Perifosine plus docetaxel in patients with platinum and taxane resistant or refractory high-grade epithelial ovarian cancer

Abstract Objectives On the basis of reversal of taxane resistance with AKT inhibition, we initiated a phase I trial of the AKT inhibitor perifosine with docetaxel in taxane and platinum-resistant or refractory epithelial ovarian cancer. Methods Patients with pathologically confirmed high-grade epithelial ovarian cancer (taxane resistant, n=10; taxane refractory, n=11) were enrolled. Peripheral blood samples and tumor biopsies were obtained and 18 F-FDG-PET and DCE-MRI scans were performed for pharmacodynamic and imaging studies. Results Patients received a total of 42 treatment cycles. No dose-limiting toxicity was observed. The median progression-free survival and overall survival were 1.9months and 4.5months, respectively. One patient with a PTEN mutation achieved a partial remission (PR) for 7.5months, and another patient with a PIK3CA mutation had stable disease (SD) for 4months. Two other patients without apparent PI3K pathway aberrations achieved SD. Two patients with KRAS mutations demonstrated rapid progression. Decreased phosphorylated S6 correlated with 18 F-FDG-PET responses. Conclusions Patients tolerated perifosine 150mg PO daily plus docetaxel at 75mg/m 2 every 4weeks. Further clinical evaluation of effects of perifosine with docetaxel on biological markers and efficacy in patients with ovarian cancer with defined PI3K pathway mutational status is warranted.