Shu Pei, Li Xiaoyu, Zhou Qi, Li Guiling, Zhang Keqiang, Yuan Li, Liu Yixian, Li Qiu, Wang Yongsheng, Xie Hui, Zheng Li
Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Clinical Trial Center, National Medical Products Administration Key Laboratory for Clinical Research and Evaluation of Innovative Drugs, West China Hospital, Sichuan University, Chengdu, China.
Signal Transduct Target Ther. 2025 Jun 25;10(1):198. doi: 10.1038/s41392-025-02281-0.
Preclinical studies have indicated that the combination of mTORC1/2 inhibitors with PD-1 antibodies exhibits synergistic effects on solid tumors. However, no clinical data supporting this combination have been reported. Therefore, we conducted a clinical trial (NCT04337463) to investigate the efficacy and safety of combining onatasertib, an mTORC1/2 inhibitor, with toripalimab, a PD-1 antibody in patients with advanced solid tumors. This open-label, phase 1/2 clinical trial included dose escalation and dose expansion cohorts to evaluate safety, tolerability, objective response rate (ORR), disease control rate (DCR) and progression-free survival (PFS). A total of 46 patients were enrolled and received onatasertib at doses of 15 mg, 20 mg, or 30 mg once daily (QD), combined with toripalimab 240 mg every 3 weeks (Q3W). No dose-limiting toxicities were observed, and the most common grade 3 or 4 treatment emergent adverse events were lymphopenia (23.9%) and rash (19.6%). The overall ORR was 26.1%, with a DCR of 73.9%, and a median PFS of 4.3 months. In cervical cancer patients, regardless of PD-L1 expression, the ORR was 52.4%, DCR was 90.5% and median PFS was 5.8 months. Notably, the 15 mg combination dose demonstrated a median PFS of 7.8 months. In conclusion, the safety profile of onatasertib in combination with toripalimab was manageable and showed encouraging clinical activity in advanced solid tumors, particularly among cervical cancer patients, irrespective of PD-L1 expression. The recommended phase 2 dose for the combination was determined to be onatasertib 15 mg QD and toripalimab 240 mg Q3W.
临床前研究表明,mTORC1/2抑制剂与PD-1抗体联合使用对实体瘤具有协同作用。然而,尚无支持这种联合用药的临床数据报道。因此,我们开展了一项临床试验(NCT04337463),以研究mTORC1/2抑制剂奥纳塞替尼与PD-1抗体托瑞帕利单抗联合用于晚期实体瘤患者的疗效和安全性。这项开放标签的1/2期临床试验包括剂量递增和剂量扩展队列,以评估安全性、耐受性、客观缓解率(ORR)、疾病控制率(DCR)和无进展生存期(PFS)。共有46例患者入组,接受每日一次(QD)15mg、20mg或30mg剂量的奥纳塞替尼,联合每3周一次(Q3W)240mg的托瑞帕利单抗治疗。未观察到剂量限制性毒性,最常见的3级或4级治疗中出现的不良事件为淋巴细胞减少(23.9%)和皮疹(19.6%)。总体ORR为26.1%,DCR为73.9%,中位PFS为4.3个月。在宫颈癌患者中,无论PD-L1表达如何,ORR为52.4%,DCR为90.5%,中位PFS为5.8个月。值得注意的是,15mg联合剂量组的中位PFS为7.8个月。总之,奥纳塞替尼与托瑞帕利单抗联合使用的安全性可控,在晚期实体瘤患者中显示出令人鼓舞的临床活性,尤其是在宫颈癌患者中,无论PD-L1表达如何。联合用药的推荐2期剂量确定为奥纳塞替尼每日15mg,托瑞帕利单抗每3周240mg。
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