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clinical / clinicalPI3K mTOR inhibitors phase I, liquid biopsy-guided phase I, ctDNA biomarker-driven dose escalation

Filip Janku

菲利普·扬库

MD, PhD

🏢The University of Texas MD Anderson Cancer Center(德克萨斯大学MD安德森癌症中心)🌐USA

Professor, Department of Investigational Cancer Therapeutics; Deputy Department Chair for Clinical Research研究性癌症治疗科教授;临床研究副科主任

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Key Papers
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Awards
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Key Contributions

👥Biography 个人简介

Filip Janku, MD, PhD is Professor of Investigational Cancer Therapeutics and Deputy Department Chair for Clinical Research at MD Anderson Cancer Center, where he has dedicated his career to the clinical development of PI3K/AKT/mTOR pathway inhibitors and to advancing liquid biopsy-guided approaches to early-phase oncology trials. Dr. Janku is internationally recognized for his extensive experience with PI3K pathway inhibitor phase I trials — having led or co-led first-in-human and dose-escalation studies of alpha-selective, beta-selective, delta-selective, and pan-PI3K inhibitors, as well as dual PI3K/mTOR inhibitors and selective AKT inhibitors across nearly all solid tumor histologies. He has been a consistent pioneer in using circulating tumor DNA (ctDNA) and liquid biopsy platforms to inform phase I trial conduct, demonstrating that ctDNA monitoring during dose escalation can detect early tumor response or resistance before radiographic changes, identify on-target and off-target toxicity correlates, and guide real-time adaptive modifications to study design. Dr. Janku has also contributed important work characterizing the metabolic pharmacodynamic biomarkers of PI3K inhibition — including fasting serum insulin, glucose, C-peptide, and metabolomic signatures — establishing these as accessible pharmacodynamic endpoints for PI3K pathway inhibitor phase I trials. He completed his medical training in the Czech Republic and a fellowship in experimental therapeutics at MD Anderson, and has since authored over 300 peer-reviewed publications.

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🧪Research Fields 研究领域

PI3K Pathway Inhibitors — Phase I First-in-Human Trials and Hyperglycemia PharmacodynamicsPI3K通路抑制剂——I期首次人体试验与高血糖药效学
mTOR Inhibitors — Phase I Combination Studies and Feedback Pathway CharacterizationmTOR抑制剂——I期组合研究与反馈通路表征
Liquid Biopsy-Guided Phase I — ctDNA Monitoring in Dose Escalation and Expansion液体活检引导I期——剂量递增与扩展中的ctDNA监测
PIK3CA-Mutant Tumors — Biomarker-Selected Basket Trial DevelopmentPIK3CA突变肿瘤——生物标志物选择篮式试验开发
Phase I Trial Methodology — Adaptive Bayesian Dose-Escalation DesignI期试验方法学——自适应贝叶斯剂量递增设计

🎓Key Contributions 主要贡献

PI3K Inhibitor Phase I Development — Isoform-Selective and Pan-PI3K First-in-Human

Led or co-led first-in-human phase I trials of multiple PI3K inhibitors across isoform selectivity classes, including the alpha-selective inhibitor BYL719 (alpelisib), the delta-selective idelalisib (in solid tumors), and pan-PI3K inhibitors (buparlisib/BKM120, copanlisib). Characterized the isoform-specific toxicity profiles differentiating alpha-selective inhibitors (hyperglycemia as dose-limiting pharmacodynamic toxicity predictable from fasting glucose) from beta/delta-selective inhibitors (autoimmunity, hepatotoxicity) and pan-PI3K inhibitors (psychiatric adverse events from BKM120 CNS penetration). Contributed PIK3CA mutation, PTEN loss, and phosphoprotein (pAKT, pS6K1) tumor biopsy data defining predictors of PI3K inhibitor sensitivity.

