Adjuvant treatment with S-1 in patients after R0-resection of adenocarcinoma of the stomach and esophagogastric junction - A multicenter phase I/II feasibility study (GMBH-STO-0114)

INTRODUCTION

S-1 has been shown to be an effective adjuvant treatment option for East Asian patients who underwent gastrectomy for stage II/III gastric cancer. We conducted a phase I/II study to evaluate the feasibility, tolerability and efficacy of administering S-1 in the adjuvant setting after R0-resection of adenocarcinoma of the stomach and esophagogastric junction (EGJ) in Caucasian patients.

METHODS

In this single-cohort, open-label, phase I/II trial, we enrolled patients with locally advanced adenocarcinoma of the stomach or EGJ having undergone R0-resection with or without neoadjuvant treatment. One treatment cycle consisted of oral S-1 (30mg/m² bid) for 14 days. Cycles were repeated every 3 weeks for 18 cycles (54 weeks). Primary endpoint was feasibility and tolerability. Safety was evaluated according to the common toxicity criteria adverse events 4.0 criteria. Secondary endpoints were one-year relapse-free survival rate, relapse-free survival (RFS) and overall survival (OS).

RESULTS

Between 10/2015 and 02/2018, 32 patients were enrolled in 12 German centres and 30 started adjuvant study treatment. Seventeen patients completed all 18 cycles. Two patients terminated study treatment due to adverse events (AEs), 7 due to patient's or investigator's decision and 4 due to recurrence or distant metastasis during adjuvant therapy. Dose levels were reduced to 25 mg/m² in 9 patients, and to 20 mg/m² in 1 patient. Of patients completing all 18 cycles, 5 did so with reduced dosage of S-1. Documented grade ≥ 3 AEs were neutropenia, diarrhoea, vomiting, polyneuropathy, palmar-plantar erythrodysaesthesia and rash. Serious AEs were observed in 7 patients. Median RFS was 32.2 months. One-year relapse-free survival rate was 77%. Data on OS were still premature at the end of the study.

CONCLUSION

Adjuvant treatment with S-1 for one year is a feasible and safe treatment option for Caucasian patients diagnosed with gastric adenocarcinoma or cancer of the EGJ cancer after R0-resection.

Negative Hyperselection of Resistance Mutations for Panitumumab Maintenance in RAS Wild-Type Metastatic Colorectal Cancer (PanaMa Phase II Trial, AIO KRK 0212)

PURPOSE

We evaluated additional mutations in RAS wild-type (WT) metastatic colorectal cancer (mCRC) as prognostic and predictive biomarkers for the efficacy of added panitumumab to a 5-fluorouracil plus folinic acid (FU/FA) maintenance as pre-specified analysis of the randomized PanaMa trial.

PATIENTS AND METHODS

Mutations (MUT) were identified using targeted next-generation sequencing (NGS; Illumina Cancer Hotspot Panel v2) and IHC. RAS/BRAF V600E/PIK3CA/AKT1/ALK1/ERBB2/PTEN MUT and HER2/neu overexpressions were negatively hyperselected and correlated with median progression-free survival (PFS) and overall survival (OS) since start of maintenance treatment, and objective response rates (ORR). Univariate/multivariate Cox regression estimated hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS

202 of 248 patients (81.5%) of the full analysis set (FAS) had available NGS data: hyperselection WT, 162 (80.2%); MUT, 40 (19.8%). From start of maintenance therapy, hyperselection WT tumors were associated with longer median PFS as compared with hyperselection MUT mCRC (7.5 vs. 5.4 months; HR, 0.75; 95% CI, 0.52-1.07; P = 0.11), OS (28.7 vs. 22.2 months; HR, 0.53; 95% CI, 0.36-0.77; P = 0.001), and higher ORR (35.8% vs. 25.0%, P = 0.26). The addition of panitumumab to maintenance was associated with significant benefit in hyperselection WT tumors for PFS (9.2 vs. 6.0 months; HR, 0.66; 95% CI, 0.47-0.93; P = 0.02) and numerically also for OS (36.9 vs. 24.9 months; HR, 0.91; 95% CI, 0.61-1.36; P = 0.50), but not in hyperselection MUT tumors. Hyperselection status interacted with maintenance treatment arms in terms of PFS (P = 0.06) and OS (P = 0.009).

