1. Safety, Antitumor Activity, and Biomarker Analysis in a Phase I Trial of the Once-daily Wee1 Inhibitor Adavosertib (AZD1775) in Patients with Advanced Solid Tumors
- Author
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James H. Doroshow, Ting-Chia Chang, Sarah B. Miller, Jennifer Zlott, Lamin Juwara, Li Chen, Abdul Rafeh Naqash, Khanh T. Do, Geraldine O'Sullivan Coyne, Elad Sharon, Deborah Wilsker, Jiuping Ji, Alice P. Chen, Biswajit Das, Shivaani Kummar, Ashley Bruns, Larry Rubinstein, Ganesh Mugundu, Richard Piekarz, Arjun Mittra, Robert J. Kinders, Naoko Takebe, Howard Streicher, and Ralph E. Parchment
- Subjects
Oncology ,Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Programmed cell death ,Cell Cycle Proteins ,Pyrimidinones ,Drug Administration Schedule ,Article ,PKMYT1 ,Text mining ,Internal medicine ,Neoplasms ,medicine ,Carcinoma ,Biomarkers, Tumor ,Humans ,Dosing ,Enzyme Inhibitors ,Aged ,Aged, 80 and over ,Cyclin-dependent kinase 1 ,biology ,Kinase ,business.industry ,Middle Aged ,Protein-Tyrosine Kinases ,medicine.disease ,Wee1 ,Treatment Outcome ,biology.protein ,Pyrazoles ,Female ,business - Abstract
Purpose: The Wee1 kinase inhibitor adavosertib abrogates cell-cycle arrest, leading to cell death. Prior testing of twice-daily adavosertib in patients with advanced solid tumors determined the recommended phase II dose (RPh2D). Here, we report results for once-daily adavosertib. Patients and Methods: A 3 + 3 dose-escalation design was used, with adavosertib given once daily on days 1 to 5 and 8 to 12 in 21-day cycles. Molecular biomarkers of Wee1 activity, including tyrosine 15–phosphorylated Cdk1/2 (pY15-Cdk), were assessed in paired tumor biopsies. Whole-exome sequencing and RNA sequencing of remaining tumor tissue identified potential predictive biomarkers. Results: Among the 42 patients enrolled, the most common toxicities were gastrointestinal and hematologic; dose-limiting toxicities were grade 4 hematologic toxicity and grade 3 fatigue. The once-daily RPh2D was 300 mg. Six patients (14%) had confirmed partial responses: four ovarian, two endometrial. Adavosertib plasma exposures were similar to those from twice-daily dosing. On cycle 1 day 8 (pre-dose), tumor pY15-Cdk levels were higher than baseline in four of eight patients, suggesting target rebound during the day 5 to 8 dosing break. One patient who progressed rapidly had a tumor WEE1 mutation and potentially compensatory PKMYT1 overexpression. Baseline CCNE1 overexpression occurred in both of two responding patients, only one of whom had CCNE1 amplification, and in zero of three nonresponding patients. Conclusions: We determined the once-daily adavosertib RPh2D and observed activity in patients with ovarian or endometrial carcinoma, including two with baseline CCNE1 mRNA overexpression. Future studies will determine whether CCNE1 overexpression is a predictive biomarker for adavosertib.
- Published
- 2021