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Miller K, Tolaney S, Emens LA, Kim SB, Hamilton E, Saura C, Sanz L, Boni V, Lynce F, Cejalvo JM, Crozier J, Wang S, Uppal H, Hannah AL, Hurvitz S. Abstract P4-01-15: Preliminary results from a phase 2 study of praluzatamab ravtansine (CX-2009) in patients with advanced breast cancer (ABC). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: CD166 is broadly expressed in normal epithelium and overexpressed in many types of malignancies, including breast cancer. Probody® therapeutic candidates are masked antibodies, conditionally activated by tumor-associated proteases, which restricts their activity to the tumor microenvironment and minimizes ‘off-tumor’ toxicity. CX-2009 is a conditionally activated humanized anti-CD166 monoclonal antibody conjugated to DM4 that showed clinical activity in ABC patients in a phase 1 study (Boni et al. Clin Cancer Res. 2022). This phase 2 study (NCT04596150) evaluates CX-2009 as monotherapy in patients with advanced HR+/HER2− BC (Arm A) and TNBC (Arm B), and in combination with pacmilimab (a conditionally activated PD-L1) in TNBC (Arm C). Methods: Key eligibility criteria for all cohorts include: ECOG 0-1, acceptable end-organ function, measurable disease, willingness to receive ocular prophylaxis for DM-4 related toxicity, and available tumor tissue for CD166 evaluation. Eligibility criteria for HR+ BC include: 2-4 prior regimens (excluding single-agent hormonal therapy with up to 2 prior cytotoxic regimens) and a prior CDK 4/6 inhibitor in the metastatic setting; eligibility criteria for TNBC include CD166 by IHC >1% by central assessment, 1-3 prior regimens in the metastatic setting and prior taxane. All patients initially received 7 mg/kg Q3W; the protocol was subsequently amended to enroll patients at 6 mg/kg Q3W. The primary endpoint was overall response rate (ORR) using RECIST v1.1 assessed by central review. Other key endpoints include ORR by investigator assessment, clinical benefit rate at 24 weeks (CBR24; defined as any response, confirmed or unconfirmed, or SD for 24 weeks), duration of response, and progression-free survival by investigator. Archival tumor specimens and blood samples were collected for correlative research including genomic analyses. Results: As of 13 May 2022, 60 patients were enrolled in Arm A (all patients started at 7 mg/kg); 52 were evaluable for efficacy by investigator. Median duration of follow-up was 29.1 weeks (range: 3.6-60.7). Median age was 60.5 years (36, 83); pts received a median of 3.5 (1, 6) prior treatments for ABC. CD166 H-Score > 200 was reported in 53.3% of patients. Arm A met the primary efficacy endpoint with a confirmed ORR by central radiology of 14.9% (n=47); by investigator, ORR was similar at 15.4% (n=52); an additional 9 patients (17.3%) had an unconfirmed response. CBR24 was 40.4%; using only confirmed responses, CBR24 was 23.1%. Median PFS was 11.4 weeks (95% CI 9.0, 13.9). Common treatment-related all-grade adverse events (TRAEs) included blurred vision (42%), nausea (35%), fatigue (35%), diarrhea (25%), peripheral neuropathy (27%), infusion-related reaction (23%) and decreased appetite (20%). Grade ≥3 ocular and neuropathic TRAEs were 15% and 10%, respectively. AEs resulting in treatment discontinuation (AEDC) were 25%. For Arm B and C, 55 and 10 patients were enrolled (the majority received a starting dose of 6 mg/kg). For Arm B, the futility boundary was crossed (ORR < 10%). Grade ≥3 ocular and neuropathic TRAEs and AEDC at 7 mg/kg in Arm B were similar to Arm A (11%, 11% and 21% respectively); whereas at 6 mg/kg, they were reduced at 3%, 0% and 0%, respectively. Biomarker data and correlation with outcomes will be presented. Conclusions: Praluzatamab ravtansine demonstrated single-agent activity in unselected heavily pretreated patients with HR+/HER2- ABC. Time to event analyses, such as PFS, were confounded by higher-than-expected toxicity at a starting dose of 7 mg/kg. The toxicity profile was generally consistent with a DM4 payload. The lower dose of 6 mg/kg appears to be better tolerated. Additional clinical studies in HR+ABC, incorporating a starting dose of 6 mg/kg and potentially including a biomarker strategy, are warranted.
Citation Format: Kathy Miller, Sara Tolaney, Leisha A. Emens, Sung-Bae Kim, Erika Hamilton, Cristina Saura, Lucia Sanz, Valentina Boni, Filipa Lynce, Juan Miguel Cejalvo, Jennifer Crozier, Shirley Wang, Hirdesh Uppal, Alison L. Hannah, Sara Hurvitz. Preliminary results from a phase 2 study of praluzatamab ravtansine (CX-2009) in patients with advanced breast cancer (ABC) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-15.
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Affiliation(s)
- Kathy Miller
- 1Indiana University Simons Comprehensive Cancer Center, Indianapolis, IN
| | | | - Leisha A. Emens
- 3University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, Pittsburgh, Pennsylvania
| | | | | | - Cristina Saura
- 6Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron University Hospital, Barcelona, Spain, Barcelona, Catalonia, Spain
| | - Lucia Sanz
- 7Vall d´Hebron Institute of Oncology, Barcelona, Spain
| | - Valentina Boni
- 8NEXT Madrid, University Hospital Quironsalud, Madrid, Spain
| | | | | | | | - Shirley Wang
- 12CytomX Therapeutics, Inc., South San Francisco, CA
| | - Hirdesh Uppal
- 13CytomX Therapeutics, Inc., South San Francisco, CA
| | - Alison L. Hannah
- 14CytomX Therapeutics, Inc., South San Francisco, CA, Sebastopol, California
| | - Sara Hurvitz
- 15University of California, Los Angeles, Los Angeles, California
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Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim N, Rugo HS, Twelves C, Diéras V, Müller V, Du Y, Currie SL, Hoch U, Tagliaferri M, Hannah AL, Cortés J. Treatment With Etirinotecan Pegol for Patients With Metastatic Breast Cancer and Brain Metastases: Final Results From the Phase 3 ATTAIN Randomized Clinical Trial. JAMA Oncol 2022; 8:1047-1052. [PMID: 35552364 PMCID: PMC9100460 DOI: 10.1001/jamaoncol.2022.0514] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Patients with breast cancer and brain metastases (BM) have a poor prognosis and high clinical need for novel treatments; however, historically, studies have often excluded these patients. Although the BEACON study did not meet its primary end point, treatment with etirinotecan pegol vs chemotherapy of the physician's choice for patients with advanced breast cancer demonstrated a significant improvement in overall survival (OS) for the prespecified patient subgroup with preexisting, pretreated, and nonprogressive BM. Objective To compare clinical outcomes in patients with BM treated with etirinotecan pegol vs chemotherapy of the physician's choice in a confirmatory trial. Design, Setting, and Participants This study was a phase 3, open-label, randomized clinical trial (ATTAIN) in patients with metastatic breast cancer and a history of stable pretreated BM who experienced disease progression while receiving chemotherapy in the metastatic setting. The trial took place at 47 sites in 10 countries, and patients were enrolled between March 7, 2017, and November 6, 2019. Interventions Patients were randomized to receive etirinotecan pegol, 145 mg/m2, every 21 days or chemotherapy (eribulin, ixabepilone, vinorelbine, gemcitabine, paclitaxel, docetaxel, or nab-paclitaxel). Main Outcomes and Measures The primary end point was OS. Key secondary end points included progression-free survival, objective response rate, duration of response, and the clinical benefit rate. Results A total of 178 female patients (9 [5.1%] Asian, 8 [4.5%] Black or African American, and 123 [69.1] White individuals) were randomized to receive treatment with etirinotecan pegol (92 [51.7%]; median [range] age, 53 [27-79] years) or chemotherapy (86 [48.3%]; median [range] age, 52 [24-77] years). Median OS was similar in both groups (etirinotecan pegol, 7.8 months; chemotherapy, 7.5 months; hazard ratio [HR], 0.90; 95% CI, 0.61-1.33; P = .60). Median progression-free survival for non-central nervous system metastases per blinded independent central review for etirinotecan pegol vs chemotherapy was 2.8 and 1.9 months (HR, 0.72; 95% CI, 0.45-1.16; P = .18) and 3.9 vs 3.3 months, respectively, for central nervous system metastases (HR, 0.59; 95% CI, 0.33-1.05; P = .07). Safety profiles between the groups were largely comparable. Conclusions and Relevance The results of the ATTAIN randomized clinical trial found no statistically significant difference in outcomes between treatment with etirinotecan pegol and chemotherapy in patients with BM. However, this study represents one of the largest published trials dedicated to patients with breast cancer and BM and may help to inform further research. Trial Registration ClinicalTrials.gov Identifier: NCT02915744.
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Affiliation(s)
- Debu Tripathy
- The University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | - Nuhad Ibrahim
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Chris Twelves
- University of Leeds and Leeds Teaching Hospitals Trust, Leeds, England
| | | | - Volkmar Müller
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yining Du
- Nektar Therapeutics, San Francisco, California
| | | | - Ute Hoch
- Nektar Therapeutics, San Francisco, California
| | | | | | - Javier Cortés
- International Breast Cancer Center, Quironsalud Group, Barcelona, Spain.,Vall d'Hebron Institute of Oncology, Barcelona, Spain
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Johnson M, El-Khoueiry A, Hafez N, Lakhani N, Mamdani H, Rodon J, Sanborn RE, Garcia-Corbacho J, Boni V, Stroh M, Hannah AL, Wang S, Castro H, Spira A. Phase I, First-in-Human Study of the Probody Therapeutic CX-2029 in Adults with Advanced Solid Tumor Malignancies. Clin Cancer Res 2021; 27:4521-4530. [PMID: 34083236 DOI: 10.1158/1078-0432.ccr-21-0194] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/05/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE PROCLAIM-CX-2029 is a phase I first-in-human study of CX-2029, a Probody-drug conjugate targeting CD71 (transferrin receptor 1) in adults with advanced solid tumors. Although the transferrin receptor is highly expressed across multiple tumor types, it has not been considered a target for antibody-drug conjugates (ADCs) due to its broad expression on normal cells. CX-2029 is a masked form of a proprietary anti-CD71 antibody conjugated to monomethyl auristatin E, designed to be unmasked in the tumor microenvironment by tumor-associated proteases, therefore limiting off-tumor toxicity and creating a therapeutic window for this previously undruggable target. PATIENTS AND METHODS This was a dose-escalation, multicenter trial to evaluate the safety, pharmacokinetics, pharmacodynamics, and antitumor activity of CX-2029. The primary endpoint was to determine the maximum tolerated dose (MTD) and cycle 1 dose-limiting toxicity (DLT). CX-2029 was administered i.v. every 3 weeks. RESULTS Forty-five patients were enrolled in eight dose levels. No DLTs were reported in the dose escalation through 4 mg/kg. At 5 mg/kg, there were two DLTs (febrile neutropenia and pancytopenia). Following expansion of the 4 mg/kg dose to six patients, two additional DLTs were observed (infusion-related reaction and neutropenia/anemia). Both the 4 and 5 mg/kg doses were declared above the maximum tolerated dose. The recommended phase II dose is 3 mg/kg. The most common dose-dependent hematologic toxicities were anemia and neutropenia. Confirmed partial responses were observed in three patients, all with squamous histologies. CONCLUSIONS The Probody therapeutic platform enables targeting CD71, a previously undruggable ADC target, at tolerable doses associated with clinical activity.See related commentary by Oberoi and Garralda, p. 4459.
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Affiliation(s)
- Melissa Johnson
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee.
| | | | | | | | | | - Jordi Rodon
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rachel E Sanborn
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, Oregon
| | - Javier Garcia-Corbacho
- Department of Medical Oncology (Hospital Clinic Barcelona)/Translational Genomics and Targeted Therapies in Solid Tumors (IDIBAPS), Barcelona, Spain
| | - Valentina Boni
- START Madrid-CIOCC, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Mark Stroh
- CytomX Therapeutics, Inc., South San Francisco, California
| | | | - Song Wang
- CytomX Therapeutics, Inc., South San Francisco, California
| | - Henry Castro
- CytomX Therapeutics, Inc., South San Francisco, California
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Naing A, Thistlethwaite F, De Vries EGE, Eskens FALM, Uboha N, Ott PA, LoRusso P, Garcia-Corbacho J, Boni V, Bendell J, Autio KA, Randhawa M, Durm G, Gil-Martin M, Stroh M, Hannah AL, Arkenau HT, Spira A. CX-072 (pacmilimab), a Probody ® PD-L1 inhibitor, in advanced or recurrent solid tumors (PROCLAIM-CX-072): an open-label dose-finding and first-in-human study. J Immunother Cancer 2021; 9:e002447. [PMID: 34301809 PMCID: PMC8311335 DOI: 10.1136/jitc-2021-002447] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Probody® therapeutics are antibody prodrugs that are activated in the tumor microenvironment by tumor-associated proteases, thereby restricting the activity to the tumor microenvironment and minimizing 'off-tumor' toxicity. We report dose-escalation and single-agent expansion phase data from the first-in-human study of CX-072 (pacmilimab), a Probody checkpoint inhibitor directed against programmed death-ligand 1 (PD-L1). METHODS In the dose-escalation phase of this multicenter, open-label study (NCT03013491), adults with advanced solid tumors (naive to programmed-death-1/PD-L1 or cytotoxic T-lymphocyte-associated antigen 4 inhibitors) were enrolled into one of seven dose-escalation cohorts, with pacmilimab administered intravenously every 14 days. The primary endpoints were safety and determination of the maximum tolerated dose (MTD). In the expansion phase, patients with one of six prespecified malignancies (triple-negative breast cancer [TNBC]; anal squamous cell carcinoma [aSCC]; cutaneous SCC [cSCC]; undifferentiated pleomorphic sarcoma [UPS]; small bowel adenocarcinoma [SBA]; and thymic epithelial tumor [TET]); or high tumor mutational burden (hTMB) tumors were enrolled. The primary endpoint was objective response (Response Evaluation Criteria In Solid Tumors v.1.1). RESULTS An MTD was not reached with doses up to 30 mg/kg. A recommended phase 2 dose (RP2D) of 10 mg/kg was chosen based on pharmacokinetic and pharmacodynamic findings in the expansion phase. Ninety-eight patients enrolled in the expansion phase: TNBC (n=14), aSCC (n=14), cSCC (n=14), UPS (n=20), SBA (n=14), TET (n=8), and hTMB tumors (n=14). Of 114 patients receiving pacmilimab at the RP2D, grade ≥3 treatment-related adverse events (TRAEs) were reported in 10 patients (9%), serious TRAEs in six patients (5%), and treatment discontinuation due to TRAEs in two patients (2%). Grade ≥3 immune-related AEs occurred in two patients (rash, myocarditis). High PD-L1 expression (ie, >50% Tumor Proportion Score) was observed in 22/144 (19%) patients. Confirmed objective responses were observed in patients with cSCC (n=5, including one complete response), hTMB (n=4, including one complete response), aSCC (n=2), TNBC (n=1), UPS (n=1), and anaplastic thyroid cancer (n=1). CONCLUSIONS Pacmilimab can be administered safely at the RP2D of 10 mg/kg every 14 days. At this dose, pacmilimab had a low rate of immune-mediated toxicity and showed signs of antitumor activity in patients not selected for high PD-L1 expression. TRIAL REGISTRATION NUMBER NCT03013491.
