Exploring the safety, effect on the tumor microenvironment, and efficacy of itacitinib in combination with epacadostat or parsaclisib in advanced solid tumors: a phase I study

• Published in: Journal for immunotherapy of cancer Vol. 10; no. 3; p. e004223
• Main Authors: Naing, Aung, Powderly, John D, Nemunaitis, John J, Luke, Jason J, Mansfield, Aaron S, Messersmith, Wells A, Sahebjam, Solmaz, LoRusso, Patricia M, Garrido-Laguna, Ignacio, Leopold, Lance, Geschwindt, Ryan, Ding, Kai, Smith, Michael, Berlin, Jordan D
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.03.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Acetonitriles; biomarkers, tumor; Biopsy; Breast cancer; Cancer; clinical trials as topic; Clinical/Translational Cancer Immunotherapy; drug therapy, combination; Exocrine glands; Humans; immunomodulation; Immunotherapy; Kinases; Lung cancer; Lymphocytes; Melanoma; Metastasis; Neoplasms - drug therapy; Oximes; Pyrazoles; Pyrimidines; Pyrroles; Pyrrolidines; Sulfonamides; Tumor Microenvironment; Tumors; United States > US; clinical trials as topic; immunomodulation; drug therapy, combination; tumor microenvironment; biomarkers, tumor
• ISSN: 2051-1426; 2051-1426
• DOI: 10.1136/jitc-2021-004223

BackgroundThis phase I multicenter study was designed to evaluate the safety, tolerability, efficacy, and translational effects on the tumor microenvironment of itacitinib (Janus-associated kinase 1 (JAK1) inhibitor) in combination with epacadostat (indoleamine 2,3-dioxygenase 1 (IDO1) inhibitor) or parsaclisib (phosphatidylinositol 3-kinase δ (PI3Kδ) inhibitor).MethodsPatients with advanced or metastatic solid tumors were enrolled and received itacitinib (100–400 mg once a day) plus epacadostat (50–300 mg two times per day; group A), or itacitinib (100–400 mg once a day) plus parsaclisib or parsaclisib monotherapy (0.3–10 mg once a day; group B).ResultsA total of 142 patients were enrolled in the study. The maximum tolerated dose was not reached for either the combination of itacitinib plus epacadostat (n=47) or itacitinib plus parsaclisib (n=90). One dose-limiting toxicity of serious, grade 3 aseptic meningitis was reported in a patient receiving itacitinib 300 mg once a day plus parsaclisib 10 mg once a day, which resolved when the study drugs were withdrawn. The most common treatment-related adverse events among patients treated with itacitinib plus epacadostat included fatigue, nausea, pyrexia, and vomiting, and for patients treated with itacitinib plus parsaclisib were fatigue, pyrexia, and diarrhea. In the itacitinib plus epacadostat group, no patient had an objective response. Among patients receiving itacitinib 100 mg once a day plus parsaclisib 0.3 mg once a day, three achieved partial response for an objective response rate (95% CI) of 7.1% (1.50 to 19.48). Treatment with itacitinib plus epacadostat demonstrated some increase in tumor CD8+ T cell infiltration and minor changes in six plasma proteins, whereas treatment with itacitinib plus high-dose parsaclisib resulted in downregulation of 20 plasma proteins mostly involved in immune cell function, with no observed change in intratumoral CD8+ T cell infiltration.ConclusionAdverse events with JAK1 inhibition combined with either IDO1 or PI3Kδ inhibition were manageable, but the combinations demonstrated limited clinical activity or enhancement of immune activation in the tumor microenvironment.Trial registration numberNCT02559492.