1
|
Loriot Y, Petrylak DP, Rezazadeh Kalebasty A, Fléchon A, Jain RK, Gupta S, Bupathi M, Beuzeboc P, Palmbos P, Balar AV, Kyriakopoulos CE, Pouessel D, Sternberg CN, Tonelli J, Sierecki M, Zhou H, Grivas P, Barthélémy P, Tagawa ST. TROPHY-U-01, a phase II open-label study of sacituzumab govitecan in patients with metastatic urothelial carcinoma progressing after platinum-based chemotherapy and checkpoint inhibitors: updated safety and efficacy outcomes. Ann Oncol 2024; 35:392-401. [PMID: 38244927 DOI: 10.1016/j.annonc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Sacituzumab govitecan (SG) is a Trop-2-directed antibody-drug conjugate containing cytotoxic SN-38, the active metabolite of irinotecan. SG received accelerated US Food and Drug Administration approval for locally advanced (LA) or metastatic urothelial carcinoma (mUC) previously treated with platinum-based chemotherapy and a checkpoint inhibitor, based on cohort 1 of the TROPHY-U-01 study. Mutations in the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene are associated with increased adverse events (AEs) with irinotecan-based therapies. Whether UGT1A1 status could impact SG toxicity and efficacy remains unclear. PATIENTS AND METHODS TROPHY-U-01 (NCT03547973) is a multicohort, open-label, phase II registrational study. Cohort 1 includes patients with LA or mUC who progressed after platinum- and checkpoint inhibitor-based therapies. SG was administered at 10 mg/kg intravenously on days 1 and 8 of 21-day cycles. The primary endpoint was objective response rate (ORR) per central review; secondary endpoints included progression-free survival, overall survival, and safety. Post hoc safety analyses were exploratory with descriptive statistics. Updated analyses include longer follow-up. RESULTS Cohort 1 included 113 patients. At a median follow-up of 10.5 months, ORR was 28% (95% CI 20.2% to 37.6%). Median progression-free survival and overall survival were 5.4 months (95% CI 3.5-6.9 months) and 10.9 months (95% CI 8.9-13.8 months), respectively. Occurrence of grade ≥3 treatment-related AEs and treatment-related discontinuation were consistent with prior reports. UGT1A1 status was wildtype (∗1|∗1) in 40%, heterozygous (∗1|∗28) in 42%, homozygous (∗28|∗28) in 12%, and missing in 6% of patients. In patients with ∗1|∗1, ∗1|∗28, and ∗28|∗28 genotypes, any grade treatment-related AEs occurred in 93%, 94%, and 100% of patients, respectively, and were managed similarly regardless of UGT1A1 status. CONCLUSIONS With longer follow-up, the ORR remains high in patients with heavily pretreated LA or mUC. Safety data were consistent with the known SG toxicity profile. AE incidence varied across UGT1A1 subgroups; however, discontinuation rates remained relatively low for all groups.
Collapse
Affiliation(s)
- Y Loriot
- Medical Oncology Department, Institut de Cancérologie Gustave Roussy, Université Paris-Saclay, Villejuif, France.
