Camonsertib, an ATRi, in Combination with Low-Dose Gemcitabine in Solid Tumors with DNA Damage Response Aberrations: Preclinical and Phase Ib Results.

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Tumor responses primarily in gynecologic cancers

• Primary Outcome: Safety and tolerability with dose optimization

• Nnt Or Sensitivity: Durable tumor control >1 year in subset of patients

• Confidence Interval: Not reported

Clinical Application

Limited by significant myelosuppression requiring careful monitoring and dose modifications Relevant for Australian oncology practice, though camonsertib not yet TGA-approved; would require special access scheme or clinical trial participation Patients with advanced solid tumors harboring DDR gene alterations, particularly gynecologic malignancies

Abstract

PURPOSE: The utility of combination treatment with gemcitabine and camonsertib, an ataxia telangiectasia and Rad3-related kinase inhibitor, in mediating tumor cell death was assessed in preclinical models, prompting clinical investigation. The phase Ib TRESR study (NCT04497116) aimed to evaluate the safety, tolerability, and preliminary efficacy of the combination in patients with advanced solid tumors harboring DNA damage repair (DDR) gene alterations. PATIENTS AND METHODS: Cell lines and tumor xenografts were tested across a range of dose levels and schedules. Patients (N = 76) harboring tumors with DDR gene alterations received camonsertib (80-120 mg) and de-escalating gemcitabine (1,000-100 mg/m2) in 21- or 28-day cycles on an intermittent dosing regimen. Safety, tolerability, and preliminary efficacy were assessed to identify an optimal dosing regimen. RESULTS: In preclinical models, low-dose camonsertib (1/3 maximum tolerated dose) and gemcitabine led to tumor regression and was well tolerated with minimal body weight loss observed. In patients, synergistic toxicities were observed, primarily myelosuppression, resulting in gemcitabine de-escalation. The introduction of a 1 week on/1 week off schedule in combination with low-dose gemcitabine allowed for spontaneous neutrophil recovery, fewer dose modifications, and improved tolerability. Tumor responses were primarily observed in patients with gynecologic cancers, with tumor control maintained for greater than 1 year in some patients. CONCLUSIONS: Camonsertib and low-dose gemcitabine demonstrated preliminary clinical activity, but due to challenging tolerability, further evaluation is warranted to identify the optimal dosing regimen and subset of patients who may benefit most from this combination.

References

1. 1.Rosen, E. Y., Yap, T. A., Fontana, E., Lee, E. K., Mahalingam, D., Højgaard, M., Mettu, N. B., Cote, G. M., Plummer, R., Koehler, M., Ulanet, D., Fei, K., Silverman, I. M., Schonhoft, J. D., Rimkunas, V., Bacque, E. S., Gomez, G., Fretland, A. J., Roulston, A., Li, L., Baruah, P., Zimmermann, M., Yang, J., Carneiro, B. A., & Lheureux, S. (2026). Camonsertib, an ATRi, in combination with low-dose gemcitabine in solid tumors with DNA damage response aberrations: Preclinical and phase Ib results. Clinical Cancer Research. https://doi.org/10.1158/1078-0432.CCR-25-2240