Predicting clinical benefit from everolimus in patients with advanced solid tumors, the CPCT-03 study
Fleur Weeber (Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis, Center for Personalized Cancer Treatment)
Geert A. Cirkel ( University Medical Centre Utrecht, Center for Personalized Cancer Treatment)
Marlous Hoogstraat (Center for Personalized Cancer Treatment, Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis)
Sander Bins (Center for Personalized Cancer Treatment, Erasmus MC)
Christa G.M. Gadellaa-van Hooijdonk ( University Medical Centre Utrecht, Center for Personalized Cancer Treatment)
Salo Ooft (Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis)
Erik van Werkhoven (Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis)
Stefan M. Willems ( University Medical Centre Utrecht, Center for Personalized Cancer Treatment)
Marijn van Stralen ( University Medical Centre Utrecht)
Wouter B. Veldhuis ( University Medical Centre Utrecht)
Nicolle J.M. Besselink ( University Medical Centre Utrecht, Center for Personalized Cancer Treatment)
Hugo M. Horlings (Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis)
Neeltje Steeghs (Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis, University Medical Centre Utrecht, Center for Personalized Cancer Treatment)
Maja J. de Jonge (Center for Personalized Cancer Treatment, Erasmus MC)
Marlies H.G. Langenberg (Center for Personalized Cancer Treatment, University Medical Centre Utrecht)
Lodewyk F.A. Wessels (Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis, TU Delft - Pattern Recognition and Bioinformatics, University Medical Centre Utrecht)
Edwin Cuppen ( University Medical Centre Utrecht)
Edwin Cuppen (Center for Personalized Cancer Treatment, Hubrecht Institute, University Medical Centre Utrecht)
J.H. Schellens (Universiteit Utrecht, Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis, University Medical Centre Utrecht, Center for Personalized Cancer Treatment)
Stefan Sleijfer (Erasmus MC, Center for Personalized Cancer Treatment, University Medical Centre Utrecht)
Martijn P. Lolkema (Erasmus MC, Center for Personalized Cancer Treatment)
Emile E. Voest (Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis, University Medical Centre Utrecht, Center for Personalized Cancer Treatment)
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Abstract
Background: In this study, our aim was to identify molecular aberrations predictive for response to everolimus, an mTOR inhibitor, regardless of tumor type. Methods: To generate hypotheses about potential markers for sensitivity to mTOR inhibition, drug sensitivity and genomic profiles of 835 cell lines were analyzed. Subsequently, a multicenter study was conducted. Patients with advanced solid tumors lacking standard of care treatment options were included and underwent a pre-treatment tumor biopsy to enable DNA sequencing of 1,977 genes, derive copy number profiles and determine activation status of pS6 and pERK. Treatment benefit was determined according to TTP ratio and RECIST. We tested for associations between treatment benefit and single molecular aberrations, clusters of aberrations and pathway perturbation. Results: Cell line screens indicated several genes, such as PTEN (P = 0.016; Wald test), to be associated with sensitivity to mTOR inhibition. Subsequently 73 patients were included, of which 59 started treatment with everolimus. Response and molecular data were available from 43 patients. PTEN aberrations, i.e. copy number loss or mutation, were associated with treatment benefit (P = 0.046; Fisher's exact test). Conclusion: Loss-of-function aberrations in PTEN potentially represent a tumor type agnostic biomarker for benefit from everolimus and warrants further confirmation in subsequent studies.
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