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Affiliation(s)
- Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Fiona Thistlethwaite
- Department of Medical Oncology, The Christie Hospital NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Elisabeth G E De Vries
- Department of Medical Oncology, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
| | - Ferry A L M Eskens
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Nataliya Uboha
- Department of Medicine, Section of Hematology and Oncology, University of Wisconsin, Carbone Cancer Center, Madison, Wisconsin, USA
| | - Patrick A Ott
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Patricia LoRusso
- Department of Medical Oncology, Yale University School of Medicine, Yale Cancer Center, New Haven, Connecticut, USA
| | | | - Valentina Boni
- Department of Medical Oncology, START Madrid-CIOCC, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Johanna Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee, USA
| | - Karen A Autio
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Manreet Randhawa
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Greg Durm
- Department of Medical Oncology, Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
| | - Marta Gil-Martin
- Medical Oncology Department, Institut Català d'Oncologia - IDIBELL, L'Hospitalet-Barcelona, Barcelona, Spain
| | - Mark Stroh
- CytomX Therapeutics Inc, South San Francisco, California, USA
| | - Alison L Hannah
- CytomX Therapeutics Inc, South San Francisco, California, USA
| | - Hendrik-Tobias Arkenau
- Drug Development Unit, Sarah Cannon Research Institute and University College London Cancer Institute, London, UK
| | - Alexander Spira
- Department of Medical Oncology, Virginia Cancer Specialists, Fairfax, Virginia, USA
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Diab A, Tannir NM, Bentebibel SE, Hwu P, Papadimitrakopoulou V, Haymaker C, Kluger HM, Gettinger SN, Sznol M, Tykodi SS, Curti BD, Tagliaferri MA, Zalevsky J, Hannah AL, Hoch U, Aung S, Fanton C, Rizwan A, Iacucci E, Liao Y, Bernatchez C, Hurwitz ME, Cho DC. Bempegaldesleukin (NKTR-214) plus Nivolumab in Patients with Advanced Solid Tumors: Phase I Dose-Escalation Study of Safety, Efficacy, and Immune Activation (PIVOT-02). Cancer Discov 2020; 10:1158-1173. [PMID: 32439653 DOI: 10.1158/2159-8290.cd-19-1510] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/16/2020] [Accepted: 05/01/2020] [Indexed: 11/16/2022]
Abstract
This single-arm, phase I dose-escalation trial (NCT02983045) evaluated bempegaldesleukin (NKTR-214/BEMPEG), a CD122-preferential IL2 pathway agonist, plus nivolumab in 38 patients with selected immunotherapy-naïve advanced solid tumors (melanoma, renal cell carcinoma, and non-small cell lung cancer). Three dose-limiting toxicities were reported in 2 of 17 patients during dose escalation [hypotension (n = 1), hyperglycemia (n = 1), metabolic acidosis (n = 1)]. The most common treatment-related adverse events (TRAE) were flu-like symptoms (86.8%), rash (78.9%), fatigue (73.7%), and pruritus (52.6%). Eight patients (21.1%) experienced grade 3/4 TRAEs; there were no treatment-related deaths. Total objective response rate across tumor types and dose cohorts was 59.5% (22/37), with 7 complete responses (18.9%). Cellular and gene expression analysis of longitudinal tumor biopsies revealed increased infiltration, activation, and cytotoxicity of CD8+ T cells, without regulatory T-cell enhancement. At the recommended phase II dose, BEMPEG 0.006 mg/kg plus nivolumab 360 mg every 3 weeks, the combination was well tolerated and demonstrated encouraging clinical activity irrespective of baseline PD-L1 status. SIGNIFICANCE: These data show that BEMPEG can be successfully combined with a checkpoint inhibitor as dual immunotherapy for a range of advanced solid tumors. Efficacy was observed regardless of baseline PD-L1 status and baseline levels of tumor-infiltrating lymphocytes, suggesting therapeutic potential for patients with poor prognostic risk factors for response to PD-1/PD-L1 blockade.See related commentary by Rouanne et al., p. 1097.This article is highlighted in the In This Issue feature, p. 1079.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/immunology
- Carcinoma, Renal Cell/drug therapy
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/immunology
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Immune Checkpoint Inhibitors/administration & dosage
- Immune Checkpoint Inhibitors/adverse effects
- Immunotherapy
- Interleukin-2/administration & dosage
- Interleukin-2/adverse effects
- Interleukin-2/analogs & derivatives
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/genetics
- Kidney Neoplasms/immunology
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/immunology
- Lymphocyte Count
- Lymphocytes, Tumor-Infiltrating/drug effects
- Lymphocytes, Tumor-Infiltrating/immunology
- Male
- Melanoma/drug therapy
- Melanoma/genetics
- Melanoma/immunology
- Middle Aged
- Nivolumab/administration & dosage
- Nivolumab/adverse effects
- Polyethylene Glycols/administration & dosage
- Polyethylene Glycols/adverse effects
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Adi Diab
- The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Nizar M Tannir
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Patrick Hwu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Cara Haymaker
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Mario Sznol
- Yale School of Medicine, New Haven, Connecticut
| | - Scott S Tykodi
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brendan D Curti
- Providence Cancer Center and Earle A. Chiles Research Institute, Portland, Oregon
| | | | | | | | - Ute Hoch
- Nektar Therapeutics, San Francisco, California
| | - Sandra Aung
- Nektar Therapeutics, San Francisco, California
| | | | | | | | - Yijie Liao
- Nektar Therapeutics, San Francisco, California
| | | | | | - Daniel C Cho
- Perlmutter Cancer Center at NYU Langone Medical Center, New York, New York
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Stroh M, Green M, Millard BL, Garner W, Lu H, Richardson JH, Hannah AL. Preliminary population pharmacokinetics supports phase II dose selection for masked anti-PD-L1 antibody CX-072. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3602 Background: PROBODY therapeutics (Pb-Tx) are antibody prodrugs designed to reduce off-tumor, on-target toxicities. The mask inhibits Pb-Tx binding in the periphery yet can be removed by tumor-associated proteases, restricting target engagement to the tumor. This is the first report of preliminary clinical pharmacokinetic (PK) analysis supporting selection of the phase II dose for CX-072, an anti–PD-L1 Pb-Tx, from the ongoing phase I/II PROCLAIM-CX-072 study (NCT03013491). Methods: A quantitative systems pharmacology (QSP) model1 was used to project the CX-072 plasma trough level (Cmin) corresponding to 95% intratumoral receptor occupancy (RO). Human PK and anti-drug antibody (ADA) data were obtained at selected times postdose following IV administration of 0.03–30 mpk CX-072 in PROCLAIM-CX-072. Population PK (POPPK) modeling was performed with NONMEM v7.3.0. Exploratory analysis and simulations were done with R v3.3.1 or later. Covariates were selected for POPPK using forward addition ( P<0.05) followed by backward deletion ( P<0.01). Results: The preliminary POPPK analyses were informed using available PK data as of August, 2019 from 135 subjects receiving CX-072 Q2W as monotherapy in the dose-escalation and expansion cohorts of PROCLAIM-CX-072. A mixture model was used to capture time- and dose-dependent apparent ADA effect on clearance (CL). The preliminary POPPK model estimates for CX-072 CL and volume of distribution (Vd) were 0.306 L/day and 4.84 L, respectively. Statistically significant covariate effects included body weight on the central Vd and CL, and albumin on CL. The QSP model predicted a CX-072 Cmin of 13–99 nM would be required for 95% intratumoral RO. POPPK simulations suggested that >95% of patients receiving CX-072 10 mg/kg Q2W would meet or exceed this targeted Cmin regardless of ADA. Additional observed data indicated that the majority of patients receiving 10 mpk CX-072 Q3W × 4 with 3 mpk ipilimumab (IPI) Q3W × 4 in the CX-072-IPI combination part of PROCLAIM-CX-072 maintained the targeted Cmin. Simulations did not suggest there would be a clinically meaningful change in exposure following a fixed dose of CX-072 800 mg relative to the 10 mpk weight-based dose. Conclusions: Preliminary PK analysis supports selection of 800 mg CX-072 Q2W as the recommended monotherapy dose and 800 mg Q3W when combined with IPI. The combination of 800 mg CX-072 + 3 mpk IPI Q3W × 4 doses, followed by monotherapy administration of 800 mg CX-072 Q2W is being further explored in phase II. Reference: 1) Stroh M et al. CPT. 2019(9):676-84. Clinical trial information: NCT03013491 .
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Affiliation(s)
- Mark Stroh
- CytomX Therapeutics, Inc., South San Francisco, CA
| | | | | | | | - Hong Lu
- CytomX Therapeutics, Inc., South San Francisco, CA
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Tannir NM, Agarwal N, Pal SK, Cho DC, Formiga M, Guo J, George DJ, Tagliaferri MA, Singel SM, O'Keeffe BA, Hannah AL, Balbas M, Penkov K. PIVOT-09: A phase III randomized open-label study of bempegaldesleukin (NKTR-214) plus nivolumab versus sunitinib or cabozantinib (investigator's choice) in patients with previously untreated advanced renal cell carcinoma (RCC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.tps763] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS763 Background: Bempegaldesleukin (BEMPEG; NKTR-214) is a first-in-class interleukin-2 (IL-2) receptor pathway agonist that activates and expands effector T cells and natural killer cells in the tumor microenvironment and increases tumor PD-L1 expression, making BEMPEG a promising agent for combination with immune checkpoint inhibitors. In a phase 1/2 study, BEMPEG plus nivolumab (NIVO) demonstrated an encouraging objective response rate (ORR) in first-line advanced RCC (46%) and a manageable safety profile. BEMPEG plus NIVO offers a potential novel immunooncology treatment option for patients with advanced RCC. Methods: A global, multicenter, randomized, open-label phase 3 study is evaluating the efficacy and safety of BEMPEG plus NIVO vs investigator’s choice of tyrosine kinase inhibitor (TKI; sunitinib [SUNI] or cabozantinib [CABO]) in patients with previously untreated advanced or metastatic RCC with a clear-cell component. Patients must not have had prior systemic therapy (including neoadjuvant, adjuvant or vaccine therapy) for RCC. Key exclusion criteria include active brain metastasis and autoimmune disease requiring systemic immunosuppressive agents. Approximately 600 patients will be randomized 1:1 to receive 0.006 mg/kg BEMPEG plus 360 mg NIVO intravenously every 3 weeks or TKI (50 mg SUNI [4 weeks on, 2 weeks off schedule] or 60 mg CABO; orally each day). Patients will be stratified by International Metastatic RCC Database Consortium (IMDC) prognostic score (0 [favorable risk] vs 1-2 [intermediate risk] vs 3-6 [poor risk]) and TKI choice (SUNI vs CABO). Primary objectives are ORR by blinded independent central review (BICR) and overall survival in the IMDC intermediate/poor risk population and the intention-to-treat (ITT) population. Secondary objectives are progression-free survival by BICR in the IMDC intermediate/poor risk population and the ITT population, safety, PD-L1 expression as a predictive biomarker, and quality of life. Enrollment is ongoing. Clinical trial information: NCT03729245.
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Affiliation(s)
| | - Neeraj Agarwal
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | | | - Daniel C. Cho
- Perlmutter Cancer Center New York University Langone Health, New York, NY
| | | | - Jun Guo
- Peking University Cancer Hospital and Institute, Beijing Shi, China
| | | | | | | | | | | | | | - Konstantin Penkov
- Private Medical Institution “Euromedservice”, St. Petersburg, Russian Federation
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Lopez JS, Kristeleit RS, Rulach R, Haris NM, Scaranti M, Mulholland PJ, Crawford D, Bashir S, Aversa C, Hannah AL, Anderson S, Engelhardt M, Kaindl T, Larger P, McKernan P, Evans TRJ, Plummer E. Phase 1/2a study of once daily oral BAL101553, a novel tumor checkpoint controller (TCC), in adult patients with progressive or recurrent glioblastoma (GBM) or high-grade glioma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2025 Background: BAL101553 (prodrug of BAL27862) is a novel TCC that promotes tumor cell death by modulating the spindle assembly checkpoint. BAL27862 is a lipophilic, small molecule shown in rodents to penetrate the brain (brain/plasma ratio around unity), with promising antitumor activity in orthotopic preclinical GBM models as monotherapy or in combination with radiotherapy (RT) with or without temozolomide. In this ongoing study (NCT02490800, CDI-CS-002), daily oral BAL101553 was initially examined in solid-tumor patients, with an MTD of 16 mg/d and DLTs of G4 hyponatremia and G2 hallucinations (Lopez 2018, JCO 36, 2018, suppl. A2530). Subsequently the study was expanded by including a separate cohort of patients with progressive or recurrent GBM or high-grade glioma (Ingles Garces 2017, JCO 35, 2018, suppl. TPS2601). Methods: Patients with histologically-confirmed GBM or high-grade glioma, with progressive or recurrent disease after prior RT with/without chemotherapy, received once-daily oral BAL101553 (28-day cycles) in a 3+3 dose-escalation design to determine the maximum tolerated dose (MTD). Adverse events were assessed by CTCAE v4.03 grade (G), and tumor response by RANO every two cycles. Pharmacokinetics (PK) were evaluated on Day 1 of Cycles 1 and 2. Results: In the ongoing study, 23 pts (13M/10F; median age 50 y), median (min–max) number of prior regimens = 2 (1–5), received doses of 8, 15, 20, 25 or 30 mg oral BAL101553 once daily. One DLT of reversible G2 depression and fatigue occurred at 20 mg. Both mean Cmax and AUC increased with dose between 8 and 30 mg. The PK exposure in GBM patients was lower than for solid tumor patients, in particular at 20 and 25 mg. At 25 mg/d (n = 3), one patient with IDH-mutated GBM had a partial response (63% area reduction per RANO) and continues on study > 8 months, and another patient had stable disease for 5 months. At 15–20 mg/d, stable disease was observed in 3/10 patients. Conclusions: The current data in patients with GBM or high-grade glioma suggest that BAL101553 is well tolerated at dose levels above the MTD established in patients with advanced solid tumors, and shows indications of clinical activity. Clinical trial information: 02490800.
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Affiliation(s)
- Juanita Suzanne Lopez
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Robert Rulach
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Noor Md Haris
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Mariana Scaranti
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | - Donna Crawford
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Saira Bashir
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Caterina Aversa
- The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | - Marc Engelhardt
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | - Thomas Kaindl
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Patrice Larger
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Phil McKernan
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - TR Jeffry Evans
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
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Tannir NM, Agarwal N, Pal SK, Formiga MN, Guo J, George DJ, Tagliaferri MA, Hannah AL, Zhang JY, O'Keeffe BA, Cho DC. A phase III randomized open label study comparing bempegaldesleukin (NKTR-214) plus nivolumab to sunitinib or cabozantinib (investigator's choice) in patients with previously untreated advanced renal cell carcinoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps4595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4595 Background: Bempegaldesleukin (NKTR-214) is a CD122-preferential IL-2 pathway agonist that stimulates proliferation and activation of tumor antigen-specific CD8+ T cells and natural killer cells within the tumor microenvironment and increases PD-1/PD-L1 expression. These properties make bempegaldesleukin (NKTR-214) a potentially promising agent for combination therapy with checkpoint inhibitors that target and inhibit the PD-1/PD-L1 pathway. In phase 1 studies, NKTR-214 plus nivolumab demonstrated encouraging objective response rates (ORR) in first-line renal cell carcinoma (RCC) and an acceptable safety profile. Immunotherapy with NKTR-214 plus nivolumab may lead to greater clinical benefit than tyrosine kinase inhibitors (TKIs), standard-of-care agents, in this patient population. Methods: This multicenter, randomized, open-label phase 3 study (NCT03729245) will evaluate the efficacy and safety of bempegaldesleukin (NKTR-214) plus nivolumab compared with investigator’s choice of TKI (sunitinib or cabozantinib) in patients with previously untreated advanced or metastatic RCC with clear cell component. Exclusion criteria include active brain metastasis and autoimmune disease. Approximately 600 patients will be randomized in a 1:1 ratio, stratified by PD-L1 status (≥1% vs < 1% or indeterminate), International Metastatic RCC Database Consortium prognostic score (1-2 [intermediate risk] vs 3-6 [poor risk]); and TKI (sunitinib or cabozantinib; cabozantinib percentage to be capped at 50%). Combination therapy will consist of bempegaldesleukin (NKTR-214) 0.006 mg/kg intravenously (IV) every 3 weeks (Q3W) plus nivolumab 360 mg IV Q3W until progression or death or maximum of 2 years. TKI therapy will consist of sunitinib 50 mg orally once daily (QD) for 4 weeks followed by 2 weeks off or cabozantinib 60 mg orally QD. Primary objectives are ORR by blinded independent central radiology (BICR) assessment and overall survival. Secondary objectives are progression-free survival by BICR, safety, predictive value of PD-L1 expression, and quality of life. Enrollment is ongoing. Clinical trial information: NCT03729245.
