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Phase I Study of Ceralasertib (AZD6738), a Novel DNA Damage Repair Agent, in Combination with Weekly Paclitaxel in
Seung Tae Kim1, Simon A Smith2, Peter Mortimer2
1Division of Hematology-Oncology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
Purpose:
Ceralasertib is a potent and selective oral inhibitor of the serine/threonine protein kinase ataxia telangiectasia and Rad3-related (ATR) protein.
Patients And Methods:
Eligible patients with solid tumors, enriched for melanoma, received ceralasertib in combination with a fixed dose of paclitaxel (80 mg/m2 on D1, D8, D15) in 28-day cycles. The dose of ceralasertib was escalated to reach an MTD in a rolling 6 design. The starting dose of ceralasertib was 40 mg QD. Fifty-seven patients (33 patients with melanoma who failed prior PD1/L1 treatment) were enrolled in 7 dose cohorts ranging from 40 mg QD to 240 mg BD plus weekly paclitaxel.
Results:
The RP2D was established as ceralasertib 240 mg BD days 1-14 plus paclitaxel 80 mg/m2 on D1, D8, D15 every 28 days. The most common toxicities were neutropenia (n = 39, 68%), anemia (n = 25, 44%), and thrombocytopenia (n = 21, 37%). In the full analysis set of 57 patients, the overall response rate (ORR) was 22.6% (95% CI, 12.5-35.3). In 33 patients with melanoma, resistant to prior anti-PD1 therapy, the ORR was 33.3% (95% CI, 18.0-51.8). In the melanoma subset, the mPFS was 3.6 months (95% CI, 2.0-5.8), the median duration of response was 9.9 months (95% CI, 3.7-23.2), and the mOS was 7.4 months (95% CI, 5.7-11.9).
Conclusions:
Ceralasertib in combination with paclitaxel was well tolerated in patients with advanced malignancies and showed evidence of antitumor activity. Durable responses were observed in patients with advanced cutaneous, acral, and mucosal melanoma resistant to anti-PD1/L1 treatment.See related commentary by Ashworth, p. 4667.
Insights
Ceralasertib combined with paclitaxel showed antitumor activity in advanced cancers. Durable responses were seen in melanoma patients resistant to PD1/L1 therapy.
Area of Science:
- Oncology
- Pharmacology
Background:
- Ataxia telangiectasia and Rad3-related (ATR) protein kinase is a key regulator of DNA damage response.
- Targeting ATR offers a potential therapeutic strategy for various solid tumors.
Purpose of the Study:
- To evaluate the safety and efficacy of ceralasertib, an ATR inhibitor, in combination with paclitaxel.
- To determine the recommended Phase 2 dose (RP2D) of ceralasertib plus paclitaxel.
Main Methods:
- A Phase 1 dose-escalation study using a rolling 6 design.
- Patients with solid tumors, including melanoma, received escalating doses of ceralasertib with fixed-dose paclitaxel.
- The study enrolled 57 patients across 7 dose cohorts.
Main Results:
- The RP2D was determined to be ceralasertib 240 mg BD plus paclitaxel 80 mg/m2.
- The overall response rate (ORR) was 22.6% in all patients and 33.3% in melanoma patients resistant to prior anti-PD1 therapy.
- Common toxicities included neutropenia, anemia, and thrombocytopenia.
Conclusions:
- Ceralasertib plus paclitaxel was well-tolerated and demonstrated antitumor activity in advanced malignancies.
- Durable responses were observed in patients with advanced melanoma resistant to anti-PD1/L1 therapy, highlighting the potential of ATR inhibition in this population.
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