TY - JOUR
T1 - Phase I dose escalation study of temsirolimus in combination with metformin in patients with advanced/refractory cancers
AU - Khawaja, Muhammad R.
AU - Nick, Alpa M.
AU - Madhusudanannair, Vinu
AU - Fu, Siqing
AU - Hong, David
AU - McQuinn, Lacey M.
AU - Ng, Chaan S.
AU - Piha-Paul, Sarina A.
AU - Janku, Filip
AU - Subbiah, Vivek
AU - Tsimberidou, Apostolia
AU - Karp, Daniel
AU - Meric-Bernstam, Funda
AU - Lu, Karen H.
AU - Naing, Aung
N1 - Funding Information:
Authors acknowledge the support of Clinical Trials Support Resource and Department of Scientific Publications at M.D. Anderson Cancer Center.
Publisher Copyright:
© Springer-Verlag Berlin Heidelberg 2016.
PY - 2016/3/24
Y1 - 2016/3/24
N2 - Purpose Mammalian target of rapamycin (mTOR) inhibitors like temsirolimus may result in undesirable AKT upregulation. Metformin inhibits mTOR through different mechanisms and may enhance temsirolimus’s antitumor activity. We conducted an open-label phase I dose escalation trial of this drug combination in patients with advanced/refractory cancers. Methods Temsirolimus, 25 mg weekly, was combined with an escalating daily dose of metformin (level 1: 500; level 2: 1000; level 3: 1500; level 4: 2000 mg) by utilizing a standard 3 + 3 trial design. Treatment was administered in 28-day cycles following initial 2-week metformin titration during the first cycle. Results Twenty-one patients (median age, 56 years) with sarcoma (n = 8), colorectal (n = 3), endometrial (n = 4), uterine carcinosarcoma (n = 2), ovarian (n = 2), and other (n = 2) cancers were enrolled. Patients had received median of four prior systemic treatments. Two dose-limiting toxicities were observed (grade 3 mucositis, grade 3 renal failure); both patients continued treatment after dose modification. Fifty-six percent patients had stable disease as best response; clinical benefit rate was 22 %. Patients continued treatment for median of 11 weeks. Conclusions Combination temsirolimus/metformin was well tolerated with modestly promising effectiveness among this heavily pretreated patient cohort. We recommend a dose of temsirolimus 25 mg weekly and metformin 2000 mg daily for phase II study.
AB - Purpose Mammalian target of rapamycin (mTOR) inhibitors like temsirolimus may result in undesirable AKT upregulation. Metformin inhibits mTOR through different mechanisms and may enhance temsirolimus’s antitumor activity. We conducted an open-label phase I dose escalation trial of this drug combination in patients with advanced/refractory cancers. Methods Temsirolimus, 25 mg weekly, was combined with an escalating daily dose of metformin (level 1: 500; level 2: 1000; level 3: 1500; level 4: 2000 mg) by utilizing a standard 3 + 3 trial design. Treatment was administered in 28-day cycles following initial 2-week metformin titration during the first cycle. Results Twenty-one patients (median age, 56 years) with sarcoma (n = 8), colorectal (n = 3), endometrial (n = 4), uterine carcinosarcoma (n = 2), ovarian (n = 2), and other (n = 2) cancers were enrolled. Patients had received median of four prior systemic treatments. Two dose-limiting toxicities were observed (grade 3 mucositis, grade 3 renal failure); both patients continued treatment after dose modification. Fifty-six percent patients had stable disease as best response; clinical benefit rate was 22 %. Patients continued treatment for median of 11 weeks. Conclusions Combination temsirolimus/metformin was well tolerated with modestly promising effectiveness among this heavily pretreated patient cohort. We recommend a dose of temsirolimus 25 mg weekly and metformin 2000 mg daily for phase II study.
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U2 - 10.1007/s00280-016-3009-7
DO - 10.1007/s00280-016-3009-7
M3 - Article
C2 - 27014780
AN - SCOPUS:84961644264
SN - 0344-5704
VL - 77
SP - 973
EP - 977
JO - Cancer Chemotherapy and Pharmacology
JF - Cancer Chemotherapy and Pharmacology
IS - 5
ER -