A three-arm randomised phase II study of the MEK inhibitor selumetinib alone or in combination with paclitaxel in metastatic uveal melanoma
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Authors
Sacco, J. J.Jackson, R.
Corrie, P.
Danson, S.
Evans, T. R. J.
Ochsenreither, S.
Kumar, S.
Goodman, A.
Larkin, J.
Karydis, I.
Steven, N.
Lorigan, Paul
Plummer, R.
Patel, P.
Psarelli, E.
Olsson-Brown, A.
Shaw, H.
Leyvraz, S.
Handley, L.
Rawcliffe, C.
Nathan, P.
Affiliation
The Christie NHS Foundation Trust, The Christie Hospital, Manchester, UK.Issue Date
2024
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AIMS: The MAPK pathway is constitutively activated in uveal melanoma (UM). Selumetinib (AZD6244, ARRY-142886), a MEK inhibitor, has shown limited activity as monotherapy in metastatic UM. Pre-clinical studies support synergistic cytotoxic activity for MEK inhibitors combined with taxanes, and here we sought to assess the clinical efficacy of combining selumetinib and paclitaxel. PATIENTS AND METHODS: Seventy-seven patients with metastatic UM who had not received prior chemotherapy were randomised to selumetinib alone, or combined with paclitaxel with or without interruption in selumetinib two days before paclitaxel. The primary endpoint was progression free survival (PFS). After amendment, the combination arms were combined for analysis and the sample size adjusted to detect a hazard ratio (HR): 0.55, 80% power at 1-sided 5% significance level. RESULTS: The median PFS in the combination arms was 4.8 months (95% CI: 3.8 - 5.6) compared with 3.4 months (2.0 - 3.9) in the selumetinib arm (HR 0.62 [90% CI 0.41 - 0.92], 1-sided p-value = 0.022). ORR was 14% and 4% in the combination and monotherapy arms respectively. Median OS was 9 months for the combination and was not significantly different from selumetinib alone (10 months) with HR of 0.98 [90% CI 0.58 - 1.66], 1-sided p-value = 0.469. Toxicity was in keeping with the known profiles of the agents involved. CONCLUSIONS: SelPac met its primary endpoint, demonstrating an improvement in PFS for combination selumetinib and paclitaxel. No improvement in OS was observed, and the modest improvement in PFS is not practice changing.Citation
Sacco JJ, Jackson R, Corrie P, Danson S, Evans TRJ, Ochsenreither S, et al. A three-arm randomised phase II study of the MEK inhibitor selumetinib alone or in combination with paclitaxel in metastatic uveal melanoma. European journal of cancer (Oxford, England : 1990). 2024 May;202:114009. PubMed PMID: 38547774. Epub 2024/03/29. eng.Journal
European Journal of CancerDOI
10.1016/j.ejca.2024.114009PubMed ID
38547774Additional Links
https://dx.doi.org/10.1016/j.ejca.2024.114009Type
ArticleLanguage
enae974a485f413a2113503eed53cd6c53
10.1016/j.ejca.2024.114009
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