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10.1200/JCO.2015.64.8808

http://scihub22266oqcxt.onion/10.1200/JCO.2015.64.8808
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suck abstract from ncbi


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pmid26951309
      J+Clin+Oncol 2016 ; 34 (14 ): 1660-8
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  • Randomized Open-Label Phase II Trial of Apitolisib (GDC-0980), a Novel Inhibitor of the PI3K/Mammalian Target of Rapamycin Pathway, Versus Everolimus in Patients With Metastatic Renal Cell Carcinoma #MMPMID26951309
  • Powles T ; Lackner MR ; Oudard S ; Escudier B ; Ralph C ; Brown JE ; Hawkins RE ; Castellano D ; Rini BI ; Staehler MD ; Ravaud A ; Lin W ; O'Keeffe B ; Wang Y ; Lu S ; Spoerke JM ; Huw LY ; Byrtek M ; Zhu R ; Ware JA ; Motzer RJ
  • J Clin Oncol 2016[May]; 34 (14 ): 1660-8 PMID26951309 show ga
  • PURPOSE: To the best of our knowledge, this study is the first to compare dual inhibition of PI3K/mammalian target of rapamycin (mTOR) by apitolisib (GDC-0980) against single inhibition of mTORC1 by everolimus in metastatic renal cell carcinoma (mRCC). PATIENTS AND METHODS: Patients with clear-cell mRCC who progressed on or after vascular endothelial growth factor-targeted therapy were randomly assigned to apitolisib 40 mg once per day or to everolimus 10 mg once per day. End points included progression-free survival, safety, overall survival, and objective response rate. Biomarker assessments were conducted. RESULTS: Eighty-five patients were randomly assigned. After 67 events, stratified analysis revealed that median progression-free survival was significantly shorter for apitolisib than for everolimus (3.7 v 6.1 months; hazard ratio, 2.12 [95% CI, 1.23 to 3.63; P < .01]); apitolisib was not favored in any stratification subgroup. Median overall survival was not significantly different but trended in favor of everolimus (16.5 v 22.8 months; hazard ratio, 1.77 [95% CI, 0.97 to 3.24; P = .06]). The objective response rate was 7.1% for apitolisib and 11.6% for everolimus. Patients administered apitolisib with a greater incidence of grade 3 to 4 adverse events were more likely to discontinue treatment (31% v 12% for everolimus). No drug-related deaths were observed. Apitolisib in comparison with everolimus was associated with substantially more high-grade hyperglycemia (40% v 9%) and rash (24% v 2%). Apitolisib pharmacokinetics suggested a relationship between exposure, and rash and hyperglycemia. Retrospective biomarker analyses revealed a relationship between VHL mutation status and outcome with everolimus but not with apitolisib. High hypoxia-inducible factor 1? protein expression was associated with better outcome in both arms. CONCLUSION: This study demonstrated that dual PI3K/mTOR inhibition by apitolisib was less effective than was everolimus in mRCC, likely because full blockade of PI3K/mTOR signaling resulted in multiple on-target adverse events. VHL mutation and hypoxia-inducible factor 1? expression may be predictive of an mTOR inhibitor benefit, although prospective validation is required.
  • |Adult [MESH]
  • |Aged [MESH]
  • |Aged, 80 and over [MESH]
  • |Antineoplastic Agents/pharmacokinetics/therapeutic use [MESH]
  • |Biomarkers, Tumor/metabolism [MESH]
  • |Bridged Bicyclo Compounds, Heterocyclic/pharmacokinetics/*therapeutic use [MESH]
  • |Carcinoma, Renal Cell/blood supply/*drug therapy/enzymology/metabolism [MESH]
  • |Disease-Free Survival [MESH]
  • |Everolimus/*therapeutic use [MESH]
  • |Female [MESH]
  • |Humans [MESH]
  • |Kidney Neoplasms/blood supply/*drug therapy/enzymology/metabolism [MESH]
  • |Male [MESH]
  • |Mechanistic Target of Rapamycin Complex 1 [MESH]
  • |Middle Aged [MESH]
  • |Multiprotein Complexes/antagonists & inhibitors [MESH]
  • |Phosphoinositide-3 Kinase Inhibitors [MESH]
  • |Pyrimidines/pharmacokinetics/*therapeutic use [MESH]


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