Luminespib plus pemetrexed in patients with non-squamous non-small cell lung cancer

Background: Luminespib (AUY922) is a second-generation heat shock protein 90 (HSP90) inhibitor with demonstrated activity in non-small cell lung cancer (NSCLC). Since luminespib reduces levels of dihydrofolate reductase (DHFR), a key enzymatic target of pemetrexed, we assessed the safety and tolerability of luminespib in combination with pemetrexed in patients with previously treated metastatic non-squamous non-small cell lung cancer (NSCLC). We also sought to study the pharmacokinetics and correlate tumor dihydrofolate reductase (DHFR) expression with clinical response. Methods: Patients received weekly luminespib at either 40 mg/m(2), 55 mg/m(2), or 70 mg/m(2) according to a standard 3 + 3 dose-escalation design along with pemetrexed at 500 mg/m(2) followed by an expansion at the maximum tolerated dose (MTD). Results: Two-dose limiting toxicities (DLTs) were experienced in the 70 mg/m(2) cohort, therefore the MTD was determined to be 55 mg/m(2). 69% (N = 9) of patients experienced ophthalmologic toxicity related to luminespib. Maximum serum concentration (Cmax) of luminespib was associated with increased grade 2 drug related adverse events (DRAEs) (r(s) = 0.74, P < 0.01), with volume of distribution (VD) inversely associated with the number of DRAEs (r(s) = 0.81, P = 0.004) and ophthalmologic related DRAEs (r(s) = 0.65, P = 0.04). The best response was partial response in one patient for 20 months, prior to expiration of all luminespib. Amongst patients treated at the MTD, the objective response rate was 14%. Conclusion: In patients with previously treated metastatic NSCLC, the MTD of luminespib in combination with pemetrexed was 55 mg/m(2) per week. The combination of luminespib and pemetrexed demonstrated clinical activity. Tolerability of luminespib with pemetrexed is limited by ocular toxicity.