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Cixutumumab and temsirolimus for patients with bone and soft-tissue sarcoma: a multicentre, open-label, phase 2 trial
Gary K Schwartz1, William D Tap, Li-Xuan Qin
1Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. schwartg@mskcc.org
Background:
Preclinical studies have shown synergistic antitumour activity by inhibition of insulin-like growth factor-1 receptor (IGF-1R) and mTOR. The expression of IGF-1R seems to be crucial for this effect. We investigated the safety and efficacy of the combination of the IGF-1R antibody cixutumumab and the mTOR inhibitor temsirolimus in patients with chemotherapy-refractory bone and soft-tissue sarcomas according to IGF-1R expression by immunohistochemistry.
Methods:
We undertook a multicentre, open-label, phase 2 study in 19 cancer centres in the USA. Patients aged at least 16 years with a histologically confirmed diagnosis of bone or soft-tissue sarcoma were allocated on the basis of IGF-1R expression by immunohistochemistry to one of three treatment groups: IGF-1R-positive soft-tissue sarcoma (group A), IGF-1R-positive bone sarcomas (group B), or IGF-1R-negative bone and soft-tissue sarcoma (group C). Patients received weekly treatment with cixutumumab (6 mg/kg, intravenous) and temsirolimus (25 mg, intravenous flat dose) in 6-week cycles. A Simon optimal two-stage design was used for every arm. The primary endpoint was progression-free survival (PFS) at 12 weeks by intention-to-treat analysis in the first 54 patients assigned to every treatment arm. Although patients still remain on treatment, this trial has completed enrolment and this represents the final analysis. This study is registered with ClinicalTrials.gov, number NCT01016015.
Findings:
Between Nov 18, 2009, and April 11, 2012, 388 patients were screened for IGF-1R expression and 54 were assigned to each arm. 17 of 54 patients in the IGF-1R-positive soft-tissue sarcoma group (31%; one-sided 95% CI lower bound 21%; two-sided 90% CI 21-43), 19 of 54 in IGF-1R-positive bone sarcoma group (35%; one-sided 95% CI lower bound 24%; two-sided 90% CI 24-47), and 21 of 54 in the IGF-1R-negative group (39%, one-sided 95% CI lower bound 28%; two-sided 90% CI 28-51) were progression free at 12 weeks. On April 6, 2011, the protocol was amended to include three additional patients in the IGF-1R-positive soft-tissue sarcoma group (total of 57 patients) and nine more in the IGF-1R-negative group (total of 63 patients). There were 2546 adverse events reported during the study, 214 (8%) of which were grade 3-4. The most common grade 3-4 toxicities in the 174 treated patients were anaemia in 16 (9%) patients, hyperglycaemia in 18 (10%), hypophosphataemia in 16 (9%), lymphopenia in 25 (14%), oral mucositis in 19 (11%), and thrombocytopenia in 19 (11%).
Interpretation:
The combination of cixutumumab and temsirolimus shows clinical activity in patients with sarcoma and forms a basis for future trials. However, IGF-1R expression by immunohistochemistry is not predictive of clinical outcome after treatment with this combination.
Funding:
National Cancer Institute and CycleforSurvival Fund, Memorial Sloan-Kettering Cancer Center.
Insights
The combination of cixutumumab and temsirolimus demonstrated clinical activity in sarcoma patients, but insulin-like growth factor-1 receptor (IGF-1R) expression did not predict treatment outcomes in this phase 2 trial.
Area of Science:
- Oncology
- Pharmacology
- Immunotherapy
Background:
- Preclinical studies suggest synergistic antitumor effects of inhibiting insulin-like growth factor-1 receptor (IGF-1R) and mTOR.
- IGF-1R expression is considered crucial for this observed synergistic activity.
- This study investigated the safety and efficacy of combining cixutumumab (an IGF-1R antibody) with temsirolimus (an mTOR inhibitor) in patients with advanced sarcomas.
Purpose of the Study:
- To evaluate the safety and efficacy of cixutumumab plus temsirolimus in patients with chemotherapy-refractory bone and soft-tissue sarcomas.
- To determine if IGF-1R expression, assessed by immunohistochemistry, predicts clinical outcome in patients receiving this combination therapy.
Main Methods:
- A multicenter, open-label, phase 2 study enrolled patients with histologically confirmed bone or soft-tissue sarcoma.
- Patients were stratified into three groups based on IGF-1R expression: positive soft-tissue sarcoma, positive bone sarcoma, and negative bone and soft-tissue sarcoma.
- The primary endpoint was 12-week progression-free survival (PFS) in the first 54 patients per arm, with patients receiving weekly cixutumumab and temsirolimus.
Main Results:
- Progression-free survival at 12 weeks was observed in 31% of patients with IGF-1R-positive soft-tissue sarcoma, 35% with IGF-1R-positive bone sarcoma, and 39% with IGF-1R-negative sarcoma.
- The most frequent grade 3-4 toxicities included lymphopenia (14%), oral mucositis (11%), thrombocytopenia (11%), and hyperglycemia (10%).
- Overall, 8% of the 2546 reported adverse events were grade 3-4.
Conclusions:
- The combination of cixutumumab and temsirolimus exhibits clinical activity in patients with sarcoma, supporting its use in future clinical trials.
- IGF-1R expression, as determined by immunohistochemistry, was not found to be predictive of clinical outcomes for this combination therapy.
- Further research is warranted to explore the therapeutic potential of this combination in sarcoma treatment.