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Affiliation(s)
| | - Neeraj Agarwal
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | | | | | - Jun Guo
- Peking University Cancer Hospital and Institute, Beijing Shi, China
| | | | | | | | | | | | - Daniel C. Cho
- Perlmutter Cancer Center New York University Langone Health, New York, NY
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Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim N, Rugo HS, Twelves C, Dieras V, Müller V, Tagliaferri M, Hannah AL, Cortés J. ATTAIN: Phase III study of etirinotecan pegol versus treatment of physician's choice in patients with metastatic breast cancer and brain metastases. Future Oncol 2019; 15:2211-2225. [PMID: 31074641 DOI: 10.2217/fon-2019-0180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The increasing incidence of breast cancer brain metastases is a major clinical problem with its associated poor prognosis and limited treatment options. The long-acting topoisomerase-1 inhibitor, etirinotecan pegol, was designed to preferentially accumulate in tumor tissue including brain metastases, providing sustained cytotoxic SN38 levels. Motivated by improved survival findings from subgroup analyses from the Phase III BEACON trial, this ongoing randomized, Phase III trial compares etirinotecan pegol to drugs commonly used for advanced breast cancer in patients with stable, treated breast cancer brain metastases who have been previously treated with an anthracycline, taxane and capecitabine. The primary end point is overall survival. Secondary end points include objective response rate, progression-free survival and time to CNS disease progression or recurrence in patients with/without CNS lesions present at study entry. Trial registration number: NCT02915744.
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Affiliation(s)
- Debu Tripathy
- The University of Texas MD Anderson Cancer Center, Department of Breast Medical Oncology, Houston, TX 77030, USA
| | - Sara M Tolaney
- Dana-Farber Cancer Institute, Center for Women's Cancers, Boston, MA 02215, USA
| | - Andrew D Seidman
- Memorial Sloan-Kettering Cancer Center, Bobst International Center, New York, NY 10065, USA
| | - Carey K Anders
- University of North Carolina School of Medicine, Duke Cancer Center, Chapel Hill, NC 27710, USA
| | - Nuhad Ibrahim
- The University of Texas MD Anderson Cancer Center, Department of Breast Medical Oncology, Houston, TX 77030, USA
| | - Hope S Rugo
- University of California San Francisco, Department of Medicine (Hematology/Oncology), San Francisco, CA 94115, USA
| | - Chris Twelves
- University of Leeds, Leeds Institute of Cancer and Pathology (LICAP), Leeds, LS2 9JT, UK.,St James' University Hospital, Institute of Oncology, Leeds, LS9 7BE, UK
| | - Veronique Dieras
- Institut Curie, Oncological Medicine Department, 75248, Paris, France
| | - Volkmar Müller
- University Medical Center Hamburg-Eppendorf, Department of Obstetrics and Gynecology, 20246 Hamburg, Germany
| | | | | | - Javier Cortés
- IOB Institute of Oncology, Quironsalud Group, 28034 Madrid & 08023 Barcelona, Spain.,Vall d'Hebron Institute of Oncology (VHIO), Breast Cancer and Melanoma Group, 08035 Barcelona, Spain
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11
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Siefker-Radtke AO, Fishman MN, Balar AV, Grignani G, Diab A, Gao J, Tagliaferri MA, Hannah AL, Karski EE, Zalevsky J, Hoch U, Rizwan ANAQI, Bilen MA. NKTR-214 + nivolumab in first-line advanced/metastatic urothelial carcinoma (mUC): Updated results from PIVOT-02. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.388] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
388 Background: Single-agent checkpoint inhibitors have changed the mUC treatment landscape; however, unmet need remains in first-line (1L) cisplatin ineligible mUC, particularly for PD-L1 negative (–) patients (pts). NKTR-214 is a CD122-biased agonist designed to provide sustained signaling through the IL-2 βγ receptor. PIVOT-02 is an ongoing study of NKTR-214 + nivolumab (nivo) in pts with advanced cancers, including mUC. Methods: Pts with mUC who were 1L cisplatin ineligible or refused standard of care (SOC) received NKTR-214 IV 0.006 mg/kg + nivo IV 360 mg q3w. Responses were assessed every 8 wks. Matched blood and tumor biopsies were evaluated for biomarkers including PD-L1 expression (assessed by Dako 28-8 PharmaDx IHC; PD-L1+ defined as ≥ 1% tumor cell staining). Results: As of 11 Oct. 2018, 34 pts received ≥ 1 dose of treatment (cisplatin ineligible [n=22]; refused SOC [n=12]). Median age was 70. Of 34 pts, 23 were efficacy evaluable (defined per protocol as having ≥ 1 post-treatment scan), 7 were pending a first scan, 1 pt was excluded for non-eligibility (no target lesion), and 3 discontinued prior to first scan. Thresholds for efficacy were exceeded in all 1L mUC cohorts under a pre-specified Fleming ORR analysis. In the efficacy evaluable population, overall ORR was 48% (11/23; 95% CI 27–69%) with a 17% CR rate (4/23) and 70% (16/23) DCR. The ORR was 50% in PD-L1– pts (5/10; 95% CI 19–81%) and 56% in PD-L1+ pts (5/9; 95% CI 21–86%). PD-L1 status was unknown in 4 efficacy-evaluable pts. The most common treatment-related AEs (TRAE, >30%) were fatigue (59%), pyrexia (38%), chills (32%), and flu-like symptoms (32%). Grade ≥ 3 TRAEs occurred in 18% of pts and 8.8% discontinued due to TRAEs. No G4/G5 TRAEs occurred. 22 pts had available baseline PD-L1 results (PD-L1+ [n=11]; PD-L1– [n=11]). 10 of the 11 PD-L1– baseline samples had matched wk 3 biopsies. Of these, 6/10 (60%) converted to PD-L1+ at wk 3. Updated results will be presented. Conclusions: NKTR-214 + nivo showed encouraging clinical activity, including CRs, and an acceptable preliminary safety profile in pts with mUC. Efficacy appears independent of PD-L1 status with a similar ORR in PD-L1– and + tumors. These data support further evaluation of the combination. Clinical trial information: NCT02983045.
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Affiliation(s)
| | | | | | | | - Adi Diab
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jianjun Gao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA
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Turner NC, Telli ML, Rugo HS, Mailliez A, Ettl J, Grischke EM, Mina LA, Balmaña J, Fasching PA, Hurvitz SA, Wardley AM, Chappey C, Hannah AL, Robson ME. A Phase II Study of Talazoparib after Platinum or Cytotoxic Nonplatinum Regimens in Patients with Advanced Breast Cancer and Germline BRCA1/2 Mutations (ABRAZO). Clin Cancer Res 2018; 25:2717-2724. [DOI: 10.1158/1078-0432.ccr-18-1891] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/18/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022]
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Hurvitz SA, Quek RG, Ettl J, Rugo H, Bhattacharyya H, Hannah AL, Litton JK. Patient-reported outcomes (PROs) in patients (pts) with advanced breast cancer (aBC) and a germline BRCA1/2 mutation (gBRCAm) receiving talazoparib (TALA) vs physician’s choice chemotherapy treatment (PCT): a focus on the EMBRACA HR+/HER2- subpopulation. Breast 2018. [DOI: 10.1016/j.breast.2018.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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14
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Litton JK, Rugo HS, Ettl J, Hurvitz SA, Gonçalves A, Lee KH, Fehrenbacher L, Yerushalmi R, Mina LA, Martin M, Roché H, Im YH, Quek RGW, Markova D, Tudor IC, Hannah AL, Eiermann W, Blum JL. Talazoparib in Patients with Advanced Breast Cancer and a Germline BRCA Mutation. N Engl J Med 2018; 379:753-763. [PMID: 30110579 PMCID: PMC10600918 DOI: 10.1056/nejmoa1802905] [Citation(s) in RCA: 1216] [Impact Index Per Article: 202.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The poly(adenosine diphosphate-ribose) inhibitor talazoparib has shown antitumor activity in patients with advanced breast cancer and germline mutations in BRCA1 and BRCA2 ( BRCA1/2). METHODS We conducted a randomized, open-label, phase 3 trial in which patients with advanced breast cancer and a germline BRCA1/2 mutation were assigned, in a 2:1 ratio, to receive talazoparib (1 mg once daily) or standard single-agent therapy of the physician's choice (capecitabine, eribulin, gemcitabine, or vinorelbine in continuous 21-day cycles). The primary end point was progression-free survival, which was assessed by blinded independent central review. RESULTS Of the 431 patients who underwent randomization, 287 were assigned to receive talazoparib and 144 were assigned to receive standard therapy. Median progression-free survival was significantly longer in the talazoparib group than in the standard-therapy group (8.6 months vs. 5.6 months; hazard ratio for disease progression or death, 0.54; 95% confidence interval [CI], 0.41 to 0.71; P<0.001). The interim median hazard ratio for death was 0.76 (95% CI, 0.55 to 1.06; P=0.11 [57% of projected events]). The objective response rate was higher in the talazoparib group than in the standard-therapy group (62.6% vs. 27.2%; odds ratio, 5.0; 95% CI, 2.9 to 8.8; P<0.001). Hematologic grade 3-4 adverse events (primarily anemia) occurred in 55% of the patients who received talazoparib and in 38% of the patients who received standard therapy; nonhematologic grade 3 adverse events occurred in 32% and 38% of the patients, respectively. Patient-reported outcomes favored talazoparib; significant overall improvements and significant delays in the time to clinically meaningful deterioration according to both the global health status-quality-of-life and breast symptoms scales were observed. CONCLUSIONS Among patients with advanced breast cancer and a germline BRCA1/2 mutation, single-agent talazoparib provided a significant benefit over standard chemotherapy with respect to progression-free survival. Patient-reported outcomes were superior with talazoparib. (Funded by Medivation [Pfizer]; EMBRACA ClinicalTrials.gov number, NCT01945775 .).
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Affiliation(s)
- Jennifer K Litton
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Hope S Rugo
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Johannes Ettl
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Sara A Hurvitz
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Anthony Gonçalves
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Kyung-Hun Lee
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Louis Fehrenbacher
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Rinat Yerushalmi
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Lida A Mina
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Miguel Martin
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Henri Roché
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Young-Hyuck Im
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Ruben G W Quek
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Denka Markova
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Iulia C Tudor
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Alison L Hannah
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Wolfgang Eiermann
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
| | - Joanne L Blum
- From the University of Texas M.D. Anderson Cancer Center, Houston (J.K.L.), and the Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology Network, Dallas (J.L.B.) - both in Texas; University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center (H.S.R.), and Pfizer (R.G.W.Q., D.M., I.C.T., A.L.H.), San Francisco, University of California, Los Angeles, Los Angeles (S.A.H.), and Kaiser Permanente, Northern California, Vallejo (L.F.) - all in California; the Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München (J.E.), and Interdisziplinäres Onkologisches Zentrum München (W.E.) - both in Munich, Germany; Institut Paoli-Calmettes, Marseille (A.G.), and Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse (H.R.) - both in France; Seoul National University Hospital (K.-H.L.) and Samsung Medical Center (Y.-H.I.) - both in Seoul, South Korea; Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel (R.Y.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (L.A.M.); and Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Oncología, Grupo Español de Investigación en Cáncer de Mama, Universidad Complutense, Madrid (M.M.)
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15
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Rugo HS, Ettl J, Woodward NE, Hurvitz SA, Goncalves A, Lee KH, Fehrenbacher L, Yerushalmi R, Mina LA, Martin M, Roche HH, Im YH, Markova D, Tudor IC, Eiermann W, Blum JL, Hannah AL, Litton JK. EMBRACA: Efficacy outcomes in clinically relevant subgroups comparing talazoparib (TALA), an oral poly ADP ribose polymerase (PARP) inhibitor, to physician's choice of therapy (PCT) in patients with advanced breast cancer and a germline BRCA mutation. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hope S. Rugo
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | | | | | - Kyung-Hun Lee
- Seoul National University Hospital, Seoul, Korea, Republic of (South)
| | | | - Rinat Yerushalmi
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, CA, Israel
| | | | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain
| | - Henri Hubert Roche
- Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse, France
| | - Young-Hyuck Im
- Samsung Medical Center, Seoul, Korea, Republic of (South)
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16
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Lopez JS, Plummer ER, Devlin MJ, Rulach R, Ingles Garces AH, Haris NRM, Miller R, Crawford D, D'Arcangelo M, Aversa C, Hannah AL, Anderson S, Engelhardt MF, Kaindl T, Larger P, Bachmann F, Lane HA, McKernan P, Evans TJ, Kristeleit RS. Phase 1/2a study of once daily oral BAL101553, a novel tumor checkpoint controller (TCC), in adult patients with advanced solid tumors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Juanita Suzanne Lopez
- The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | - Robert Rulach
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Noor R Md Haris
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Rowan Miller
- University College London Cancer Institute, London, United Kingdom
| | - Donna Crawford
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Manolo D'Arcangelo
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Caterina Aversa
- The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | | | - Thomas Kaindl
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Patrice Larger
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Felix Bachmann
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Heidi A Lane
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Phil McKernan
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
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Eiermann W, Rugo HS, Diab S, Ettl J, Hurvitz SA, Goncalves A, Lee KH, Fehrenbacher L, Yerushalmi R, Mina LA, Martin M, Roche HH, Im YH, Markova D, Tudor IC, Blum JL, Hannah AL, Litton JK. Analysis of germline BRCA1/2 mutated (gBRCAmut) hormone receptor-positive (HR+) and triple negative breast cancer (TNBC) treated with talazoparib (TALA). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Hope S. Rugo
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Sami Diab
- University of Colorado Cancer Center, Aurora, CO
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | | | - Kyung-Hun Lee
- Seoul National University Hospital, Seoul, Korea, Republic of (South)
| | | | - Rinat Yerushalmi
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, CA, Israel
| | | | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain
| | - Henri Hubert Roche
- Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse, Toulouse, France
| | - Young-Hyuck Im
- Samsung Medical Center, Seoul, Korea, Republic of (South)
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Hurvitz SA, Turner NC, Telli ML, Rugo HS, Mailliez A, Ettl J, Grischke EM, Mina LA, Balmaña J, Fasching PA, Tudor C, Quek RGW, Hannah AL, Robson ME, Wardley AM. Abstract P5-19-05: Health-related quality of life during a phase 2 study of talazoparib in patients with advanced breast cancer and germline BRCA1/2 mutations (ABRAZO). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-19-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Talazoparib (TALA; 1 mg/d) was well tolerated and exhibited promising antitumor activity in ABRAZO, a 2-cohort, 2-stage, open-label phase 2 study (NCT02034916) in patients (pts) with locally advanced or metastatic breast cancer and gBRCA1/2 mutations following platinum-based therapy (cohort 1 [C1]) or ≥3 platinum-free cytotoxic-based regimens (cohort 2 [C2]). This analysis evaluates health-related quality of life (QoL) for both cohorts.
