title: Idelalisib, an inhibitor of phosphatidylinositol 3-kinase p110δ, for relapsed/refractory chronic lymphocytic leukemia.
abstract: In a phase 1 trial, idelalisib (GS-1101, CAL-101), a selective inhibitor of the lipid kinase PI3Kδ, was evaluated in 54 patients with relapsed/refractory chronic lymphocytic leukemia (CLL) with adverse characteristics including bulky lymphadenopathy (80%), extensive prior therapy (median 5 [range 2-14] prior regimens), treatment-refractory disease (70%), unmutated IGHV (91%), and del17p and/or TP53 mutations (24%). Patients were treated at 6 dose levels of oral idelalisib (range 50-350 mg once or twice daily) and remained on continuous therapy while deriving clinical benefit. Idelalisib-mediated inhibition of PI3Kδ led to abrogation of Akt phosphorylation in patient CLL cells and significantly reduced serum levels of CLL-related chemokines. The most commonly observed grade ≥3 adverse events were pneumonia (20%), neutropenic fever (11%), and diarrhea (6%). Idelalisib treatment resulted in nodal responses in 81% of patients. The overall response rate was 72%, with 39% of patients meeting the criteria for partial response per IWCLL 2008 and 33% meeting the recently updated criteria of PR with treatment-induced lymphocytosis.(1,2) The median progression-free survival for all patients was 15.8 months. This study demonstrates the clinical utility of inhibiting the PI3Kδ pathway with idelalisib. Our findings support the further development of idelalisib in patients with CLL. These trials were registered at clinicaltrials.gov as #NCT00710528 and #NCT01090414.
authors.affiliation: Dana Farber Cancer Institute, Boston, MA;
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Brown
authors.affiliation: The Ohio State University, Columbus, OH;
authors.forename: John C
authors.initials: JC
authors.lastname: Byrd
authors.affiliation: Stanford University, Stanford, CA;
authors.forename: Steven E
authors.initials: SE
authors.lastname: Coutre
authors.affiliation: The Ohio State University, Columbus, OH;
authors.forename: Don M
authors.initials: DM
authors.lastname: Benson
authors.affiliation: Sarah Cannon Research Institute, Nashville, TN;
authors.forename: Ian W
authors.initials: IW
authors.lastname: Flinn
authors.affiliation: Washington University, St. Louis, MO;
authors.forename: Nina D
authors.initials: ND
authors.lastname: Wagner-Johnston
authors.affiliation: Oregon Health & Sciences University, Portland, OR;
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Spurgeon
authors.affiliation: University of Wisconsin, Madison, WI;
authors.forename: Brad S
authors.initials: BS
authors.lastname: Kahl
authors.affiliation: Moffitt Cancer Center and.
authors.forename: Celeste
authors.initials: C
authors.lastname: Bello
authors.affiliation: Gilead Sciences, Inc., Seattle, WA; and.
authors.forename: Heather K
authors.initials: HK
authors.lastname: Webb
authors.affiliation: Gilead Sciences, Inc., Seattle, WA; and.
authors.forename: Dave M
authors.initials: DM
authors.lastname: Johnson
authors.affiliation: Gilead Sciences, Inc., Seattle, WA; and.
authors.forename: Sissy
authors.initials: S
authors.lastname: Peterman
authors.affiliation: Gilead Sciences, Inc., Seattle, WA; and.
authors.forename: Daniel
authors.initials: D
authors.lastname: Li
authors.affiliation: Gilead Sciences, Inc., Seattle, WA; and.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Jahn
authors.affiliation: Gilead Sciences, Inc., Seattle, WA; and.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Lannutti
authors.affiliation: Gilead Sciences, Inc., Seattle, WA; and.
authors.forename: Roger G
authors.initials: RG
authors.lastname: Ulrich
authors.affiliation: Gilead Sciences, Inc., Seattle, WA; and.
authors.forename: Albert S
authors.initials: AS
authors.lastname: Yu
authors.affiliation: Gilead Sciences, Inc., Seattle, WA; and.
authors.forename: Langdon L
authors.initials: LL
authors.lastname: Miller
authors.affiliation: Weill Cornell Medical College, New York, NY.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Furman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D000081082:Phosphoinositide-3 Kinase Inhibitors; D011687:Purines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D052999:Quinazolinones / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000081082:Phosphoinositide-3 Kinase Inhibitors; D011687:Purines; D052999:Quinazolinones; C552946:idelalisib