PMID- 27893038 OWN - NLM STAT- MEDLINE DCOM- 20170420 LR - 20220331 IS - 2374-2445 (Electronic) IS - 2374-2437 (Linking) VI - 3 IP - 4 DP - 2017 Apr 1 TI - Targeting the PI3K/AKT/mTOR Pathway for the Treatment of Mesenchymal Triple-Negative Breast Cancer: Evidence From a Phase 1 Trial of mTOR Inhibition in Combination With Liposomal Doxorubicin and Bevacizumab. PG - 509-515 LID - 10.1001/jamaoncol.2016.5281 [doi] AB - IMPORTANCE: Triple-negative breast cancer (TNBC) classified by transcriptional profiling as the mesenchymal subtype frequently harbors aberrations in the phosphoinositide 3-kinase (PI3K) pathway, raising the possibility of targeting this pathway to enhance chemotherapy response. Up to 30% of mesenchymal TNBC can be classified histologically as metaplastic breast cancer, a chemorefractory group of tumors with a mixture of epithelial and mesenchymal components identifiable by light microscopy. While assays to identify mesenchymal TNBC are under development, metaplastic breast cancer serves as a clinically identifiable surrogate to evaluate potential regimens for mesenchymal TNBC. OBJECTIVE: To assess safety and efficacy of mammalian target of rapamycin (mTOR) inhibition in combination with liposomal doxorubicin and bevacizumab in patients with advanced metaplastic TNBC. DESIGN, SETTING, AND PARTICIPANTS: Phase 1 study with dose escalation and dose expansion at the University of Texas MD Anderson Cancer Center of patients with advanced metaplastic TNBC. Patients were enrolled from April 16, 2009, to November 4, 2014, and followed for outcomes with a cutoff date of November 1, 2015, for data analysis. INTERVENTIONS: Liposomal doxorubicin, bevacizumab, and the mTOR inhibitors temsirolimus or everolimus using 21-day cycles. MAIN OUTCOMES AND MEASURES: Safety and response. When available, archived tissue was evaluated for aberrations in the PI3K pathway. RESULTS: Fifty-two women with metaplastic TNBC (median age, 58 years; range, 37-79 years) were treated with liposomal doxorubicin, bevacizumab, and temsirolimus (DAT) (N = 39) or liposomal doxorubicin, bevacizumab, and everolimus (DAE) (N = 13). The objective response rate was 21% (complete response = 4 [8%]; partial response = 7 [13%]) and 10 (19%) patients had stable disease for at least 6 months, for a clinical benefit rate of 40%. Tissue was available for testing in 43 patients, and 32 (74%) had a PI3K pathway aberration. Presence of PI3K pathway aberration was associated with a significant improvement in objective response rate (31% vs 0%; P = .04) but not clinical benefit rate (44% vs 45%; P > .99). CONCLUSIONS AND RELEVANCE: Using metaplastic TNBC as a surrogate for mesenchymal TNBC, DAT and DAE had notable activity in mesenchymal TNBC. Objective response was limited to patients with PI3K pathway aberration. A randomized trial should be performed to test DAT and DAE for metaplastic TNBC, as well as nonmetaplastic, mesenchymal TNBC, especially when PI3K pathway aberrations are identified. FAU - Basho, Reva K AU - Basho RK AD - Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston. FAU - Gilcrease, Michael AU - Gilcrease M AD - Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston. FAU - Murthy, Rashmi K AU - Murthy RK AD - Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston. FAU - Helgason, Thorunn AU - Helgason T AD - Investigational Cancer Therapeutics (Phase I Trials Program), The University of Texas MD Anderson Cancer Center, Houston. FAU - Karp, Daniel D AU - Karp DD AD - Investigational Cancer Therapeutics (Phase I Trials Program), The University of Texas MD Anderson Cancer Center, Houston. FAU - Meric-Bernstam, Funda AU - Meric-Bernstam F AD - Investigational Cancer Therapeutics (Phase I Trials Program), The University of Texas MD Anderson Cancer