Sponsor: Dana-Farber Cancer Institute (other)
Phase: 2
Start date: Dec. 24, 2018
Planned enrollment: 180
Gedatolisib (PF-05212384; PKI‑587) is an investigational, intravenous dual inhibitor of class I PI3K isoforms and mTOR complexes 1/2 being developed primarily for hormone receptor–positive, HER2‑negative (HR+/HER2−) advanced breast cancer and other solid tumors. Early first‑in‑human work established a weekly dosing schedule with a manageable toxicity profile, and subsequent studies have explored combinations with endocrine therapy, CDK4/6 inhibitors, chemotherapy, PARP inhibitors, and other agents. (pubmed.ncbi.nlm.nih.gov)
Gedatolisib potently inhibits all four class I PI3K isoforms (p110α/β/γ/δ) and mTORC1/2, aiming to produce comprehensive blockade of PI3K/AKT/mTOR signaling and limit adaptive resistance seen with single‑node inhibitors. Preclinical work in breast cancer models showed greater anti‑proliferative and cytotoxic activity versus alpelisib (PI3Kα), capivasertib (AKT), or everolimus (mTORC1), irrespective of PAM‑pathway mutational status. (pubmed.ncbi.nlm.nih.gov)
Ongoing/Planned phase 3: VIKTORIA‑2 (first‑line HR+/HER2− ABC, endocrine‑resistant) is randomizing fulvestrant + investigator’s‑choice CDK4/6 inhibitor with or without gedatolisib; first patient dosed July 24, 2025. (aacrjournals.org)
Note: Several efficacy and safety data above derive from conference abstracts or company‑reported topline results; peer‑reviewed, full phase 3 results are pending publication. (biospace.com)
Last updated: Oct 2025
Zotatifin (eFT226) is an investigational, first‑in‑class small‑molecule inhibitor of the RNA helicase eIF4A being studied primarily in solid tumors, with the most mature human data in ER‑positive/HER2‑negative metastatic breast cancer (mBC). Early phase studies suggest antitumor activity when combined with fulvestrant ± abemaciclib, with manageable toxicity. (ascopubs.org)
Clinical experience comes from a phase 1/2, open‑label study (NCT04092673) with dose escalation and expansion cohorts.
Note: Additional dose‑escalation work in 2024 identified 0.2 mg/kg every 2 weeks as an RP2D for the doublet (zotatifin + fulvestrant), per company SEC filing. (sec.gov)
Notes - Zotatifin remains investigational; efficacy signals are from early‑phase cohorts without randomized comparisons. Reported PFS and dosing updates after 2023 largely come from company communications and regulatory filings summarizing meeting presentations; peer‑reviewed, full clinical publications have not yet reported mature outcomes. (sec.gov)
Last updated: Oct 2025
Samotolisib (LY3023414) is an oral, ATP‑competitive dual inhibitor of class I PI3K isoforms and mTORC1/2 with additional activity against DNA‑dependent protein kinase (DNA‑PK). It has shown target engagement and preliminary antitumor activity across early-phase trials, with the recommended phase 2 dose (RP2D) established at 200 mg twice daily. Development has included monotherapy and combinations (e.g., with enzalutamide in metastatic castration‑resistant prostate cancer). A recent endometrial cancer pilot combining letrozole/abemaciclib/samotolisib was terminated early due to discontinuation of LY3023414 development, though a partial response was observed in one patient. (pubmed.ncbi.nlm.nih.gov)
Metastatic castration‑resistant prostate cancer (post‑abiraterone): Double‑blind phase Ib/II randomized enzalutamide ± samotolisib (200 mg BID). Radiographic PFS improved to 10.2 months with samotolisib/enzalutamide vs 5.5 months with placebo/enzalutamide (HR 0.64; 95% CI 0.41–1.01; P=0.03). PCWG2‑PFS was 3.8 vs 2.8 months (P=0.003). Benefit appeared greater in AR‑V7–negative and PTEN‑intact subgroups. Objective RECIST responses were infrequent (PR 4.6% in each arm), but disease control per RECIST was ~80% in both arms. (pmc.ncbi.nlm.nih.gov)
Advanced endometrial cancer with PI3K‑pathway alterations (single‑arm phase 2): In 25 efficacy‑evaluable, heavily pretreated patients, overall response rate (ORR) was 16% (4 confirmed PRs), clinical benefit rate 28%, median PFS 2.5 months, and median OS 9.2 months. No clear genomic predictor of response was identified within the predefined PI3K‑pathway alterations. (pubmed.ncbi.nlm.nih.gov)
Advanced mesothelioma (phase 1 expansion, monotherapy): Single‑agent activity was limited. Reported ORR 2–5% with disease control rate ~43–46% and median PFS ~2.8 months. (synapse.mskcc.org)