Methods: QoL was assessed on day 1 (baseline) and every 6 weeks for the initial 24 weeks and every 12 weeks thereafter, or sooner if progression was clinically suspected, using the EORTC QLQ-C30 and its breast cancer module, QLQ-BR23. For all scales, results were summarized using descriptive statistics for each cohort and at each time point, based on Characters (max 3400 including title, body and table [including spaces]): 3363 No abbreviations in title; title sentence case; define acronyms; no figures Category: Psychosocial, QOL, and Educational Aspects – Other 2 observed values and changes from baseline (clinically meaningful defined as ≥10-point change from baseline). Time to deterioration (TTD; defined as ≥10-point decrease in global health status [GHS]/functional scales or increase in symptom scales) analyses using survival analysis methods were carried out on the GHS/functional scales of QLQ-C30 and symptom scales of QLQ-BR23.
Results:GHS was maintained from baseline across all time points for both C1 and C2 except at week 24 in C2, when a statistically significant but not clinically meaningful improvement in GHS was observed. In C1, statistically significant and clinically meaningful improvement was observed at specific time points in 4 functional scales (body image, week 6; sexual functioning, week 24; sexual enjoyment, week 36; and future perspective, weeks 6, 18, and 24) and in 3 symptom scales (dyspnea, week 24; insomnia, week 24; and breast symptoms, weeks 6 and 36). Statistically significant and clinically meaningful deterioration in C1 was observed in 2 functional scales (emotional functioning, week 12 and end of treatment, and role functioning, end of treatment) and in 1 symptom scale (fatigue, week 6). In C2, statistically significant and clinically meaningful improvement was observed at specific time points in 4 functional scales (role functioning, week 24; social functioning, week 24; sexual enjoyment, week 18; and future perspective, weeks 6, 12, and 18) and in 5 symptom scales (nausea/vomiting, week 18; pain, weeks 12, 18, and 24; insomnia, week 24; breast symptoms, weeks 12 and 18; and arm symptoms, week 48). For C2, no statistically significant and clinically meaningful deterioration was observed for any functional or symptoms scales across all time points, except in the dyspnea symptom scale at week 18. For C1 and C2, the median (95% confidence interval) TTD of GHS was 2.8 (2.1-3.0) and 5.5 (4.2-5.7) months, respectively. The median TTD for all QLQ-C30 functional scales for C1 and C2 ranged 2.1-3.1 and 4.2-5.6 months, respectively; the median TTD for all QLQ-BR23 symptoms scales ranged 2.6-4.0 and 4.2-5.6 months, respectively.
Conclusions: The QoL of TALA-treated patients during ABRAZO was maintained. QoL is being evaluated among atients with germline BRCA1/2 mutated advanced BC treated with TALA vs physician's choice chemotherapy in the phase 3 EMBRACA trial (NCT01945775).
Citation Format: Hurvitz SA, Turner NC, Telli ML, Rugo HS, Mailliez A, Ettl J, Grischke E-M, Mina LA, Balmaña J, Fasching PA, Tudor C, Quek RGW, Hannah AL, Robson ME, Wardley AM. Health-related quality of life during a phase 2 study of talazoparib in patients with advanced breast cancer and germline BRCA1/2 mutations (ABRAZO) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-19-05.
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Affiliation(s)
- SA Hurvitz
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - NC Turner
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - ML Telli
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - HS Rugo
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - A Mailliez
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - J Ettl
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - E-M Grischke
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - LA Mina
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - J Balmaña
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - PA Fasching
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - C Tudor
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - RGW Quek
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - AL Hannah
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - ME Robson
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - AM Wardley
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
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Telli ML, Turner NC, Mailliez A, Ettl J, Grischke EM, Mina LA, Balmaña J, Hurvitz SA, Wardley AM, Fasching PA, Tudor C, Nguyen L, Hannah AL, Robson ME, Rugo HS. Abstract P1-14-03: ABRAZO: Exposure-efficacy and -safety analyses of breast cancer patients with germline BRCA1/2 mutations receiving talazoparib in a phase 2 open-label trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-14-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Talazoparib (TALA) is a dual-mechanism poly (ADP-ribose) polymerase (PARP) inhibitor that traps PARP on DNA. Efficacy results of this phase 2 trial were previously presented (Turner et al, ASCO 2017, abstract 1007). This study included sparse pharmacokinetic (PK) sampling for patients through cycle 4 of therapy. Exploratory analyses included assessment of exposure versus parameters of efficacy and safety.
Methods: ABRAZO (NCT02034916) was a parallel-cohort, open-label phase 2 study of TALA (1 mg/d) following (i) platinum-based therapy (cohort 1) or (ii) ≥3 platinum-free cytotoxic-based regimens (cohort 2) in patients with locally advanced or metastatic breast cancer and germline BRCA1/2 mutation. Sparse PK sampling was performed on day 1 of cycles 1-4, consisting of a predose sample collected ≤60 minutes prior to dosing and 2 postdose samples collected ≥30 minutes after dosing (time of food ingestion prior to the dose was collected). The collection times of the 2 postdose samples were separated by ≥2 hours. Efficacy parameters included radiographic progression-free survival (rPFS) by central review and objective response rate (ORR). Safety parameters included incidence of overall adverse events (AEs) and grade ≥3 AEs. Individual AUCs (area under concentration-time curves) for exposure-response analyses were predicted by population PK analyses.
Results: Patients were divided into AUC tertiles: low (median, 109.0 ng*hr/mL; n=27), intermediate (median, 170.8 ng*hr/mL; n=27), and high (median, 219.2 ng*hr/mL; n=27). Median rPFS was 5.3 months (95% confidence interval [CI], 3.1, 8.3) in the lowest AUC tertile, 5.6 months (95% CI, 3.7, 8.4) in the intermediate AUC tertile, and 5.3 months (95% CI, 3.9, 5.6) in the highest AUC tertile. The ORR was 22.2% (95% CI, 8.6, 42.3) in the lowest AUC tertile, 25.9% (95% CI, 11.1, 46.3) in the intermediate AUC tertile, and 37.0% (95% CI, 19.4, 57.6) in the highest AUC tertile. AEs of any grade were reported in 11 patients (40.7%) in the lowest AUC tertile, 21 patients (77.8%) in the intermediate AUC tertile, and 22 patients (81.5%) in the highest AUC tertile. Grade ≥3 AEs were reported in 8 patients (29.6%) in the lowest AUC tertile and in 18 patients (66.7%) in the intermediate and highest AUC tertiles. The most common AEs in all 3 exposure tertiles were anemia, thrombocytopenia, and neutropenia.
Conclusions: Median rPFS did not change with increasing systemic exposure. There may be a trend to higher ORR in patients with highest systemic exposure. A larger percentage of patients experienced AEs with elevated systemic exposure. Increased response rates with greater exposure does not translate to improved rPFS. These results should be interpreted with caution due to the low patient numbers in each cohort.
Citation Format: Telli ML, Turner NC, Mailliez A, Ettl J, Grischke E-M, Mina LA, Balmaña J, Hurvitz SA, Wardley AM, Fasching PA, Tudor C, Nguyen L, Hannah AL, Robson ME, Rugo HS. ABRAZO: Exposure-efficacy and -safety analyses of breast cancer patients with germline BRCA1/2 mutations receiving talazoparib in a phase 2 open-label trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-14-03.
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Affiliation(s)
- ML Telli
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - NC Turner
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - A Mailliez
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - J Ettl
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - E-M Grischke
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - LA Mina
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - J Balmaña
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - SA Hurvitz
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - AM Wardley
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - PA Fasching
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - C Tudor
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - L Nguyen
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - AL Hannah
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - ME Robson
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - HS Rugo
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
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Lenz HJ, Philip P, Saunders M, Kolevska T, Mukherjee K, Samuel L, Bondarde S, Dobbs T, Tagliaferri M, Hoch U, Hannah AL, Berkowitz M. Randomized study of etirinotecan pegol versus irinotecan as second-line treatment for metastatic colorectal cancer. Cancer Chemother Pharmacol 2017; 80:1161-1169. [PMID: 29043412 DOI: 10.1007/s00280-017-3438-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/19/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Etirinotecan pegol (EP) is a long-acting topoisomerase-I inhibitor designed to provide sustained exposure to SN-38 (active metabolite of irinotecan). This phase II study compared EP versus irinotecan as second-line treatment for KRAS-mutant, irinotecan-naïve, metastatic colorectal cancer (mCRC). METHODS Patients were randomized to EP 145 mg/m2 or irinotecan 350 mg/m2 Q21d until disease progression/unacceptable toxicity. The primary endpoint was progression-free survival (PFS) with response determined by central radiologic review (RECIST version 1.1). RESULTS The study was terminated before completing accrual due to evolving standards of care. Eighty-three patients were randomized. Median PFS was longer with EP versus irinotecan (4.0 versus 2.8 months, respectively; HR 0.65; 95% CI 0.40-1.04; P = 0.07). Six-month PFS rates were 32.8 and 15.4%, respectively. Median OS was 9.6 and 8.4 months in EP and irinotecan arms, respectively (HR 0.91; 95% CI 0.56-1.49). ORRs were 10 and 5%, respectively (P = 0.676); median DOR was significantly longer in EP arm (7.9 versus 1.4 months; P = 0.018). The most common grade-3/4 adverse events for EP and irinotecan were diarrhea (21 vs 20%), neutropenia (10 vs 22%), abdominal pain (14 vs 5%), nausea (14 vs 2%), and vomiting (12 vs 7%), respectively. CONCLUSION EP is active and safe for second-line treatment of KRAS-mutant, irinotecan-naïve mCRC.
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Affiliation(s)
- Heinz-Josef Lenz
- USC Norris Comprehensive Cancer Center, 1441 Eastlake Ave Rm 3456, Los Angeles, CA, 90089-9173, USA.
| | - Philip Philip
- Barbara Ann Karmanos Cancer Institute, 4th Fl, HWCRC 4100 John R Detroit, Detroit, MI, 48201, USA.,Wayne State University, Detroit, MI, USA
| | - Mark Saunders
- Christie Hospital NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Tatjana Kolevska
- Kaiser Permanente Medical Center, 2nd Floor, Hallway C, 975 Sereno Drive, Vallejo, CA, 94589, USA
| | - Kalyan Mukherjee
- Chittaranjan National Cancer Institute, 37 Shyama Prasad Mukherjee Road, Bhawanipur, Kolkata, West Bengal, 700026, India
| | - Leslie Samuel
- ANCHOR Unit Clinic D, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK
| | - Shailesh Bondarde
- Shatabdi Super Specialty Hospital, Suyojit City Center, Mumbai Naka, Nashik, 422 005, India
| | - Tracy Dobbs
- Tennessee Cancer Specialists, 1415 Old Weisgarser Road, Knoxville, TN, 37909-1292, USA
| | - Mary Tagliaferri
- Nektar Therapeutics, 455 Mission Bay Boulevard South, San Francisco, CA, 94158, USA
| | - Ute Hoch
- Nektar Therapeutics, 455 Mission Bay Boulevard South, San Francisco, CA, 94158, USA
| | - Alison L Hannah
- Nektar Therapeutics, 455 Mission Bay Boulevard South, San Francisco, CA, 94158, USA
| | - Maurice Berkowitz
- UCLA Geffen School of Medicine, 201 S. Buena Vista Street, Suite 200, Burbank, CA, 91505, USA
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Rustin G, Vergote I, Micha JP, Duska LR, Reed N, Bendell J, Spitz D, Dark G, Hoch U, Tagliaferri M, Hannah AL, Garcia AA. A multicenter, open-label, expanded phase 2 study to evaluate the safety and efficacy of etirinotecan pegol, a polymer conjugate of irinotecan, in women with recurrent platinum-resistant or refractory ovarian cancer. Gynecol Oncol 2017; 147:276-282. [PMID: 28935273 DOI: 10.1016/j.ygyno.2017.08.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/15/2017] [Accepted: 08/24/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Etirinotecan pegol (EP) is a novel polyethylene glycol conjugated form of irinotecan with documented activity in platinum-resistant ovarian cancer (PROC). We report the results of the expanded portion of a phase II study of EP in patients with PROC who received prior pegylated liposomal doxorubicin (PLD) or who were unable to receive it. METHODS This multicenter, open-label, phase II study evaluated EP q21d for PROC. The primary endpoint was objective response rate (ORR) by Response Evaluation Criteria in Solid Tumors version 1.0. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and safety. Patient populations evaluated included a modified intent-to-treat (mITT) group consisting of all patients who received at least one dose and with measurable disease and a primary efficacy (pEFF) group (subset of the mITT population who received prior PLD). RESULTS One hundred thirty-nine patients were enrolled. Of the 132 patients in the mITT group, 20 achieved an ORR (15.2%; 95% CI 9.5-22.4); median PFS and OS were 4.4 months and 10.2 months, respectively. In the pEFF group (n=104), 15 patients (14.4%; 95% CI 8.3-22.7) achieved an ORR; median PFS and OS were 4.4 months and 10.9 months, respectively. The most common grade 3/4 toxicities were diarrhea (20%), abdominal pain (17%), vomiting (14%), dehydration (13%), and nausea (13%). Severe diarrhea was reduced to 15% with strict adherence to screening and management guidelines. CONCLUSIONS This study confirms the activity and safety of single-agent EP in patients with PROC, including patients who received prior PLD. Further evaluation earlier in the disease course and in combination is warranted.
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Affiliation(s)
- G Rustin
- Mount Vernon Hospital, Middlesex, United Kingdom
| | - I Vergote
- Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - J P Micha
- Gynecologic Oncology Associates, Newport Beach, CA, USA
| | - L R Duska
- University of Virginia Health System, Division of Gynecologic Oncology, Charlottesville, VA, USA
| | - N Reed
- Beatson West of Scotland Cancer Centre, Gartnavel General Hospital, Glasgow, United Kingdom
| | - J Bendell
- Tennessee Oncology, PLLC, Sarah Cannon Research Institute, Nashville, TN, USA
| | - D Spitz
- Palm Beach Cancer Institute, West Palm Beach, FL, USA
| | - G Dark
- Freemen Hospital, High Heaton, Newcastle-upon-Tyne, United Kingdom
| | - U Hoch
- Nektar Therapeutics, San Francisco, CA, USA
| | | | - A L Hannah
- Nektar Therapeutics, San Francisco, CA, USA
| | - A A Garcia
- USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, CA, USA; LSU Stanley S. Scott Cancer Center, New Orleans, LA, USA.