Center, Houston5Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston6Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston. FAU - Hess, Kenneth R AU - Hess KR AD - Biostatistics, The University of Texas MD Anderson Cancer Center, Houston. FAU - Herbrich, Shelley M AU - Herbrich SM AD - Pediatrics, The University of Texas MD Anderson Cancer Center, Houston. FAU - Valero, Vicente AU - Valero V AD - Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston. FAU - Albarracin, Constance AU - Albarracin C AD - Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston. FAU - Litton, Jennifer K AU - Litton JK AD - Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston. FAU - Chavez-MacGregor, Mariana AU - Chavez-MacGregor M AD - Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston9Health Services Research, The University of Texas MD Anderson Cancer Center, Houston. FAU - Ibrahim, Nuhad K AU - Ibrahim NK AD - Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston. FAU - Murray, James L 3rd AU - Murray JL 3rd AD - Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston. FAU - Koenig, Kimberly B AU - Koenig KB AD - Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston. FAU - Hong, David AU - Hong D AD - Investigational Cancer Therapeutics (Phase I Trials Program), The University of Texas MD Anderson Cancer Center, Houston. FAU - Subbiah, Vivek AU - Subbiah V AD - Investigational Cancer Therapeutics (Phase I Trials Program), The University of Texas MD Anderson Cancer Center, Houston. FAU - Kurzrock, Razelle AU - Kurzrock R AD - Investigational Cancer Therapeutics (Phase I Trials Program), The University of Texas MD Anderson Cancer Center, Houston10Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, La Jolla. FAU - Janku, Filip AU - Janku F AD - Investigational Cancer Therapeutics (Phase I Trials Program), The University of Texas MD Anderson Cancer Center, Houston. FAU - Moulder, Stacy L AU - Moulder SL AD - Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston4Investigational Cancer Therapeutics (Phase I Trials Program), The University of Texas MD Anderson Cancer Center, Houston. LA - eng GR - P30 CA016672/CA/NCI NIH HHS/United States PT - Clinical Trial, Phase I PT - Journal Article PL - United States TA - JAMA Oncol JT - JAMA oncology JID - 101652861 RN - 0 (Elafin) RN - 0 (PI3 protein, human) RN - 0 (Protein Kinase Inhibitors) RN - 0 (liposomal doxorubicin) RN - 2S9ZZM9Q9V (Bevacizumab) RN - 3WJQ0SDW1A (Polyethylene Glycols) RN - 624KN6GM2T (temsirolimus) RN - 80168379AG (Doxorubicin) RN - 9HW64Q8G6G (Everolimus) RN - EC 2.7.1.1 (MTOR protein, human) RN - EC 2.7.11.1 (Proto-Oncogene Proteins c-akt) RN - EC 2.7.11.1 (TOR Serine-Threonine Kinases) RN - W36ZG6FT64 (Sirolimus) SB - IM MH - Adult MH - Aged MH - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use MH - Bevacizumab/*administration & dosage/adverse effects MH - Doxorubicin/administration & dosage/adverse effects/*analogs & derivatives MH - Elafin/metabolism MH - Everolimus/administration & dosage/adverse effects MH - Female MH - Humans MH - Kaplan-Meier Estimate MH - Middle Aged MH - Polyethylene Glycols/administration & dosage/adverse effects MH - Proportional Hazards Models MH - Protein Kinase Inhibitors/administration & dosage/adverse effects MH - Proto-Oncogene Proteins c-akt/antagonists & inhibitors MH - Signal Transduction/drug effects MH - Sirolimus/administration & dosage/adverse effects/analogs & derivatives MH - TOR Serine-Threonine Kinases/metabolism MH - Triple Negative Breast Neoplasms/*drug therapy/pathology EDAT- 2016/11/29 06:00 MHDA- 2017/04/21 06:00 CRDT- 2016/11/29 06:00 PHST- 2016/11/29 06:00 [pubmed] PHST- 2017/04/21 06:00 [medline] PHST- 2016/11/29 06:00 [entrez] AID - 2587051 [pii] AID - 10.1001/jamaoncol.2016.5281 [doi] PST - ppublish SO - JAMA Oncol. 2017 Apr 1;3(4):509-515. doi: 10.1001/jamaoncol.2016.5281.