumetinib (KOSELUGO™; ARRY-142886), an orally active, allosteric mitogen-activated protein kinase 1 and 2 (MEK1/2) inhibitor, in pancreas cancer patients with somatic KRASG12R mutations. Methods In this two-stage, phase II study (NCT03040986) patients with advanced pancreas cancer harboring somatic KRASG12R variants who had received at least one standard-of-care systemic therapy regimen received 75 mg selumetinib orally twice a day until disease progression or unacceptable toxicity occurred. The primary outcome of the study was best objective response (BOR). Results From August 2017 to February 2018 a total of 8 patients with confirmed somatic KRASG12R mutations and a median age of 61.5 years were treated with selumetinib. Seven out of eight (87.5%) had received two or more lines of prior systemic chemotherapy. After a median follow-up period of 8.5 months (range 2 to 20), three patients had stable disease for more than 6 months while receiving selumetinib. No patients achieved an objective partial response. Median progression-free survival (PFS) was 3.0 months (95% CI, 0.8-8.2) and median overall survival (OS) 9 months (95% CI, 2.5-20.9). Conclusion This study in heavily pre-treated pancreatic adenocarcinoma patients suggests alternative strategies beyond single agent MEK inhibition are required for this unique, molecular subset of pancreatic cancer patients. The trial was registered on February 2nd, 2017 under identifier NCT03040986 with ClinicalTrials.gov .

Keywords: KRAS G12 mutational isoform; MEK inhibitor; Pancreas cancer; Phase II; Selumetinib.

Conflict of interest statement

All authors declare that they have no competing interests.

All authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Clinical and biochemical responses of selumetinib in KRASG12R-mutant pancreatic cancer patients. a. Best objective responses (BORs) measured as best percentage change in tumor volume by RECIST1.1 from baseline of patients treated with selumetnib. Dashed line indicates cut-off for partial response. b. Serum CA19–9 concentrations (U/mL) pre- and on-treatment with selumetinib
Fig. 2
Fig. 2
Survival outcomes with selumetinib. a. Kaplan-Meier estimate of progression-free survival (median PFS = 3.0 months (95% CI, 0.8–8.2 months). b. Kaplan-Meier estimate of overall survival (median OS = 8.9 months (95% CI, 2.5–20.9 months). Censored patients are indicated by -

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