A phase I/II study of the mTOR inhibitor everolimus in combination with hyperCVAD chemotherapy in patients with relapsed/refractory acute lymphoblastic leukemia

Naval Daver, Yanis Boumber, Hagop Kantarjian, Farhad Ravandi, Jorge Cortes, Michael E. Rytting, Jitesh D. Kawedia, Jordan Basnett, Kirk S. Culotta, Zhihong Zeng, Hongbo Lu, Mary Ann Richie, Rebecca Garris, Lianchun Xiao, Wenbin Liu, Keith A. Baggerly, Elias Jabbour, Susan O'Brien, Jan Burger, Linda J. BendallDeborah Thomas, Marina Konopleva

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

Purpose: Previous studies suggest a potential therapeutic role for mTOR inhibition in lymphoid malignancies. This single-center phase I/II study was designed to test the safety and efficacy of the mTOR inhibitor everolimus in combination with HyperC-VAD chemotherapy in relapsed/refractory acute lymphoblastic leukemia (ALL). Experimental Design: Twenty-four patients were treated; 15 received everolimus 5 mg/day and 9 received 10 mg/day with HyperCVAD. Results: The median age of patients was 25 years (range, 11-64) and median number of prior treatments was 2 (range, 1-7). Grade 3 mucositis was the dose-limiting toxicity and the maximum tolerated everolimus dose was 5 mg/day. Responses included complete remission (CR) in 6 patients (25%), CR without platelet recovery (CRp) in 1 (4%), and CR without recovery of counts (CRi) in 1 (4%), for an overall response rate of 33%. In addition, partial response (PR) was noted in 2 patients (8%). Seven of 11 patients treated in first salvage achieved CR/CRp (64%). The median OS was 29 weeks for patients in first salvage versus 15 weeks for patients in second salvage and beyond (P > 0.001). A response was noted in 5 of 10 (50%) heavily pretreated T-ALL patients (median of 4 prior salvage regimens). Everolimus significantly inhibited phosphorylation of S6RP, but this did not correlate with response. No significant decreases in p4EBP1 and pAkt levels were noted. Responders had higher everolimus dose-adjusted area under the curve (P = 0.025) and lower clearance (P = 0.025) than nonresponders. Conclusions: The combination of HyperCVAD and everolimus is well tolerated and moderately effective in relapsed ALL, specifically T-ALL.

Original languageEnglish (US)
Pages (from-to)2704-2714
Number of pages11
JournalClinical Cancer Research
Volume21
Issue number12
DOIs
StatePublished - Jun 15 2015
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'A phase I/II study of the mTOR inhibitor everolimus in combination with hyperCVAD chemotherapy in patients with relapsed/refractory acute lymphoblastic leukemia'. Together they form a unique fingerprint.

  • Cite this

    Daver, N., Boumber, Y., Kantarjian, H., Ravandi, F., Cortes, J., Rytting, M. E., Kawedia, J. D., Basnett, J., Culotta, K. S., Zeng, Z., Lu, H., Richie, M. A., Garris, R., Xiao, L., Liu, W., Baggerly, K. A., Jabbour, E., O'Brien, S., Burger, J., ... Konopleva, M. (2015). A phase I/II study of the mTOR inhibitor everolimus in combination with hyperCVAD chemotherapy in patients with relapsed/refractory acute lymphoblastic leukemia. Clinical Cancer Research, 21(12), 2704-2714. https://doi.org/10.1158/1078-0432.CCR-14-2888