A phase 2 study of alisertib (MLN8237) in recurrent or persistent uterine leiomyosarcoma: An NRG Oncology/Gynecologic Oncology Group study 0231D

Objective This two-stage Phase II study assessed the activity of single agent alisertib in patients with recurrent/persistent uterine leiomyosarcoma (uLMS). Methods Eligibility criteria included histologically-confirmed, recurrent or persistent uLMS, age ≥ 18, 1–2 prior cytotoxic regimens, and RECIST version 1.1 measurable disease. The primary objective of the study was to evaluate the efficacy of alisertib through the frequency of patients with objective tumor responses and the frequency who survived event-free for at least 6 months (EFS6). The endpoints for EFS were RECIST progression, death, or beginning a subsequent therapy. The null hypothesis jointly specified the probability of a patient experiencing a tumor response to less than or equal to 5% and the probability of a patient surviving event-free for at least 6 months to less than or equal to 20%. A two-stage design was used with a target accrual of 23 patients for stage 1 and 47 pts. cumulative for stage 2. Confidence intervals do not correct for multiplicity. Results Twenty-three patients were enrolled with two patients excluded on central histology review, yielding 21 eligible patients. Median age was 61 years. Prior treatment was either 1 cytotoxic regimen (71.4%) or 2 (28.6%). The most common treatment related AEs (grade 3 or worse) were anemia Hensley et al. (2008a), leukopenia Hensley et al. (2008b), neutropenia Maki et al. (2007), thrombocytopenia Huang et al. (2012), mucositis Hensley et al. (2008a), diarrhea Huang et al. (2012), and palmer-planter syndrome Zivanovic et al. (2012). There were no objective responses (0%; 90% CI: 0–10.4%). Best response was stable disease (38.1%); 12 patients had progressive disease (57.1%). EFS6 was 0% (90% CI: 0–10.4%). Median PFS and OS were 1.7 (90% CI: 1.4–3.2) and 14.5 months (90% CI: 7.6 - NA), respectively. Conclusion Alisertib did not demonstrate clinically meaningful single agent activity in previously treated uLMS.