Other combinations: A phase Ib study of prexasertib (CHK1 inhibitor) plus samotolisib in solid tumors reported preliminary activity (ORR 13–25% in certain expansion cohorts) but with notable myelosuppression. A small endometrial cancer pilot of letrozole/abemaciclib/samotolisib was stopped early after 5 patients when LY3023414 development was discontinued; one patient achieved a partial response. (pubmed.ncbi.nlm.nih.gov)
Monotherapy (first‑in‑human phase 1): Common related AEs were mostly grade 1–2 and included nausea (38%), fatigue (34%), and vomiting (32%); dose‑limiting toxicities occurred at higher doses (450 mg QD: thrombocytopenia, hypotension, hyperkalemia; 250 mg BID: hypophosphatemia, fatigue, mucositis). RP2D was 200 mg BID. (aacrjournals.org)
Endometrial cancer phase 2 (monotherapy): Frequent all‑grade treatment‑related AEs included anemia (71%), hyperglycemia (71%), hypoalbuminemia (68%), and hypophosphatemia (61%). (pubmed.ncbi.nlm.nih.gov)
Prostate cancer combination (phase II): With enzalutamide, the most common AEs included fatigue (63%), diarrhea (62%), and nausea (59%); grade ≥3 AEs occurred in ~30% overall. Pharmacokinetic interaction with enzalutamide reduced samotolisib exposure by ~35% but remained within the targeted efficacious range. (aacrjournals.org)
Notes: As of October 7, 2025, published clinical data remain from early‑phase studies; at least one recent trial in endometrial cancer was halted due to discontinuation of LY3023414 development. (pubmed.ncbi.nlm.nih.gov)
Last updated: Oct 2025
Goal: To evaluate the antitumor activity and safety of endocrine therapy with letrozole plus the CDK4/6 inhibitor abemaciclib, alone or combined with agents targeting translational control (zotatifin) or the PI3K/AKT/mTOR pathway (gedatolisib or LY3023414), and with metformin, in ER-positive endometrial cancer and in low-grade serous ovarian cancer.
Patients: Adults (≥18 years) with measurable, recurrent or metastatic endometrial cancer or endometrial carcinosarcoma with an endometrioid epithelial component (ER≥1% by IHC), or with low-grade serous carcinoma of the ovary, fallopian tube, or peritoneum (ER status not required). ECOG 0–1, adequate organ function, and available archival tissue are required. Prior therapies are allowed without limit; prior CDK4/6 inhibitor exposure is excluded for most cohorts but required for Cohort 7. Cohorts 6–7 require TP53 wild type and glycemic control (HbA1c ≤6.4%, fasting glucose ≤140 mg/dL). Key exclusions include active brain metastases, recent chemo/radiation or strong CYP3A4 modifiers, significant cardiovascular risk, uncontrolled hypertension, and prior PI3K-pathway inhibitors for Cohorts 6–7.
Design: Multi-cohort, open-label, non-randomized phase 2 study. Parallel cohorts test doublet and triplet combinations with expansion permitted. Planned enrollment is 180.
Treatments: Cohort 1A: abemaciclib plus letrozole. Cohort 3: abemaciclib, letrozole, and metformin; metformin is an antihyperglycemic agent explored for antiproliferative and pro-apoptotic effects in cancer. Cohorts 4–5: abemaciclib, letrozole, and zotatifin; zotatifin (eFT226) is a first-in-class selective eIF4A inhibitor that clamps eIF4A onto polypurine motifs in 5′ UTRs, selectively suppressing translation of oncogenic mRNAs (e.g., RTKs, cyclin D1). Early-phase studies in ER+/HER2– metastatic breast cancer have shown manageable safety and signals of activity when combined with endocrine therapy and abemaciclib, with partial responses and median PFS around 7 months in small cohorts. Cohorts 6–7: abemaciclib, letrozole, and gedatolisib; gedatolisib is a potent pan-class I PI3K and mTORC1/2 inhibitor that provides comprehensive PAM pathway blockade. In phase 1b breast cancer studies, gedatolisib combined with CDK4/6 inhibition and endocrine therapy produced high response rates in treatment-naïve HR+ disease and meaningful activity after prior CDK4/6 inhibitors, with a manageable toxicity profile dominated by expected class effects. Cohorts 1–2 include LY3023414 (samotolisib) with or without letrozole; LY3023414 is an oral dual PI3K/mTOR and DNA-PK inhibitor with a short half-life and transient pathway inhibition. Single-agent activity has been observed in biomarker-selected endometrial cancer and in combination with enzalutamide in mCRPC, improving progression-free endpoints; common adverse events include GI symptoms, fatigue, anemia, hyperglycemia, and hypophosphatemia. All cohorts include continuous oral abemaciclib BID; letrozole is given daily; zotatifin is IV on days 1 and 8 of 21-day cycles; gedatolisib is IV on days 1, 8, and 15 of 28-day cycles; LY3023414 is oral BID.
