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Clin Cancer Res. 2015 Jun 15;21(12):2704-14. doi: 10.1158/1078-0432.CCR-14-2888. Epub 2015 Feb 27.

A Phase I/II Study of the mTOR Inhibitor Everolimus in Combination with HyperCVAD Chemotherapy in Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia.

Author information

1
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
2
Hematology/Oncology Fellowship Program, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
3
Department of Pharmacy Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
4
Center for Cancer Research, Westmead Millennium Institute, University of Sydney, Westmead, New South Wales, Australia.
5
Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
6
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
7
Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
8
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas. mkonople@mdanderson.org debthomas@mdanderson.org.

Abstract

PURPOSE:

Previous studies suggest a potential therapeutic role for mTOR inhibition in lymphoid malignancies. This single-center phase I/II study was designed to test the safety and efficacy of the mTOR inhibitor everolimus in combination with HyperCVAD chemotherapy in relapsed/refractory acute lymphoblastic leukemia (ALL).

EXPERIMENTAL DESIGN:

Twenty-four patients were treated; 15 received everolimus 5 mg/day and 9 received 10 mg/day with HyperCVAD.

RESULTS:

The median age of patients was 25 years (range, 11-64) and median number of prior treatments was 2 (range, 1-7). Grade 3 mucositis was the dose-limiting toxicity and the maximum tolerated everolimus dose was 5 mg/day. Responses included complete remission (CR) in 6 patients (25%), CR without platelet recovery (CRp) in 1 (4%), and CR without recovery of counts (CRi) in 1 (4%), for an overall response rate of 33%. In addition, partial response (PR) was noted in 2 patients (8%). Seven of 11 patients treated in first salvage achieved CR/CRp (64%). The median OS was 29 weeks for patients in first salvage versus 15 weeks for patients in second salvage and beyond (P ≤ 0.001). A response was noted in 5 of 10 (50%) heavily pretreated T-ALL patients (median of 4 prior salvage regimens). Everolimus significantly inhibited phosphorylation of S6RP, but this did not correlate with response. No significant decreases in p4EBP1 and pAkt levels were noted. Responders had higher everolimus dose-adjusted area under the curve (P = 0.025) and lower clearance (P = 0.025) than nonresponders.

CONCLUSIONS:

The combination of HyperCVAD and everolimus is well tolerated and moderately effective in relapsed ALL, specifically T-ALL.

PMID:
25724525
PMCID:
PMC4470787
DOI:
10.1158/1078-0432.CCR-14-2888
[Indexed for MEDLINE]
Free PMC Article

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