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Barry B, Dolivet G, Clatot F, Huguet F, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Coste F, Cupissol D, Cuvelier P, De Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, De Raucourt D. [French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]. Bull Cancer 2024; 111:393-415. [PMID: 38418334 DOI: 10.1016/j.bulcan.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVES The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations. METHODOLOGY To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS). RESULTS The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients' care journey. CONCLUSION All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.
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Affiliation(s)
- Béatrix Barry
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, ORL et CCF, Nancy (54), France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Duffas
- Centre hospitalier de Libourne, ORL et CMF, Libourne, France
| | | | | | | | - Diane Evrard
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | | | - Nicolas Fakhry
- Assistance publique-Hôpitaux de Marseille, ORL et CCF, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didier Salvan
- Centre hospitalier Sud Francilien, ORL et CCF, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
| | - Véronique Block
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
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Dolivet G, Barry B, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Clatot F, Coste F, Cupissol D, Cuvelier P, de Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Huguet F, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, de Raucourt D. [National standard for the treatment of squamous cell carcinoma of upper aerodigestive tract]. Bull Cancer 2024; 111:327-332. [PMID: 38336530 DOI: 10.1016/j.bulcan.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Gilles Dolivet
- ORL et CCF, Institut de cancérologie de Lorraine, Nancy, France.
| | - Béatrix Barry
- ORL et CCF, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | | | | | | | | | | | | | | | | | - Philippe Cuvelier
- ORL et CCF libéral à Bayonne et centre hospitalier Oloron, Oloron-Sainte-Marie, France
| | | | | | - Olivier Duffas
- ORL et CMF, centre hospitalier de Libourne, Libourne, France
| | | | | | | | - Diane Evrard
- ORL et CCF, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | | | - Nicolas Fakhry
- ORL et CCF, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sophie Renard
- ORL et CCF, Institut de cancérologie de Lorraine, Nancy, France
| | - Didier Salvan
- ORL et CCF, centre hospitalier sud francilien, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif spécifique régional du cancer Grand Est - NEON, Nancy, France
| | - Véronique Block
- Dispositif spécifique régional du cancer Grand Est - NEON, Nancy, France
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Freyer G, Floquet A, Tredan O, Carrot A, Langlois-Jacques C, Lopez J, Selle F, Abdeddaim C, Leary A, Dubot-Poitelon C, Fabbro M, Gladieff L, Lamuraglia M. Bevacizumab, olaparib, and durvalumab in patients with relapsed ovarian cancer: a phase II clinical trial from the GINECO group. Nat Commun 2024; 15:1985. [PMID: 38443333 PMCID: PMC10914754 DOI: 10.1038/s41467-024-45974-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/29/2022] [Accepted: 02/08/2024] [Indexed: 03/07/2024] Open
Abstract
Most patients with advanced ovarian cancer (AOC) ultimately relapse after platinum-based chemotherapy. Combining bevacizumab, olaparib, and durvalumab likely drives synergistic activity. This open-label phase 2 study (NCT04015739) aimed to assess activity and safety of this triple combination in female patients with relapsed high-grade AOC following prior platinum-based therapy. Patients were treated with olaparib (300 mg orally, twice daily), the bevacizumab biosimilar FKB238 (15 mg/kg intravenously, once-every-3-weeks), and durvalumab (1.12 g intravenously, once-every-3-weeks) in nine French centers. The primary endpoint was the non-progression rate at 3 months for platinum-resistant relapse or 6 months for platinum-sensitive relapse per RECIST 1.1 and irRECIST. Secondary endpoints were CA-125 decline with CA-125 ELIMination rate constant K (KELIM-B) per CA-125 longitudinal kinetics over 100 days, progression free survival and overall survival, tumor response, and safety. Non-progression rates were 69.8% (90%CI 55.9%-80.0%) at 3 months for platinum-resistant relapse patients (N = 41), meeting the prespecified endpoint, and 43.8% (90%CI 29.0%-57.4%) at 6 months for platinum-sensitive relapse (N = 33), not meeting the prespecified endpoint. Median progression-free survival was 4.1 months (95%CI 3.5-5.9) and 4.9 months (95%CI 2.9-7.0) respectively. Favorable KELIM-B was associated with better survival. No toxic deaths or major safety signals were observed. Here we show that further investigation of this triple combination may be considered in AOC patients with platinum-resistant relapse.
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Affiliation(s)
- Gilles Freyer
- Department of Medical Oncology, Lyon 1 University, Lyon, France.
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France.
- Institut de Cancérologie des HCL, Lyon, France.
| | - Anne Floquet
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Department of Medical Oncology - Gynecological Tumors, Institut Bergonié, Bordeaux, France
| | - Olivier Tredan
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Aurore Carrot
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- EMR 3738, UFR Lyon-Sud, Université Lyon1, Lyon, France
| | - Carole Langlois-Jacques
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Biostatistics and Bioinformatics Department, Hospices Civils de Lyon, Lyon, France
| | - Jonathan Lopez
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Department of Biochemistry and Molecular Biology, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Selle
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Department of Medical Oncology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Cyril Abdeddaim
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Gynecologic Oncology Department, Centre Oscar Lambret, Lille, France
| | - Alexandra Leary
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Coraline Dubot-Poitelon
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Medical Oncology, Institut Curie Saint Cloud, Paris, France
| | - Michel Fabbro
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Laurence Gladieff
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Medical Oncology, Institut Claudius Regaud IUCT-Oncopole, Toulouse, France
| | - Michele Lamuraglia
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Medical Oncology, Institut de Cancérologie du CHUSE, Saint-Etienne, France
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André T, Berton D, Curigliano G, Sabatier R, Tinker AV, Oaknin A, Ellard S, de Braud F, Arkenau HT, Trigo J, Gravina A, Kristeleit R, Moreno V, Abdeddaim C, Vano YA, Samouëlian V, Miller R, Boni V, Torres AA, Gilbert L, Brown J, Dewal N, Dabrowski C, Antony G, Zografos E, Veneris J, Banerjee S. Antitumor Activity and Safety of Dostarlimab Monotherapy in Patients With Mismatch Repair Deficient Solid Tumors: A Nonrandomized Controlled Trial. JAMA Netw Open 2023; 6:e2341165. [PMID: 37917058 PMCID: PMC10623195 DOI: 10.1001/jamanetworkopen.2023.41165] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/14/2023] [Indexed: 11/03/2023] Open
Abstract
Importance Mismatch repair deficiency (dMMR) occurs in various cancers, and these tumors are attractive candidates for anti-programmed cell death 1 therapies, such as dostarlimab, a recently approved immune checkpoint inhibitor. Objective To assess the antitumor activity and safety of dostarlimab in patients with advanced or recurrent dMMR solid tumors. Design, Setting, And Participants The GARNET trial was a phase 1, open-label, single-group, multicenter study that began enrolling May 8, 2017. Participants had advanced or recurrent dMMR and microsatellite instability-high (MSI-H) or polymerase epsilon (POLE)-altered solid tumors. The data cut for this interim analysis was from November 1, 2021, with median follow-up of 27.7 months. Interventions Patients received 500 mg of dostarlimab intravenously every 3 weeks for 4 doses, then 1000 mg every 6 weeks until disease progression, discontinuation, or withdrawal. Main Outcomes and Measures The primary objective was to evaluate objective response rate and duration of response in patients with dMMR solid tumors by blinded independent central review using Response Evaluation Criteria in Solid Tumors, version 1.1. Results The efficacy population included 327 patients (median [range] age, 63 [24-85] years; 235 [71.9%] female; 7 [2.1%] Asian, 6 [1.8%] Black, and 206 [63.0%] White patients), with 141 patients (43.1%) with dMMR endometrial cancer, 105 patients (32.1%) with dMMR colorectal cancer, and 81 patients (24.8%) with other dMMR tumor types. All patients had at least 1 previous line of therapy. Objective response rate assessed per blinded independent central review for dMMR solid tumors was 44.0% (95% CI, 38.6% to 49.6%). Median duration of response was not reached (range, ≥1.18 to ≥47.21 months); 72.2% of responders (104 of 144) had a response lasting 12 or more months. Median progression-free survival was 6.9 months (95% CI, 4.2 to 13.6 months); probability of progression-free survival at 24 months was 40.6% (95% CI, 35.0% to 46.1%). Median overall survival was not reached (95% CI, 31.6 months to not reached). The most frequent immune-related adverse events were hypothyroidism (25 [6.9%]), alanine aminotransferase increase (21 [5.8%]), and arthralgia (17 [4.7%]). No new safety concerns were identified. Conclusions And Relevance In this nonrandomized controlled trial, dostarlimab was a well-tolerated treatment option with rapid, robust, and durable antitumor activity in patients with diverse dMMR solid tumors. These findings suggest that dostarlimab provides meaningful long-term benefit in a population with high unmet need. Trial Registration ClinicalTrials.gov Identifier: NCT02715284.