Outcomes: Co-primary endpoints: 6-month progression-free survival rate and objective response rate by RECIST 1.1. Secondary endpoints: overall survival and treatment-related toxicities per CTCAE v5.0.
Burden on patient: Moderate. Patients will take continuous oral therapy (abemaciclib with or without letrozole and metformin/LY3023414) and, in select cohorts, receive IV infusions of zotatifin on days 1 and 8 of 21-day cycles or gedatolisib on days 1, 8, and 15 of 28-day cycles, necessitating frequent clinic visits. Safety monitoring will require regular laboratory assessments (hematology, chemistry, liver function, glucose/HbA1c for PAM inhibitors) and periodic imaging for RECIST response, comparable to typical phase 2 oncology studies. No intensive pharmacokinetic sampling is described; archival tissue is required but no mandatory fresh biopsies are specified, which limits procedural burden. Travel and time commitments increase during infusion weeks, particularly for the 3-dose-per-28-day gedatolisib schedule.
Last updated: Oct 2025
Inclusion Criteria:
* Participants must have cytologically or histologically confirmed endometrial cancer that is recurrent or metastatic and/or resistant to standard therapies, or for which no standard therapy is available.Participants enrolled in the second stage of Cohort 1A, or into Cohort 3, 4, 6 and 7, must have histologically confirmed either i) endometrioid endometrial cancer or ii) endometrial carcinosarcoma with endometrioid epithelial component
* For Cohort 5: Participants must have histologically confirmed diagnosis of low-grade serous carcinoma of ovary, fallopian tube or peritoneum; original diagnosis of de novo low-grade serous carcinoma or original diagnosis of serous borderline tumor with subsequent diagnosis of low-grade serous carcinoma. Participants whose tumors contain both low-grade serous carcinoma and high-grade serous carcinoma are not eligible.
* Participants must have ER-positive disease, defined as ≥ 1 percent of tumor cell nuclei being immunoreactive by immunohistochemistry (IHC). If multiple analyses have been performed, judgment should be based on the most recent biopsy or pathology specimen analyzed in a CLIA-certified laboratory. For Cohort 5, participants are eligible regardless of ER positive or negative status.
* Participants must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as ≥20 mm with conventional techniques or as ≥10 mm with spiral CT scan, MRI, or calipers by clinical exam.
* Age ≥ 18 years
* ECOG performance status of 0 or 1
* Participants must have normal organ and bone marrow function as defined below:
* Absolute neutrophil count ≥ 1,500/mcL
* Platelets ≥ 100,000/mcL
* Total bilirubin ≤ 1.5 × institutional upper limit of normal (ULN). Patients with Gilbert's syndrome with a total bilirubin \= 2.0 times ULN and direct bilirubin within normal limits are permitted.
* AST(SGOT)/ALT(SGPT) ≤ 3× institutional ULN
* Creatinine ≤ 1.5 × institutional ULN, OR
* Creatinine clearance ≥ 60 mL/min/1.73 m2 for participants with creatinine levels above institutional normal.
* For cohorts 4, 5, 6 and 7, patients must not have remaining ovarian function to be included. Women who have ovarian function are eligible but must be placed on hormonal suppression.
* The effects of the study agents on the developing human fetus are unknown. For this reason, women of child-bearing potential must agree to use a medically approved contraceptive method during the treatment period and for 3 months following the last dose of study agent. Contraceptive methods may include an intrauterine device (IUD) or barrier method. If condoms are used as a barrier method, a spermicidal agent should be added as a double barrier protection. Should a woman become pregnant or suspect she is pregnant while she is participating in this study, she should inform her treating physician immediately. A negative serum pregnancy test is required for study entry from women of childbearing potential.
