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AZD5363 plus paclitaxel versus placebo plus paclitaxel as first-line therapy for metastatic triple-negative breast cancer (PAKT): A randomised, double-blind, placebo-controlled, phase II trial

Schmid, Peter; Abraham, Jacinta; Chan, Stephen; Wheatley, Duncan; Brunt, Murray; Nemsadze, Gia; Baird, Richard; Hee Park, Yeon; Hall, Peter; Perren, Timothy; Stein, Robert C.; László, Mangel; Ferrero, Jean-Marc; Phillips, Melissa; Conibear, John; Sarker, Shah-Jalal; Prendergast, Aaron; Cartwright, Hayley; Mousa, Kelly; Turner, Nicholas C.

Authors

Peter Schmid

Jacinta Abraham

Stephen Chan

Duncan Wheatley

Gia Nemsadze

Richard Baird

Yeon Hee Park

Peter Hall

Timothy Perren

Robert C. Stein

Mangel László

Jean-Marc Ferrero

Melissa Phillips

John Conibear

Shah-Jalal Sarker

Aaron Prendergast

Hayley Cartwright

Kelly Mousa

Nicholas C. Turner



Abstract

Background: The PI3K/AKT signalling pathway is frequently activated in triple-negative breast cancer (TNBC). AZD5363 is a highly-selective, oral, small molecule AKT inhibitor. The PAKT trial investigated the addition of AZD5363 to paclitaxel as 1st-line therapy for TNBC. Methods: This investigator-led, double-blind, placebo-controlled, randomised phase II trial, recruited women with previously untreated, metastatic TNBC at 42 sites in 6 countries. Patients were randomly assigned (1:1) to paclitaxel 90mg/m2 (days 1, 8, & 15) with either AZD5363 (400mg BD) or placebo (days 2-5, 9-12, 16-19) every 28 days until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), PFS in the subgroup with PIK3CA/AKT1/PTEN-alterations, response, and safety. Results: Between 05/2014 and 06/2017, 140 patients were randomised to paclitaxel + AZD5363 (n = 70) or paclitaxel + placebo (n = 70). Median duration of follow-up was 18.2 months (95% CI, 13.6 to 24.0). In the ITT analysis, median PFS was 5.9 months (m) for AZD5363 compared to 4.2m for placebo (hazard ratio [HR], 0.75; 95% CI, 0.52 to 1.08; one-sided p = 0.06; two-sided p = 0.11 [predefined significance level of 0.10, one-sided]). Median OS was 19.1m for AZD5363 compared to 12.6m for placebo (HR, 0.64; 95% CI, 0.40 to 1.01; one-sided p = 0.02; two-sided p = 0.04). Results for the subgroup with PIK3CA/AKT1/PTEN-altered tumours will be presented. Most common grade 3 or worse adverse events were diarrhoea (12% [8/68] of AZD5363-treated patients vs 1% [1/70] of placebo-treated patients), infection (4% vs 1%), neutropenia (3% vs 3%), rash (4% vs 0) and fatigue (4% vs 0). Conclusions: The trial met its primary endpoint. Addition of AZD5363 to 1st-line paclitaxel therapy for TNBC resulted in significantly longer PFS and OS. AZD5363 warrants further investigation for the treatment of TNBC. Clinical trial information: NCT02423603.

Conference Name 2018 ASCO Annual Meeting I
Conference Location Chicago, IL, USA
Start Date Jun 1, 2018
End Date Jun 5, 2018
Acceptance Date May 20, 2018
Publication Date May 20, 2018
DOI https://doi.org/10.1200/JCO.2018.36.15_suppl.1007
Publisher URL https://ascopubs.org/doi/10.1200/JCO.2018.36.15_suppl.1007

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