| | - D P Petrylak
- Genitourinary Oncology, Yale School of Medicine, New Haven
| | | | - A Fléchon
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - R K Jain
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa
| | - S Gupta
- Division of Oncology, Department of Medicine, Huntsman Cancer Institute, Salt Lake City
| | - M Bupathi
- Medical Oncology, Rocky Mountain Cancer Centers, Littleton, USA
| | - P Beuzeboc
- Oncology and Supportive Care Department, Hôpital Foch, Suresnes, France
| | - P Palmbos
- Urologic Oncology Clinic, Rogel Cancer Center, University of Michigan, Ann Arbor
| | - A V Balar
- Genitourinary Oncology Department, New York University Langone Medical Center, New York
| | - C E Kyriakopoulos
- Division of Hematology, Oncology and Palliative Care, University of Wisconsin-Madison, Madison, USA
| | - D Pouessel
- Department of Medical Oncology and Clinical Research Unit, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse (IUCT-Oncopôle), Toulouse, France
| | - C N Sternberg
- Department of Genitourinary Oncology, Weill Cornell Medical College of Cornell University, New York
| | - J Tonelli
- Clinical Development - Oncology, Gilead Sciences, Inc., Parsippany
| | - M Sierecki
- Clinical Development - Oncology, Gilead Sciences, Inc., Parsippany
| | - H Zhou
- Department of Biometrics, Gilead Sciences, Inc., Foster City
| | - P Grivas
- Department of Medicine, University of Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, USA
| | - P Barthélémy
- Medical Oncology Department, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - S T Tagawa
- Department of Genitourinary Oncology, Weill Cornell Medical College of Cornell University, New York
| |
Collapse
|
2
|
Kramer MW. Systemtherapie des Urothelkarzinoms der Harnblase. ASCO UND EHA 2023, UROTHELKARZINOM, NIERENZELLKARZINOM 2023; 32:261-267. [DOI: 10.47184/tk.2023.04-05.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Die Systemtherapie des Harnblasenkarzinoms hat durch die Integration immunonkologischer Strategien in die Therapiekonzepte bei muskelinvasiven Karzinomen und im metastasierten Stadium deutliche Fortschritte gemacht. Nach dem Versagen von platinbasierter Chemotherapie und Immuntherapie ergeben sich außerdem neue Optionen für die Therapie in späteren Linien. Neben den Inhibitoren des Fibroblasten-Wachstumsfaktor-Rezeptors (FGFR) sind hier vor allem Antikörper-Wirkstoff-Konjugate vielversprechend.
Collapse
|
3
|
Nielsen TJ, Varga MG, Cronister CT, Ring BZ, Seitz RS, Ross DT, Schweitzer BL, McGregor K. The 27-gene IO score is associated with efficacy of PD-1/L1 inhibitors independent of FGFR expression in a real-world metastatic urothelial carcinoma cohort. Cancer Immunol Immunother 2023:10.1007/s00262-023-03401-x. [PMID: 36806983 DOI: 10.1007/s00262-023-03401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/07/2023] [Indexed: 02/23/2023]
Abstract
Multiple targeted therapeutics have been approved by the FDA for mUC, including immune checkpoint inhibitors (ICIs) and more recently targeted agents for both FGFR and Nectin-4. FGFR3-aberrant and Nectin-4 expressing cells have been associated with an immunosuppressed phenotype. Given that less than half of all patients respond to these agents as monotherapies and less than 20% are eligible to receive salvage therapy, effective personalized treatment plans are critical. Typical biomarkers for ICIs such as PD-L1 and TMB have not been definitive in mUC, yet a biomarker-driven optimization of first-line therapy and subsequent sequencing have the potential to achieve higher and more durable response rates. The IO score is a 27-gene tumor immune microenvironment (TIME) classifier that has been associated with the clinical benefits of ICIs in multiple cancer types, including mUC. This study demonstrates that the IO score was associated with both progression-free survival (PFS) and overall survival (OS) in a real-world cohort of mUC patients treated with ICIs. Furthermore, the IO score was independent of and provided information incremental to TMB. Interestingly, the IO score predicted benefit in patients with high FGFR expression, despite conflicting data regarding response rates among the FGFR aberrant population. Taken together, these results demonstrate that the IO score assessment of the TIME is associated with a clinical benefit from ICI therapy and that this novel biomarker may inform therapeutic sequencing decisions in mUC, potentially improving outcomes for this notoriously difficult-to-treat disease.
