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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Clin+Oncol
2016 ; 34
(14
): 1660-8
Nephropedia Template TP
gab.com Text
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English Wikipedia
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]