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Affiliation(s)
- Thierry André
- Saint-Antoine Hospital, INSERM, Unité Mixte de Recherche Scientifique 938, and SIRIC CURAMUS, Sorbonne University, Paris, France
| | - Dominique Berton
- GINECO and Institut de Cancerologie de l’Ouest, Centre René Gauducheau, Saint-Herblain, France
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS, Milan, Italy
- Department of Medical Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - Renaud Sabatier
- Department of Medical Oncology, Institut Paoli-Calmettes, CRCM, INSERM, CNRS, Aix-Marseille University, Marseille, France
| | - Anna V. Tinker
- BC Cancer–Vancouver, Vancouver, British Columbia, Canada
| | - Ana Oaknin
- Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Susan Ellard
- BC Cancer–Kelowna, Kelowna, British Columbia, Canada
| | - Filippo de Braud
- Ordinario di Oncologia Medica Direttore Scuola di Specialità in Oncologia Medica Università di Milano, Direttore Dipartimento Oncologia e Ematoncologia Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - José Trigo
- Medical Oncology Department, Hospital Virgen de la Victoria IBIMA, Malaga, Spain
| | - Adriano Gravina
- Clinical Trials Unit, Instituto Nazionale Tumori, IRCCS, Fondazione “G. Pascale,” Naples, Italy
| | | | - Victor Moreno
- START Madrid FJD, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Cyril Abdeddaim
- Centre de Lutte Contre le Cancer–Centre Oscar Lambret, Lille, France
| | - Yann-Alexandre Vano
- Department of Medical Oncology, Hôpital Européen Georges-Pompidou, Institut du Cancer Paris CARPEM, AP-HP Centre–Université Paris Cité, Paris, France
| | - Vanessa Samouëlian
- Gynecologic Oncology Division, Centre Hospitalier de l’Université de Montréal (CHUM), Centre de Recherche du CHUM, and Université de Montréal, Montreal, Quebec, Canada
| | - Rowan Miller
- University College London, St Bartholomew’s Hospital London, London, United Kingdom
| | - Valentina Boni
- NEXT Oncology Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - Antonio Antón Torres
- Department of Medical Oncology, Hospital Universitario Miguel Servet and IIS Aragon, Zaragoza, Spain
| | - Lucy Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jubilee Brown
- Division of Gynecologic Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | | | | | | | | | | | - Susana Banerjee
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
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5
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Gauduchon T, Kfoury M, Lorusso D, Floquet A, Ventriglia J, Salaun H, Moubarak M, Rivoirard R, Polastro L, Favier L, You B, Berton D, de la Motte Rouge T, Mansi L, Abdeddaim C, Prulhiere K, Lancry Lecomte L, Provansal M, Dalban C, Ray-Coquard I. PARP inhibitors (PARPi) prolongation after local therapy for oligo-metastatic progression in relapsed ovarian cancer patients. Gynecol Oncol 2023; 173:98-105. [PMID: 37105063 DOI: 10.1016/j.ygyno.2023.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/26/2022] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND PARP inhibitors (PARPi) have revolutionized the management of high-grade epithelial ovarian cancer (HGOC) treatment. However, a significant number of patients relapse or progress under PARPi, leading to the introduction of a new line of systemic therapy such as chemotherapy. In patients with a limited number of metastatic sites at progression, -referred to as an oligometastatic progression- a potential indication for local therapy followed by re-introduction or continuation of PARPi treatment rather than initiating a new line of chemotherapy could be proposed. However, the impact of such strategies on progression free survival (PFS) in these patients remains unknown. METHODS This international multicenter retrospective study evaluated the efficacy of PARPi continuation or re-introduction in patients with HGOC after local treatment for oligometastatic progression. The main objective was to assess PFS under PARPi after local therapy (PFS post-LT). Secondary objectives included safety and overall survival (OS). RESULTS 74 patients were identified in 20 centers between April 2020 and November 2021. 65% of patients were BRCA mutated and 92% had received ≥2 lines of prior systemic chemotherapy before the initial introduction of PARPi. Main progression sites were lymph nodes (42%), peritoneum (27%), liver (16%), other visceral (16%) and abdominal wall (4%). Local therapies included radiotherapy (45%), surgery (43%), both (7%), percutaneous thermal ablation (4%) or chemoembolization (1%). Median PFS post-LT was 11.5 months [95% CI 7.4; 17.2]. After a median follow up of 14.8 months, 6 patients (8.1%) discontinued PARPi due to toxicity. The 1-year overall survival rate was 90.7% [95% CI 79.1; 96.0]. CONCLUSIONS With close to one year without progression or introduction of a new line of systemic therapy, this study reports the feasibility and potential benefit of this original strategy in patients with oligometastatic progression under PARPi.
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Affiliation(s)
| | - Maria Kfoury
- Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Domenica Lorusso
- Gynecologic Oncology, Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | - Anne Floquet
- Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Jole Ventriglia
- Medical Oncology, IRCCS National Cancer Institute "Fondazione G. Pascale", Naples, Italy
| | | | - Malak Moubarak
- Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Romain Rivoirard
- Medical Oncology, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Laura Polastro
- Medical Oncology, Institut Jules Bordet, Brussels, Belgium
| | - Laure Favier
- Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Benoit You
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Groupement Hospitalier Sud, GINECO, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, EA 3738 CICLY, Lyon, France
| | - Dominique Berton
- Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | - Laura Mansi
- Medical Oncology, Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz, Besançon, France
| | | | | | | | | | - Cécile Dalban
- Department of Biostatistics, Direction de Recherche Clinique et de l'innovation du Centre Léon Bérard, Lyon 69008, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est Inserm, Lyon 69008, France.
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6
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Cherifi F, Lefevre Arbogast S, Font J, Abdeddaim C, Becourt S, Penel N, Coquan E, Lequesne J, Gidron Y, Joly F. The promising prognostic value of vagal nerve activity at the initial management of ovarian cancer. Front Oncol 2022; 12:1049970. [PMID: 36523968 PMCID: PMC9745166 DOI: 10.3389/fonc.2022.1049970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/21/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Identifying new modifiable prognostic markers is important for ovarian cancer (OC). Low parasympathic activity is associated with inflammation, oxidative stress and sympathetic nervous system activation. Previous studies reported that low vagal nerve activity, measured by low heart rate variability (HRV), may predict poor cancer prognosis. We aimed to examine the prognostic value of HRV in OC. METHODS This bicentric retrospective study included patients diagnosed with serous OC FIGO stage ≥IIB, between January 2015 and August 2019, with electrocardiograms (ECG) available around diagnosis. HRV was measured from ECG using the time domain parameter of standard deviation of all normal-to-normal heartbeat intervals (SDNN). Optimal SDNN cut-off was determined using the Youden index criteria of time-dependent ROC curves. We used multivariate cox proportional hazard models to investigate the association between HRV and overall survival (OS), while adjusting for well-known OC prognostic factors. RESULTS The 202 patients included were 65.7 years-old on average, 93% had stage FIGO IIIC/IV, 56% had complete surgical resection. Median OS was 38.6 months [95%CI:34.4-47.4]. The median SDNN was 11.1ms, with an optimal cut-off of 10ms to predict OS. OS was shorter for patients with low HRV compared to high HRV (26.4 vs 45.1 months; p<0.001). In multivariate analysis, HRV remained an independent prognostic factor with a two-fold higher risk of death among patients with low SDNN compared to those with high SDNN (HR=2.03, 95%CI=1.35-3.06, p<0.001). CONCLUSION Low HRV, was associated with worse OS in OC patients, supporting previous studies on the prognostic role of HRV in cancer. If replicated in prospective studies, vagal nerve activity may be a new therapeutic target in OC.
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Affiliation(s)
- François Cherifi
- Department of Medical Oncology, Centre François Baclesse, Caen, France
- Department of Clinical Research, Centre Francois Baclesse, Caen, France
| | - Sophie Lefevre Arbogast
- Department of Clinical Research, Centre Francois Baclesse, Caen, France
- Normandie Université, UNICAEN, Institut National de la Santé et de la Recherche Médicale (Inserm) U1086, ANTICIPE, Caen, France
| | - Jonaz Font
- Department of Cardiology, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Cyril Abdeddaim
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Elodie Coquan
- Department of Medical Oncology, Centre François Baclesse, Caen, France
- Department of Clinical Research, Centre Francois Baclesse, Caen, France
| | - Justine Lequesne
- Department of Clinical Research, Centre Francois Baclesse, Caen, France
| | - Yori Gidron
- Department of Nursing, Faculty of Health Sciences, Haifa University, Haifa, Israel
| | - Florence Joly
- Department of Medical Oncology, Centre François Baclesse, Caen, France
- Normandie Université, UNICAEN, Institut National de la Santé et de la Recherche Médicale (Inserm) U1086, ANTICIPE, Caen, France
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7
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Thibault G, Kfoury M, Lorusso D, Floquet A, Ventriglia J, Salaun H, Moubarak M, Rivoirard R, Polastro L, Favier L, You B, Berton-Rigaud D, De La Motte Rouge T, Mansi L, Abdeddaim C, Prulhiere K, Lancry Lecomte L, Provansal Gross M, Dalban C, Ray-Coquard I. 528MO Is re-introduction or continuation of PARP inhibitors after local therapy for oligo-metastatic progression in patients with relapsed ovarian cancer relevant? Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.656] [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: 11/25/2022] Open
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8
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You B, Leary A, Rodrigues M, Follana P, Abdeddaim C, Joly F, Bin S, Villeneuve L, Alexandre M, Boutitie F, Maucort-Boulch D, Schwiertz V, Freyer G. Abstract CT005: Safety and efficacy of olaparib combined to metronomic cyclophosphamide and metformin in recurrent advanced/metastatic endometrial cancer patients: ENDOLA trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct005] [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
Objectives: In patients with recurrent advanced endometrial carcinomas (EC), innovative treatments are needed after platinum chemotherapy. EC are characterized by frequent defective DNA repair, along with alterations of PI3K-AKT-mTor, and IGF1R pathways. In preclinical studies, the activity of PARP inhibitor is increased by the inhibition of PI3K-AKT pathway. Metformin inhibits the PI3K-AKT-mTor signaling pathway, and reduces IGF1 circulating levels. Metronomic cyclophosphamide may increase the activity of PARP inhibitors through DNA alkylating and anti-angiogenic effects. ENDOLA trial was meant to assess the safety and efficacy of the triplet olaparib (PARP 1-3 inhibitor) + metronomic cyclophosphamide + metformin in patients with advanced EC
Methods: ENDOLA trial (NCT02755844) was an academic French prospective multicenter phase I/II open-label dose-escalation study meant to assess the safety, the Recommended Phase II trial Dose (RP2D), and the efficacy of olaparib combined to metronomic cyclophosphamide 50 mg PO QD and metformin 500 mg PO TID in patients with recurrent advanced EC. In the phase I part, olaparib was dose-escalated from PO 150 mg to 300 mg BID with a continual reassessment method (CRM), aiming at defining the RP2D. In the phase II part, the cohort was expanded to assess the efficacy of the triplet in terms of non-progression rate at 10 weeks (H0= 20%; H1= 50%; 1-sided α risk=0.01; power = 90%).
