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Authors | J. Wolf D. Planchard R.S. Heist B. Solomon M. Sebastian A. Santoro N. Reguart U. Stammberger L. Manganelli H. Wu A. Mais C. Dooms | ||||||||||||
Title | Phase Ib study of LXH254 + LTT462 in patients with KRAS- or BRAF-mutant NSCLC | ||||||||||||
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URL | https://www.annalsofoncology.org/article/S0923-7534(20)41697-7/fulltext | ||||||||||||
Abstract Text | Background LXH254 is a BRAF/CRAF inhibitor and LTT462 is an ERK1/2 inhibitor. Both have demonstrated preclinical activity in MAPK-pathway driven xenograft models and have been evaluated as single agents in phase I dose-finding studies. Methods This phase Ib open-label trial (NCT02974725) explored LXH254 combinations; here we report on LXH254 + LTT462 dose escalation. Patients (pts) with advanced/metastatic KRAS- or BRAF-mutant NSCLC received oral LXH254 (50–350 mg once daily [QD] or 300–600 mg twice daily [BID]) and oral LTT462 (100–300 mg QD). Objectives included evaluating the recommended dose for expansion (RDE), safety, pharmacokinetics (PK) and preliminary efficacy of LXH254 + LTT462. Results As of 20 Aug 2019, 49 pts had been treated. 45 (92%) discontinued, primarily due to progressive disease (PD; n=29; 59%). Median age was 62 yrs (range: 35–82), 67% had ≥stage IIIB disease, 82% received ≥2 prior therapies. Median duration of exposure to study treatment was 6 wks (range: 1–36). LXH254 + LTT462 PK parameters were consistent with single-agent data; exposure was approximately dose proportional for both. 5 DLTs were reported in 4 pts: Grade (G) 3 rash and G3 hand-foot syndrome; G4 asymptomatic amylase increase; G3 asymptomatic lipase increase; G3 retinal detachment. Treatment-related (tr) AEs were reported in 90% of pts, most commonly (≥20%) dermatitis acneiform, nausea (both 29%), pruritis (27%), diarrhea (24%). G3/4 trAEs were reported in 33% of pts, most commonly (≥4%) lipase increase, amylase increase (both 6%), acute polyneuropathy (4%). Maximum tolerated dose was not reached; the RDE was LXH254 400 mg BID + LTT462 200 mg QD. 2 pts (4%; BRAF-mutant: 1 typical [V600E], 1 atypical [K601N]) had an unconfirmed partial response (uPR) and received treatment >4 months at LXH254 doses ≥300 mg BID. 16 pts (33%; including the 2 uPRs) had stable disease; of those, 2 BRAF-mutant pts (V600E, G466A) had tumor shrinkage ≥25%. 19 pts (39%) had PD. Response was unknown in 13 pts due to discontinuation prior to first assessment and 1 pt due to insufficient data. Conclusions. LXH254 + LTT462 was generally well tolerated and the RDE has been declared. Preliminary signs of efficacy were seen in pts with BRAF-mutant NSCLC; dose expansion is ongoing. |
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Therapy Name | Drugs | Efficacy Evidence | Clinical Trials |
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Gene | Variant | Impact | Protein Effect | Variant Description | Associated with drug Resistance |
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Molecular Profile | Indication/Tumor Type | Response Type | Therapy Name | Approval Status | Evidence Type | Efficacy Evidence | References |
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BRAF V600E | lung non-small cell carcinoma | predicted - sensitive | LTT462 + LXH 254 | Case Reports/Case Series | Actionable | In a Phase Ib trial, LTT462 and LXH 254 combination therapy was well tolerated and resulted in an unconfirmed partial response (PR) in 4% (2/49) and stable disease (SD) in 33% (16/49) of patients with advanced or metastatic KRAS- or BRAF-mutant non-small cell lung cancer, with 1 patient harboring BRAF V600E achieving an unconfirmed PR and 1 achieving SD with over 25% tumor reduction (Ann Oncol 31 (suppl 4):S881-S882; NCT02974725). | detail... |
BRAF G466A | lung non-small cell carcinoma | predicted - sensitive | LTT462 + LXH 254 | Case Reports/Case Series | Actionable | In a Phase Ib trial, LTT462 and LXH 254 combination therapy was well tolerated and resulted in an unconfirmed partial response (PR) in 4% (2/49) and stable disease (SD) in 33% (16/49) of patients with advanced or metastatic KRAS- or BRAF-mutant non-small cell lung cancer, with 1 patient harboring BRAF G466A achieving SD with over 25% tumor reduction (Ann Oncol 31 (suppl 4):S881-S882; NCT02974725). | detail... |
BRAF K601N | lung non-small cell carcinoma | predicted - sensitive | LTT462 + LXH 254 | Case Reports/Case Series | Actionable | In a Phase Ib trial, LTT462 and LXH 254 combination therapy was well tolerated and resulted in an unconfirmed partial response (PR) in 4% (2/49) and stable disease (SD) in 33% (16/49) of patients with advanced or metastatic KRAS- or BRAF-mutant non-small cell lung cancer, with 1 patient harboring BRAF K601N achieving an unconfirmed PR (Ann Oncol 31 (suppl 4):S881-S882; NCT02974725). | detail... |