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Cortés J, Rugo HS, Awada A, Twelves C, Perez EA, Im SA, Gómez-Pardo P, Schwartzberg LS, Diéras V, Yardley DA, Potter DA, Mailliez A, Moreno-Aspitia A, Ahn JS, Zhao C, Hoch U, Tagliaferri M, Hannah AL, O'Shaughnessy J. Erratum to: Prolonged survival in patients with breast cancer and a history of brain metastases: results of a preplanned subgroup analysis from the randomized phase III BEACON trial. Breast Cancer Res Treat 2017; 166:327-328. [PMID: 28884461 DOI: 10.1007/s10549-017-4482-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Javier Cortés
- Ramon y Cajal University Hospital, Madrid, Spain and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Hope S Rugo
- University of California, San Francisco, CA, USA
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | - Chris Twelves
- Leeds Institute of Cancer and Pathology and St James's University Hospital, Leeds, UK
| | | | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | - David A Potter
- Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Alvaro Moreno-Aspitia
- Ramon y Cajal University Hospital, Madrid, Spain and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Jin-Seok Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Carol Zhao
- Nektar Therapeutics, San Francisco, CA, USA
| | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA, USA
| | | | | | - Joyce O'Shaughnessy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center/U.S. Oncology, 3410 Worth Street, Suite 400, Dallas, TX, 75246, USA.
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23
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Cortés J, Rugo HS, Awada A, Twelves C, Perez EA, Im SA, Gómez-Pardo P, Schwartzberg LS, Diéras V, Yardley DA, Potter DA, Mailliez A, Moreno-Aspitia A, Ahn JS, Zhao C, Hoch U, Tagliaferri M, Hannah AL, O'Shaughnessy J. Prolonged survival in patients with breast cancer and a history of brain metastases: results of a preplanned subgroup analysis from the randomized phase III BEACON trial. Breast Cancer Res Treat 2017; 165:329-341. [PMID: 28612225 PMCID: PMC5543189 DOI: 10.1007/s10549-017-4304-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 02/07/2023]
Abstract
Purpose Conventional chemotherapy has limited activity in patients with breast cancer and brain metastases (BCBM). Etirinotecan pegol (EP), a novel long-acting topoisomerase-1 inhibitor, was designed using advanced polymer technology to preferentially accumulate in tumor tissue including brain metastases, providing sustained cytotoxic SN38 levels. Methods The phase 3 BEACON trial enrolled 852 women with heavily pretreated locally recurrent or metastatic breast cancer between 2011 and 2013. BEACON compared EP with treatment of physician’s choice (TPC; eribulin, vinorelbine, gemcitabine, nab-paclitaxel, paclitaxel, ixabepilone, or docetaxel) in patients previously treated with anthracycline, taxane, and capecitabine, including those with treated, stable brain metastases. The primary endpoint, overall survival (OS), was assessed in a pre-defined subgroup of BCBM patients; an exploratory post hoc analysis adjusting for the diagnosis-specific graded prognostic assessment (GPA) index was also conducted. Results In the trial, 67 BCBM patients were randomized (EP, n = 36; TPC, n = 31). Treatment subgroups were balanced for baseline characteristics and GPA indices. EP was associated with a significant reduction in the risk of death (HR 0.51; P < 0.01) versus TPC; median OS was 10.0 and 4.8 months, respectively. Improvement in OS was observed in both poorer and better GPA prognostic groups. Survival rates at 12 months were 44.4% for EP versus 19.4% for TPC. Consistent with the overall BEACON population, fewer patients on EP experienced grade ≥3 toxicity (50 vs. 70%). Conclusions The significant improvement in survival in BCBM patients provides encouraging data for EP in this difficult-to-treat subgroup of patients. A phase three trial of EP in BCBM patients is underway (ClinicalTrials.gov NCT02915744). Electronic supplementary material The online version of this article (doi:10.1007/s10549-017-4304-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Javier Cortés
- Ramon y Cajal University Hospital, Madrid, Spain, and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Hope S Rugo
- University of California, San Francisco, CA, USA
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | - Chris Twelves
- Leeds Institute of Cancer and Pathology and St James's University Hospital, Leeds, UK
| | | | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | - David A Potter
- Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Alvaro Moreno-Aspitia
- Ramon y Cajal University Hospital, Madrid, Spain, and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jin-Seok Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Carol Zhao
- Nektar Therapeutics, San Francisco, CA, USA
| | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA, USA
| | | | | | - Joyce O'Shaughnessy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center/U.S. Oncology, 3410 Worth Street, Suite 400, Dallas, TX, 75246, USA.
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Turner NC, Telli ML, Rugo HS, Mailliez A, Ettl J, Grischke EM, Mina LA, Balmana Gelpi J, Fasching PA, Hurvitz SA, Wardley AM, Chappey C, Verret W, Hannah AL, Robson ME. Final results of a phase 2 study of talazoparib (TALA) following platinum or multiple cytotoxic regimens in advanced breast cancer patients (pts) with germline BRCA1/2 mutations (ABRAZO). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.1007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
1007 Background: TALA is a dual-mechanism PARP inhibitor that traps PARP on DNA. This study was designed to assess the activity of TALA in pts with g BRCA1/2mutation previously exposed to platinum or multiple prior cytotoxic regimens. Methods: ABRAZO (NCT02034916) is a 2-cohort, 2-stage phase 2 study of TALA (1 mg/d) following platinum-based therapy (Cohort 1 [C1]) or ≥ 3 platinum-free cytotoxic-based regimens (Cohort 2 [C2]) in pts with locally advanced or metastatic breast cancer (MBC) and g BRCA1/2mutation. Pts had ECOG PS ≤ 1 and measurable disease by RECIST v1.1. Five responses per cohort were required in ≤ 35 pts to progress to stage 2. The primary endpoint was confirmed ORR by independent radiology facility (IRF). Secondary endpoints: clinical benefit rate ≥ 24 weeks (CBR24), DOR, PFS, and OS. Results: From May 2014 to Feb 2016, 84 pts were enrolled (C1, n = 49; C2, n = 35). At data cutoff (1 Sep 2016), 9 pts continued on treatment. Both cohorts proceeded to stage 2 before enrollment closed. Median age was 50 (range, 31–75) years; 58% of pts had an ECOG PS of 0. TNBC/HR+ incidence in C1 and C2 was 59%/41% and 17%/83%, respectively. Median number of prior cytotoxic regimens administered for advanced disease was 2 in C1 and 4 in C2. ORR by IRF for BRCA1/BRCA2 was 24%/34%, and ORR by IRF for TNBC/HR+ was 26%/29%. Common all grade AEs: anemia (52%), fatigue (45%), nausea (42%), diarrhea (33%), thrombocytopenia (33%), and neutropenia (27%). Grade ≥ 3 AEs: anemia (35%), thrombocytopenia (19%), and neutropenia (15%). Nonhematological AEs grade ≥ 3 did not occur. AEs related to TALA led to drug discontinuation in 3 pts (4%); 4 AEs resulted in death, none related to TALA. Conclusions: TALA was well tolerated in MBC pts with a g BRCA1/2 mutation, exhibiting promising antitumor activity in C1 and C2. TALA vs physician’s choice of treatment in g BRCA1/2-mutated MBC is being evaluated in the phase 3 EMBRACA trial (NCT01945775). Clinical trial information: NCT02034916. [Table: see text]
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Affiliation(s)
- Nicholas C. Turner
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
| | | | - Hope S. Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | | | - Johannes Ettl
- Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | | | | | - Sara A. Hurvitz
- University of California Los Angeles Health, Santa Monica, CA
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Kristeleit RS, Evans TJ, Ingles Garces AH, Slater S, Drew Y, Devlin MJ, Haris NRM, Diamantis N, MacDonald J, Bachmann F, Hannah AL, Anderson S, Lane HA, Schmitt-Hoffmann A, McKernan P, Engelhardt MF, Greystoke A, Miller R, Plummer ER, Lopez JS. Phase 1/2a trial of daily oral BAL101553, a novel tumor checkpoint controller (TCC), in advanced solid tumors. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2532 Background: BAL101553 (prodrug of BAL27862) is a small molecule TCC that binds microtubules and promotes tumor cell death by activation of the spindle assembly checkpoint. In a previous study (NCT01397929, Lopez et al. JCO 34, 2016; abstr 2525), 2-h IV infusion on Days 1, 8, 15 (q28d) of BAL101553 up to 80 mg/m2 (maximum administered dose, MAD) showed vascular toxicities, including transient hypertension, which appeared to be Cmax related. The recommended Phase 2 dose (RP2D) was 30 mg/m2 weekly IV. Based on nonclinical models, antiproliferative effects of BAL27862 are driven by AUC. This trial explores whether once daily oral administration of BAL101553 reduces Cmax-related toxicity and improves the therapeutic window (NCT02490800). Methods: Patients (pts) with advanced solid tumors who failed standard therapy, received QD oral BAL101553 (28-d cycles) in a 3+3 dose-escalation design to determine the MTD. Adverse events were assessed by CTCAEv4 grade (G); tumor response by RECIST 1.1; serial PK on Day 1 of Cycles 1 and 2. Results: In the ongoing study, 19 pts (9M/10F; median age 67 y) received doses of 2, 4, 8, 16 or 30 mg oral BAL101553 QD. The MAD was 30 mg with DLTs of reversible G2 hallucination and asymptomatic, reversible G3 electrolyte imbalances. No DLTs were observed at ≤ 16 mg. Dosing is ongoing between 16 and 30 mg QD to determine the MTD. BAL27862 exposures after oral QD dosing of BAL101553 compared to weekly 2-h infusions suggested high relative oral bioavailability. The BAL27862 weekly AUC at the oral MAD (30 mg QD) compared to the RP2D of 30 mg/m2 for 2-h IV was more than 5-fold higher (19,656 vs 3,584 ng*h/mL) and Cmax was 1.5-fold lower (171 vs 266 ng/mL). Both Cmaxand AUC were dose-proportional, with low/moderate variability. Oral BAL101553 had no effects on blood pressure and showed no vascular toxicity. 5 pts had stable disease (2 pts [cholangiocarcinoma, neuroendocrine pancreatic cancer] > 4 cycles). Conclusions: Daily oral BAL101553 enables higher weekly exposures of BAL27862 with lower Cmax levels compared with a 2-h weekly infusion, due to the absence of Cmax related vascular toxicity. Doses up to 16 mg QD are well tolerated. The MAD has been identified as 30 mg QD; definition of the MTD is ongoing. Clinical trial information: NCT02490800.
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Affiliation(s)
| | | | | | - Sarah Slater
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Yvette Drew
- Northern Centre for Cancer Care, Newcastle-upon-Tyne, United Kingdom
| | | | - Noor R Md Haris
- Northern Centre for Cancer Care, Newcastle-upon-Tyne, United Kingdom
| | - Nikolaos Diamantis
- The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Julie MacDonald
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Felix Bachmann
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | | | - Heidi A Lane
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | - Phil McKernan
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | | | - Rowan Miller
- University College London, London, United Kingdom
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Ingles Garces AH, Plummer ER, Lopez JS, Kristeleit RS, MacDonald J, Sweeting L, Devlin MJ, Drew Y, Hannah AL, Aceto N, Anderson S, Lane HA, Larger P, Maurer M, McKernan P, Engelhardt MF, Greystoke A, Coleman N, Evans TJ, Mulholland PJ. A phase I study to assess the safety, pharmacokinetics (PK), pharmacodynamics (PD) and antitumor activities of daily oral BAL101553, a novel tumor checkpoint controller (TCC) in adult patients with progressive or recurrent glioblastoma (GBM) or high-grade glioma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps2601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS2601 Background: BAL101553 (prodrug of BAL27862) is a novel TCC that promotes tumor cell death by modulating the spindle assembly checkpoint. BAL27862 is a lipophilic, small molecule (MW 387) shown in rats to penetrate the brain (1:1 plasma ratio) and has shown promising antitumor activity in orthotopic preclinical models of GBM as monotherapy or in combination with radiotherapy (RT) with/without chemotherapy. In a completed Phase 1 study with 2-h IV infusions (Days 1, 8, 15, q28d, NCT01397929 , CDI-CS-001, Lopez et al. J Clin Oncol 34, 2016 suppl; 2525), dose-limiting vascular effects were observed and appeared Cmax related. Preclinical data suggest that antiproliferative effects of BAL101553/27862 are driven by exposure (AUC); thus vascular toxicity and antitumor activity are mediated by different PK drivers. In this ongoing study (NCT02490800, CDI-CS-002), daily oral BAL101553 was initially examined in solid-tumor patients; no vascular toxicities were observed at doses up to the MAD of 30 mg QD. Given this absence, the study was amended to enroll separate cohorts of patients with progressive or recurrent GBM or high-grade glioma. Methods: This is an ongoing multicenter, open-label, Phase 1 dose-escalation study using a 3+3 design to determine the MTD, characterize dose-limiting toxicities and assess the PK, PD and antitumor activities of daily oral administration of BAL101553 in consecutive 28-day cycles at a starting dose of 8 mg QD. Patients with histologically-confirmed GBM or high-grade glioma, with progressive or recurrent disease after prior RT with/without chemotherapy, are eligible for enrollment. This includes patients with histologically-confirmed low-grade glioma with unequivocal evidence by imaging of transformation to high-grade glioma. Adverse events are assessed using CTCAEv4; tumor response by RANO (every 2 cycles). The dose escalation allows for doubling of dose levels depending on observed toxicities. PD assessments include circulating tumor cells. PK profiles are assessed throughout the first two treatment cycles. Clinical trial information: NCT02490800.
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Affiliation(s)
| | | | | | | | - Julie MacDonald
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Lorna Sweeting
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Yvette Drew
- Northern Centre for Cancer Care, Newcastle-upon-Tyne, United Kingdom
| | | | - Nicola Aceto
- University of Basel and University Hospital Basel, Basel, Switzerland
| | | | - Heidi A Lane
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Patrice Larger
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Martina Maurer
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Phil McKernan
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | | | - Niamh Coleman
- The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
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Twelves C, Cortés J, O'Shaughnessy J, Awada A, Perez EA, Im S, Gómez-Pardo P, Schwartzberg LS, Diéras V, Yardley DA, Potter DA, Mailliez A, Moreno-Aspitia A, Ahn JS, Zhao C, Hoch U, Tagliaferri M, Hannah AL, Rugo HS. Health-related quality of life in patients with locally recurrent or metastatic breast cancer treated with etirinotecan pegol versus treatment of physician's choice: Results from the randomised phase III BEACON trial. Eur J Cancer 2017; 76:205-215. [DOI: 10.1016/j.ejca.2017.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 01/10/2017] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
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Richardson PG, Smith AR, Triplett BM, Kernan NA, Grupp SA, Antin JH, Lehmann L, Miloslavsky M, Hume R, Hannah AL, Nejadnik B, Soiffer RJ. Earlier defibrotide initiation post-diagnosis of veno-occlusive disease/sinusoidal obstruction syndrome improves Day +100 survival following haematopoietic stem cell transplantation. Br J Haematol 2017; 178:112-118. [PMID: 28444784 DOI: 10.1111/bjh.14727] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/14/2017] [Indexed: 11/28/2022]
Abstract
Hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a progressive, potentially fatal complication of conditioning for haematopoietic stem cell transplant (HSCT). The VOD/SOS pathophysiological cascade involves endothelial-cell activation and damage, and a prothrombotic-hypofibrinolytic state. Severe VOD/SOS (typically characterized by multi-organ dysfunction) may be associated with >80% mortality. Defibrotide is approved for treating severe hepatic VOD/SOS post-HSCT in the European Union, and for hepatic VOD/SOS with renal or pulmonary dysfunction post-HSCT in the United States. Previously, defibrotide (25 mg/kg/day in 4 divided doses for a recommended ≥21 days) was available through an expanded-access treatment protocol for patients with VOD/SOS. Data from this study were examined post-hoc to determine if the timing of defibrotide initiation post-VOD/SOS diagnosis affected Day +100 survival post-HSCT. Among 573 patients, defibrotide was started on the day of VOD/SOS diagnosis in approximately 30%, and within 7 days in >90%. The relationship between Day +100 survival and treatment initiation before/after specific days post-diagnosis showed superior survival when treatment was initiated closer to VOD/SOS diagnosis with a statistically significant trend over time for better outcomes with earlier treatment initiation (P < 0·001). These results suggest that initiation of defibrotide should not be delayed after diagnosis of VOD/SOS.