Results: From Sept 2016 to Nov 2019, 35 patients enrolled, and 31 were assessable (median age: 69, IQR: 62-72; endometrioid: n=18 (51.4%); serous: n=11 (35.5%); carcinosarcoma: n=2 (6.5%)). In the phase I part (17 patients), 1 DLT (5.9%) was observed: grade 3 fatigue during cycle 1 at 150 mg. Dose-escalation was possible up to 300 mg BID, that was the RP2D. In the phase II part (14 patients), the overall response rate was 20.8%, and the disease-control rate was 66.6 %. The non-progression rate at 10 weeks was 61.5% (95% CI 42.8-80.2). The median PFS was 5.1 months, including 7.5 months (5.1-8.9) for endometrioid, and 4.3 months (2.7-5.8) for serous carcinomas. Treatment-related serious adverse-events (AEs) occurred in 3 patients (grade 3 fatigue; grade 4 lymphopenia; grade 4 lymphopenia & neutropenia). The most frequent grade 3-4 treatment-related AEs were lymphopenia (32.3%); anemia (16.1%); neutropenia (16.1%); and fatigue (12.9%).
Conclusions: In heavily pre-treated patients with advanced EC, olaparib 300 mg BID could be safely combined to metformin 1500 mg/day and metronomic cyclophosphamide 50 mg/day. With a 61.5% non-progression rate at 10 weeks, the 1st-objective was reached. The 5.1 month median PFS (7.5 for endometrioid and 4.3 for serous) is promising compared to those observed with chemotherapy or immunotherapy-based combination in KEYNOTE-775 (Colombo et al. Proc ESMO 2021). Investigation in phase III is warranted.
Citation Format: Benoit You, Alexandra Leary, Manuel Rodrigues, Philippe Follana, Cyril Abdeddaim, Florence Joly, Sylvie Bin, Laurent Villeneuve, Marine Alexandre, Florent Boutitie, Delphine Maucort-Boulch, Verane Schwiertz, Gilles Freyer. Safety and efficacy of olaparib combined to metronomic cyclophosphamide and metformin in recurrent advanced/metastatic endometrial cancer patients: ENDOLA trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT005.
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Affiliation(s)
- Benoit You
- 1CITOHL, IC-HCL, HCL, GINECO, Pierre Benite, France
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9
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Ray-Coquard IL, Penel N, Bompas E, Coquan E, Soulie P, Cousin S, Bertucci F, Tosi D, Heudel PE, Abdeddaim C, Pautier P, Kalbacher E, Selle F, Floquet A, Gambotti L, Simon C, Lamrani-Ghaouti A, Chevret S, Even C. Potential clinical activity of pembrolizumab monotherapy in ovarian sex cords, rare epithelial carcinoma, and other rare ovarian tumor histotypes: The French AcSé pembrolizumab study from Unicancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5572] [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: 11/20/2022] Open
Abstract
5572 Background: AcSé Pembrolizumab is a Phase 2, non-randomized parallel arms, multicentric basket trial investigating the efficacy and safety of pembrolizumab monotherapy in different cohorts of patients with rare cancers (NCT03012620). Here we report the results in the rare ovarian tumors cohort. Methods: Selected histotypes were all rare ovarian cancers (incidence < 6/100,000/year). Main inclusion criteria were age > 18, ECOG PS≤1, resistant disease to platinum based chemotherapy, and systematic histological central review by expert pathologist from TMRG network. Patients (pts) received pembrolizumab 200 mg IV on Day 1 of every 21-day cycle for a maximum of 2 years. The primary endpoint was the confirmed objective response rate according to RECIST v1.1 at 12 weeks. Secondary endpoints included best response rate, duration of response, progression-free survival (PFS), overall survival (OS), and safety. The 7 subgroups of pts analyzed were carcinosarcoma (CS), clear cell carcinoma (CCC), low grade serous carcinoma (LGSC), mucinous carcinoma (MEOC), sex cord tumors (SCT), germ cell tumor (GCT), and smarcA4 deficient hypercalcemic ovarian tumor (SCHOCCT). Results: 62 pts from 22 centers, were included from 08/2017 to 12/2020. Median Age was 53.5 years old [36-64]. Median number of previous lines of chemotherapy was 2 (range 1-4). The median number of cycles was 8 (range, 1-35) with 44 pts (70.9%) who discontinued the trial after a mean number of 6.8 cycles. There were 2 pts (3.2%) with partial response (PR) at 12 weeks. The best response in ITT was complete response (CR) in 1 patient (1%), PR in 3 (14.3%), and stable disease (SD) in 21 (33.8%). The occurrence of best response depended on the histotype with 1 CR (33%) in GCT (cancerized teratoma), 2 PR (20%) in CCC, and 1 PR (4%) in LGSC. 4/4 pts (100%) reported PD as best response in SCOOHT (Table 1). Median duration of response or stabilized disease was 7.8 months [IQR, 4.1 to 9.0]. At the data cut off, 6-month PFS was 29% [19.7-42.8] and 6-month OS was 77.8% [67.7-89.3] on the overall population. Outcomes differed according to subgroups and will be presented. There were a total of 62 adverse events (AEs) reported in 28 pts. For 5 pts (8%) AEs lead to drug discontinuation. AEs were of grade 1 (n = 9), grade 2 (n = 8), or grade ≥ 3 (n = 45: 42 grade 3, 2 grade 4, and 1 grade 5). Conclusions: Pembrolizumab is safe and well tolerate in this population of rare ovarian cancer pts. AcSé study reports prolonged responses in very selected subtypes of rare ovarian tumor (CCC, cancerized teratoma, and LGCS). Acknowledgements: TMRG (national cancer network dedicated to rare gynecological tumors), GINECO group for partnership, La Ligue Nationale contre le Cancer, INCa and MSD. Clinical trial information: NCT03012620. [Table: see text]
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Affiliation(s)
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | | | | | | | | | - Francois Bertucci
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Diego Tosi
- Medical Oncology Department, Institut du Cancer de Montpellier, Montpellier, France
| | | | - Cyril Abdeddaim
- Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
| | - Patricia Pautier
- GINECO, French Sarcoma Group and Gustave Roussy Cancer Center, Villejuif, France
| | - Elsa Kalbacher
- Groupe d’Investigateurs Nationaux pour l’Etute des Cancers Ovariens and CHRU Jean Minjoz, Besançon, France
| | | | - Anne Floquet
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, and Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens, Bordeaux, France
| | | | | | | | | | - Caroline Even
- Head and Neck Department, Gustave Roussy, Villejuif, France
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10
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Heudel P, Frenel JS, Dalban C, Bazan F, Joly F, Arnaud A, Abdeddaim C, Chevalier-Place A, Augereau P, Pautier P, Chakiba C, You B, Lancry-Lecomte L, Garin G, Marcel V, Diaz JJ, Treilleux I, Pérol D, Fabbro M, Ray-Coquard I. Safety and Efficacy of the mTOR Inhibitor, Vistusertib, Combined With Anastrozole in Patients With Hormone Receptor-Positive Recurrent or Metastatic Endometrial Cancer: The VICTORIA Multicenter, Open-label, Phase 1/2 Randomized Clinical Trial. JAMA Oncol 2022; 8:1001-1009. [PMID: 35551299 PMCID: PMC9100474 DOI: 10.1001/jamaoncol.2022.1047] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Endometrial cancer is often hormone-dependent and treated with aromatase inhibitors. The PI3K-AKT-mTOR pathway deregulation observed in endometrial cancer drives hormonal resistance, thus supporting the rationale of combining mTOR inhibitor with endocrine therapy. Objective To evaluate the safety and efficacy of vistusertib in combination with anastrozole in the treatment of women with hormone receptor-positive recurrent or metastatic endometrial cancer. Design, Settings, and Participants The VICTORIA study was a multicenter, open-label, randomized clinical trial that accrued 75 patients with hormone receptor-positive recurrent or metastatic endometrial cancer from 12 cancer centers in France in April 2016 to October 2019. After a safety run-in period, a Simon 2-stage design was used. Data analyses were performed from December 11, 2020, to March 11, 2021. Interventions Patients were randomized in a 2:1 ratio to oral vistusertib (125 mg twice daily 2 days per week) and oral anastrozole (1 mg daily) in the combination vistusertib with anastrozole arm (V+A arm) or oral anastrozole alone (A arm). Main Outcomes and Measures The primary end point was serious adverse events for the safety run-in period and progression-free rate at 8 weeks (8wk-PFR)-assessed with a blinded independent central review in phase 2. The secondary end points were objective response rate, duration of response, progression-free survival (PFS), overall survival, and incidence of adverse events. Results Of the 75 patients who were randomized, 73 (median [range] age, 69.5 [37-88] y; all female) were treated: V+A arm, 49 patients; A arm, 24 patients. In the V+A arm, the 8wk-PFR was 67.3% (unilateral 95% CI, 54.7%) and in the A arm, 39.1% (unilateral 95% CI, 22.2%). No significant serious adverse events were reported during the safety run-in period (n = 6 in V+A arm). The overall response rate was 24.5% (95% CI, 13.3%-38.9%) in the V+A arm vs 17.4% (95% CI, 5.0%-38.8%) in the A arm. With a median follow-up of 27.7 months, median PFS was 5.2 (95% CI, 3.4-8.9) in the V+A arm and 1.9 (95% CI, 1.6-8.9) months in the A arm. Fatigue, lymphopenia, hyperglycemia, and diarrhea were the most common (grade ≥2) adverse events associated with vistusertib. Conclusions and Relevance This multicenter, open-label, phase 1/2 randomized clinical trial demonstrated that adding vistusertib to anastrozole improved 8wk-PFR, overall response rate, and PFS for patients with endometrial cancer and had manageable adverse events. Identification of molecular subgroups would allow for more precise selection of patients who may be most likely to experience favorable outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT02730923.
