Phase I study of ceralasertib (AZD6738), a novel DNA damage repair agent, in combination with weekly paclitaxel in refractory cancer
Mené sur 57 patients atteints d'un cancer de stade avancé (dont 33 cas de mélanome), cet essai de phase I évalue la dose maximale tolérée du céralasertib (un inhibiteur d'ATR dispensé par voie orale) en combinaison avec le paclitaxel, après l'échec de traitements à base d'anti-PD1/PD-L1
Résumé en anglais
Purpose: Ceralasertib is a potent and selective oral inhibitor of the serine/threonine protein kinase ataxia telangiectasia and Rad3-related (ATR) protein.
Experimental Design: Eligible patients with solid tumors, enriched for melanoma, received ceralasertib in combination with a fixed dose of paclitaxel (80 mg/m2 on D1, D8, D15) in 28-day cycles. The dose of ceralasertib was escalated to reach a maximum tolerated dose (MTD) in a rolling 6 design. The starting dose of ceralasertib was 40 mg QD. Fifty seven patients (33 melanoma patients who failed prior PD1/L1 treatment) were enrolled in 7 dose cohorts ranging from 40 mg QD to 240 mg BD plus weekly paclitaxel.
Results: The RP2D was established as ceralasertib 240 mg BD days 1-14 plus paclitaxel 80 mg/m2 on D1, D8, D15 every 28 days. The most common toxicities were neutropenia (n=39, 68%), anemia (n=25, 44%), and thrombocytopenia (n=21, 37%). In the full analysis set of 57 patients, the overall response rate (ORR) was 22.6% (95% CI, 12.5-35.3). In 33 patients with melanoma, resistant to prior anti-PD1 therapy, the ORR was 33.3% (95% CI, 18.0 - 51.8). In the melanoma subset, the mPFS was 3.6 months (95% CI 2.0 - 5.8), the median duration of response was 9.9 months (95% CI 3.7 - 23.2) and the mOS was 7.4 months (95% CI 5.7 - 11.9).
Conclusions: Ceralasertib in combination with paclitaxel was well tolerated in patients with advanced malignancies and showed evidence of anti-tumor activity. Durable responses were observed in patients with advanced cutaneous, acral, and mucosal melanoma resistant to anti-PD1/L1 treatment.