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Affiliation(s)
- Paul G Richardson
- Jerome Lipper Multiple Myeloma Center, Division of Hematologic Malignancy, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Angela R Smith
- Division of Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Brandon M Triplett
- Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nancy A Kernan
- Pediatric BMT Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephan A Grupp
- Pediatric Oncology, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph H Antin
- Stem Cell/Bone Marrow Transplantation Program, Division of Hematologic Malignancy, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Leslie Lehmann
- Center for Stem Cell Transplantation, Division of Hematologic Malignancy, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Robin Hume
- Jazz Pharmaceuticals, Palo Alto, CA, USA
| | | | | | - Robert J Soiffer
- Stem Cell/Bone Marrow Transplantation Program, Division of Hematologic Malignancy, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Richardson PG, Smith AR, Triplett BM, Kernan NA, Grupp SA, Antin JH, Lehmann L, Shore T, Iacobelli M, Miloslavsky M, Hume R, Hannah AL, Nejadnik B, Soiffer RJ. Defibrotide for Patients with Hepatic Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome: Interim Results from a Treatment IND Study. Biol Blood Marrow Transplant 2017; 23:997-1004. [PMID: 28285079 DOI: 10.1016/j.bbmt.2017.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/06/2017] [Indexed: 12/14/2022]
Abstract
Hepatic veno-occlusive disease, or sinusoidal obstruction syndrome (VOD/SOS), is a serious and potentially fatal complication of conditioning for hematopoietic stem cell transplantation (HSCT) or of chemotherapy regimens alone. Defibrotide is a complex mixture of single-stranded polydeoxyribonucleotides that is approved in the United States for treating hepatic VOD/SOS with renal or pulmonary dysfunction post-HSCT and in the European Union, Israel, and South Korea for treating severe hepatic VOD/SOS post-HSCT. Defibrotide was previously available in the United States as an investigational drug through a treatment protocol (treatment IND) study. Interim results of that large, treatment IND study of patients with VOD/SOS and with or without multiorgan dysfunction (MOD; also known as multiorgan failure) are presented here. Defibrotide was administered i.v. at 6.25 mg/kg every 6 hours (25 mg/kg/day), with a recommended treatment duration of at least 21 days. Enrolled patients (n = 681) were diagnosed with VOD/SOS based on Baltimore or modified Seattle criteria or liver biopsy analysis. Among the 573 HSCT recipients, 288 (50.3%; 95% confidence interval [CI], 46.2% to 54.4%) were alive at day +100 post-HSCT. Day +100 survival for the pediatric (≤16 years) and adult (>16 years) subgroups was 54.5% (95% CI, 49.1% to 60.0%; n = 174 of 319) and 44.9% (95% CI, 38.8% to 51.0%; n = 114 of 254), respectively. In the MOD subgroup, 159 of 351 patients (45.3%; 95% CI, 40.1% to 50.5%) of patients were alive at day +100 post-HSCT. Treatment with defibrotide was generally well tolerated, and drug-related toxicities were consistent with previous studies. Adverse events were reported in 69.6% of safety-evaluable patients (399 of 573). Other than VOD/SOS and associated MOD symptoms, the most commonly reported treatment-emergent adverse event was hypotension (13.8%). Day +100 survival results observed in this trial were consistent with results seen in previous trials of defibrotide for VOD/SOS in adult and pediatric patients. These data support the potential benefit of defibrotide in treating a VOD/SOS patient population that includes those with and without MOD.
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Affiliation(s)
- Paul G Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
| | | | | | - Nancy A Kernan
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stephan A Grupp
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph H Antin
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Leslie Lehmann
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Robin Hume
- Jazz Pharmaceuticals, Palo Alto, California
| | | | | | - Robert J Soiffer
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Doede T, Viddam A, Villa KF, Hannah AL, Weaver C, Tappe W. Diagnosis of Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome (VOD/SOS) with or Without Multi-Organ Dysfunction (MOD) after Hematopoietic Stem Cell Transplantation (HSCT): Analysis of a Multicenter Chart Review. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lopez J, Evans TJ, Plummer ER, Diamantis N, Shaw HM, Zubairi IH, Haris NRM, MacDonald J, Greystoke A, Roux RL, Tunariu N, Molife LR, Hannah AL, Anderson S, Lane HA, Maurer M, Schmitt-Hoffmann A, Bachmann F, Engelhardt MF, Kristeleit RS. Phase 1/2a trial of intravenous BAL101553, a novel tumor checkpoint controller (TCC), in advanced solid tumors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.2525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Juanita Lopez
- The Royal Marsden/Institute of Cancer Research, Sutton, United Kingdom
| | | | | | | | | | | | - Noor R Md Haris
- Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Julie MacDonald
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | - Nina Tunariu
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | - L Rhoda Molife
- The Royal Marsden/Institute of Cancer Research, Sutton, United Kingdom
| | | | | | - Heidi A Lane
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Martina Maurer
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | - Felix Bachmann
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
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Kristeleit RS, Evans TJ, Lopez J, Slater S, D'Arcangelo M, Drew Y, Adeleke S, Brown J, Crawford D, Diamantis N, Gougis P, Tzankov A, Hannah AL, Anderson S, Lane HA, Schmitt-Hoffmann A, Maurer M, Bachmann F, Engelhardt MF, Plummer ER. A Phase 1 study to assess the safety, pharmacokinetics (PK), pharmacodynamics (PD) and antitumor activities of daily oral BAL101553, a novel tumor checkpoint controller (TCC) in adult patients with advanced solid tumors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.tps2594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Juanita Lopez
- The Royal Marsden/Institute of Cancer Research, Sutton, United Kingdom
| | - Sarah Slater
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Yvette Drew
- Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Sola Adeleke
- University College London, London, United Kingdom
| | - Jessica Brown
- Drug Development Unit, Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Donna Crawford
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Paul Gougis
- University College London, London, United Kingdom
| | | | | | | | - Heidi A Lane
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | - Martina Maurer
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Felix Bachmann
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
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Richardson PG, Riches ML, Kernan NA, Brochstein JA, Mineishi S, Termuhlen AM, Arai S, Grupp SA, Guinan EC, Martin PL, Steinbach G, Krishnan A, Nemecek ER, Giralt S, Rodriguez T, Duerst R, Doyle J, Antin JH, Smith A, Lehmann L, Champlin R, Gillio A, Bajwa R, D'Agostino RB, Massaro J, Warren D, Miloslavsky M, Hume RL, Iacobelli M, Nejadnik B, Hannah AL, Soiffer RJ. Phase 3 trial of defibrotide for the treatment of severe veno-occlusive disease and multi-organ failure. Blood 2016; 127:1656-65. [PMID: 26825712 PMCID: PMC4817309 DOI: 10.1182/blood-2015-10-676924] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/22/2016] [Indexed: 11/20/2022] Open
Abstract
Hepatic veno-occlusive disease (VOD), also called sinusoidal obstruction syndrome (SOS), is a potentially life-threatening complication of hematopoietic stem cell transplantation (HSCT). Untreated hepatic VOD/SOS with multi-organ failure (MOF) is associated with >80% mortality. Defibrotide has shown promising efficacy treating hepatic VOD/SOS with MOF in phase 2 studies. This phase 3 study investigated safety and efficacy of defibrotide in patients with established hepatic VOD/SOS and advanced MOF. Patients (n = 102) given defibrotide 25 mg/kg per day were compared with 32 historical controls identified out of 6867 medical charts of HSCT patients by blinded independent reviewers. Baseline characteristics between groups were well balanced. The primary endpoint was survival at day +100 post-HSCT; observed rates equaled 38.2% in the defibrotide group and 25% in the controls (23% estimated difference; 95.1% confidence interval [CI], 5.2-40.8;P= .0109, using a propensity-adjusted analysis). Observed day +100 complete response (CR) rates equaled 25.5% for defibrotide and 12.5% for controls (19% difference using similar methodology; 95.1% CI, 3.5-34.6;P= .0160). Defibrotide was generally well tolerated with manageable toxicity. Related adverse events (AEs) included hemorrhage or hypotension; incidence of common hemorrhagic AEs (including pulmonary alveolar [11.8% and 15.6%] and gastrointestinal bleeding [7.8% and 9.4%]) was similar between the defibrotide and control groups, respectively. Defibrotide was associated with significant improvement in day +100 survival and CR rate. The historical-control methodology offers a novel, meaningful approach for phase 3 evaluation of orphan diseases associated with high mortality. This trial was registered at www.clinicaltrials.gov as #.
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Affiliation(s)
- Paul G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Marcie L Riches
- Division of Hematology/Oncology, University of North Carolina Hospitals, Bone Marrow and Stem Cell Transplant Clinic, University of North Carolina Cancer Hospital, Chapel Hill, NC
| | - Nancy A Kernan
- Pediatric Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Joel A Brochstein
- Department of Pediatrics, Stem Cell Transplant Program, Cohen Children's Medical Center, New Hyde Park, NY
| | - Shin Mineishi
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Amanda M Termuhlen
- Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA
| | - Sally Arai
- Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
| | - Stephan A Grupp
- Pediatric Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Eva C Guinan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Department of Hematology/Oncology, Children's Hospital, Boston, MA
| | - Paul L Martin
- Division of Pediatric Blood and Marrow Transplant, Duke University Medical Center, Durham, NC
| | - Gideon Steinbach
- Gastroenterology Division, University of Washington School of Medicine and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Amrita Krishnan
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Eneida R Nemecek
- Pediatric Bone Marrow Transplant Program, Oregon Health and Science University, Portland, OR
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Tulio Rodriguez
- Hematology/Oncology, Loyola University Medical Center, Chicago, IL
| | - Reggie Duerst
- Stem Cell Transplant Program, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - John Doyle
- Pediatric Hematology/Oncology, CancerCare Manitoba and the University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph H Antin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Angela Smith
- Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN
| | - Leslie Lehmann
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Department of Hematology/Oncology, Children's Hospital, Boston, MA
| | - Richard Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - Alfred Gillio
- Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ
| | - Rajinder Bajwa
- Department of Hematology/Oncology/BMT, The Ohio State University/Nationwide Children's Hospital, Columbus, OH
| | | | - Joseph Massaro
- Department of Mathematics and Statistics, Boston University, Boston, MA
| | - Diane Warren
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Robin L Hume
- Regulatory Affairs, Jazz Pharmaceuticals, Palo Alto, CA
| | | | - Bijan Nejadnik
- Research and Clinical Development, Galena Biopharma, San Ramon, CA; and
| | | | - Robert J Soiffer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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Kernan NA, Grupp SA, Banerjee K, Hannah AL, Hume R, Nejadnik B, Richardson PG. Pooled Treatment Analysis of Pediatric Patients with Defibrotide for Hepatic Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome and Multi-Organ Dysfunction Following Hematopoietic Stem Cell Transplant. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Richardson PG, Kernan NA, Brochstein JA, Mineishi S, Arai S, Grupp SA, Guinan E, Martin PL, Steinbach G, Krishnan A, Nemecek ER, Duerst RE, Antin JH, Lehmann L, Gillio AP, Bajwa R, Miloslavsky M, Hume R, Iacobelli M, Nejadnik B, Hannah AL, Soiffer RJ. Defibrotide for the Treatment of Hepatic Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome with Multi-Organ Dysfunction: Final Results from a Pivotal, Historically Controlled, Phase 3 Trial. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Richardson PG, Riches ML, Kernan NA, Brochstein JA, Mineishi S, Termuhlen AM, Arai S, Grupp SA, Miloslavsky M, Nejadnik B, Hannah AL, Soiffer RJ. Defibrotide for Hepatic Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome with Multi-Organ Dysfunction: A Concordance Analysis Between Day+100 Complete Response and Survival. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rugo HS, Cortes J, Awada A, O'Shaughnessy J, Twelves C, Im SA, Hannah AL, Lu L, Sy S, Caygill K, Zajchowski D, Davis DW, Hoch U, Perez EA. Abstract P1-13-02: Early change in topoisomerase 1 (Top1) positive circulating tumor cells (CTCs) is associated with overall survival (OS) in patients with advanced breast cancer after treatment with etirinotecan pegol. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-13-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Etirinotecan pegol (EP) is a long-acting Top1 inhibitor providing sustained levels of active metabolite throughout the entire chemotherapy cycle. The phase 3 BEACON trial compared EP to treatment of physician's choice (TPC) in patients with advanced breast cancer, demonstrating a non-statistically significant 2.1 month difference in survival favoring EP in the intent to treat population. A novel aspect of the BEACON trial is to explore the utility of biomarkers measured in CTCs for predicting efficacy with EP. Pre- and post-treatment CTCs were isolated from blood of 77% of the 852 BEACON patients. Target-specific pharmacodynamic biomarkers for EP measured in CTCs were analyzed to identify patients most responsive to treatment with EP.
Methods: Donation of blood samples for CTC analysis was voluntary. Participating BEACON patients had serial (baseline, Cycle 2 Day 1 [C2D1], Cycle 4 Day 1 [C4D1], End of Treatment) 7.5-mL whole blood samples drawn in EDTA tubes and shipped within 96 hours ambient to ApoCell (Houston, TX) for processing. PBMCs were separated by Ficoll® gradient, and CTCs were isolated using ApoStream® technology. Isolated cells were deposited on three slides and stained for DAPI, CD45, cytokeratin markers, as well as Top1, Top2, Ki67, γH2AX, Rad51, ABCG2, and TUNEL. Biomarkers were quantified by iCys® laser scanning cytometer equipped with image analysis software, and correlated with OS using Cox multiple regression and Kaplan-Meier analyses.
Results: The CTC substudy yielded 611 pre-treatment, 519 C2D1, 268 C4D1, and 431 End of Treatment samples. Among the successfully processed blood samples, 98% had detectable CTCs, with a median of 63, 46, 51, and 57 CTCs/mL at baseline, C2D1, C4D1, and End of Treatment, respectively. Cox regression analyses of CTC number and percentage of Top1, Top2, Ki67, or TUNEL positive CTCs identified a correlation for post-treatment number of Top1-positive CTCs with OS in patients receiving EP. To assess the impact of Top1-positive CTCs, patients were classified as Top1-High (> median) or Top1-Low (≤ median) based on the percent of Top1-positive CTCs at baseline. Among the Top1-High patients at baseline, significantly improved OS (HR 0.54, p=0.007) was observed for those who converted to Top1-Low after their first treatment with EP (C2D1), but not TPC (HR 1.12, p=0.613). These results suggest that decreased number of Top1-positive CTCs may reflect EP target engagement with Top1, as these patients derived the most benefit from treatment.
Conclusions: CTC collection and analysis was successfully incorporated into the phase 3 BEACON study, with 77% patient participation. CTC detection rate using ApoStream® was high, permitting evaluation of biomarkers at baseline and post-treatment. Significantly improved OS was observed in patients who had a decreased number of Top1-positive CTCs following cycle 1 of EP.
Citation Format: Rugo HS, Cortes J, Awada A, O'Shaughnessy J, Twelves C, Im S-A, Hannah AL, Lu L, Sy S, Caygill K, Zajchowski D, Davis DW, Hoch U, Perez EA. Early change in topoisomerase 1 (Top1) positive circulating tumor cells (CTCs) is associated with overall survival (OS) in patients with advanced breast cancer after treatment with etirinotecan pegol. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-13-02.
