1. Identification of optimal dosing schedules of dacomitinib and osimertinib for a phase I/II trial in advanced EGFR-mutant non-small cell lung cancer.
- Author
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Poels KE, Schoenfeld AJ, Makhnin A, Tobi Y, Wang Y, Frisco-Cabanos H, Chakrabarti S, Shi M, Napoli C, McDonald TO, Tan W, Hata A, Weinrich SL, Yu HA, and Michor F
- Subjects
- Acrylamides pharmacokinetics, Acrylamides toxicity, Aniline Compounds pharmacokinetics, Aniline Compounds toxicity, Antineoplastic Agents administration & dosage, Antineoplastic Agents pharmacokinetics, Antineoplastic Agents pharmacology, Antineoplastic Agents toxicity, Antineoplastic Combined Chemotherapy Protocols, Carcinoma, Non-Small-Cell Lung genetics, Carcinoma, Non-Small-Cell Lung pathology, Carcinoma, Non-Small-Cell Lung secondary, Cell Line, Tumor, Cell Survival drug effects, Cell Survival genetics, Cohort Studies, Computer Simulation, ErbB Receptors antagonists & inhibitors, ErbB Receptors genetics, ErbB Receptors metabolism, Humans, Lung Neoplasms genetics, Lung Neoplasms pathology, Models, Statistical, Models, Theoretical, Mutation, Quinazolinones pharmacokinetics, Quinazolinones toxicity, Acrylamides administration & dosage, Acrylamides pharmacology, Aniline Compounds administration & dosage, Aniline Compounds pharmacology, Carcinoma, Non-Small-Cell Lung drug therapy, Drug Resistance, Neoplasm, Lung Neoplasms diet therapy, Quinazolinones administration & dosage, Quinazolinones pharmacology
- Abstract
Despite the clinical success of the third-generation EGFR inhibitor osimertinib as a first-line treatment of EGFR-mutant non-small cell lung cancer (NSCLC), resistance arises due to the acquisition of EGFR second-site mutations and other mechanisms, which necessitates alternative therapies. Dacomitinib, a pan-HER inhibitor, is approved for first-line treatment and results in different acquired EGFR mutations than osimertinib that mediate on-target resistance. A combination of osimertinib and dacomitinib could therefore induce more durable responses by preventing the emergence of resistance. Here we present an integrated computational modeling and experimental approach to identify an optimal dosing schedule for osimertinib and dacomitinib combination therapy. We developed a predictive model that encompasses tumor heterogeneity and inter-subject pharmacokinetic variability to predict tumor evolution under different dosing schedules, parameterized using in vitro dose-response data. This model was validated using cell line data and used to identify an optimal combination dosing schedule. Our schedule was subsequently confirmed tolerable in an ongoing dose-escalation phase I clinical trial (NCT03810807), with some dose modifications, demonstrating that our rational modeling approach can be used to identify appropriate dosing for combination therapy in the clinical setting.
- Published
- 2021
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