Olaparib maintenance versus placebo in platinum-sensitive non-small cell lung cancer: the Phase 2 randomized PIPSeN trial

BACKGROUND

Platinum-sensitivity is a phenotypic biomarker of Poly (ADP-ribose) polymerase inhibitors (PARPi) sensitivity in histotypes where PARPi are approved. Approximately one-third of non-small cell lung cancers (NSCLC) are platinum-sensitive. The double-blind, randomized phase II PIPSeN (NCT02679963) study evaluated olaparib, a PARPi, as maintenance therapy for patients with platinum-sensitive advanced NSCLC.

METHODS

Chemonaïve patients with ECOG performance status of 0-1, platinum-sensitive, EGFR- and ALK-wild-type, stage IIIB-IV NSCLC were randomized (R) to receive either olaparib (O) maintenance or a placebo (P). The primary objective was progression-free survival (PFS) from R. Secondary objectives included overall survival (OS) and safety. With an anticipated hazard ratio of 0.65, 144 patients were required to be randomized, and approximately 500 patients enrolled.

RESULTS

The trial was prematurely terminated because anti-PD(L)1 therapy was approved during the trial recruitment. A total of 182 patients were enrolled, with 60 patients randomized: 33 and 27 in the O and P arms, respectively. Patient and tumor characteristics were well-balanced between arms, except for alcohol intake (33% vs 11% in the O and P arms, respectively, p = 0.043). The median PFS was 2.9 and 2.0 months in the O and P arms, respectively (logrank p = 0.99). The median OS was 9.4 and 9.5 months in the O and P arms, respectively (p = 0.28). Grade ≥3 toxicities occurred in 15 and 8 patients in O and P arms, with no new safety concerns.

CONCLUSION

PIPSeN was terminated early after enrollment of only 50% of the pre-planned population, thus being statistically underpowered. Olaparib maintenance did neither improve median PFS nor OS in this patient population.

Abstract S12-04: COVID-19 disease in patients with lung cancer in Spain: GRAVID Lung Cancer Patients Disease (GRAVID study)

Background: Previous reports indicate that lung cancer patients are at an increased risk of severe COVID-19 disease and higher mortality rate compared to general population. However, prognostic factors are not yet clearly identified. The LunG canceR pAtients coVid19 Disease (GRAVID) study aimed to describe clinical characteristics, outcomes and predictors of poor prognosis in patients with lung cancer and COVID-19. Methods: In this large nationwide prospective study, medical records of lung cancer patients with COVID-19 diagnosis from 65 spanish hospitals were included. Clinical features, treatments and disease outcomes were collected. The primary endpoint was to determine any-cause mortality; secondary endpoints were hospitalization and admission at intensive care units (ICU). Risk factors of poor prognosis were identified by univariable and multivariable logistic regression models. Results: Overal, 447 patients were analysed. Mean age was 67.1 ± 9·8 years, and the majority were men (332, 74·3%) and current/former smokers (383 (85.7%). NSCLC was the most frequent cancer type (377, 84.5%), being adenocarcinoma (228, 51·0%) the predominant histology. 354 patients (79.2%) had unresectable stage III or metastatic disease, and 266 (59.5%) where receiving anticancer treatment, mostly first-line chemotherapy. 350 (78.3%) patients were hospitalized for a mean of 13·4 ± 11·4 days, 9 (2.0%) patients were admitted to ICU, and 146 (32.7%) patients died. Advanced disease and corticosteroid treatment at hospitalization were predictors of mortality. Non-terminal stage hospitalized patients with lymphocytopenia and high LDH showed an increased risk of death. Severity of COVID-19 correlated to mortality, admission at ICU and mechanical ventilation. Conclusion: With underlying comorbidities and immunocompromised status, patients with lung cancer and COVID-19 present high hospitalization and mortality rates. These outcomes, alongside the identification of prognostic factors, may inform physicians on risks and benefits for this population to provide individualized oncological care.

Citation Format: Jose Maria Mazarico Gallego, Antonio Calles, Monica Antoñanzas, Cristina Pangua, Xabier Mielgo Rubio, Ernest Nadal, Rafael Lopez Castro, Ana Lopez-Martin, Edel del Barco, Manuel Domine, Virginia Calvo, Pilar Diz, Carmen Sandoval, Elia Sais Girona, Ivana Gabriela Sullivan, M. Angeles Sala, Gema Garcia Ledo, Jose Ramon Jarabo, Rosa Alvarez Alvarez, Javier Baena, Maria Gonzalez-Cao, Mariano Provencio. COVID-19 disease in patients with lung cancer in Spain: GRAVID Lung Cancer Patients Disease (GRAVID study) [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S12-04.

