A phase I trial of bortezomib in combination with everolimus for treatment of relapsed/refractory non-Hodgkin lymphoma

Abstract

B-cell non-Hodgkin lymphomas (NHL) display dysregulation of pathways controlling cell proliferation and apoptosis. Combined proteasome and mTOR inhibition, demonstrated with bortezomib and everolimus in a preclinical model, thus warrants evaluation in humans. We conducted a phase I study to identify the maximum tolerated dose (MTD) and safety of this combination in relapsed/refractory (r/r) NHL. Twenty-nine patients were enrolled from July 2008 to March, 2015. Toxicities were primarily hematologic, and dose-limiting thrombocytopenia defined the MTD as 5 mg everolimus daily with 1.3 mg/m² bortezomib d1, 4, 8, and 11 every 21 days. Of 25 response-evaluable patients there was one complete response in a patient with MCL and three partial responses (two MCL, one FL) for an overall response rate of 16%. In conclusion, the combination of everolimus and bortezomib results in dose limiting thrombocytopenia, but is tolerable. This combination has limited clinical activity in heavily pretreated NHL.

Keywords:

• Lymphoma and Hodgkin disease
• signaling therapies
• chemotherapeutic approaches

Acknowledgements

The authors wish to acknowledge mentorship and input on trial design provided by the American Society of Clinical Oncology and American Association for Cancer Research, at the 2007 ASCO/AACR Workshop on Methods in Clinical Cancer Research. Study coordination and data collection were supported in our partnership with Leukemia & Lymphoma Society. Research funding was provided by Millennium/Takeda and Novartis.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2017.1347932

Additional information

Funding

Research funding was provided by Millennium/Takeda and Novartis.