Collapse
Affiliation(s)
| | | | | | - Brian Z Ring
- Oncocyte Corporation, 15 Cushing, Irvine, CA, 92618, USA
| | - Robert S Seitz
- Oncocyte Corporation, 15 Cushing, Irvine, CA, 92618, USA
| | - Douglas T Ross
- Oncocyte Corporation, 15 Cushing, Irvine, CA, 92618, USA
| | | | | |
Collapse
|
4
|
Powles T, Petrylak DP, Rosenberg JE. Beyond Chemotherapy and Checkpoint Inhibitors: Weighing the Risks and Benefits of the Novel Therapies for Metastatic Urothelial Carcinoma. J Clin Oncol 2021; 39:3411-3412. [PMID: 34491780 DOI: 10.1200/jco.21.01430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Thomas Powles
- Thomas Powles, MD, Barts Cancer Centre, Queen Mary University of London, London, United Kingdom; Daniel P. Petrylak, MD, Smilow Cancer Center, Yale School of Medicine, New Haven, CT; and Jonathan E. Rosenberg, MD, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel P Petrylak
- Thomas Powles, MD, Barts Cancer Centre, Queen Mary University of London, London, United Kingdom; Daniel P. Petrylak, MD, Smilow Cancer Center, Yale School of Medicine, New Haven, CT; and Jonathan E. Rosenberg, MD, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan E Rosenberg
- Thomas Powles, MD, Barts Cancer Centre, Queen Mary University of London, London, United Kingdom; Daniel P. Petrylak, MD, Smilow Cancer Center, Yale School of Medicine, New Haven, CT; and Jonathan E. Rosenberg, MD, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
5
|
Lavoie J, Sridhar SS, Ong M, North S, Alimohamed N, McLeod D, Eigl BJ. The Rapidly Evolving Landscape of First-Line Targeted Therapy in Metastatic Urothelial Cancer: A Systematic Review. Oncologist 2021; 26:e1381-e1394. [PMID: 34028134 PMCID: PMC8342568 DOI: 10.1002/onco.13827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Metastatic urothelial carcinoma (mUC) historically is treated with first-line platinum-based combination chemotherapy, preferably cisplatin plus gemcitabine whenever possible. In recent years, multiple classes of targeted therapy have demonstrated benefit, with some receiving approval in mUC. This review will summarize phase III efficacy and safety data for targeted agents, principally immune checkpoint inhibitors (ICIs), as either first-line or first-line switch-maintenance therapy for mUC and interpret these findings in the context of the current treatment landscape. MATERIALS AND METHODS Published and presented phase III data on targeted therapy for the first-line or first-line switch-maintenance treatment of mUC were identified using the key search terms "targeted therapy" AND "urothelial carcinoma" AND "advanced" OR respective aliases according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS Of the six eligible phase III targeted therapy trials, two assessing ICIs met their primary endpoints in platinum-eligible patients. First-line ICI plus chemotherapy combinations have not improved overall survival (OS), although final OS results of the IMVigor 130 trial are pending. Switch-maintenance using an ICI in patients achieving at least stable disease following platinum-based chemotherapy statistically significantly improved OS (21.4 vs. 14.3 months, hazard ratio, 0.69; 95% confidence interval, 0.56-0.86; p = .001). Current sequencing options for mUC include first-line platinum-based chemotherapy with a switch to ICI either immediately or upon disease progression. CONCLUSION Recent targeted therapy trials have expanded ICI sequencing options for mUC. The treatment landscape is likely to evolve rapidly, with results from multiple phase III trials expected in the next 5 years. IMPLICATIONS FOR PRACTICE Multiple classes of targeted agents are approved for use in metastatic urothelial carcinoma (mUC). Six phase III trials have recently provided insight on the benefit of these agents in the first-line setting. In platinum-eligible patients, immune checkpoint inhibitors (ICIs) combined with first-line platinum-based chemotherapy failed to demonstrate improved survival, although ICI monotherapy as switch-maintenance significantly improved overall survival in patients with mUC who had achieved at least stable disease following first-line platinum-based chemotherapy. In patients ineligible for any chemotherapy, pembrolizumab, atezolizumab, or pembrolizumab in combination with enfortumab vedotin may be options.