* Ability to understand and the willingness to sign a written informed consent document.
* Ability to swallow and retain oral medication.
* Participants can have received an unlimited number of prior therapies.
* Participants must have archival tissue available for analysis in the form of a formalin-fixed paraffin embedded (FFPE) block or unstained slides. Note: confirmation of availability of archival tissue is the only requirement for eligibility, archival tissue does not need to be received by the study team prior to enrollment
* For Cohorts 6 and 7, participants must have HbA1c ≤6.4% and fasting plasma glucose (FPG) ≤140 mg/dL.
* For Cohort 6 and 7, patients must have wildtype TP53 as assessed either by immunohistochemistry or any CLIA-certified next-generation sequencing assay.
* For Cohort 7, patients must have received prior CDK4/6 inhibitor therapy and developed disease progression as deemed by the investigator. Patients who have stopped CDK4/6 inhibitor therapy because of intolerance are ineligible.
Exclusion Criteria:
* Participants who have had chemotherapy, immune therapy, other investigational therapy, or major surgery within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to the first dose of study medication. Previous hormonal therapy, including prior letrozole, is allowed and there is no required washout period for hormonal therapy.
* Participants who have had tyrosine kinase inhibitor (TKI) therapy within 5 half-lives of study entry.
* Participants who have had radiation therapy within 2 weeks of the first dose of study medication.
* Participants who have received previous treatment with CDK4/6 inhibitors, including but not limited to previous abemaciclib therapy. For Cohorts 4 and 5, prior treatment with CDK4/6 inhibitors is allowed in up to 50% of participants for each cohort (≤8 participants in the first stage and ≤18 total in both stages for each cohort \[if the study goes to second stage\]). For Cohort 7, patients must have received prior treatment with CDK4/6 inhibitors.
* Participants who are currently receiving metformin therapy (if enrolling to Cohort 3).
* Participants who have impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of the study drugs
* Participants with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to the study agents that the participant will be administered.
* Participants who at the time of study enrollment are known to require concomitant therapy with moderate or strong CYP3A4 inducers, or strong inhibitors of CYP3A4. Due to potential drug interactions, concomitant use of these medications is not permitted for the duration of treatment on trial. Participants are eligible for study entry if an appropriate substitution is made prior to the first dose of study medication.
* Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
* Use of known QT-prolonging drugs during screening or expected requirement for use during study therapy.
* Participants with histories or evidence of cardiovascular risk including any of the following: acute coronary syndromes (i.e. myocardial infarction or angina), coronary angioplasty, or stenting within 6 months prior to study enrollment.
* Pregnant women are excluded from this study because the study agents are anti-cancer agents with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with the study agents, breastfeeding must be discontinued if the mother is treated on trial.
* Individuals with a history of a different malignancy are ineligible with the following exceptions: individuals who have been treated and are disease-free for a minimum of 5 years prior to study enrollment, or individuals who are deemed by the treating investigator to be at low risk for disease recurrence. Additionally, individuals with the following cancers are eligible if diagnosed and treated within the past 5 years: basal or squamous cell carcinomas of the skin, and breast or cervical carcinomas in situ.
* Known HIV-positive participants are ineligible because of the increased risk of lethal infections when treated with marrow-suppressive therapy.
* Participants with a history of uncontrolled hypertension despite optimal medical management, defined as systolic blood pressure \> 150 mmHg or diastolic blood pressure \> 90 mmHg.
* For Cohorts 6 and 7: Inability to determine the corrected QT interval using Fridericia's formula (QTcF) on the ECG (i.e., unreadable or not interpretable) or QTcF\>480 msec (determined by mean of triplicate ECGs at screening).
* For Cohorts 6 and 7, participants with type 1 diabetes or uncontrolled type 2 diabetes.
* For Cohorts 6 and 7, participants who have previously received any PI3K pathway inhibitors are ineligible. Up to 10 patients in Cohort 6 and up to 10 patients in Cohort 7 may have received prior mTOR inhibitor therapy such as everolimus.
Boston, Massachusetts, 02215, United States
No email / (617) 667-5661
Status: Recruiting
Boston, Massachusetts, 02215, United States
[email protected] / 877-338-7425
Status: Recruiting
Boston, Massachusetts, 02214, United States
No email / 617-724-4000
Status: Recruiting