Patient case: 70-year-old male with non-small cell lung cancer; genetic feature: KRAS (G12C)

Clinical trial: A Study of the GSK MEK Inhibitor GSK1120212 and Everolimus in Cancer Subjects

Summary: The purpose of this study is to determine the recommended dose and regimen for the orally administered MEK inhibitor GSK1120212 dosed in combination with everolimus in subjects with solid tumors. The escalation part of the study will determine the MTD. The combination will be further explored in the expansion part in subjects with metastatic pancreatic cancer. In addition, subjects with KRAS mutant non-small cell lung cancer will be enrolled.

Detailed description: MEK112110 is a dose-escalation, open-label study to determine the recommended dose and regimen for the orally administered MEK inhibitor GSK1120212 dosed in combination with everolimus in subjects with solid tumors. This will be accomplished using a dose-escalation procedure starting at low doses of GSK1120212 and everolimus. Dose escalation will continue based on predefined parameters until the maximum tolerated dose is identified. The recommended doses and regimens will be selected based on the safety and pharmacokinetic profiles. The clinical activity of GSK1120212 dosed in combination with everolimus will be explored further in an expansion cohort consisting of 20 subjects with metastatic pancreatic cancer. In addition a substudy will be conducted in 40 subjects with KRAS-mutant non-small cell lung cancer.

Eligibility: Inclusion Criteria:
  -  Capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the consent form.
  -  Age 18 years old or older and able to swallow oral medication.
  -  Performance Status score of 0 or 1 according to the Eastern Cooperative Oncology (ECOG) scale for Dose Escalation Cohort. Subjects with ECOG of 2 can be enrolled for expansion cohort.
  -  Tumor Type criteria as listed in the protocol
  -  Fasting glucose < 126mg/dL
  -  Male subjects must agree to use one of the contraception methods listed in the protocol.
  -  A female subject is eligible to participate if she is of non-childbearing potential, and if she is of childbearing potential she must use protocol defined contraception methods.
  -  Calcium phosphate product less than or equal to 4.0 mmol2/L2 (50 mg2/dL2)
  -  Adequate organ system function as defined below in the protocol.
  Exclusion Criteria:
  -  Malignancies related to HIV or solid organ transplant.
  -  Primary malignant brain tumors.
  -  Chemotherapy, radiotherapy, or immunotherapy within 28 days (or 42 days for prior nitrosoureas or mitomycin C) prior to the first dose of GSK1120212. Chemotherapy regimens given continuously or on a weekly basis with limited potential for delayed toxicity are permitted with approval of a GSK Medical Monitor if dosing of that agent is terminated at least 14 days prior to the first dose of GSK1120212.
  -  Use of an investigational anti-cancer drug within 28 days or 5 half-lives, whichever is shorter preceding the first dose of GSK1120212 - as long as a minimum of 14 days has passed between the last dose of the prior investigational anti-cancer drug and the first dose of GSK1120212.
  -  Previous treatment with an mTOR inhibitor unless approved by GSK Medical Monitor.
  -  Previous treatment with GSK1120212.
  -  History of sensitivity to any of the study medications, or components thereof or a history of drug or other allergy that, in the opinion of the investigator or GSK Medical Monitor, contraindicates their participation.
  -  Known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to the study drug, DMSO, or excipients. (To date there are no known FDA approved drugs chemically related to GSK1120212).
  -  Use of a prohibited medication (as defined in the protocol).
  -  Current use of anticoagulants (e.g. warfarin, heparin) at therapeutic levels within seven days prior to the first dose of GSK1120212. Low dose (prophylactic) low molecular weight heparin (LMWH) is permitted provided that subject's PT and PTT meet entry criteria. Subjects required therapeutic levels of LMWH must receive approval from GSK Medical Monitor and monitored appropriately as clinically indicated.
  -  Gastrointestinal disease predicted to interfere with absorption of an oral drug, systemic disease, major surgery, or social/psychological issues that in the opinion of investigators would jeopardize compliance with protocol.
  -  History of retinal vein occlusion (RVO) or central serous retinopathy (CSR).
  -  Predisposing factors to RVO including uncontrolled hypertension, uncontrolled diabetes, uncontrolled hyperlipidemia, and coagulopathy.
  -  Visible retinal pathology as assessed by ophthalmologic exam that is considered a risk factor for RVO or CSR.
  -  Intraocular pressure > 21mm Hg as measured by tonography.
  -  Glaucoma diagnosed within 1 month prior to study Day 1.
  -  Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression. Subjects previously treated for these conditions that are asymptomatic and off corticosteroids for at least two weeks are permitted. Subjects are not permitted to receive enzyme inducing anti-epileptic drugs (EIAEDs).
  -  Unresolved toxicity greater than common terminology criteria for adverse events (CTCAE) grade 1 from previous anti-cancer therapy except alopecia (if applicable) unless agreed to by a GSK Medical Monitor and the Investigator.
  -  History of acute coronary syndromes (including unstable angina), coronary angioplasty, or stenting within the past 24 weeks.
  -  QTc interval ≥ 480 msecs.
  -  Class II, III, or IV heart failure as defined by the New York Heart Association (NYHA) functional classification system.
  -  Pregnant or lactating female.
  -  History or active hepatitis B or C.
  -  History of HIV infection.
  -  Subjects on chronic antifungal therapy.
  -  Unwillingness or inability to follow the procedures outlined in the protocol.

Relevance to patient case: possibly relevant