Background
The clinical activity of allosteric mTOR inhibitors in renal cell carcinoma (RCC) may be limited by upstream activation of PI3-Kinase/Akt resulting from mTORC1 inhibition. Based on this rationale, two independent Phase II trials (Perifosine 228 and 231) were conducted to assess the efficacy and safety of the novel Akt inhibitor perifosine in patients with advanced RCC who had failed prior VEGF-targeted therapy.
Methods
In Perifosine 228, 24 patients with advanced RCC were treated with perifosine (100 mg PO daily). Perifosine 231 enrolled two groups treated with daily perifosine (100 mg PO daily): Group A: No prior mTOR inhibitor, 32 patients; Group B: one prior mTOR inhibitor, 18 patients.
Results
In Perifosine 228, one patient achieved a partial response (PR) (ORR 4%; 95% CI [0.7, 20]) and 11 patients experienced a best response of stable disease (SD) (46%). Median PFS was 14.2 weeks (95% CI [7.7, 21.6]). In Perifosine 231, five patients experienced a PR (ORR 10% 95% CI [4.5, 22.2]) and 16 patients experienced a best response of SD (32%). Median PFS was 14 weeks [95% CI (12.9, 20.7)]. Overall, perifosine was well tolerated with very few grade 3 and 4 events. Most common toxicities included nausea, diarrhea, musculoskeletal pain, and fatigue.
Conclusion
Although perifosine shows activity in patients with advanced RCC following failure of VEGF-targeted therapy, this activity is not superior to currently available second-line agents. Nonethelesss, perifosine may be worthy of further study in RCC in combination with other currently available therapies.