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Ferris RL, Haddad R, Even C, Tahara M, Dvorkin M, Ciuleanu TE, Clement PM, Mesia R, Kutukova S, Zholudeva L, Daste A, Caballero-Daroqui J, Keam B, Vynnychenko I, Lafond C, Shetty J, Mann H, Fan J, Wildsmith S, Morsli N, Fayette J, Licitra L. Durvalumab with or without tremelimumab in patients with recurrent or metastatic head and neck squamous cell carcinoma: EAGLE, a randomized, open-label phase III study. Ann Oncol 2020; 31:942-950. [PMID: 32294530 DOI: 10.1016/j.annonc.2020.04.001] [Citation(s) in RCA: 213] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Targeting the programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) axis has demonstrated clinical benefit in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). Combining immunotherapies targeting PD-L1 and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) has shown evidence of additive activity in several tumor types. This phase III study evaluated the efficacy of durvalumab (an anti-PD-L1 monoclonal antibody) or durvalumab plus tremelimumab (an anti-CTLA-4 monoclonal antibody) versus standard of care (SoC) in R/M HNSCC patients. PATIENTS AND METHODS Patients were randomly assigned to receive 1 : 1 : 1 durvalumab (10 mg/kg every 2 weeks [q2w]), durvalumab plus tremelimumab (durvalumab 20 mg/kg q4w plus tremelimumab 1 mg/kg q4w × 4, then durvalumab 10 mg/kg q2w), or SoC (cetuximab, a taxane, methotrexate, or a fluoropyrimidine). The primary end points were overall survival (OS) for durvalumab versus SoC, and OS for durvalumab plus tremelimumab versus SoC. Secondary end points included progression-free survival (PFS), objective response rate, and duration of response. RESULTS Patients were randomly assigned to receive durvalumab (n = 240), durvalumab plus tremelimumab (n = 247), or SoC (n = 249). No statistically significant improvements in OS were observed for durvalumab versus SoC [hazard ratio (HR): 0.88; 95% confidence interval (CI): 0.72-1.08; P = 0.20] or durvalumab plus tremelimumab versus SoC (HR: 1.04; 95% CI: 0.85-1.26; P = 0.76). The 12-month survival rates (95% CI) were 37.0% (30.9-43.1), 30.4% (24.7-36.3), and 30.5% (24.7-36.4) for durvalumab, durvalumab plus tremelimumab, and SoC, respectively. Treatment-related adverse events (trAEs) were consistent with previous reports. The most common trAEs (any grade) were hypothyroidism for durvalumab and durvalumab plus tremelimumab (11.4% and 12.2%, respectively), and anemia (17.5%) for SoC. Grade ≥3 trAE rates were 10.1%, 16.3%, and 24.2% for durvalumab, durvalumab plus tremelimumab, and SoC, respectively. CONCLUSION There were no statistically significant differences in OS for durvalumab or durvalumab plus tremelimumab versus SoC. However, higher survival rates at 12 to 24 months and response rates demonstrate clinical activity for durvalumab. TRIAL REGISTRATION ClinicalTrials.gov: NCT02369874.
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Affiliation(s)
- R L Ferris
- Department of Otolaryngology, UPMC Hillman Cancer Center, Pittsburgh, USA.
| | - R Haddad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - C Even
- Head and Neck Department, Gustave Roussy, Villejuif, France
| | - M Tahara
- National Cancer Center Hospital East, Kashiwa, Japan
| | - M Dvorkin
- Omsk Regional Oncology Dispensary, Omsk, Omskaya, Russian Federation
| | - T E Ciuleanu
- Ion Chiricuta Institute of Oncology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - P M Clement
- Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - R Mesia
- Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Kutukova
- Chemotherapy Department, SPb SBIH City Clinical Oncology Dispensary, Saint Petersburg, Russian Federation
| | - L Zholudeva
- Regional Transcarpathian Oncological Dispensary, Uzhgorod, Ukraine
| | - A Daste
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - B Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - I Vynnychenko
- Sumy State University, Sumy Regional Oncology Center, Sumy, Ukraine
| | - C Lafond
- Department of Oncology, Clinique Victor Hugo/Centre Jean Bernard, Le Mans, France
| | - J Shetty
- Late-stage ImmunoOncology, AstraZeneca, Gaithersburg, USA
| | - H Mann
- Research and Development Oncology, AstraZeneca, Cambridge, UK
| | - J Fan
- Late-stage ImmunoOncology, AstraZeneca, Gaithersburg, USA
| | - S Wildsmith
- Research and Development Oncology, AstraZeneca, Cambridge, UK
| | - N Morsli
- Research and Development Oncology, AstraZeneca, Cambridge, UK
| | - J Fayette
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - L Licitra
- Head & Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori Milano, University of Milan, Milan, Italy.
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