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Affiliation(s)
- HS Rugo
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - J Cortes
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - A Awada
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - J O'Shaughnessy
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - C Twelves
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - S-A Im
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - AL Hannah
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - L Lu
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - S Sy
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - K Caygill
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - D Zajchowski
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - DW Davis
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - U Hoch
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
| | - EA Perez
- University of California, San Francisco, San Francisco, CA; Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Consultant, Sebastopol, CA; Nektar Therapeutics, San Francisco, CA; Oncology Consulting Services, San Francisco, CA; Apocell, Inc., Houston, TX; Mayo Clinic, Jacksonville, FL
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Cortes J, Awada A, Perez EA, Rugo HS, Twelves C, Im SA, Zhao C, Hoch U, Ney J, Hannah AL, O'Shaughnessy J. Abstract P4-11-08: Impact of treatment on quality of life (QOL) in the BEACON study, a randomized phase III trial of etirinotecan pegol (EP) versus treatment of physician's choice (TPC) in patients (pts) with advanced breast cancer (aBC) whose disease has progressed following anthracycline (A), taxane (T) and capecitabine (C). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-11-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The need remains for novel agents that prolong survival and/or improve QOL in women with aBC. EP is a long-acting topoisomerase 1 inhibitor engineered to produce sustained exposure to irinotecan and its active metabolite SN38. Given previous efficacy seen in an earlier phase II trial in MBC, EP 145 mg/m2 every 3 weeks was compared to TPC (one of 7 single-agent regimens) in the randomized phase 3 BEACON study (NCT01492101). As reported at ASCO 2015 (abstract 1001), EP prolonged median overall survival by 2.1 months, although this did not reach statistical significance (12.4 vs 10.3 months; HR 0.87, p=0.08). Grade ≥ 3 adverse events were significantly less common with EP (48% vs 63% with TPC, p<0.001). We now present results of the QOL analyses.
Methods: Patients completed validated health-related QoL (HRQoL) questionnaires, EORTC QLQ-C30 (version 3.0) and breast cancer-specific QLQ-BR23, pretreatment and every 8 weeks until progression, death or withdrawal of consent. Questionnaires were scored according to the EORTC manual. For each scale, raw scores were standardized via a linear transformation to a range from 0 to 100. Absolute scores and changes from baseline were analyzed longitudinally and categorically using a 5-point difference calculated by treatment group. Comparisons between treatment groups were conducted to evaluate the differences in global health status, functional scores and symptoms over time.
Results: The majority of patients who were randomized (total: 733/852 [86%], EP: 378/429 [88%], TPC: 355/423 [84%]) completed at least one post-baseline HRQoL questionnaire. In the EORTC QLQ-C30, grade ≥ 3 AEs significantly impacted HRQoL measured by global health status and 5 additional functional domains. Of the six domains, compared to TPC in a longitudinal analysis, EP was statistically superior in the mean treatment effect through Week 32 in global health status p=0.02 and physical functioning scale p=0.01. EP was also numerically superior in all other scales. In EORTC QLQ-C30 and BR-23, a total of 13 symptoms were measured and categorically analyzed. There were no treatment differences in 7 of 13 symptom scales. EP was associated with worsening of 3 symptom scales: appetite loss, nausea/vomiting, and diarrhea. TPC was associated with worsening of 2 symptom scales: dyspnea and systemic side effects.
Conclusions: In the phase 3 BEACON trial comparing EP to TPC, the more favorable toxicity profile of EP resulted in an improvement in global health status and physical function (results of the symptom scales confirmed the different toxicities of the two arms). EP remains a promising investigational therapy for aBC.
Citation Format: Cortes J, Awada A, Perez EA, Rugo HS, Twelves C, Im S-A, Zhao C, Hoch U, Ney J, Hannah AL, O'Shaughnessy J. Impact of treatment on quality of life (QOL) in the BEACON study, a randomized phase III trial of etirinotecan pegol (EP) versus treatment of physician's choice (TPC) in patients (pts) with advanced breast cancer (aBC) whose disease has progressed following anthracycline (A), taxane (T) and capecitabine (C). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-08.
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Affiliation(s)
- J Cortes
- Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Mayo CLinic, Jacksonville, FL; University of California, San Francisco, San Francisco, CA; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Nektar Therapeutics, San Francisco, CA; Consultant, Sebastopol, CA; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - A Awada
- Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Mayo CLinic, Jacksonville, FL; University of California, San Francisco, San Francisco, CA; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Nektar Therapeutics, San Francisco, CA; Consultant, Sebastopol, CA; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - EA Perez
- Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Mayo CLinic, Jacksonville, FL; University of California, San Francisco, San Francisco, CA; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Nektar Therapeutics, San Francisco, CA; Consultant, Sebastopol, CA; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - HS Rugo
- Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Mayo CLinic, Jacksonville, FL; University of California, San Francisco, San Francisco, CA; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Nektar Therapeutics, San Francisco, CA; Consultant, Sebastopol, CA; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - C Twelves
- Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Mayo CLinic, Jacksonville, FL; University of California, San Francisco, San Francisco, CA; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Nektar Therapeutics, San Francisco, CA; Consultant, Sebastopol, CA; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - S-A Im
- Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Mayo CLinic, Jacksonville, FL; University of California, San Francisco, San Francisco, CA; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Nektar Therapeutics, San Francisco, CA; Consultant, Sebastopol, CA; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - C Zhao
- Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Mayo CLinic, Jacksonville, FL; University of California, San Francisco, San Francisco, CA; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Nektar Therapeutics, San Francisco, CA; Consultant, Sebastopol, CA; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - U Hoch
- Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Mayo CLinic, Jacksonville, FL; University of California, San Francisco, San Francisco, CA; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Nektar Therapeutics, San Francisco, CA; Consultant, Sebastopol, CA; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - J Ney
- Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Mayo CLinic, Jacksonville, FL; University of California, San Francisco, San Francisco, CA; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Nektar Therapeutics, San Francisco, CA; Consultant, Sebastopol, CA; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - AL Hannah
- Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Mayo CLinic, Jacksonville, FL; University of California, San Francisco, San Francisco, CA; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Nektar Therapeutics, San Francisco, CA; Consultant, Sebastopol, CA; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - J O'Shaughnessy
- Vall D'Hebron University Hospital, Barcelona, Spain; Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Mayo CLinic, Jacksonville, FL; University of California, San Francisco, San Francisco, CA; University of Leeds, Leeds, United Kingdom; Seoul National University College of Medicine, Seoul, Korea; Nektar Therapeutics, San Francisco, CA; Consultant, Sebastopol, CA; Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
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Perez EA, Awada A, O'Shaughnessy J, Rugo HS, Twelves C, Im SA, Gómez-Pardo P, Schwartzberg LS, Diéras V, Yardley DA, Potter DA, Mailliez A, Moreno-Aspitia A, Ahn JS, Zhao C, Hoch U, Tagliaferri M, Hannah AL, Cortes J. Etirinotecan pegol (NKTR-102) versus treatment of physician's choice in women with advanced breast cancer previously treated with an anthracycline, a taxane, and capecitabine (BEACON): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol 2015; 16:1556-1568. [PMID: 26482278 DOI: 10.1016/s1470-2045(15)00332-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND New options are needed for patients with heavily pretreated breast cancer. Etirinotecan pegol is a long-acting topoisomerase-I inhibitor that prolongs exposure to, but reduces the toxicity of, SN38 (the active metabolite of irinotecan). We assessed whether etirinotecan pegol is superior to currently available treatments for patients with previously treated, locally recurrent or metastatic breast cancer. METHODS In this open-label, multicentre, randomised phase 3 study (BEACON; BrEAst Cancer Outcomes with NKTR-102), conducted at 135 sites in 11 countries, patients with locally recurrent or metastatic breast cancer previously treated with an anthracycline, a taxane, and capecitabine (and two to five previous regimens for advanced disease) were randomly assigned (1:1) centrally via an interactive response system to etirinotecan pegol (145 mg/m(2) as a 90-min intravenous infusion every 3 weeks) or single-drug treatment of physician's choice. Patients with stable brain metastases and an Eastern Cooperative Oncology Group performance status of 0-1 were eligible. Randomisation was stratified with a permuted block scheme by region, previous eribulin, and receptor status. After randomisation, patients and investigators were aware of treatment assignments. The primary endpoint was overall survival in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01492101. FINDINGS Between Dec 19, 2011, and Aug 20, 2013, 852 patients were randomly assigned; 429 to etirinotecan pegol and 423 to treatment of physician's choice. There was no significant difference in overall survival between groups (median 12·4 months [95% CI 11·0-13·6] for the etirinotecan pegol group vs 10·3 months [9·0-11·3] for the treatment of physician's choice group; hazard ratio 0·87 [95% CI 0·75-1·02]; p=0·084). The safety population includes the 831 patients who received at least one dose of assigned treatment (425 assigned to etirinotecan pegol and 406 to treatment of physician's choice). Serious adverse events were recorded for 128 (30%) patients treated with etirinotecan pegol and 129 (32%) treated with treatment of physician's choice. Fewer patients in the etirinotecan pegol group had grade 3 or worse toxicity than those in the treatment of physician's choice group (204 [48%] vs 256 [63%]; p<0·0001). The most common grade 3 or worse adverse events were diarrhoea (41 [10%] in the experimental group vs five [1%] in the control group), neutropenia (41 [10%] vs 125 [31%]), and peripheral neuropathy (two [<1%] vs 15 [4%]). Three patients in the etirinotecan pegol group died of treatment-related adverse events (pneumonia, myelodysplastic syndrome, and acute renal failure) and two in the treatment of physician's choice group (neutropenic sepsis and septic shock). INTERPRETATION This trial did not demonstrate an improvement in overall survival for etirinotecan pegol compared to treatment of physician's choice in patients with heavily pre-treated advanced breast cancer. The toxicity profile noted in the etirinotecan pegol group differed from that in the control group. In view of the frequency of cross-resistance and overlapping toxicities noted with many available drugs and the need for effective drugs in highly refractory disease, etirinotecan pegol may warrant further research in some subgroups of patients. FUNDING Nektar Therapeutics.
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Affiliation(s)
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | | | - Hope S Rugo
- University of California, San Francisco, CA, USA
| | - Chris Twelves
- University of Leeds and St James's University Hospital, Leeds, UK
| | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | | | - David A Potter
- University of Minnesota Department of Medicine and Masonic Cancer Center, Minneapolis, MN, USA
| | | | | | - Jin-Seok Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Carol Zhao
- Nektar Therapeutics, San Francisco, CA, USA
| | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA, USA
| | | | | | - Javier Cortes
- Vall d'Hebron Institute of Oncology, Barcelona, Spain; Ramon y Cajal University Hospital, Madrid, Spain
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Perez EA, Awada A, O'Shaughnessy J, Rugo HS, Twelves C, Im SA, Zhao C, Hoch U, Hannah AL, Cortes J. Phase III trial of etirinotecan pegol (EP) versus Treatment of Physician’s Choice (TPC) in patients (pts) with advanced breast cancer (aBC) whose disease has progressed following anthracycline (A), taxane (T) and capecitabine (C): The BEACON study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.1001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Hope S. Rugo
- University of California, San Francisco, San Francisco, CA
| | | | - Seock-Ah Im
- Seoul National University College of Medicine, Seoul, South Korea
| | | | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA
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Kristeleit RS, Smith AD, Haris NRM, Zubairi IH, King JW, de Miguel Luken MJ, D'Arcangelo M, MacDonald J, Brown NF, Calvert AH, Hannah AL, Anderson S, Bachmann F, Maurer M, Schmitt-Hoffmann A, Lane HA, Engelhardt MF, Evans TJ, Plummer R, Molife LR. A randomized Phase 2a study to assess pharmacodynamics, antitumor activity and safety of intravenous BAL101553, a novel microtubule inhibitor, at two dose levels in adult patients with selected advanced solid tumors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps2611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Alan D. Smith
- The Royal Marsden/Institute of Cancer Research, Sutton, Surrey, United Kingdom
| | - Noor R Md Haris
- Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | | | - Judy W. King
- University College London, London, United Kingdom
| | | | | | - Julie MacDonald
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | | | | | - Felix Bachmann
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Martina Maurer
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | - Heidi A Lane
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | | | - Ruth Plummer
- Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - L Rhoda Molife
- The Royal Marsden/Institute of Cancer Research, Sutton, Surrey, United Kingdom
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Molife LR, Imseeh G, Capelan M, El-Khouly F, Cresti N, Smith AD, Averion D, Md. Haris N, Stimpson SJ, Gumbleton T, Lane HA, Bachmann F, Schmitt-Hoffmann A, Tzankov A, Hannah AL, Anderson S, Bette U, Calvert AH, Plummer R, Kristeleit RS. Phase I/IIa trial of the novel microtubule inhibitor BAL101553 in advanced solid tumors: Phase I completed. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.2562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- L Rhoda Molife
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Marta Capelan
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Nicola Cresti
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Alan David Smith
- Drug Development Unit at The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Dexter Averion
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Noor Md. Haris
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Sarah Jane Stimpson
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Todd Gumbleton
- University College London Hospital, London, United Kingdom
| | - Heidi A Lane
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | - Felix Bachmann
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | | | - Alexandar Tzankov
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | | | | | - Ullrich Bette
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | | | - Ruth Plummer
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
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Schwartzberg LS, Yardley DA, Elias AD, Patel MR, Gucalp A, Burris HA, Peterson AC, Hannah AL, Blaney ME, Gibbons J, Tudor IC, Steinberg JL, LoRusso P, Infante JR, Hudis CA, Traina TA. Enzalutamide plus exemestane: A pilot study to assess safety, pharmacokinetics, and effects on circulating estrogens in women with advanced hormone-positive breast cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Denise A. Yardley
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN
| | | | - Manish R. Patel
- Florida Cancer Specialists and Research Institute, Sarasota, FL
| | - Ayca Gucalp
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Howard A. Burris
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN
| | | | | | | | | | | | | | | | | | - Clifford A. Hudis
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tiffany A. Traina
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Hoch U, Fry DG, Chia YL, Caygill K, Hannah AL, Perez EA, Cortez J, Awada A, O'Shaughnessy J, Twelves C, Rugo HS, Im SA, Xu B, Anderes KL, Davis DW. Etirinotecan pegol (EP) target-specific pharmacodynamic (PD) biomarkers measured in circulating tumor cells (CTCs) from patients in the phase III BEACON study in patients with metastatic breast cancer (mBC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1087 Background: EP is a unique topoisomerase 1 inhibitor that provides continuous exposure to SN38. EP demonstrated a 29% overall response rate in patients with mBC, leading to a phase III global BEACON study in patients with mBC. CTCs in patient blood samples provide a minimally invasive approach to detect PD markers of drug activity. We developed quantitative multiplex immunofluorescent assays to measure target-specific PD biomarkers for EP in CTCs isolated pre- and post-treatment. Methods: Assays for Top1, Top2, g-H2Ax, Rad51, ABCG2, and Ki-67 were developed using control (0.1% DMSO) and drug-treated (SN38, 10 uM) tumor cell lines (HCT116, MCF7, A549, SKBr3) and PBMCs from healthy donors. The optimal antibody for each biomarker was then multiplexed in a panel with antibodies against cytokeratin, CD45 and DAPI for phenotypic identification of CTCs. For analysis of BEACON pts, serial 7.5 mL whole blood samples were drawn and shipped ambient to Apocell (Houston, TX) for further processing. PBMCs were separated and CTCs were isolated using ApoStream technology. CTCs were stained for PD markers and analyzed using an iCys laser scanning cytometer equipped with image analysis software. Results: Antibodies bound to tumor cells showed staining confined to the nucleus (Top1, Top2, g-H2AX, Ki-67) or membrane (ABCG2), exhibited defined peak separation from their isotype controls, and signal strength correlated with cellular expression of high and low levels of markers. To date, ~ 80% of BEACON pts consent to participate in the CTC sub-study. As of 30 Oct 2012, data from 167 pre-dose blood samples from BEACON pts were available. 99% of blood samples were successfully processed. 93% had detectable CTCs, yielding a median of 216 CTCs (range: 7.5-14816). Staining was positive for Top1, Top2, g-H2Ax, Rad51, ABCG2, and Ki-67 in 82%, 89%, 16%, 53%, 31%, 52% of samples, respectively. Conclusions: EP target-specific pharmacodynamic biomarkers can be reliably measured in CTCs isolated from patients participating in BEACON. Sample collection and analysis of pre- and post-treatment samples is ongoing. Clinical trial information: NCT01492101.