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Affiliation(s)
- Pierre Heudel
- Medical Oncology Department, Centre Léon Bérard, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France.,Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France
| | - Jean-Sébastien Frenel
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France.,Medical Oncology Department Institut Cancérologie de l'Ouest, St Herblain, France
| | - Cécile Dalban
- Clinical Research Department, Centre Léon Bérard, Lyon, France
| | - Fernando Bazan
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France.,Medical Oncology Department, Hôpital Jean Minjoz, Besançon, France
| | - Florence Joly
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France.,Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Antoine Arnaud
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France.,Institut Sainte Catherine, Avignon, France
| | - Cyril Abdeddaim
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France.,Centre Oscar Lambret, Lille, France
| | - Annick Chevalier-Place
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France.,Centre Oscar Lambret, Lille, France
| | - Paule Augereau
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France.,Institut Cancérologie Paul Papin, Angers, France
| | - Patricia Pautier
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France.,Institut Gustave Roussy, Villejuif, France
| | - Camille Chakiba
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France.,Institut Bergonié, Bordeaux, France
| | - Benoit You
- University Claude Bernard Lyon 1, Lyon, France.,Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France.,Department of Medical Oncology, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,EMR EA UCBL/HCL 3738 CICLY, Lyon, France
| | - Laurence Lancry-Lecomte
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France.,Institut Daniel Hollard, Grenoble, France
| | - Gwenaelle Garin
- Clinical Research Department, Centre Léon Bérard, Lyon, France
| | - Virginie Marcel
- University Claude Bernard Lyon 1, Lyon, France.,Inserm U1052, CNRS UMR5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France.,Institut Convergence PLAsCAN, Lyon, France
| | - Jean Jacques Diaz
- University Claude Bernard Lyon 1, Lyon, France.,Inserm U1052, CNRS UMR5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France.,Institut Convergence PLAsCAN, Lyon, France
| | - Isabelle Treilleux
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France.,Biopathology Department, Centre Léon Bérard, Lyon, France
| | - David Pérol
- Clinical Research Department, Centre Léon Bérard, Lyon, France
| | - Michel Fabbro
- Medical Oncology Department, Institut de Cancérologie de Montpellier, Montpellier, France
| | - Isabelle Ray-Coquard
- Medical Oncology Department, Centre Léon Bérard, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France.,Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein, France
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11
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Andre T, De Braud FG, Jimenez-Rodriguez B, Berton D, Curigliano G, Arkenau T, Antón Torres A, Paez D, Ellard S, Abdeddaim C, Castanon Alvarez E, Aubin F, Duan T, Veneris JT, Zografos E, Starling N. Antitumor activity and safety of dostarlimab monotherapy in patients with mismatch repair deficient non-endometrial solid tumors: A post-hoc subgroup analysis of patients with colorectal cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.201] [Citation(s) in RCA: 1] [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
201 Background: Dostarlimab is a programmed death receptor-1 (PD-1) blocking antibody that is approved in the US as a monotherapy in adult patients (pts) with mismatch repair deficient (dMMR) recurrent or advanced endometrial cancer that has progressed on or following prior treatment with a platinum-containing regimen or dMMR recurrent or advanced solid tumors that have progressed on or following prior treatment and who have no satisfactory alternative treatment options. Here, we report on the antitumor activity and safety of dostarlimab monotherapy in pts with dMMR colorectal cancer (CRC), a post-hoc subgroup analysis of cohort F of the GARNET trial. Methods: GARNET is a phase 1, multicenter, open-label, single-arm study of dostarlimab monotherapy in pts with advanced or recurrent solid tumors. Cohort F of the GARNET expansion cohorts enrolled pts with dMMR/MSI-H or POLε mutated non-endometrial solid tumors, including pts with CRC. Pts must have progressed per blinded independent central review (BICR) following prior systemic therapy for advanced disease. Pts with CRC were required to have progressive disease after or been intolerant to fluoropyrimidine, oxaliplatin, and irinotecan. Pts received 500 mg intravenous dostarlimab every 3 weeks for 4 cycles, followed by 1000 mg every 6 weeks until discontinuation. Primary endpoints were objective response rate (ORR) and duration of response by BICR per RECIST v1.1. Pts were included in the efficacy analysis if they received ≥1 dose of dostarlimab, had measurable disease at baseline, and had ≥24 weeks of follow-up. All pts who received ≥1 dose of dostarlimab were included in the safety analysis. Results: As of the March 01, 2020 interim analysis data cut, 141 pts with dMMR non-endometrial solid tumors were included in the safety analysis, with 106 in the efficacy analysis. Of the pts in the efficacy analysis, 69 (65.1%) had CRC. Confirmed ORR by BICR per RECIST v1.1 in pts with dMMR CRC was 36.2% (95% CI, 25.0%–48.7%). There were 3 complete responses and 22 partial responses. At the data cut, 23 pts (92%) were still on treatment. Median duration of response had not been reached for pts with CRC. In the overall dMMR non-endometrial solid tumor population, treatment-related adverse events (TRAEs) were reported in 68.1% of pts, with 8.5% of pts experiencing at least 1 grade ≥3 TRAE. The most common grade ≥3 TRAE was lipase increased in 2 (1.4%) of pts. Only 5 pts (3.5%) discontinued dostarlimab due to at TRAE. Treatment-related serious AEs were reported in 9 (6.4%) pts. Conclusions: Dostarlimab demonstrated durable clinically meaningful antitumor activity in pts with dMMR CRC, which was consistent with that seen in patients with dMMR non-CRC solid tumors. No new safety signals were detected in patients with dMMR non-endometrial solid tumors. Clinical trial information: NCT02715284.
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Affiliation(s)
- Thierry Andre
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Filippo G. De Braud
- Medical Oncology Department, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori and Oncology and Hemato-oncology Department, University of Milan, Milan, Italy
| | | | - Dominique Berton
- GINECO & Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, and University of Milano, Milan, Italy
| | - Tobias Arkenau
- Sarah Cannon Research Institute UK Limited, London, United Kingdom
| | - Antonio Antón Torres
- Hospital Universitario Miguel Servet, Geicam Breast Cancer Group, Zaragoza, Spain
| | - David Paez
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Cyril Abdeddaim
- Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
| | | | - Francine Aubin
- Centre De Recherche Du Centre Hospitalier de L'université De Montréal (CHUM), Montreal, QC, Canada
| | | | | | | | - Naureen Starling
- The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
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12
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Guiard E, Clatot F, Even C, Perréard M, Abdeddaim C, Johnson A, Vauléon E, Rambeau A. Impact of previous nivolumab treatment on the response to taxanes in patients with recurrent/metastatic head and neck squamous cell carcinoma. Eur J Cancer 2021; 159:125-132. [PMID: 34743067 DOI: 10.1016/j.ejca.2021.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/25/2021] [Accepted: 09/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors are widely used in recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC). We aimed to describe response rates to taxanes after progression on nivolumab in R/M HNSCC patients. METHODS In this multicentric retrospective comparative study, we included patients treated with taxane monotherapy from 2014 to 2020. Patients were divided into two groups depending on whether they received nivolumab before taxanes (post-nivolumab group) or not (control group). The primary end-point was objective response rate (ORR) comparison between the two groups. The secondary end-points included disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and PFS ratio (PFSr=PFS associated with taxanes divided by PFS associated with the previous line of treatment), a survival marker used for comparison of different treatment lines. RESULTS Between July 2014 and August 2020, 185 patients were included (114 in the control group and 71 in the post-nivolumab group). ORR was significantly higher in the post-nivolumab group (39.4% versus 26.3%, p = 0.03) as was DCR (69% versus 50%, P = 0.06). The median OS (7.5 months) and PFS (3.5 months) were not significantly different in the two groups, whereas PFSr was significantly improved in the post-nivolumab group (1.63 versus 1.11, P = 0.004). CONCLUSION Response and DCRs with taxanes are improved after prior exposure to nivolumab. Thus, taxane monotherapy could be a good choice as third-line therapy after nivolumab following a platinum-based first line. These results currently apply to patients without access to or potential benefit from first-line pembrolizumab.
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Affiliation(s)
- Emeline Guiard
- Medical Oncology Department, Centre François Baclesse, Caen, France.
| | - Florian Clatot
- Medical Oncology Department, Centre Henri Becquerel, Rouen, France
| | - Caroline Even
- Head and Neck Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Marion Perréard
- Head and Neck Surgery Department, University Hospital, Caen, France
| | - Cyril Abdeddaim
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - Alison Johnson
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Elodie Vauléon
- Medical Oncology Department, Centre Eugène Marquis, Rennes, France
| | - Audrey Rambeau
- Medical Oncology Department, Centre François Baclesse, Caen, France
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13
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Trédan O, Provansal M, Abdeddaim C, Lardy-Cleaud A, Hardy-Bessard AC, Kalbacher E, Floquet A, Venat-Bouvet L, Lortholary A, Pop O, Frenel JS, Cancel M, Largillier R, Louvet C, You B, Zannetti A, Anota A, Treilleux I, Pissaloux D, Houlier A, Savoye AM, Mouret-Reynier MA, Meunier J, Levaché CB, Brocard F, Ray-Coquard I. Regorafenib or Tamoxifen for platinum-sensitive recurrent ovarian cancer with rising CA125 and no evidence of clinical or RECIST progression: A GINECO randomized phase II trial (REGOVAR). Gynecol Oncol 2021; 164:18-26. [PMID: 34696892 DOI: 10.1016/j.ygyno.2021.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of regorafenib versus tamoxifen in platinum-sensitive ovarian cancer biological recurrence, defined by CA-125 increase without radiological (RECIST criteria) or symptomatic evidence of progression. PATIENTS AND METHODS 116 patients with platinum-sensitive ovarian cancer presenting an isolated increase of CA-125 were planned to be randomized. Regorafenib was administered orally at 160 or 120 mg daily, 3 weeks on/1 week off or tamoxifen at 40 mg daily, until disease progression or development of unacceptable toxicity. The primary endpoint was Progression-Free Survival, assessed by progression according to RECIST 1.1 or death (by any cause). Secondary endpoints included Overall Survival, Best Response and CA-125 response rate. RESULTS 68 patients were randomized. Median age was 67 years (range: 30-87). Primary site of cancer was ovarian for most patients (92.6%). Tumors were predominantly serous / (89.7%), high grade (83.6%) and initial FIGO staging was III for 69.6% of the patients. Most (79.4%) patients were included after the first line of platinum-based treatment. After a median follow-up of 32 months, there was no difference of progression-free survival (PFS) between regorafenib and tamoxifen groups (p = 0.72), with median PFS of 5.6 months (CI 90%: 3.84-7.52) for the tamoxifen arm and 4.6 months (CI 90%: 3.65-7.33) for the regorafenib arm. There was also no difference in term of overall survival, best response or CA-125 response, delay to next therapy. Regorafenib presented a less favorable safety profile than tamoxifen, with grade 3/4 events occurring for 90.9% of the patients compared to 54.3% for tamoxifen. The most frequent were cutaneous, digestive, and biological events. Notably, hand-foot syndrome occurred in 36.4% of these patients. CONCLUSION Regorafenib presented an unfavorable toxicity profile compared to tamoxifen, with no superior efficacy in this population of patients.
