A phase I trial of sequential dosing of sonidegib and pembrolizumab in advanced solid tumors (aST) and non–small-cell lung cancer (NSCLC).

Mohamed Shanshal Mayo Clinic, Rochester, MN info_outline Mohamed Shanshal, Nathan R. Foster, Yanyan Lou, Yujie Zhao, Mahesh Seetharam, Aaron Scott Mansfield, Konstantinos Leventakos, Mojun Zhu, Kimberly O. Steinert, Elizabeth Mikula, Qian Shi, Sani Haider Kizilbash, Haidong Dong, Alex A. Adjei, Wen Wee Ma

Authors Mohamed Shanshal Mayo Clinic, Rochester, MN info_outline Mohamed Shanshal, Nathan R. Foster, Yanyan Lou, Yujie Zhao, Mahesh Seetharam, Aaron Scott Mansfield, Konstantinos Leventakos, Mojun Zhu, Kimberly O. Steinert, Elizabeth Mikula, Qian Shi, Sani Haider Kizilbash, Haidong Dong, Alex A. Adjei, Wen Wee Ma Organizations Mayo Clinic, Rochester, MN, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, Mayo Clinic, Jacksonville, FL, Mayo Clinic Florida, Jacksonville, FL, Mayo Clinic, Phoenix, AZ, Department of Oncology, Mayo Clinic, Rochester, MN, Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, Cleveland Clinic, Cleveland, OH Abstract Disclosures Research Funding Pharmaceutical/Biotech Company Sun Pharma Background: Pembrolizumab interrupts PD-1/-L1 interaction and is efficacious in many cancers. However, resistance invariably emerges in the majority of patients. Potential mechanisms include activation of compensatory pathways. The inhibition of sonic hedgehog signaling (sHH) was previously shown to induce intra-tumoral (IT) infiltration by CD4+, CD8+ and HLA-DR class II cells. Our preclinical data showed sHH inhibitor enhanced IT penetration by monoclonal antibodies and induced PD-L1 expression. We conducted a phase I study using a novel sequential pulse dosing of sonedegib followed by pembrolizumab in aST with an expansion cohort to determine the maximum tolerated dose (MTD), tolerability and preliminary efficacy. Methods: The dose escalation utilized a 3+3 design to determine the MTD and proceeded to expansion cohort upon determination of the MTD. Patients enrolled to each dose level were observed for dose limiting toxicities (DLTs) during the 1 st cycle. The expansion cohort consisted of NSCLC and head/neck squamous cell carcinoma (HNSCC) previously treated by anti-PD1/-L1. The recommended phase 2 dose (RP2D) was determined following the review of the toxicity profile of the combination from all cycles. The study treatment consisted of sonidegib oral daily from day 1 to 8 and pembrolizumab I.V. 200 mg on day 8 on an every 3-week cycle. The sonidegib dose levels explored were 400, 600 and 800 mg. Archival tumor and blood specimens were collected for correlative studies. Adverse events (AEs) were categorized and graded per CTCAE v5.0, and tumor response by RECIST v1.1. Results: The study enrolled a total of 33 patients and 29 received treatment (13 in escalation and 16 in expansion), including patients with NSCLC, HNSCC, skin cancer, gastric cancer and melanoma. The enrollment to the NSCLC cohort is complete and HNSCC continues. No DLT was encountered during dose escalation and the MTD was not reached. The highest planned dose level was selected to proceed to expansion (sonidegib 800mg days 1-8 in combination with pembrolizumab I.V. 200 mg on day 8 on an every 3-week cycle). The expansion cohort proceeded to enroll 15 patients evaluable for AEs (10 NSCLC and 5 HSNCC). Grade 3 and above treatment-related AEs across all patients were hyperglycemia, fatigue, dyspepsia, abdominal pain. The mature efficacy data will be reported at the meeting. Conclusions: The study successfully determined the RP2D of sonidegib when dosed sequentially with pembrolizumab in advanced solid tumors. The AE profile of the combination is similar to that for respective agents given individually. The efficacy data among anti-PD1/-PDL1-treated NSCLC will be reported at the meeting. Clinical trial information: NCT04007744.

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