title: A phase 2 study of alisertib (MLN8237) in recurrent or persistent uterine leiomyosarcoma: An NRG Oncology/Gynecologic Oncology Group study 0231D.
abstract: OBJECTIVE
  This two-stage Phase II study assessed the activity of single agent alisertib in patients with recurrent/persistent uterine leiomyosarcoma (uLMS).
  
  
  METHODS
  Eligibility criteria included histologically-confirmed, recurrent or persistent uLMS, age≥18, 1-2 prior cytotoxic regimens, and RECIST version 1.1 measurable disease. The primary objective of the study was to evaluate the efficacy of alisertib through the frequency of patients with objective tumor responses and the frequency who survived event-free for at least 6months (EFS6). The endpoints for EFS were RECIST progression, death, or beginning a subsequent therapy. The null hypothesis jointly specified the probability of a patient experiencing a tumor response to less than or equal to 5% and the probability of a patient surviving event-free for at least 6months to less than or equal to 20%. A two-stage design was used with a target accrual of 23 patients for stage 1 and 47 pts. cumulative for stage 2. Confidence intervals do not correct for multiplicity.
  
  
  RESULTS
  Twenty-three patients were enrolled with two patients excluded on central histology review, yielding 21 eligible patients. Median age was 61years. Prior treatment was either 1 cytotoxic regimen (71.4%) or 2 (28.6%). The most common treatment related AEs (grade 3 or worse) were anemia Hensley et al. (2008a) , leukopenia Hensley et al. (2008b) , neutropenia Maki et al. (2007) , thrombocytopenia Huang et al. (2012) , mucositis Hensley et al. (2008a) , diarrhea Huang et al. (2012) , and palmer-planter syndrome Zivanovic et al. (2012) . There were no objective responses (0%; 90% CI: 0-10.4%). Best response was stable disease (38.1%); 12 patients had progressive disease (57.1%). EFS6 was 0% (90% CI: 0-10.4%). Median PFS and OS were 1.7 (90% CI: 1.4-3.2) and 14.5months (90% CI: 7.6 - NA), respectively.
  
  
  CONCLUSIONS
  Alisertib did not demonstrate clinically meaningful single agent activity in previously treated uLMS.
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA. Electronic address: hymand@mskcc.org.
authors.forename: David M
authors.initials: DM
authors.lastname: Hyman
authors.affiliation: NRG Oncology Statistics and Data Management Center, Buffalo, NY 14263, USA. Electronic address: msill@gogstats.org.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Sill
authors.affiliation: NRG Oncology Statistics and Data Management Center, Buffalo, NY 14263, USA. Electronic address: hlankes@gogstats.org.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Lankes
authors.affiliation: Cancer Therapy Evaluation Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA. Electronic address: rpiekarz@nih.gov.
authors.forename: Richard
authors.initials: R
authors.lastname: Piekarz
authors.affiliation: Abington Hospital, Jefferson Health, Abington, PA 19001, USA. Electronic address: mshahin@abingtonhealth.org.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Shahin
authors.affiliation: University of Mississippi Medical Center, Jackson, MS 39216, USA. Electronic address: mridgway@umc.edu.
authors.forename: Mildred R
authors.initials: MR
authors.lastname: Ridgway
authors.affiliation: Ohio State University, Wexner Medical Center, Hilliard, OH 43026, USA. Electronic address: Floor.Backes@osumc.edu.
authors.forename: Floor
authors.initials: F
authors.lastname: Backes
authors.affiliation: Gynecologic Oncology, The University of Chicago Medicine & Biological Sciences, Chicago, IL 60637, USA. Electronic address: mtenney@bsd.uchicago.edu.
authors.forename: Meaghen E
authors.initials: ME
authors.lastname: Tenney
authors.affiliation: Women & Infants Hospital, Providence, RI 02905, USA. Electronic address: cmathews@wihri.org.
authors.forename: Cara A
authors.initials: CA
authors.lastname: Mathews
authors.affiliation: Hospital of Central Connecticut, New Britain, CT 06050, USA. Electronic address: James.HoffmanMD@baystatehealth.org.
authors.forename: James S
authors.initials: JS
authors.lastname: Hoffman
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA. Electronic address: aghajanc@mskcc.org.
authors.forename: Carol
authors.initials: C
authors.lastname: Aghajanian
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA. Electronic address: hensleym@mskcc.org.
authors.forename: Martee L
authors.initials: ML
authors.lastname: Hensley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001381:Azepines / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000188:drug therapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use*; D066066:Response Evaluation Criteria in Solid Tumors; D019233:Retreatment; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D001381:Azepines; C550258:MLN 8237; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines
keywords: Alisertib; Aurora kinase; Uterine leiomyosarcoma