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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+Hematol+Oncol
2018 ; 11
(1
): 71
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gab.com Text
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English Wikipedia
Randomized, phase I/II study of gemcitabine plus IGF-1R antagonist (MK-0646)
versus gemcitabine plus erlotinib with and without MK-0646 for advanced
pancreatic adenocarcinoma
#MMPMID29843755
Abdel-Wahab R
; Varadhachary GR
; Bhosale PR
; Wang X
; Fogelman DR
; Shroff RT
; Overman MJ
; Wolff RA
; Javle M
J Hematol Oncol
2018[May]; 11
(1
): 71
PMID29843755
show ga
BACKGROUND: Binding of insulin-like growth factor-I (IGF-1) to its receptor
(IGF-1R) initiates downstream signals that activate PI3K/Akt/mTOR and MEK/Erk
pathways, which stimulate cancer cell proliferation and induce drug resistance.
Cross talk between IGF-1R and epidermal growth factor receptor (EGFR) mediates
resistance to anti-EGFR agents. We studied safety, tolerability, and outcomes of
MK-0646, IGF-1 monoclonal antibody, in combination with gemcitabine (G) ±
erlotinib (E) in metastatic pancreatic cancer. METHODS: Our study included a
phase I dose escalation and phase II randomization and expansion cohorts. A 3?+?3
dose escalation protocol was used to determine MK-0646 maximum tolerable dose
(MTD) in combination with G ± E standard doses. For phase II, patients were
randomized to arm A (G + MK), arm B (G + MK + E), or arm C (G + E). Primary
endpoint was progression-free survival (PFS). Secondary endpoints were overall
survival (OS), disease control rate, toxicity, and correlation between OS and
IGF-1 in patients treated with MK-0646. RESULTS: MK-0646 MTD was 10 mg/kg in
combination with G and 5 mg/kg in combination with G + E. In randomization
cohort, 15 patients were treated in each arm. Disease control rates were 50, 60,
and 40% respectively. PFS was not different between the three arms. OS was
significantly different between arm A (10.4 months) and C (5.7 months)
(P?=?0.02). However, addition of erlotinib in arm B yielded no OS benefit
compared to arm A (P?=?0.6). Plasma and tissue IGF-1 levels did not correlate
with OS (P?=?0.64, 0.87). Grade 3-4 toxicity during phase II cohorts were
neutropenia (10/arm A, 14/arm B, 5/arm C), leukopenia (5/A, 5/B, 7/C),
thrombocytopenia (8/A, 9/B, 2/C), hyponatremia (1/A, 3/B), and hyperglycemia
(8/A, 1/B). CONCLUSIONS: MK-0646 was tolerable in combination with G and
associated with improvement in OS but not PFS as compared with G + E. Tissue and
serum IGF-1 did not correlate with clinical outcome. TRIAL REGISTRATION: This
trial is registered in ClinicalTrial.gov under the Identifier NCT00769483 and
registration date was October 9, 2008.