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Affiliation(s)
- Olivier Trédan
- Département d'Oncologie Médicale, Centre Léon Bérard, Lyon, France
| | - Magali Provansal
- Département d'Oncologie Médicale, Institut Paoli Calmettes, Marseille, France
| | - Cyril Abdeddaim
- Département d'Oncologie Médicale, Centre Oscar Lambret, Lille, France
| | | | - Anne-Claire Hardy-Bessard
- Département d'Oncologie Médicale, Centre Armoricain de Radiothérapie, d'Imagerie Médicale et d'Oncologie (CARIO)-Hôpital Privé des Côtes d'Armor (HPCA), Plérin, France
| | - Elsa Kalbacher
- Département d'Oncologie Médicale CHU de Besançon, Besançon, France
| | - Anne Floquet
- Département d'Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | | | - Alain Lortholary
- Département d'Oncologie Médicale, Institut de Cancérologie Catherine de Sienne, Hôpital Privé du Confluent, Nantes, France
| | - Oana Pop
- Département d'Oncologie Médicale, Centre Hospitalier Annecy-Genevois, Pringy, France
| | - Jean-Sébastien Frenel
- Département d'Oncologie Médicale, ICO Centre René Gauducheau, Saint-Herblain, France
| | - Mathilde Cancel
- Département d'Oncologie Médicale, CHU Bretonneau Centre, Tours, France
| | - Rémy Largillier
- Département d'Oncologie Médicale, Centre Azuréen de Cancérologie, Mougins, France
| | - Christophe Louvet
- Département d'Oncologie Médicale, Institut Mutualiste Montsouris, Paris, France
| | - Benoît You
- Département d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Lyon, France
| | - Alain Zannetti
- Département d'Oncologie Médicale, Centre Hospitalier de Cholet, Cholet, France
| | | | | | - Daniel Pissaloux
- Département d'Anatomopathologie, Centre Léon Bérard, Lyon, France
| | - Aurélie Houlier
- Département d'Anatomopathologie, Centre Léon Bérard, Lyon, France
| | - Aude-Marie Savoye
- Département d'Oncologie Médicale, Institut Jean Godinot, Reims, France
| | | | - Jérôme Meunier
- C Département d'Oncologie Médicale, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | - Fabien Brocard
- Département d'Oncologie Médicale, ORACLE - Centre d'Oncologie de Gentilly, Nancy, France
| | - Isabelle Ray-Coquard
- Département d'Oncologie Médicale, Centre Léon Bérard, Lyon, France; University Claude Bernard, GINECO, Lyon, France
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Oaknin A, Tinker AV, Gilbert L, Samouëlian V, Mathews C, Brown J, Barretina-Ginesta MP, Moreno V, Gravina A, Abdeddaim C, Banerjee S, Guo W, Danaee H, Im E, Sabatier R. Clinical activity and safety of the anti-PD-1 monoclonal antibody dostarlimab for patients with recurrent or advanced dMMR endometrial cancer. Future Oncol 2021; 17:3781-3785. [PMID: 34427115 DOI: 10.2217/fon-2021-0598] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This document provides a short summary of the GARNET trial which was published in JAMA Oncology in October 2020. At the end of this document, there are links to websites where you can find more information about this study. The trial enrolled adult participants with advanced solid tumors. This report is restricted to patients with a particular type of endometrial cancer that has a deficient mismatch repair (dMMR) status. Patients received a trial treatment called dostarlimab (also known by the brand name Jemperli). In the US, dostarlimab is approved as a single therapy in adult patients with dMMR recurrent or advanced endometrial cancer that has progressed on or after platinum-based chemotherapy. In the EU, dostarlimab is approved as a single therapy in adult patients with recurrent or advanced dMMR/microsatellite instability-high (MSI-H) endometrial cancer that has progressed on or after treatment with a platinum-containing regimen. The GARNET trial looked at dostarlimab given intravenously to patients with dMMR endometrial cancer from 7 countries. The trial showed that dostarlimab was successful in shrinking the tumor in 42% of these patients. In general, the percentage of participants who experienced medical problems (referred to as side effects) was low and within expectations for this type of treatment. ClinicalTrials.gov NCT number: NCT02715284. To read the full Plain Language Summary of this article, click on the View Article button above and download the PDF. Link to original article here.
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Affiliation(s)
- Ana Oaknin
- Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Anna V Tinker
- Division of Medical Oncology, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | - Lucy Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Vanessa Samouëlian
- Gynecologic Oncology Service, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Cara Mathews
- Women and Infants' Program in Women's Oncology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Jubilee Brown
- Levine Cancer Institute, Division of Gynecologic Oncology, Atrium Health, Charlotte, North Carolina
| | - Maria-Pilar Barretina-Ginesta
- Medical Oncology Department, Catalan Institute of Oncology, Girona, Spain.,Girona Biomedical Research Institute, Department of Medical Sciences, Medical School University of Girona, Girona, Spain
| | - Victor Moreno
- START Madrid-Fundación Jiménez Díaz, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Adriano Gravina
- Struttura Complessa Sperimentazioni Cliniche, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Pascale, Naples, Italy
| | - Cyril Abdeddaim
- Department of Gynecological Oncology, Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
| | - Susana Banerjee
- Gynaecology Unit, The Royal Marsden National Health Service Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Wei Guo
- Oncology Development Bioststats Unit, GlaxoSmithKline, Waltham, Massachusetts
| | - Hadi Danaee
- Experimental Medicine Unit, GlaxoSmithKline, Waltham, Massachusetts
| | - Ellie Im
- Oncology Clinical Development-Immuno-Oncology Clinical Unit, GlaxoSmithKline, Waltham, Massachusetts
| | - Renaud Sabatier
- Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille-Predictive Oncology Laboratory, Centre de Recherche en Cancérologie de Marseille, Department of Medical Oncology, Aix-Marseille University, Inserm, Centre National de la Recherche Scientifique, Marseille, France
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15
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Szturz P, Vinches M, Remenár É, van Herpen CML, Abdeddaim C, Stewart JS, Fortpied C, Vermorken JB. Prognostic factor analysis and long-term results of the TAX 323 (EORTC 24971) study in unresectable head and neck cancer patients. Eur J Cancer 2021; 156:109-118. [PMID: 34425403 DOI: 10.1016/j.ejca.2021.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/12/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the TAX 323 (EORTC 24971) phase III trial enrolling patients with unresectable locoregionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN), the addition of docetaxel (T) to cisplatin and 5-fluorouracil (PF)-based induction chemotherapy prior to definite radiotherapy significantly improved progression-free survival (PFS) and overall survival (OS). METHODS The data were updated for PFS, OS and treatment-related long-term side-effects. Baseline clinical and laboratory data of 17 variables were collected and subjected to univariate and multivariate prognostic factor analyses for OS. RESULTS All 358 patients randomised between 1999 and 2002 were included in the long-term analysis with a median follow-up of 8.6 years. The primary end-point of PFS remained significantly improved with TPF compared with PF (adjusted hazard ratio [HR], 0.70; 95% CI, 0.56-0.88, p = 0.002), translating into a persisting benefit in OS (adjusted HR, 0.75; 95% CI, 0.60-0.95, p = 0.015). Long-term side-effects in the TPF/PF arms comprised tracheostomy (7%/5%), feeding tube dependency (3%/6%) and gastrostomy (11%/11%). Second malignancy occurred in 8%/3%, respectively. Out of 177 patients randomised to the TPF arm, 160 were included in the multivariate analysis. Grade 2 or more dysphagia (p = 0.002) and grade 2 or more pain (p = 0.004) at baseline were identified as independent negative prognostic factors. In addition, OS differed across primary tumour sites (p = 0.027) and was worse in patients with a higher N-stage (p = 0.025). CONCLUSIONS In LA-SCCHN patients treated with sequential chemoradiotherapy, TPF induction chemotherapy demonstrated long-lasting efficacy, superior to the PF regimen. Higher-grade dysphagia and pain are unfavourable prognosticators.
