Phase II study of MLN8237 (Alisertib) in advanced/ metastatic sarcoma

Mark A. Dickson, M. R. Mahoney, W. D. Tap, S. P. D'Angelo, M. L. Keohan, B. A. Van Tine, M. Agulnik, L. E. Horvath, J. S. Nair, G. K. Schwartz

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42 Scopus citations

Abstract

Background: Aurora kinase A (AURKA) is commonly overexpressed in sarcoma. The inhibition of AURKA by shRNA or by a specific AURKA inhibitor blocks in vitro proliferation of multiple sarcoma subtypes. MLN8237 (alisertib) is a novel oral adenosine triphosphate-competitive AURKA inhibitor. Patients and methods: This Cancer Therapy Evaluation Program-sponsored phase II study of alisertib was conducted through the Alliance for Clinical Trials in Oncology (A091102). Patients were enrolled into histology-defined cohorts: (i) liposarcoma, (ii) leiomyosarcoma, (iii) undifferentiated sarcoma, (iv) malignant peripheral nerve sheath tumor, or (v) other. Treatment was alisertib 50 mg PO b.i.d. d1-d7 every 21 days. The primary end point was response rate; progression-free survival (PFS) was secondary. One response in the first 9 patients expanded enrollment in a cohort to 24 using a Simon two-stage design. Results: Seventy-two patients were enrolled at 24 sites [12 LPS, 10 LMS, 11 US, 10 malignant peripheral nerve sheath tumor (MPNST), 29 Other]. The median age was 55 years; 54% were male; 58%/38%/4% were ECOG PS 0/1/2. One PR expanded enrollment to the second stage in the other sarcoma cohort. The histology-specific cohorts ceased at the first stage. There were two confirmed PRs in the other cohort (both angiosarcoma) and one unconfirmed PR in dedifferentiated chondrosarcoma. Twelve-week PFS was 73% (LPS), 44% (LMS), 36% (US), 60% (MPNST), and 38% (Other). Grade 3-4 adverse events: oral mucositis (12%), anemia (14%), platelet count decreased (14%), leukopenia (22%), and neutropenia (42%). Conclusions: Alisertib was well tolerated. Occasional responses, yet prolonged stable disease, were observed. Although failing to meet the primary RR end point, PFS was promising. Trial registration ID: NCT01653028.

Original languageEnglish
Pages (from-to)1855-1860
Number of pages6
JournalAnnals of Oncology
Volume27
Issue number10
DOIs
StatePublished - Jan 1 2016

Keywords

  • Aurora kinase inhibitors
  • Bone sarcoma
  • Phase II clinical trials
  • Soft tissue sarcoma

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    Dickson, M. A., Mahoney, M. R., Tap, W. D., D'Angelo, S. P., Keohan, M. L., Van Tine, B. A., Agulnik, M., Horvath, L. E., Nair, J. S., & Schwartz, G. K. (2016). Phase II study of MLN8237 (Alisertib) in advanced/ metastatic sarcoma. Annals of Oncology, 27(10), 1855-1860. https://doi.org/10.1093/ANNONC/MDW281