Phase 2 study of buparlisib (BKM120), a pan-class I PI3K inhibitor, in patients with metastatic triple-negative breast cancer

  • Laia Paré (Contributor)
  • Cristina Saura (Contributor)
  • Joaquin Gavilá (Contributor)
  • Gordon B. Mills (Contributor)
  • Pamela Céliz (Contributor)
  • Eva Ciruelos (Contributor)
  • Ian E. Krop (Contributor)
  • Carlos L. Arteaga (Contributor)
  • Patricia Villagrasa (Contributor)
  • Ana C. Garrido-Castro (Contributor)
  • Hao Guo (Contributor)
  • Zhan Xu (Contributor)
  • Nancy U. Lin (Contributor)
  • Violeta Serra (Contributor)
  • Yisheng Li (Contributor)
  • Romualdo Barroso-Sousa (Contributor)
  • Begoña Bermejo (Contributor)
  • Aleix Prat (Contributor)
  • Jordi Rodon (Contributor)
  • Eric P. Winer (Contributor)
  • David B. Solit (Contributor)
  • Lewis C. Cantley (Contributor)
  • Jennifer Savoie (Contributor)

Dataset

Description

Abstract Background Treatment options for triple-negative breast cancer remain limited. Activation of the PI3K pathway via loss of PTEN and/or INPP4B is common. Buparlisib is an orally bioavailable, pan-class I PI3K inhibitor. We evaluated the safety and efficacy of buparlisib in patients with metastatic triple-negative breast cancer. Methods This was a single-arm phase 2 study enrolling patients with triple-negative metastatic breast cancer. Patients were treated with buparlisib at a starting dose of 100 mg daily. The primary endpoint was clinical benefit, defined as confirmed complete response (CR), partial response (PR), or stable disease (SD) for ≥ 4 months, per RECIST 1.1. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and toxicity. A subset of patients underwent pre- and on-treatment tumor tissue biopsies for correlative studies. Results Fifty patients were enrolled. Median number of cycles was 2 (range 1–10). The clinical benefit rate was 12% (6 patients, all SD ≥ 4 months). Median PFS was 1.8 months (95% confidence interval [CI] 1.6–2.3). Median OS was 11.2 months (95% CI 6.2–25). The most frequent adverse events were fatigue (58% all grades, 8% grade 3), nausea (34% all grades, none grade 3), hyperglycemia (34% all grades, 4% grade 3), and anorexia (30% all grades, 2% grade 3). Eighteen percent of patients experienced depression (12% grade 1, 6% grade 2) and anxiety (10% grade 1, 8% grade 2). Alterations in PIK3CA/AKT1/PTEN were present in 6/27 patients with available targeted DNA sequencing (MSK-IMPACT), 3 of whom achieved SD as best overall response though none with clinical benefit ≥ 4 months. Of five patients with paired baseline and on-treatment biopsies, reverse phase protein arrays (RPPA) analysis demonstrated reduction of S6 phosphorylation in 2 of 3 patients who achieved SD, and in none of the patients with progressive disease. Conclusions Buparlisib was associated with prolonged SD in a very small subset of patients with triple-negative breast cancer; however, no confirmed objective responses were observed. Downmodulation of key nodes in the PI3K pathway was observed in patients who achieved SD. PI3K pathway inhibition alone may be insufficient as a therapeutic strategy for triple-negative breast cancer. Trial registration NCT01790932 . Registered on 13 February 2013; NCT01629615 . Registered on 27 June 2012.
Date made availableJan 1 2020
Publisherfigshare Academic Research System

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