A Randomized, Phase II Trial of Cetuximab With or Without PX-866, an Irreversible Oral Phosphatidylinositol 3-Kinase Inhibitor, in Patients With Metastatic Colorectal Carcinoma

The phosphotidyinositol-3 kinase (PI3K) pathway in frequently activated on metastatic colorectal carcinoma (CRC). We combined a novel PI3K inhibitor, PX-866, with cetuximab for patients with KRAS codon 12 wide type metastatic CRC. Patients receiving PX-866 plus cetuximab did not improvement in response rate, progression-free survival, or overall survival compared to cetuximab alone. Toxicity, especially gastrointestinal, was higher in the combination arm. Background: The phosphotidylinositol-3 kinase (PI3K)/serine-threonine kinase/mammalian target of rapamycin signaling pathway is frequently altered in colorectal cancer (CRC). PX-866 is an oral, irreversible, pan-isoform inhibitor of PI3K. This randomized phase II study evaluated cetuximab with or without PX-866 in patients with metastatic, antiepidermal growth factor receptor-naive, KRAS codon 12 and 13 wild-type CRC. Patients and Methods: Patients with metastatic CRC who had received both oxaliplatin and irinotecan were randomized (1: 1) to cetuximab (400 mg/m(2) loading then 250 mg/m(2) weekly) with or without PX-866 (8 mg orally daily; arms A and B, respectively). The primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate, overall survival (OS), toxicity, and correlation of relevant biomarkers with efficacy outcomes. Results: A total of 85 patients were enrolled. The median PFS was 59 days versus 104 days for arms A (cetuximab + PX-866) and B (cetuximab alone), respectively (P = 77). OS between the 2 arms (266 vs. 333 days for arm A vs. B) were similar (P = 83). Overall toxicity, including treatment-related toxicity, was higher in arm A compared with arm B, especially in terms of all-grade nausea (66% vs. 37%), vomiting (50% vs. 29%), diarrhea (64% vs. 18%), and rash (66% vs. 37%). Grade 3 diarrhea occurred in 19% of patients in Arm A and 0% in Arm B. PIK3CA mutations and PTEN loss by immunohistochemistry were infrequently seen. Conclusion: The addition of PX-866 to cetuximab did not improve PFS, objective response rate, or OS in patients with metastatic CRC. The combination arm had greater toxicity and may have been harmful in this study.