Sponsor: Celcuity Inc (industry)
Phase: 3
Start date: Dec. 8, 2022
Planned enrollment: 701
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
Goal: Evaluate whether adding the pan-PI3K/mTOR inhibitor gedatolisib to fulvestrant, with or without palbociclib, improves outcomes versus standard-of-care therapies in HR-positive, HER2-negative advanced breast cancer that has progressed on a CDK4/6 inhibitor plus a non-steroidal aromatase inhibitor, with analyses stratified by PIK3CA mutation status.
Patients: Adults with inoperable locally advanced or metastatic HR+/HER2− breast cancer, ECOG 0–1, who experienced radiographic progression on or after a CDK4/6 inhibitor combined with a non-steroidal aromatase inhibitor. Both sexes eligible; pre/peri-menopausal women require LHRH agonist therapy. Adequate organ function is required and evaluable disease per RECIST v1.1 is mandatory; bone-only disease must include lytic or mixed lesions. Key exclusions include prior PI3K/Akt/mTOR inhibitors, chemotherapy or ADCs for advanced disease, >2 prior lines of endocrine therapy, uncontrolled diabetes, active/untreated CNS metastases, and significant recent cardiovascular disease.
Design: Phase 3, open-label, randomized, multi-arm study with allocation by PIK3CA mutation status. Approximately 701 participants will be randomized after central confirmation of PIK3CA status. Efficacy is assessed by blinded independent central review of imaging per RECIST v1.1.
Treatments: For PIK3CA wild-type: Arm A gedatolisib + palbociclib + fulvestrant; Arm B gedatolisib + fulvestrant; Arm C fulvestrant alone (active comparator). For PIK3CA-mutant: Arm D gedatolisib + palbociclib + fulvestrant; Arm F gedatolisib + fulvestrant; Arm E alpelisib + fulvestrant (active comparator). Gedatolisib is an intravenously administered, potent pan-class I PI3K and mTORC1/2 inhibitor targeting the PI3K/AKT/mTOR pathway to overcome resistance to endocrine and CDK4/6 therapies. Early-phase studies in HR+/HER2− disease showed manageable safety and promising activity when combined with palbociclib and endocrine therapy, including objective responses in both treatment-naïve and CDK4/6-pretreated cohorts, with neutropenia largely attributable to palbociclib. Fulvestrant is a SERD standard therapy; palbociclib is a CDK4/6 inhibitor standard-of-care partner; alpelisib is a PI3Kα inhibitor approved with fulvestrant for PIK3CA-mutant disease.
Outcomes: Primary endpoint: progression-free survival by blinded independent central review in both PIK3CA wild-type and mutant cohorts. Key secondary endpoints include overall survival, overall response rate, duration of response, time to response, and clinical benefit rate, all per RECIST v1.1 and BICR. Additional secondary endpoints assess patient-reported outcomes and quality of life (FACT-B TOI, NFBSI-16, PROMIS Physical Function 8c, EQ-5D-5L) and safety/tolerability per NCI CTCAE v5.0.
Burden on patient: Moderate. Participation requires baseline and longitudinal tumor tissue availability for PIK3CA testing, regular clinic visits for IV gedatolisib infusions, and oral administration of palbociclib and/or alpelisib or fulvestrant injections depending on arm. Imaging at regular intervals per RECIST with centralized review, routine laboratory monitoring including glucose and metabolic panels, hematology for CDK4/6-related myelosuppression, and adverse event assessments are expected. Compared with standard-of-care endocrine-based regimens, burden increases due to IV infusions, potential more frequent labs for metabolic and hematologic monitoring, and clinic time for fulvestrant injections; however, there are no intensive pharmacokinetic schedules typical of early-phase trials, and imaging frequency is likely similar to standard practice.
Last updated: Oct 2025
Inclusion Criteria:
1. Histologically or cytologically confirmed diagnosis of metastatic or locally advanced breast cancer Adult females, pre- and/or post-menopausal, and adult males. Pre-menopausal (and peri-menopausal) women can be enrolled if amenable to treatment with an LHRH agonist. Patients are to have commenced concomitant treatment with LHRH agonist prior to or on Cycle 1, Day 1 and must be willing to continue on it for the duration of the study.