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Affiliation(s)
- Ute Hoch
- Nektar Therapeutics, San Francisco, CA
| | | | | | | | | | | | - Javier Cortez
- Vall d'Hebron Institute of Oncoloy, Barcelona, Spain
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | | | - Christopher Twelves
- University of Leeds and St. James's University Hospital, Leeds, United Kingdom
| | - Hope S. Rugo
- University of California, San Francisco, San Francisco, CA
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Binghe Xu
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Calvert AH, Gonzalez M, Ganguli S, Ng M, Benafif S, Capelan M, Goldstein R, Shah K, Jarvis C, Flynn M, Forster M, Anderson S, Schmitt-Hoffman A, Lane H, Engelhardt M, Hannah AL, Tzankov A, Bachmann F, Molife LR, Kristeleit R. A first-in-human (FIH) dose-escalation study of the safety, pharmacokinetics (PK), and pharmacodynamics (PD) of intravenous BAL101553, a novel microtubule inhibitor, in adult patients with advanced solid tumors. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2566 Background: BAL101553, a pro-drug of the small molecule BAL27862, is a novel microtubule targeting agent (MTA) with cytotoxic and vascular disrupting properties. Pre-clinical data showed anti-proliferative activity in several in vitro and xenograft tumour models, including tumours refractory to conventional MTAs through diverse resistance mechanisms. Primary objectives of this FIH study were determination of the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT). Secondary objectives included the evaluation of PK, PD and anti-tumour activity. Methods: An accelerated titration dose-escalation design was used. Eligible patients (pts) with advanced solid tumours, who had failed standard therapy, received BAL101553 as a 2-h intravenous infusion on days 1, 8 and 15 of a 28-day cycle. Adverse events (AEs) were assessed according to CTCAEv4. Disease response was assessed by RECIST 1.1 every 2 cycles. Results: 16 pts (7 male; median age 52 years; range 29-80) with solid tumours were treated at 4 dose levels (15, 30, 45 and 60 mg/m2). DLTs were observed at 60 mg/m2 and included rapidly reversible grade (G) 3 hypertension (HTN) and G3 reduced mobility/ dizziness. DLT criteria for HTN were subsequently modified. Frequent drug-related AEs were injection site reactions, nausea, vomiting (all G1-2), and G2-3 HTN (transient during the infusion; responding to nifedipine). One pt experienced G2 peripheral neuropathy at 60 mg/m2. PK analyses indicated conversion of BAL101553 to the active BAL27862, dose proportional exposure for both compounds and a half-life of BAL27862 in a range of 11 to 27 h. Preliminary tumour PD data comparing pre/post biopsies showed loss of CD34+ capillaries and focally decreased proliferation. A confirmed partial response was demonstrated in 1 pt with ampullary (pancreaticobiliary) cancer maintained on treatment for >16 cycles with intra-pt dose escalation. 2 pts (laryngeal and rectal cancer) demonstrated stable disease >16 weeks. Conclusions: BAL101553 is well tolerated up to 60 mg/m2 with evidence of anti-tumour activity. Dose escalation continues to determine the MTD. Clinical trial information: NCT01397929.
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Affiliation(s)
| | | | - Sushila Ganguli
- University College London Hospitals NHS Foundation Trust, london, United Kingdom
| | - Matthew Ng
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Sarah Benafif
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Marta Capelan
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Robert Goldstein
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Krunal Shah
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Claire Jarvis
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | - Heidi Lane
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | | | | | - Alexandar Tzankov
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Felix Bachmann
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | - L Rhoda Molife
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Konner J, Grisham RN, Park J, O’Connor OA, Cropp G, Johnson R, Hannah AL, Hensley ML, Sabbatini P, Mironov S, Danishefsky S, Hyman D, Spriggs DR, Dupont J, Aghajanian C. Erratum to: Phase I clinical, pharmacokinetic, and pharmacodynamic study of KOS-862 (Epothilone D) in patients with advanced solid tumors and lymphoma. Invest New Drugs 2012. [DOI: 10.1007/s10637-011-9780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Konner J, Grisham RN, Park J, O'Connor OA, Cropp G, Johnson R, Hannah AL, Hensley ML, Sabbatini P, Mironov S, Miranov S, Danishefsky S, Hyman D, Spriggs DR, Dupont J, Aghajanian C. Phase I clinical, pharmacokinetic, and pharmacodynamic study of KOS-862 (Epothilone D) in patients with advanced solid tumors and lymphoma. Invest New Drugs 2012; 30:2294-302. [PMID: 22072399 PMCID: PMC4003559 DOI: 10.1007/s10637-011-9765-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 10/19/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To determine the maximum tolerated dose and safety of the epothilone, KOS-862, in patients with advanced solid tumors or lymphoma. PATIENTS AND METHODS Patients were treated weekly for 3 out of 4 weeks (Schedule A) or 2 out of 3 weeks (Schedule B) with KOS-862 (16-120 mg/m(2)). Pharmacokinetic (PK) sampling was performed during cycles 1 and 2; pharmacodynamic (PD) assessment for microtubule bundle formation (MTBF) was performed after the 1st dose, only at or above 100 mg/m(2). RESULTS Thirty-two patients were enrolled, and twenty-nine completed ≥1 cycle of therapy. Dose limiting toxicity [DLT] was observed at 120 mg/m(2). PK data were linear from 16 to 100 mg/m(2), with proportional increases in mean C(max) and AUC(tot) as a function of dose. Full PK analysis (mean ± SD) at 100 mg/m(2) revealed the following: half-life (t (½)) = 9.1 ± 2.2 h; volume of distribution (V(z)) = 119 ± 41 L/m(2); clearance (CL) = 9.3 ± 3.2 L/h/m(2). MTBF (n = 9) was seen in 40% of PBMCs within 1 h and in 15% of PBMC at 24-hours post infusion at 100 mg/m(2). Tumor shrinkage (n = 2, lymphoma), stable disease >3 months (n = 5, renal, prostate, oropharynx, cholangiocarcinoma, and Hodgkin lymphoma), and tumor marker reductions (n = 1, colorectal cancer/CEA) were observed. CONCLUSION KOS-862 was well tolerated with manageable toxicity, favorable PK profile, and the suggestion of clinical activity. The maximum tolerated dose was determined to be 100 mg/m(2) weekly 3-on/1-off. MTBF can be demonstrated in PBMCs of patients exposed to KOS-862.
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Affiliation(s)
- Jason Konner
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Montgomery RB, Joshua A, Hannah AL, Peterson AC, Lopez C, Gleave ME, Taplin ME. A randomized, open-label, phase II study of MDV3100 alone or in combination with leuprolide and dutasteride as neoadjuvant therapy to prostatectomy in intermediate and high-risk prostate cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.tps4695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4695 Background: MDV3100 is a potent androgen receptor (AR) signaling inhibitor (ARSI) that inhibits AR signaling via three mechanisms: inhibition of androgen binding to AR, inhibition of AR nuclear translocation, and inhibition of nuclear AR-DNA binding. In vivo, MDV3100 induces significant prostate cancer apoptosis, an effect not seen with anti-androgens. To date, the use of neoadjuvant androgen deprivation therapy has not led to an improvement in time to PSA progression (Soloway 2002; Aus 2002). While serum androgens may be suppressed using luteinizing hormone-releasing hormone agonists, intratumoral levels of androgens remain, driving continued AR signaling and prostate cancer survival. More effective inhibition of AR signaling may improve local and systemic disease control. Methods: MDV3100-07 will assess the effect of 6 mos of neoadjuvant AR blockade with AR inhibition alone (MDV3100) or in combination with maximal suppression of androgens (MDV3100 +leuprolide [L] + dutasteride [D]). Eligible patients will have treatment-naive localized prostate cancer and be candidates for radical prostatectomy. Patients must have either PSA > 10 ng/mL or Gleason score ≥ 7 (4 + 3) with ≥3 cores containing tumor. Patients with evidence of metastatic/nodal disease are excluded. All patients receive MDV3100 (160 mg/d PO); those randomized to MDV3100+L+D therapy also receive L (22.5mg IM q3m) and D (0.5 mg/day PO). Serum/tumor androgen levels will be serially assessed. Tissue from the diagnostic and prostatectomy specimens will be evaluated for androgen levels, AR signaling profiles, and selected markers of apoptosis and mitotic indices. The primary efficacy endpoint is pathological complete response (pCR) rate at time of radical prostatectomy. For each arm, the percent of patients who achieve a pCR will be compared to the percent pCR in patients treated with neoadjuvant leuprolide, estimated to be 5% in a mixed low-to-intermediate risk population. Target Accrual: 40 pts will be randomized 1:1 to MDV3100 or MDV3100+L+D therapy. Keywords:MDV3100, prostate cancer, androgen receptor, anti-androgen, Phase 2, neoadjuvant.
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Awada A, Leung ACF, Zhao C, Hannah AL, Perez EA. OT3-01-07: The BEACON Study (BrEAst Cancer Outcomes with NKTR-102): A Phase 3 Open-Label, Randomized, Multicenter Study of NKTR-102 Versus Treatment of Physician's Choice (TPC) in Patients (pts) with Locally Recurrent or Metastatic Breast Cancer (MBC) Previously Treated with an Anthracycline, a Taxane, and Capecitabine (ATC). Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-ot3-01-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
NKTR-102 is a next-generation topoisomerase I inhibitor-polymer conjugate with a markedly reduced Cmax and a continuous exposure profile compared to irinotecan. A phase 2 trial of single-agent NKTR-102 compared a dose of 145 mg/m2 every 2w or every 3w in 3rd-line MBC (Awada et al, ASCO 2011). Overall the ORR was 29% (including 3% CR) with the prior ATC subset demonstrating an ORR of 31%. Dosing every 3w was better tolerated; in this arm, median PFS equaled 5.3m and median OS equaled 13.1m.
Trial Design: NKTR-102 will be compared to TPC in an open-label, randomized, parallel, two arm multicenter Phase 3 pivotal study in pts with previously treated locally recurrent or metastatic breast cancer.
Key Entry Criteria: Adult females, with ECOG 0 or 1 with adequate liver, kidney and marrow function. All patients must have received prior therapy with an anthracycline (in neo/adjuvant or metastatic setting or both), a taxane (in neo/adjuvant or metastatic setting or both) and capecitabine (in neo/adjuvant or locally advanced/metastatic setting or both) unless not medically appropriate or explicitly contraindicated for the patient. All chemotherapy- and radiation-related toxicities must have resolved to ≤ Grade 1, except for stable sensory neuropathy ≤ Grade 2 and alopecia. Pts with brain metastases may be eligible, if stable for prior 4 weeks without steroids. Pts with Grade ≥ 2 pre-existing diarrhea or receiving chronic anti-diarrheal supportive care are not eligible.
Statistical Methods: The primary efficacy endpoint is OS. Secondary endpoints include ORR by RECIST v1.1 and PFS. Pts will be randomized 1:1 to NKTR-102 given IV at 145 mg/m2 over 90-min every 21 days or TPC. Patients randomized to TPC will receive single agent chemotherapy, limited to choice of one of the following 5 agents: eribulin, ixabepilone, vinorelbine, gemcitabine, or a taxane. The investigator must decide which agent will be given to the patient prior to randomization. Pts will be stratified by geographical region and disease characteristics.
Target Accrual: Approximately 840 patients (420 pts per treatment arm) will be randomized in order to obtain 615 deaths (alpha = 0.05; power 90% with one interim analysis scheduled when 50% of the deaths have occurred). PK sampling will be performed in a subset of pts and blood and/or tumor samples are planned for potential predictive markers of response and toxicity. Enrollment is expected to remain open until the end of 2013.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT3-01-07.
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Affiliation(s)
- A Awada
- 1Universite Libre de Bruxelles, Brussels, Belgium; Nektar Therapeutics, San Francisco, CA; Mayo Clinic, Jacksonville, FL
| | - ACF Leung
- 1Universite Libre de Bruxelles, Brussels, Belgium; Nektar Therapeutics, San Francisco, CA; Mayo Clinic, Jacksonville, FL
| | - C Zhao
- 1Universite Libre de Bruxelles, Brussels, Belgium; Nektar Therapeutics, San Francisco, CA; Mayo Clinic, Jacksonville, FL
| | - AL Hannah
- 1Universite Libre de Bruxelles, Brussels, Belgium; Nektar Therapeutics, San Francisco, CA; Mayo Clinic, Jacksonville, FL
| | - EA Perez
- 1Universite Libre de Bruxelles, Brussels, Belgium; Nektar Therapeutics, San Francisco, CA; Mayo Clinic, Jacksonville, FL
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Lam ET, Goel S, Schaaf LJ, Cropp GF, Hannah AL, Zhou Y, McCracken B, Haley BI, Johnson RG, Mani S, Villalona-Calero MA. Phase I dose escalation study of KOS-1584, a novel epothilone, in patients with advanced solid tumors. Cancer Chemother Pharmacol 2011; 69:523-31. [PMID: 21874318 DOI: 10.1007/s00280-011-1724-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 08/02/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE First-in-man study of KOS-1584, a second generation epothilone. METHODS Patients with advanced solid malignancies received KOS-1584 every 3 weeks until disease progression. Using a modified Fibonacci dose escalation scheme, one patient was enrolled at each dose level until the first instance of grade 2 toxicity. Thereafter, a standard 3 + 3 design was utilized. RESULTS Sixty-six patients in 14 cohorts were dosed from 0.8 to 48 mg/m(2). Diarrhea, arthralgias, and encephalopathy were dose-limiting toxicities (DLTs) at doses ≥36 mg/m(2). At the recommended phase II dose (RP2D), the most common adverse effects were peripheral neuropathy (low grade), fatigue, arthralgias/myalgias, and diarrhea (31, 6%). The incidence of neutropenia was low. The overall clearance, volume of distribution, and half-life of KOS-1584 were 11 ± 6.17 L/h/m(2), 327 ± 161 L/m(2), and 21.9 ± 8.75 h, respectively. The half-life for the seco-metabolite (KOS-1891) was 29.6 ± 13.8 h. KOS-1584 exhibited linear pharmacokinetics. A dose-dependent increase in microtubulin bundle formation was observed at doses ≥27 mg/m(2). Two patients achieved partial responses and 24 patients had stable disease (SD). CONCLUSIONS The RP2D of KOS-1584 is 36 mg/m(2). The lack of severe neurologic toxicity, diarrhea, neutropenia, or hypersensitivity reactions; favorable pharmacokinetic profile; and early evidence of activity support further evaluation.
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Affiliation(s)
- Elaine T Lam
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210-1240, USA
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