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Affiliation(s)
- Petr Szturz
- Medical Oncology, Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Marie Vinches
- The European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Éva Remenár
- Hospitalier Order of Saint John of God Hospital Buda, Budapest, Hungary
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Catherine Fortpied
- The European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
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André T, Berton D, Curigliano G, Arkenau H, Trigo J, Ellard S, Moreno V, Abdeddaim C, Antón A, Kumar S, Guo W, Im E, Starling N. SO-9 Analysis of the immune-related endpoints of the mismatch repair–deficient non-endometrial solid cancers cohort from the GARNET study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.033] [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] Open
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17
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Berton D, Banerjee SN, Curigliano G, Cresta S, Arkenau HT, Abdeddaim C, Kristeleit RS, Redondo A, Leath CA, Antón Torres A, Guo W, Im E, Andre T. Antitumor activity of dostarlimab in patients with mismatch repair-deficient/microsatellite instability–high tumors: A combined analysis of two cohorts in the GARNET study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.2564] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2564 Background: Dostarlimab is an investigational, humanized programmed death 1 (PD-1) receptor monoclonal antibody that blocks interaction with the PD-1 ligands, PD-L1 and PD-L2. GARNET (NCT02715284) is a phase 1 study assessing the antitumor activity and safety of dostarlimab monotherapy in patients with solid tumors. Methods: This multicenter, open-label, single-arm study is being conducted in 2 parts: dose escalation and expansion. Here we report on the 2 expansion cohorts that enrolled mismatch repairdeficient/microsatellite instabilityhigh (dMMR/MSI-H) patients. Cohort A1 enrolled patients with advanced or recurrent dMMR/MSI-H endometrial cancer (EC), and cohort F enrolled patients with advanced or recurrent dMMR/MSI-H or POLε-hypermutated non-EC solid tumors, mainly gastrointestinal (GI) tumors (99 [93.4%] had GI tumors, including 69 [65.1%] with colorectal cancer). Patients received 500 mg IV of dostarlimab every 3 weeks for 4 cycles, then 1000 mg IV every 6 weeks until disease progression or discontinuation. The primary endpoints were objective response rate (ORR) and duration of response (DOR) by RECIST v1.1. Here we report ORR and DOR, by individual cohort and as an overall population, in patients with dMMR tumors identified by immunohistochemistry testing. Results: For this interim analysis, an efficacy analysis was performed for the patients who had baseline measurable disease and ≥6 months of follow-up in the study (N = 209). The ORR was 41.6% (95% CI, 34.9%48.6%) for the combined A1+F dMMR cohorts (Table). Responses were durable, and median DOR has not been reached in either cohort (median follow-up: cohort A1, 16.3 months; cohort F, 12.4 months). A total of 267 patients were included in the safety population (all patients who received ≥1 dose; cohort A1, N = 126; cohort F, N = 141). Treatment-related adverse events (TRAEs) were consistent across tumor types. Overall, the most frequently reported any-grade TRAEs were asthenia (13.9%), diarrhea (13.5%), and fatigue (11.2%). The most common grade ≥3 TRAEs were anemia (2.2%), lipase increased (1.9%), alanine aminotransferase increased (1.1%), and diarrhea (1.1%). No deaths were attributed to dostarlimab. Conclusions: Dostarlimab demonstrated durable antitumor activity in patients with dMMR solid tumors, with consistent antitumor activity seen across endometrial and nonendometrial tumor types. The safety profile was manageable, with no new safety signals detected. Most TRAEs were low grade and were similar across cohorts. Clinical trial information: NCT02715284. [Table: see text]
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Affiliation(s)
- Dominique Berton
- GINECO & Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
| | - Susana N. Banerjee
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, and University of Milano, Milan, Italy
| | - Sara Cresta
- IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | | | - Cyril Abdeddaim
- Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
| | | | | | | | | | - Wei Guo
- GlaxoSmithKline, Waltham, MA
| | | | - Thierry Andre
- Sorbonne University and Saint-Antoine Hospital, Paris, France
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18
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Blanc-Durand F, Yaniz E, Genestie C, Rouleau E, Berton D, Lortholary A, Dohollou N, Desauw C, Fabbro M, Malaurie E, Bonichon-Lamichhane N, Dubot C, Kurtz JE, De Rauglaudre G, Raban N, Abdeddaim C, Ferron G, Kaminsky MC, Llop-Guevara A, Leary A. Evaluation of a RAD51 functional assay in advanced ovarian cancer, a GINECO/GINEGEPS study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5513] [Citation(s) in RCA: 6] [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: 11/20/2022] Open
Abstract
5513 Background: Homologous recombination deficiency (HRD), defined as BRCA1/2 mutation ( BRCAmut)or high genomic instability, is currently used to identify patients (pts) with epithelial ovarian cancer (EOC) most likely to benefit from PARP inhibitors. While these genomic tests are useful, they are imperfect: some BRCAm EOC demonstrate primary PARPi resistance and some HR-proficient benefit. Another approach to evaluate HRD is to measure the capacity of tumor cells to recruit nuclear RAD51 foci during S/G2 phase in the presence of double strand DNA damage using multiplexed immunofluorescence (IF) for RAD51, geminin (GMN) and yH2AX. We aimed to describe for the 1st time HRD using this RAD51 functional assay in EOC and correlate RAD51 status to platinum response and BRCAmut. Methods: Tumor samples and clinical data were collected prospectively from pts in the randomized CHIVA trial of neoadjuvant platinum chemotherapy +/- nintedanib. IF for RAD51, GMN, and DAPI was performed on a 3uM slide from FFPE blocks, where feasible, yH2AX was positively scored on a consecutive slide. Tumors were considered RAD51-deficient if < 10% of gem+ tumor cells (TC) had > 5 RAD51+ foci. BRCAmut were identified by NGS. Results: 155 baseline chemotherapy naïve EOC samples were available. All were advanced stage (IIIC/IV), 75% were G3, 7% G2, 2% G1, and 16% grade UK. A contributive RAD51 result was obtained for 90% (139/155) of samples. Contributive NGS results were available for 130 samples. Overall, yH2AX scores were high (median % TC+: 86%, IQR: 56%-100%) confirming the presence of significant basal DNA damage in high grade EOC. Only 8 samples were yH2AX-low, including two of the three G1 tumors. In contrast, 55% (76/155) of samples were considered RAD51-deficient (score < 10%). With regard to outcome, pts with RAD51-deficient tumors had significantly higher overall response rates to neoadjuvant platinum (68% vs 37%, p = 0.04) and significantly longer median progression-free survival (HR 0.50, IC95% 0.25-0.98, p = 0.02). Considering BRCA status, 15% of tumors harbored a deleterious BRCAmut and 67% of these were RAD51-deficient. Importantly among BRCAmut EOC, the RAD51-proficient tumors had significantly poorer response to neoadjuvant chemotherapy (RR = 17% vs 75%, p = 0.02). Conclusions: We evaluated a novel functional assay of HR functionality in advanced EOC. The assay requires minimal tissue and yields contributive results in 90% of cases. Overall, EOC demonstrate high levels of basal DNA damage, yet 55% fail to recruit RAD51 foci during S/G2 cell cycle phase. These RAD51-deficient EOC have improved outcome after neoadjuvant platinum. Conversely, the RAD51 assay also identified a small subset of RAD51-high BRCAmut tumors with poor platinum response. Whether this RAD51 functional assay may also predict PARP inhibitor benefit is currently being investigated.
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Affiliation(s)
| | - Elisa Yaniz
- Gustave Roussy Cancer Center, Inserm U981, Villejuif, France
| | | | | | - Dominique Berton
- GINECO & Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
| | - Alain Lortholary
- Institut of Cancerology Catherine de Sienne GINECO-Hôpital Privé du Confluent, Nantes, France
| | | | | | | | | | | | - Coraline Dubot
- GINECO and Institut Curie-Hôpital René Huguenin, Saint-Cloud, France
| | | | | | - Nadia Raban
- GINECO and CHU La Milétrie, Poitiers, France
| | - Cyril Abdeddaim
- Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
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19
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Heudel PE, Frenel JS, Dalban C, Bazan F, Joly F, Arnaud A, Abdeddaim C, Chevalier A, Augereau P, Pautier P, Chakiba C, You B, Lancry Lecomte L, Garin G, MArcel V, Diaz JJ, Treilleux I, Pérol D, Fabbro M, Ray-Coquard IL. Victoria: A multicentric, randomized, open-label, phase I/II of mTOR inhibitor (VISTUSERTIB) combined with anastrozole in patients with hormone receptor-positive advanced/metastatic endometrial cancer—A CLIPP program INCA in collaboration with GINECO group. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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
5507 Background: Endometrial carcinoma is generally hormone dependent and aromatase inhibitors are used in routine practice before or after 1st line chemotherapy (CT) for HR positive patients. Deregulation of the Pi3K-Akt-mTOR signaling pathway is observed in many tumor types including endometroid carcinoma driven oncogenesis and hormonal resistance. Vistusertib (V) is a small-molecule ATP competitive inhibitor of both mTORC1 and mTORC2 complexes. Methods: Adult patients (pts) with recurrent oestrogen or progesterone (ER and/or PR) positive advanced/metastatic endometrial carcinoma, one previous line of chemotherapy (CT) allowed, with ECOG PS 0/1, were randomised (2:1, stratification according to prior CT line: 0 vs 1) to receive V (125 mg bid/2 days/week, orally) + Anastrozole (A, 1 mg/d, orally) or A alone. Treatments were given until progression, intolerable toxicity or patient willingness. Following a safety run in phase, a Simon’s 2-stage design was employed to explore the 8-week progression free rate (PFR-8W) according to central review (p1: 60%, p0: 40%, type I error rate of 5%, power of 80%). At the end of Stage II, if ≥24/46 evaluable pts are progression free at 8w in Arm A+V, the combination will be considered of interest for further investigation. Overall response rate (ORR) by RECIST v1.1, safety and progression-free survival (PFS) were key secondary endpoints. Results: Out of 75 patients (pts) enrolled, 73 were randomised and treated (Arm V+A: 49; Arm A: 24; median age: 69.5 y [36.8; 87.8]), BMI ≥30 kg/m²: 45%). PS ECOG was 0 (48%) and 44% of randomised pts were chemotherapy naïve; 12% previously received hormonal therapy. At the end of the safety run-in, no major safety concerns were reported. At the end of Simon’ Stage II, centrally assessed PFR-8W was 67.3% (33/49 [95% CI unilateral: 54.7; -]) for A + V arm and 39.1% (9/23 [[95% CI unilateral: 22.2; -[) for arm A. Median PFS was 5.2 months (95% CI: 3.4-8.9) and 1.9 months (95% CI: 1.6-8.9) for A+V and A arms, respectively. One complete response and 11 partial responses (PR) were observed (ORR: 24.5 % (CI 95% [13.3 – 38/9%]) in the combination arm and 4 PR in arm A (ORR: 17.4% [CI 95%: 5-38.8%]). Fatigue, lymphopenia, hyperglycaemia and diarrhoea were the main (≥10%) Grade ≥2 adverse events related to V. Overall survival and translational research are ongoing. Conclusions: The A+V combination demonstrated clinically and meaningful improvement in 8w-PFR and median PFS with manageable toxicity. PI3K pathway remains a key target for new therapies in endometrial cancer and translational research must help to better select pts benefiting from these targeted therapies. Clinical trial information: NCT02730923.
