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2015 ; 21
(1
): 49-59
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Combination of the mTOR inhibitor ridaforolimus and the anti-IGF1R monoclonal
antibody dalotuzumab: preclinical characterization and phase I clinical trial
#MMPMID25320355
Di Cosimo S
; Sathyanarayanan S
; Bendell JC
; Cervantes A
; Stein MN
; Braña I
; Roda D
; Haines BB
; Zhang T
; Winter CG
; Jha S
; Xu Y
; Frazier J
; Klinghoffer RA
; Leighton-Swayze A
; Song Y
; Ebbinghaus S
; Baselga J
Clin Cancer Res
2015[Jan]; 21
(1
): 49-59
PMID25320355
show ga
PURPOSE: Mammalian target of rapamycin (mTOR) inhibition activates compensatory
insulin-like growth factor receptor (IGFR) signaling. We evaluated the
ridaforolimus (mTOR inhibitor) and dalotuzumab (anti-IGF1R antibody) combination.
EXPERIMENTAL DESIGN: In vitro and in vivo models, and a phase I study in which
patients with advanced cancer received ridaforolimus (10-40 mg/day every day ×
5/week) and dalotuzumab (10 mg/kg/week or 7.5 mg/kg/every other week) were
explored. RESULTS: Preclinical studies demonstrated enhanced pathway inhibition
with ridaforolimus and dalotuzumab. With 87 patients treated in the phase I
study, main dose-limiting toxicities (DLT) of the combination were primarily
mTOR-related stomatitis and asthenia at doses of ridaforolimus lower than
expected, suggesting blockade of compensatory pathways in normal tissues. Six
confirmed partial responses were reported (3 patients with breast cancer); 10 of
23 patients with breast cancer and 6 of 11 patients with ER(+)/high-proliferative
breast cancer showed antitumor activity. CONCLUSIONS: Our study provides
proof-of-concept that inhibiting the IGF1R compensatory response to mTOR
inhibition is feasible with promising clinical activity in heavily pretreated
advanced cancer, particularly in ER(+)/high-proliferative breast cancer
(ClinicalTrials.gov identifier: NCT00730379).