2. Negative pregnancy test for women of childbearing potential. Female subjects of childbearing potential must use an effective and/or acceptable contraceptive method from screening until 1 year after the last dose of study treatment
3. Confirmed diagnosis of estrogen receptor positive and/or progesterone receptor positive, as per American Society of Clinical Oncology/College of American Pathologists (ASCO-CAP) guidelines (2020), based on most recent tumor biopsy utilizing an assay consistent with local standards
4. Documented HER2 immunohistochemistry (IHC) negative as per ASCO-CAP 2018 guidance
5. Adequate archival or fresh tumor tissue for the analysis of PIK3CA mutational status
6. Subject must have documentation of radiological disease progression on or after the last prior treatment and also have radiologically evaluable disease (measurable and/or non-measurable) according to RECIST v1.1, per local assessment. Subjects with bone only disease must have lytic or mixed lytic/blastic lesions that can be accurately assessed; bone only blastic lesions with no soft tissue component is not allowed.
7. Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
8. Life expectancy of at least 3 months
9. Progressed during or after CDK4/6 inhibitor combination treatment with non-steroidal aromatase inhibitor (AI)
10. Adequate bone marrow, hepatic, renal and coagulation function
Exclusion Criteria:
1. History of malignancies other than adequately treated non-melanoma skin cancer, curatively treated in situ cancer of the cervix, or other solid tumors curatively treated with no evidence of disease for ≥3 years
2. Prior treatment with a phosphoinositide 3-kinase (PI3K) inhibitor, a protein kinase B (Akt) inhibitor, or a mechanistic target of rapamycin (mTOR) inhibitor
3. Prior treatment with chemotherapy and antibody drug conjugates for advanced disease is not permitted (prior adjuvant or neoadjuvant chemotherapy is permitted)
4. More than 2 lines of prior endocrine therapy treatment
5. Bone only disease that is only blastic with no soft tissue component
6. Subjects with type 1 diabetes or uncontrolled type 2 diabetes
7. Known and untreated, or active, brain or leptomeningeal metastases
a. Subjects with previously treated central nervous system (CNS) metastases may be enrolled in the study if they meet the following criteria: do not require supportive therapy with steroids; do not have seizures and do not exhibit uncontrolled neurological symptoms; stable disease confirmed by radiographic assessment within at least 4 weeks prior to enrollment
8. Patients with advanced, symptomatic, visceral spread that are at risk of life-threatening complication in the short-term
9. History of clinically significant cardiovascular abnormalities such as: Congestive heart failure (New York Heart Association (NYHA) classification ≥ II within 6 months of study entry
1. Myocardial infarction within 12 months of study entry
2. History of any uncontrolled (or untreated) clinically significant cardiac arrhythmias, (e.g., ventricular tachycardia), complete left bundle branch block, high grade AV block (e.g., bifascicular block, Mobitz type II and third degree AV block), supraventricular, nodal arrhythmias, or conduction abnormality in the previous 12 months
3. Uncontrolled hypertension defined by systolic blood pressure (SBP) ≥160 mmHg and/or diastolic blood pressure (DBP) ≥100 mmHg, with or without antihypertensive medication (initiation or adjustment of antihypertensive medication\[s\] is allowed prior to screening)
4. Long QT syndrome, family history of idiopathic sudden death or congenital long QT syndrome, or any of the following:
* i. Risk factors for Torsades de Pointes (TdP) including uncorrected hypokalemia or hypomagnesemia, or history of clinically significant/symptomatic bradycardia
* ii. On screening, 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)
10. Known hypersensitivity to the study drugs or their components
11. Pregnant or breast-feeding women
12. Concurrent participation in another interventional clinical trial
1. Subjects must agree not to participate in another clinical trial (other than observational) at any time during participation in VIKTORIA-1.
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