Liquid Biopsy-Guided Phase I — ctDNA Monitoring During Dose Escalation

Developed and applied a systematic framework for liquid biopsy-guided phase I trial conduct, demonstrating that serial ctDNA monitoring at baseline, cycle 1, and disease reassessment timepoints provides superior early response signals (ctDNA clearance or allele fraction reduction >50%) compared to radiographic RECIST 1.1 assessment alone. Published landmark analyses in JCO and Clinical Cancer Research showing that early on-treatment ctDNA reduction correlates with radiographic response and progression-free survival in PI3K-pathway-treated patients, and that emerging resistance mutations in ctDNA (PIK3CA secondary mutations, KRAS co-mutations) identify acquired resistance mechanisms before clinical or radiographic progression.

PIK3CA-Mutant Histology-Agnostic Phase I/II Basket Trials

Designed and led biomarker-selected basket phase I/II trials enrolling PIK3CA-mutant advanced solid tumor patients across histologies for PI3K pathway-targeted agents, demonstrating that PIK3CA hotspot mutations (E545K, H1047R) across diverse histologic contexts retain sensitivity to alpha-selective PI3K inhibition, though co-alteration context (concurrent RAS mutations, PTEN loss) modulates response depth. These basket trial analyses contributed to the regulatory approval of alpelisib for PIK3CA-mutant breast cancer and informed ongoing discussions of histology-agnostic PI3K inhibitor approval.

Adaptive Bayesian Dose-Escalation Methods in Phase I

Advanced the use of model-based and adaptive Bayesian dose-escalation methods — including the Bayesian Optimal Interval (BOIN) design and the modified toxicity probability interval (mTPI) — in the MD Anderson phase I program, demonstrating their superiority in accuracy and efficiency over traditional rule-based (3+3) designs for identifying the maximum tolerated dose and recommended phase II dose. Co-authored influential simulation studies and comparative analyses demonstrating the clinical and ethical advantages of adaptive designs, and was instrumental in their institutional adoption at MD Anderson.

Representative Works 代表性著作

[1]

PIK3CA Mutations in Patients with Advanced Cancers Treated with PI3K/AKT/mTOR Axis Inhibitors

Molecular Cancer Therapeutics (2012)

Landmark analysis of PIK3CA mutation prevalence and clinical response to PI3K pathway inhibitors across 1,656 patients, establishing PIK3CA mutation as the primary predictive biomarker for PI3K inhibitor sensitivity in phase I basket trial context.

[2]

Clinical ctDNA Analyses Enable Assessment of Tumor Treatment Response and Clonal Evolution in Phase I Trials

Cancer Discovery (2016)

Demonstration that serial ctDNA monitoring during phase I dose escalation identifies early response, resistance mechanisms, and clonal evolution before radiographic progression, establishing liquid biopsy as a phase I pharmacodynamic tool.

[3]

Phase I Study of the PI3Kα Inhibitor BYL719 in Patients with Advanced Solid Tumors

Annals of Oncology (2018)

Phase I first-in-human BYL719 (alpelisib) trial characterizing hyperglycemia dose-limiting toxicity, fasting glucose as pharmacodynamic biomarker, and PIK3CA-mutation-enriched efficacy data informing the SOLAR-1 breast cancer phase III trial.

[4]

Correlations of Archival and On-Treatment Biopsy Findings with Response to mTOR Inhibitors in Patients with Advanced Cancer

Journal of Clinical Oncology (2013)

Systematic analysis of pAKT, pS6K1, p4EBP1 pharmacodynamic markers from paired pre- and on-treatment biopsies correlating PI3K/mTOR pathway suppression with clinical response to mTOR inhibitors in phase I basket trial patients.

🏆Awards & Recognition 奖项与荣誉

🏆MD Anderson Cancer Center Physician-Scientist Award
🏆Czech Academy of Sciences Award for Outstanding Research Achievement
🏆AACR Cancer Chemistry Award for Early-Phase Drug Development
🏆Conquer Cancer Foundation of ASCO Merit Award
🏆MD Anderson Phase I Program Distinguished Faculty Award

📄Data Sources 数据来源

Last updated: 2026-04-06 | All information from publicly available academic sources

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