Collapse
Affiliation(s)
| | - Srikala S. Sridhar
- Medical Oncology, Princess Margaret Cancer Center, University of TorontoTorontoOntarioCanada
| | - Michael Ong
- Medical Oncology, Ottawa Hospital Research Institute, University of OttawaOttawaOntarioCanada
| | - Scott North
- Medical Oncology, Cross Cancer Institute, University of AlbertaEdmontonAlbertaCanada
| | - Nimira Alimohamed
- Medical Oncology, Tom Baker Cancer Centre, University of CalgaryCalgaryAlbertaCanada
| | | | - Bernhard J. Eigl
- Medical Oncology, BC Cancer – Vancouver, University of British ColumbiaVancouverBritish ColumbiaCanada
| |
Collapse
|
6
|
Powles T, Rosenberg JE, Sonpavde GP, Loriot Y, Durán I, Lee JL, Matsubara N, Vulsteke C, Castellano D, Wu C, Campbell M, Matsangou M, Petrylak DP. Enfortumab Vedotin in Previously Treated Advanced Urothelial Carcinoma. N Engl J Med 2021; 384:1125-1135. [PMID: 33577729 PMCID: PMC8450892 DOI: 10.1056/nejmoa2035807] [Citation(s) in RCA: 518] [Impact Index Per Article: 172.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with advanced urothelial carcinoma have poor overall survival after platinum-containing chemotherapy and programmed cell death protein 1 (PD-1) or programmed death ligand 1 (PD-L1) inhibitor treatment. METHODS We conducted a global, open-label, phase 3 trial of enfortumab vedotin for the treatment of patients with locally advanced or metastatic urothelial carcinoma who had previously received platinum-containing chemotherapy and had had disease progression during or after treatment with a PD-1 or PD-L1 inhibitor. Patients were randomly assigned in a 1:1 ratio to receive enfortumab vedotin (at a dose of 1.25 mg per kilogram of body weight on days 1, 8, and 15 of a 28-day cycle) or investigator-chosen chemotherapy (standard docetaxel, paclitaxel, or vinflunine), administered on day 1 of a 21-day cycle. The primary end point was overall survival. RESULTS A total of 608 patients underwent randomization; 301 were assigned to receive enfortumab vedotin and 307 to receive chemotherapy. As of July 15, 2020, a total of 301 deaths had occurred (134 in the enfortumab vedotin group and 167 in the chemotherapy group). At the prespecified interim analysis, the median follow-up was 11.1 months. Overall survival was longer in the enfortumab vedotin group than in the chemotherapy group (median overall survival, 12.88 vs. 8.97 months; hazard ratio for death, 0.70; 95% confidence interval [CI], 0.56 to 0.89; P = 0.001). Progression-free survival was also longer in the enfortumab vedotin group than in the chemotherapy group (median progression-free survival, 5.55 vs. 3.71 months; hazard ratio for progression or death, 0.62; 95% CI, 0.51 to 0.75; P<0.001). The incidence of treatment-related adverse events was similar in the two groups (93.9% in the enfortumab vedotin group and 91.8% in the chemotherapy group); the incidence of events of grade 3 or higher was also similar in the two groups (51.4% and 49.8%, respectively). CONCLUSIONS Enfortumab vedotin significantly prolonged survival as compared with standard chemotherapy in patients with locally advanced or metastatic urothelial carcinoma who had previously received platinum-based treatment and a PD-1 or PD-L1 inhibitor. (Funded by Astellas Pharma US and Seagen; EV-301 ClinicalTrials.gov number, NCT03474107.).
Collapse
Affiliation(s)
- Thomas Powles
- Barts Cancer Centre, Queen Mary University of London, London, United Kingdom
| | | | - Guru P Sonpavde
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Yohann Loriot
- Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Ignacio Durán
- Hospital Universitario Marques de Valdecilla, IDIVAL, Cantabria, Spain
| | - Jae-Lyun Lee
- Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Christof Vulsteke
- Center for Oncological Research (CORE), University of Antwerp, Integrated Cancer Center Ghent, Ghent, Belgium
| | | | | | | | | | | |
Collapse
|