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Phase I Study of the Anti-IGF-1R Monoclonal Antibody, Cixutumumab in Combination with Everolimus and Octreotide LAR in Advanced Low to Intermediate Grade Neuroendocrine Tumors #MMPMID25900182
Endocr Relat Cancer 2015[Jun]; 22 (3): 431-41 PMID25900182show ga
Preclinical data suggest multiple roles for the insulin like growth factor receptor 1 (IGF-1R) in neuroendocrine tumors (NET) including mediating resistance to mTOR inhibitors. Everolimus, an oral mTOR inhibitor and octreotide LAR are approved for subgroups of well differentiated NET. The primary objective was to establish the safety and recommended phase II dose (RP2D) of cixutumumab, a monoclonal antibody against IGF-1R with everolimus and octreotide LAR. Patients with well differentiated NET were treated with everolimus 10 mg po daily, octreotide LAR 20 mg IM every 21 days and escalating doses of cixutumumab. An expansion cohort was enrolled at RP2D. Correlative studies included evaluation of mTOR pathway inhibition in paired tumor biopsies and effects of this combination on metabolism per indirect calorimetry. 19 patients with progressive disease, including 9 to the expansion portion were enrolled. 2 patients had dose limiting toxicities of grade 3 mucositis at cixutumumab 15 mg/kg. Long term tolerance at RP2D was problematic, the most common ? grade 3 adverse event (AE) being fatigue. One patient with metastatic insulinoma had a confirmed partial response while seventeen had stable disease. Median progression free survival was 43.6 weeks and median overall survival was 25.5 months.Conclusions: The RP2D of this combination per predefined study protocol cixutumumab iv 10 mg/kg, octreotide LAR 20 mg IM every 21 days plus everolimus 10 mg po daily is associated with non-DLT toxicities limiting long term tolerance. Although a signal of activity was noted in this study, this will need to be reconciled with limited tolerance of the combination and data from larger studies of anti-IGF-1R monoclonal antibodies in NET that have been disappointing.