A phase 2 and pharmacological study of sapanisertib in patients with relapsed and/or refractory acute lymphoblastic leukemia

• Published in: Cancer medicine (Malden, MA) MA), 2023-12, Vol.12 (23), p.21229-21239
• Main Authors: Al‐Kali, Aref, Aldoss, Ibrahim, Atherton, Pamela J., Strand, Carrie A., Shah, Bijal, Webster, Jonathan, Bhatnagar, Bhavana, Flatten, Karen S., Peterson, Kevin L., Schneider, Paula A., Buhrow, Sarah A., Kong, Jianping, Reid, Joel M., Adjei, Alex A., Kaufmann, Scott H.
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; AKT protein; ALL; Anorexia; Benzoxazoles; Bone marrow; Cell cycle; Chemotherapy; Clinical trials; Cytotoxicity; Drug dosages; Enrollments; Humans; Hyperglycemia; Hypotheses; Immunoblotting; Kinases; Leukemia; Leukopenia; Lymphatic leukemia; Lymphopenia; mTOR inhibitor; Mucositis; Neutropenia; Patients; Pharmacokinetics; Phosphorylation; Pneumonitis; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Proteins; sapanisertib; Seizures; Solid tumors; Success; Thrombocytopenia; TOR protein; Toxicity; Transplants & implants; Tumors
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.6701

Background Despite recent approval of several new agents, relapsed acute lymphoblastic leukemia (ALL) remains challenging to treat. Sapanisertib (MLN0128/TAK‐228) is an oral TORC1/2 inhibitor that exhibited preclinical activity against ALL. Methods We conducted a single‐arm multi‐center Phase II study of sapanisertib monotherapy (3 mg orally daily of the milled formulation for 21 days every 28 days) in patients with ALL through the Experimental Therapeutics Clinical Trials Network (NCI‐9775). Results Sixteen patients, 15 of whom were previously treated (median 3 prior lines of therapy), were enrolled. Major grade 3–4 non‐hematologic toxicities included mucositis (3 patients) and hyperglycemia (2 patients) as well as hepatic failure, seizures, confusion, pneumonitis, and anorexia (1 patient each). Grade >2 hematological toxicity included leukopenia (3), lymphopenia (2), thrombocytopenia, and neutropenia (1). The best response was stable disease in 2 patients (12.5%), while only 3 patients (19%) were able to proceed to Cycle 2. Pharmacokinetic analysis demonstrated drug exposures similar to those observed in solid tumor patients. Immunoblotting in serially collected samples indicated limited impact of treatment on phosphorylation of mTOR pathway substrates such as 4EBP1, S6, and AKT. Conclusion In summary, single‐agent sapanisertib had a good safety profile but limited target inhibition or efficacy in ALL as a single agent. This trial was registered at ClinicalTrials.gov as NCT02484430. Sapanisertib 3 mg daily was safe for patients with relapsed/refractory acute lymphoblastic leukemia. Its efficacy as single agent is limited.