Ruxolitinib and exemestane for estrogen receptor positive, aromatase inhibitor resistant advanced breast cancer.
Igor MakhlinNicholas P McAndrewE Paul WileytoAmy S ClarkRobin HolmesLisa N BottalicoClementina MesarosIan A BlairGrace R JeschkeKevin R FoxSusan M DomchekJennifer M MatroAngela R BradburyMichael D FeldmanElizabeth O HexnerJacqueline F BrombergAngela M DeMichelePublished in: NPJ breast cancer (2022)
Circulating IL-6, an activator of JAK/STAT signaling, is associated with poor prognosis and aromatase inhibitor (AI) resistance in hormone-receptor positive (HR+) breast cancer. Here we report the results of a phase 2 single-arm Simon 2-stage trial combining Ruxolitinib, an oral selective inhibitor of JAK1/2, with exemestane, a steroidal AI, in patients with HR+ metastatic breast cancer (MBC) after progression on non-steroidal AI (NSAI). Safety and efficacy were primary objectives, and analysis of inflammatory markers as predictors of response was a key secondary objective. Twenty-five subjects enrolled. The combination of ruxolitinib and exemestane was safe, though anemia requiring transfusion in 5/15 (33%) at the 25 mg dose in stage 1 led to a reduction to 15 mg twice daily in stage 2 (with no additional transfusions). Clinical benefit rate (CBR) in the overall study population was 24% (95% CI 9.4-45.1); 6/25 patients demonstrated stable disease for ≥6 months. Median progression-free survival was 2.8 months (95% CI 2.6-3.9). Exploratory biomarkers revealed high levels of systemic inflammation and 60% harbored a high-risk IL-6 genotype. Pharmacodynamics demonstrated modest on-target inhibition of phosphorylated-STAT3 by ruxolitinib at a tolerable dose. Thus, ruxolitinib combined with exemestane at a tolerable dose was safe but minimally active in AI-resistant tumors of patients with high levels of systemic inflammation. These findings highlight the need for more potent and specific therapies targeting inflammation in MBC.
Keyphrases
- metastatic breast cancer
- poor prognosis
- artificial intelligence
- estrogen receptor
- free survival
- end stage renal disease
- chronic kidney disease
- long non coding rna
- ejection fraction
- anti inflammatory drugs
- oxidative stress
- machine learning
- prognostic factors
- study protocol
- physical activity
- deep learning
- cell proliferation
- patient reported outcomes
- single cell
- immune response
- patient reported