First-in-human study of RLY-2608, a pan-mutant and isoform selective PI3Kα inhibitor, as a single agent in patients (pts) with advanced solid tumors and in combination with fulvestrant in pts with advanced breast cancer.
Authors: Saura Cristina , Sanz Lucia , Kim Janice , Jhaveri Komal L. , Guerrero Angel , Tolosa Ortega Pablo , Schott Anne F. , Curigliano Giuseppe , Perez Cesar Augusto , Nanda Rita , Hamilton Erika P. , Henry Jason Timothy , Wisinski Kari Braun , Sammons Sarah L , Segar Jennifer Margaret , Ponce Aix Santiago , Bergamino Sirvén Milana , Spira Alexander I. , Schram Alison M. , Varkaris Andreas 
Published: June 2024

TPS1128 Background: Oncogenic mutations in PIK3CA occur in ~35% of HR+, HER2– breast cancer (BC) and are frequent in multiple solid tumors. The approval of alpelisib, a non-mutant selective PI3Kα inhibitor, validates PI3Kα as a therapeutic target. However, inhibition of wild-type PI3Kα leads to significant toxicity, including hyperglycemia and rash. RLY-2608, a novel, oral allosteric PI3Kα inhibitor, is designed to overcome these limitations via mutant- and isoform-selective PI3Kα inhibition for greater target coverage, improved tolerability, and anti-tumor activity. ReDiscover (NCT05216432) is the ongoing, first-in-human study to investigate the maximum tolerated dose (MTD), recommended phase 2 doses (RP2Ds), safety, pharmacokinetics (PK), pharmacodynamics (PD) and anti-tumor activity of RLY-2608 monotherapy in pts with PIK3CA-mutant advanced solid tumors; and of RLY-2608 plus fulvestrant with or without ribociclib in pts with PIK3CA-mutant, HR+, HER2– BC. To date RLY-2608 plus fulvestrant has completed dose escalation; 400 and 600 mg BID is being investigated in the combination regimens, based on safety, PK, PD, and anti-tumor activity. Methods: This global, multi-center, dose escalation/expansion study of RLY-2608 monotherapy includes adult pts with advanced solid tumors who are refractory or intolerant to, or have declined, standard therapy. RLY-2608 is also being investigated in combination with fulvestrant and in combination with fulvestrant and ribociclib, each in previously treated pts with HR+, HER2– advanced/metastatic BC. Eligibility criteria include presence of a PIK3CA mutation (blood or tumor) per local assessment, ECOG performance status 0–1, evaluable disease per RECIST 1.1, and no prior treatment with a PI3K pathway inhibitor. RLY-2608 is administered daily in 4-week cycles. Adverse events (AEs) per CTCAE v5, PK, biomarkers (pAKT, mutant ctDNA and insulin pathway markers) and anti-tumor activity are assessed serially. Dose escalation employs a Bayesian Optimal Interval design to identify the MTD. Following dose escalation, expansion cohorts are enrolling patients with select PIK3CA-mutated solid tumors for treatment with RLY-2608 monotherapy and patients with HR+, HER2– metastatic BC for treatment with RLY-2608 plus fulvestrant with or without ribociclib. Primary endpoints are MTD/RP2D and AE profile; key secondary endpoints are PIK3CA genotype in blood and tumor, PK, biomarkers, and overall response rate. All dose expansion cohorts in ReDiscover are now enrolling in the United States and Europe. Clinical trial information: NCT05216432 .