Targeted Therapy in Locally Advanced and Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (LA-R/M HNSCC)

Surgery and radiotherapy are the standard treatment options for patients with squamous cell carcinoma of the head and neck (SCCHN). Chemoradiotherapy is an alternative for patients with locally advanced disease. In recurrent/metastatic disease and after progression to platin-based regimens, no standard treatments other than best supportive care are currently available. Most SCCHN tumours overexpress the epidermal growth factor receptor (EGFR). This receptor is a tyrosine-kinase membrane receptor that has been implicated in angiogenesis, tumour progression and resistance to different cancer treatments. In this review, we analysed the different drugs and pathways under development to treat SCCHN, especially recurrent/metastatic disease. Until now, the EGFR signalling pathway has been considered the most important target with respect to new drugs; however, new drugs, such as immunotherapies, are currently under study. As new treatments for SCCHN are developed, the influence of therapies with respect to overall survival, progression free survival and quality of life in patients with this disease is changing.

A 1.2-V 140-nW 10-bit Sigma-Delta Modulator for Electroencephalogram Applications

This paper presents a second-order Sigma-Delta modulator for electroencephalogram applications with 10 bits of resolution, 1.2 V of supply voltage, and only 140 nW of power consumption over a bandwidth of 25 Hz. Low-voltage operation has been achieved using quasi-floating-gate-based circuits. The use of a new class-AB operational amplifier in weak inversion allows very low power consumption. Experimental results show an energy efficiency of 1.6 pJ per quantization level, making it the most energy-efficient converter reported to date in the very low signal bandwidth range.

Phase I study of bi-weekly pemetrexed (P) plus cisplatin (C) in patients with advanced cancer

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Background: Cisplatin and pemetrexed have demonstrated clinical activity in several malignant tumors including mesothelioma and non small cell lung cancer. There is preclinical evidence of synergism between both agents as well as clinical non-overlapping toxicities, thus providing the rationale for their evaluation in combination. Our aim was to develop a well-tolerated combination of bi-weekly CP able to deliver higher dose intensity than the every 3-week standard. Methods: Escalating doses of P from a starting dose level of 300 mg/m2, with a fixed-dose of C 50 mg/m2, both biweekly on 28-day cycles, were administered to patients with refractory advanced solid malignancies and calculated creatinine clearance = 45 mL/min. Results: Twenty one patients (5 female/16 male); median age 61 (39–76); ECOG 0 (16), 1 (5); lung cancer (9); soft-tissue sarcoma (3); unknown primary, bladder, breast, rectum, esophagus, melanoma, mesothelioma, prostate, and tonsil (1, each) have received a total of 48 courses (median 2, range 0–5), at P dose levels of 300 mg/m2 [8 pts, Dose level 1 (DL1)], 400 mg/m2 (7 pts, DL2), and 500 mg/m2 (6 pts, DL3), with full doses of C. Four patients were non-evaluable (2 at DL1, 1 at DL2 and 1 at DL3) because of early PD (2) and non-drug related serious adverse event (2 pt). Dose Limiting Toxicities (DLT) were G4 neutropenia (1 pt) at 300 mg/m2; and prolonged G 1/2 thrombocytopenia (1 pt) at 500 mg/m2. There were also 2 pts with non-DLT G4 neutropenia at DL3. The rest of toxicities were mild to moderate being the most frequent asthenia, nausea, anorexia, stomatatis, and sensory neuropathy. DL3 was considered the Maximum Tolerated Dose (MTD) and the previous level with P at 400 mg/m2 was declared the recommended phase II dose. Three additional patients were treated at DL2 for dose confirmation. A PR has been observed in 2 pts with NSCLC, 1 pt with breast, and 1 with esophagus cancer. Conclusions: Biweekly administration of pemetrexed (400 mg/m2) plus cisplatin (50 mg/m2) is clinically well tolerated and can be used safely. The regimen delivers higher dose intensity of P and equal of C as the standard. This regimen is currently being studied in a phase 2 trial in patients with locally advanced, non resectable or metastatic urothelial cancer.

No significant financial relationships to disclose.