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Affiliation(s)
| | - Jean-Sebastien Frenel
- GINECO & Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
| | | | | | - Florence Joly
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | | | - Cyril Abdeddaim
- Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
| | - Annick Chevalier
- Département d’Oncologie Médicale, Centre Oscar-Lambret, Lille, France
| | - Paule Augereau
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Angers, France
| | | | | | - Benoit You
- Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, EMR UCBL/HCL 3738, Lyon, GINECO & GINEGEPS, Lyon, France
| | | | | | | | | | | | - David Pérol
- Departement of Clinical Research, Centre Léon-Bérard, Lyon, France
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El Hajj H, Vanseymortier M, Hudry D, Bogart E, Abdeddaim C, Leblanc E, Le Deley MC, Narducci F. Rationale and study design of the CHIPPI-1808 trial: a phase III randomized clinical trial evaluating hyperthermic intraperitoneal chemotherapy (HIPEC) for stage III ovarian cancer patients treated with primary or interval cytoreductive surgery. ESMO Open 2021; 6:100098. [PMID: 33819750 PMCID: PMC8047490 DOI: 10.1016/j.esmoop.2021.100098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/01/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Ovarian cancer remains the most lethal gynecologic malignancy with high recurrence rates. Because recurrence involves primarily the peritoneum, intraperitoneal chemotherapy is being evaluated as a new approach to treat microscopic peritoneal disease. One trial showed that cisplatin–paclitaxel intraperitoneal chemotherapy with intravenous paclitaxel improved survival but increased morbidity. Another trial reported a significant improvement in overall survival (OS) and disease-free survival (DFS) without increasing the morbidity (P = 0.76) or mortality rates (hazard ratio 0.67, P = 0.02) after adding hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreduction. The current trial aims to evaluate the impact of adding HIPEC to primary or interval cytoreductive surgery for epithelial ovarian cancer (EOC) on the efficacy, safety, treatment feasibility, and quality of life. Patients and methods This is an international, multicenter, open-label, randomized (1 : 1), two-arm, phase III clinical trial that will enroll 432 patients with newly diagnosed International Federation of Gynecology and Obstetrics (FIGO) stage III EOC. Patients are randomized to receive or not HIPEC with the standard of care. Inclusion criteria include patients with FIGO stage III EOC, Fallopian tube carcinoma or primary peritoneal cancer who undergo complete primary or interval cytoreduction. The primary objective is to assess DFS of the addition of HIPEC. Secondary objectives are the assessment of OS, safety, return to intended oncologic treatment, quality of life and the trade-off between efficacy and morbidity. Conclusions The results might help extend the indications of HIPEC to include patients undergoing primary cytoreduction, providing a standardized protocol for HIPEC in EOC management and reliable information on the quality of life after adding HIPEC. Ovarian cancer remains the most lethal gynecologic cancer with high rates of recurrence involving primarily the peritoneum. Intraperitoneal chemotherapy is being evaluated as a new therapeutic approach to treat microscopic peritoneal disease. This trial evaluates the impact of adding HIPEC to primary or interval cytoreductive surgery for EOC. This trial evaluates the efficacy, safety, treatment feasibility and quality of life after the addition of HIPEC. This is an international, multicenter, open label, randomized, phase III clinical trial.
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Affiliation(s)
- Houssein El Hajj
- Gynecologic Oncology Department, Oscar Lambret Cancer Centre, Lille, France.
| | - M Vanseymortier
- Clinical Research and Innovation Department, Oscar Lambret Cancer Centre, Lille, France
| | - D Hudry
- Gynecologic Oncology Department, Oscar Lambret Cancer Centre, Lille, France
| | - E Bogart
- Clinical Research and Innovation Department, Oscar Lambret Cancer Centre, Lille, France
| | - C Abdeddaim
- Medical Oncology Department, Oscar Lambret Cancer Center, Lille, France
| | - E Leblanc
- Gynecologic Oncology Department, Oscar Lambret Cancer Centre, Lille, France
| | - M C Le Deley
- Paris-Saclay University, Paris-Sud University, UVSQ, CESP, INSERM, Villejuif, France
| | - F Narducci
- Gynecologic Oncology Department, Oscar Lambret Cancer Centre, Lille, France
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21
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Andre T, Berton D, Curigliano G, Ellard S, Trigo Pérez JM, Arkenau HT, Abdeddaim C, Moreno V, Guo W, Im E, Starling N. Safety and efficacy of anti–PD-1 antibody dostarlimab in patients (pts) with mismatch repair-deficient (dMMR) solid cancers: Results from GARNET study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.9] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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
9 Background: Dostarlimab is a humanized anti–PD-1 monoclonal antibody that binds the PD-1 receptor, blocking interaction with ligands PD-L1 and PD-L2. The ongoing phase 1 GARNET study (NCT02715284) is evaluating dostarlimab in pts with advanced solid tumors. Here we present safety and efficacy data from cohort F. Methods: Cohort F of the GARNET trial enrolled pts with dMMR or POLEmut non-endometrial solid tumors; the majority were gastrointestinal (GI) in origin. Pts must have progressed per blinded independent central review (BICR) following prior systemic therapy for advanced disease and had dMMR status by local immunohistochemistry. Pts received 500 mg dostarlimab Q3W for 4 cycles and 1000 mg Q6W until discontinuation. Objective response rate (ORR) and duration of response (DOR) were assessed by BICR per RECIST v1.1. Pts were included in the efficacy analysis if they received ≥1 dose of dostarlimab, had measurable disease at baseline, and 6 mo of follow up. All pts who received ≥1 dose were included in the safety analysis. Results: 144 pts were included in the safety analysis, with 106 dMMR pts in the efficacy analysis (1 POLEmut pt with a confirmed PR was not included in this population). Of the 106 pts, 99 (93.4%) had GI tumors. Confirmed ORR in dMMR pts was 38.7% (95% CI: 29.4, 48.6), with a complete response rate of 7.5%. ORR was consistent across tumor type (Table). At the data cutoff, median duration of follow-up (n = 107; dMMR and POLEmut pts) was 12.4 months and median DOR was not reached. The Kaplan–Meier estimated probability of maintaining response at 12 and 18 months was 91.0% and 80.9% respectively. Treatment-related adverse events (TRAEs) were reported in 68.8% of pts; 8.3% of pts experienced at least 1 grade ≥3 TRAE. The most common was lipase increased in 2 (1.4%) pts. Treatment-related serious AEs (SAEs) were reported in 6 (5.5%) pts, and 2 pts (1.8%) discontinued dostarlimab due to a TRAE. No deaths were attributed to dostarlimab. Conclusions: Dostarlimab demonstrated durable antitumor activity in a cohort of dMMR solid tumor pts, the majority of whom had GI cancers. The safety profile was consistent with other cohorts in GARNET, with immune-related TRAEs infrequent and low grade. Clinical trial information: NCT02715284. [Table: see text]
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Affiliation(s)
- Thierry Andre
- Sorbonne Université and Hôpital Saint Antoine, Paris, France
| | - Dominique Berton
- GINECO & Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, and University of Milano, Milan, Italy
| | | | | | | | - Cyril Abdeddaim
- Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
| | - Victor Moreno
- START Madrid-FJD, Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Wei Guo
- GlaxoSmithKline, Waltham, MA
| | | | - Naureen Starling
- Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
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22
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Oaknin A, Tinker AV, Gilbert L, Samouëlian V, Mathews C, Brown J, Barretina-Ginesta MP, Moreno V, Gravina A, Abdeddaim C, Banerjee S, Guo W, Danaee H, Im E, Sabatier R. Clinical Activity and Safety of the Anti-Programmed Death 1 Monoclonal Antibody Dostarlimab for Patients With Recurrent or Advanced Mismatch Repair-Deficient Endometrial Cancer: A Nonrandomized Phase 1 Clinical Trial. JAMA Oncol 2020; 6:1766-1772. [PMID: 33001143 PMCID: PMC7530821 DOI: 10.1001/jamaoncol.2020.4515] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Question What is the clinical antitumor activity and safety of dostarlimab for patients with deficient mismatch repair endometrial cancer? Findings In this nonrandomized phase 1 clinical trial, the confirmed objective response rate was 42%; 13% of patients had a confirmed complete response, and 30% of patients had a confirmed partial response. Anemia (3%), colitis (2%), and diarrhea (2%) were the most common grade 3 or higher treatment-related adverse events. Meaning Dostarlimab was associated with clinically meaningful and durable antitumor activity with an acceptable safety profile for patients with deficient mismatch repair endometrial cancers that have progressed after prior platinum-based chemotherapy. Importance Deficient mismatch mutation repair mechanisms may sensitize endometrial cancers to anti–programmed death 1 (PD-1) therapies. Dostarlimab (TSR-042) is an investigational anti–PD-1 antibody that binds with high affinity to the PD-1 receptor. Objective To assess the antitumor activity and safety of dostarlimab for patients with deficient mismatch repair endometrial cancer. Design, Setting, and Participants This ongoing, open-label, single-group, multicenter study began part 1 on March 7, 2016, and began enrolling patients with deficient mismatch mutation repair endometrial cancer on May 8, 2017. Median follow-up was 11.2 months (range, 0.03 [ongoing] to 22.11 [ongoing] months; based on radiological assessments). Statistical analysis was performed July 8 to August 9, 2019. Interventions Patients received 500 mg of dostarlimab intravenously every 3 weeks for 4 doses, then 1000 mg every 6 weeks until disease progression, treatment discontinuation, or withdrawal. Main Outcomes and Measures The primary end point was objective response rate and duration of response by blinded independent central review using Response Evaluation Criteria in Solid Tumors, version 1.1. Results As of the data cutoff, 104 women (median age, 64.0 years [range, 38-80 years]) with deficient mismatch mutation repair endometrial cancers were enrolled and treated with dostarlimab. Of these, 71 had measurable disease at baseline and at 6 months or more of follow-up and were included in the analysis. There was a confirmed response in 30 patients (objective response rate, 42.3%; 95% CI, 30.6%-54.6%); 9 patients (12.7%) had a confirmed complete response, and 21 patients (29.6%) had a confirmed partial response. Responses were durable; the median duration of response was not reached (median follow-up was 11.2 months). The estimated likelihood of maintaining a response was 96.4% at 6 months and 76.8% at 12 months. Anemia (3 of 104 [2.9%]), colitis (2 of 104 [1.9%]), and diarrhea (2 of 104 [1.9%]) were the most common grade 3 or higher treatment-related adverse events. Conclusions and Relevance In this nonrandomized trial, dostarlimab was associated with clinically meaningful and durable antitumor activity with an acceptable safety profile for patients with deficient mismatch mutation repair endometrial cancers after prior platinum-based chemotherapy. Trial Registration ClinicalTrials.gov identifier: NCT02715284
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Affiliation(s)
- Ana Oaknin
- Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Anna V Tinker
- Division of Medical Oncology, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | - Lucy Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Vanessa Samouëlian
- Gynecologic Oncology Service, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Cara Mathews
- Women and Infants' Program in Women's Oncology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Jubilee Brown
- Levine Cancer Institute, Division of Gynecologic Oncology, Atrium Health, Charlotte, North Carolina
| | - Maria-Pilar Barretina-Ginesta
- Medical Oncology Department, Catalan Institute of Oncology, Girona, Spain.,Girona Biomedical Research Institute, Department of Medical Sciences, Medical School University of Girona, Girona, Spain
| | - Victor Moreno
- START Madrid-Fundación Jiménez Díaz, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Adriano Gravina
- Struttura Complessa Sperimentazioni Cliniche, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Pascale, Naples, Italy
| | - Cyril Abdeddaim
- Department of Gynecological Oncology, Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
| | - Susana Banerjee
- Gynaecology Unit, The Royal Marsden National Health Service Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Wei Guo
- Oncology Development Bioststats Unit, GlaxoSmithKline, Waltham, Massachusetts
| | - Hadi Danaee
- Experimental Medicine Unit, GlaxoSmithKline, Waltham, Massachusetts
| | - Ellie Im
- Oncology Clinical Development-Immuno-Oncology Clinical Unit, GlaxoSmithKline, Waltham, Massachusetts
| | - Renaud Sabatier
- Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille-Predictive Oncology Laboratory, Centre de Recherche en Cancérologie de Marseille, Department of Medical Oncology, Aix-Marseille University, Inserm, Centre National de la Recherche Scientifique, Marseille, France
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23
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Franco A, Tresch E, Sakji I, Makhloufi S, Abdeddaim C, Julieron M, Dansin E, Chevalier D, Mouawad F, Lefebvre G. 952P Neutrophil-to-lymphocyte ratio (NLR) and survival in recurrent or metastatic head and neck cancer patients treated with immunotherapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1067] [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: 11/25/2022] Open
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24
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Derquin F, Floquet A, Hardy-Bessard AC, Edeline J, Lotz JP, Alexandre J, Pautier P, Angeles MA, Delanoy N, Lefeuvre-Plesse C, Cancel M, Treilleux I, Augereau P, Lavoue V, Kalbacher E, Berton Rigaud D, Selle F, Nadeau C, Gantzer J, Joly F, Guillemet C, Pomel C, Favier L, Abdeddaim C, Venat-Bouvet L, Provansal M, Fabbro M, Kaminsky MC, Lortholary A, Lecuru F, Coquard IR, de La Motte Rouge T. Need for risk-adapted therapy for malignant ovarian germ cell tumors: A large multicenter analysis of germ cell tumors' patients from French TMRG network. Gynecol Oncol 2020; 158:666-672. [PMID: 32624235 DOI: 10.1016/j.ygyno.2020.06.491] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Malignant ovarian germ cell tumors are rare tumors, affecting young women with a generally favorable prognosis. The French reference network for Rare Malignant Gynecological Tumors (TMRG) aims to improve their management. The purpose of this study is to report clinicopathological features and long-term outcomes, to explore prognostic parameters and to help in considering adjuvant strategy for stage I patients. PATIENTS AND METHODS Data from patients with MOGCT registered among 13 of the largest centers of the TMRG network were analyzed. We report clinicopathological features, estimated 5-year event-free survival (5y-EFS) and 5-year overall survival (5y-OS) of MOGCT patients. RESULTS We collected data from 147 patients including 101 (68.7%) FIGO stage I patients. Histology identifies 40 dysgerminomas, 52 immature teratomas, 32 yolk sac tumors, 2 choriocarcinomas and 21 mixed tumors. Surgery was performed in 140 (95.2%) patients and 106 (72.1%) received first line chemotherapy. Twenty-two stage I patients did not receive chemotherapy. Relapse occurred in 24 patients: 13 were exclusively treated with upfront surgery and 11 received surgery and chemotherapy. 5y-EFS was 82% and 5y-OS was 92.4%. Stage I patients who underwent surgery alone had an estimated 5y-EFS of 54.6% and patients receiving adjuvant chemotherapy 94.4% (P < .001). However, no impact on estimated 5y-OS was observed: 96.3% versus 97.8% respectively (P = .62). FIGO stage, complete primary surgery and post-operative alpha fetoprotein level significantly correlated with survival. CONCLUSION Adjuvant chemotherapy does not seem to improve survival in stage I patients. Active surveillance can be proposed for selected patients with a complete surgical staging.
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Affiliation(s)
- F Derquin
- Medical Oncology Department, Centre Hospitaliser Yves Le Foll, Saint Brieuc, France
| | - A Floquet
- Medical Oncology Department, Institut Bergonié, Bordeaux, France
| | | | - J Edeline
- Medical Oncology Department, Centre Eugène Marquis, Rennes, France
| | - J P Lotz
- Medical Oncology Department, Sorbonne University, APHP, Paris, France
| | - J Alexandre
- Medical Oncology Department, Hôpital Cochin, APHP, Paris, France
| | - P Pautier
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - M A Angeles
- Surgical Oncology Department, Institut Claudius Regaud, Toulouse, France
| | - N Delanoy
- Medical Oncology Department, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | | | - M Cancel
- Medical Oncology Department, Centre Hospitalier Universitaire Bretonneau, Tours, France
| | - I Treilleux
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - P Augereau
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Angers, France
| | - V Lavoue
- Gynecology Department, Centre Hospitalier Universitaire, Rennes, France
| | - E Kalbacher
- Medical Oncology Department, Centre Hospitalier Régional Universitaire, Besançon, France
| | - D Berton Rigaud
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Nantes, France
| | - F Selle
- Diaconnesses Hospital Group, Paris, France
| | - C Nadeau
- Gynecology Department, CHU de Poitiers, Poitiers, France
| | - J Gantzer
- Medical Oncology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - F Joly
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - C Guillemet
- Medical Oncology Department, Centre Henri-Becquerel, Rouen, France
| | - C Pomel
- Medical Oncology Department, Centre Jean Perrin, Clermont-Ferrand, France
| | - L Favier
- Medical Oncology Department, Centre Georges François Leclerc, Dijon, France
| | - C Abdeddaim
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - L Venat-Bouvet
- Medical Oncology Department, CHU Dupuytren, Limoges, France
| | - M Provansal
- Medical Oncology Department, Institut Paoli Calmettes, Marseille, France
| | - M Fabbro
- Medical Oncology Department, Institut régional du Cancer Montpellier, Montpellier, France
| | - M C Kaminsky
- Medical Oncology Department, Institut de Cancérologie de Lorraine - Alexis Vautrin, Vandoeuvre-Les-Nancy, France
| | - A Lortholary
- Medical Oncology Department, Hôpital Privé du Confluent, Nantes, France
| | - F Lecuru
- Medical Oncology Department, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - I Ray Coquard
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
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25
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Leary A, Awada A, Delord JP, Floquet A, Ray-Coquard IL, Abdeddaim C, Fabbro M, Kalbacher E, Vergote I, Banerjee SN, Frenois FX, Noël G, Lantz O, Cassard L, Coste A, Villard M, Lemee F, Tabah-Fisch IM, Le Tourneau C. First-in-human first-in-class phase I trial of murlentamab, an anti-Mullerian-hormone receptor II (AMHRII) monoclonal antibody acting through tumor-associated macrophage (TAM) engagement, as single agent and in combination with carboplatin (C) and paclitaxel (P) in AMHRII-expressing advanced/metastatic gynecological cancer patients (pts). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2521] [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: 11/20/2022] Open
Abstract
2521 Background: Membranous expression of AMHRII is found in ~70% of gynecological tumors. Murlentamab (M) binds with high affinity both AMHRII (at cell membrane) and CD16 (on macrophage, via its low fucose Fc). M reprograms TAMs, restoring their antitumoral functions (phagocytosis) resulting in cytotoxic T cell reactivation. Methods: Pts with advanced/metastatic AMHRII-expressing ovarian, cervical or endometrial cancer with measurable disease and performance status ≤ 1 received M as single agent (SA) in 8 dose escalating and 2 expansion cohorts. Combination with CP was studied in 2 escalating cohorts. Safety, recommended dose determination, antitumor activity, pharmacodynamics (PD) effects (circulating immune cells and tumor microenvironment (TME) from paired biopsies) were assessed. Results: 68 heavily pretreated (median 4 prior lines) pts received M for 0.5 to 11 months (mo) (59 pts M SA and 9 pts M + CP). No dose limiting toxicity was reported. Most common toxicity was G1-2 asthenia (29 %). Eight pts (12%) had G ≥ 3 reversible toxicities (asthenia, nausea/vomiting, anorexia, arthralgia). No antidrug antibody was detected. One partial response (PR) was achieved with M SA in a granulosa pt. In CP combination, 4/9 pts (44%) responded to treatment (1 Complete Response and 3 PRs). Overall, 22/67 (33%) pts were progression-free at 4 mos. Among 17 pts treated ≥ 6 mos, 6/9 (67%) granulosa pts with M SA and 4/5 (80%) endometrium and cervix with CP combination had a longer PFS than under previous regimen. PD blood assessment of 25 pts treated with M SA showed an increase in classical monocytes, and T cells and neutrophils activation. Changes in TME under M will be presented. Conclusions: Murlentamab was very well tolerated, demonstrated immune PD effects and showed hints of antitumor activity. These results together with its innovative immunological mode of action support development of M in AMHRII-expressing cancers, in combination with chemotherapy or other immune oncology drugs. Clinical trial information: NCT02978755.
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Affiliation(s)
- Alexandra Leary
- Gustave-Roussy Cancer Campus, Villejuif, and Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens, France
| | - Ahmad Awada
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Anne Floquet
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, and Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens, Bordeaux, France
| | | | | | - Michel Fabbro
- GINECO & Institut du Cancer de Montpellier, Montpellier, France
| | | | - Ignace Vergote
- University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | | | - Grégory Noël
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | | | - Lydie Cassard
- Laboratory of Immunomonitoring in Oncology, Gustave Roussy, Villejuif, France
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