CONCLUSIONS

Extended molecular profiling beyond RAS may have the potential to improve the patient selection for anti-EGFR containing maintenance regimens.

Nivolumab Switch Maintenance Therapy After Tyrosine Kinase Inhibitor Induction in Metastatic Renal Cell Carcinoma: A Randomized Clinical Trial by the Interdisciplinary Working Group on Renal Tumors of the German Cancer Society (NIVOSWITCH; AIO-NZK-0116ass)

BACKGROUND

The role of immune checkpoint inhibitor (ICI) maintenance therapy in metastatic renal cell carcinoma (mRCC) is undefined.

OBJECTIVE

To determine whether switch maintenance therapy with nivolumab improves clinical outcomes in patients with mRCC with tyrosine kinase inhibitor (TKI) sensitivity.

DESIGN, SETTING, AND PARTICIPANTS

This open-label phase 2 trial randomized patients with a partial response or stable disease after 10-12-wk TKI induction therapy to either TKI or nivolumab maintenance. Key inclusion criteria were measurable disease, clear cell histology, Eastern Cooperative Oncology Group performance status (ECOG PS) 0-2, and adequate organ function.

INTERVENTION

Intravenous nivolumab 8 × 240 mg every 2 wk, followed by 480 mg every 4 wk or sunitinib 50 mg (4-2 regimen) or pazopanib 800 mg once daily orally.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES

The primary endpoint was overall survival (OS). Secondary endpoints were the objective response rate (ORR; Response Evaluation Criteria in Solid Tumors v1.1), progression-free survival (PFS), safety (Common Terminology Criteria for Adverse Events v4.03), and patient-reported outcomes (Functional Assessment of Cancer Therapy Kidney Symptom Index). The Kaplan-Meier method, two-sided log-rank tests, and Cox regression models were used for statistical analysis.

RESULTS AND LIMITATIONS

Maintenance therapy was nivolumab for 25 patients (51.0%) and TKI for 24 (48.9%). The median age was 65 yr (range 35-79). Nine patients (18.4%) were female, 31 (63.3%) had ECOG PS of 0, and 15 (30.6%) had favorable risk. OS data are immature (17 deaths, 34.7%). The ORR was 20.0% (n = 5) for nivolumab and 52.2% (n = 12) for TKI. PFS was worse with nivolumab (hazard ratio 2.57, 95% confidence interval 1.36-4.89; p = 0.003). Grade ≥3 adverse events occurred in 14 patients (56.0%) with nivolumab and 17 (70.8%) with TKI. A major limitation is early termination of our study.

CONCLUSIONS

TKI treatment achieved superior ORR and PFS in comparison to nivolumab maintenance therapy. Our data do not indicate a role for nivolumab switch maintenance in mRCC.

PATIENT SUMMARY

Patients with metastatic kidney cancer who experienced a tumor response or disease stabilization after a short period of targeted treatment with a tyrosine kinase inhibitor did not benefit from a switch to the immunotherapy drug nivolumab. Patients who continued their original treatment achieved better responses and a longer time without disease progression. This trial is registered on EudraCT as 2016-002170-13 and on ClinicalTrials.gov as NCT02959554.

Conversion of Problematic Winery Waste into Valuable Substrate for Baker's Yeast Production and Solid Biofuel: A Circular Economy Approach§

Research background

Wine production, which is considered a major sector in food industry, often involves the use of a large amount of resources. Moreover, wine making generates a large amount of grape pomace, which is generally used for low-value applications such as fertiliser and animal feed. The aim of the present research is to explore the possibility of improving the overall sustainability of traditional winemaking.

Experimental approach

A zero-waste process was developed. It includes the production of white wine and the substantial valorisation of grape pomace, which is converted into solid biofuel, tartaric acid and concentrated grape extract as feedstock for industrial baker's yeast production.

Results and conclusions

We estimate that a significant surplus of renewable energy of approx. 3 MJ/kg processed grapes can be obtained during this conversion. The suitability of grape extract as a potential substrate for industrial baker's yeast production was evaluated and the feasibility of a partial replacement of molasses (up to 30 %) was demonstrated.

Novelty and scientific contribution

We present a circular economy approach for the conversion of winery biowaste into high-value resources such as feedstock and solid biofuel.

Soft Reconstruction Kernels Improve HCC Imaging on a Photon-Counting Detector CT

RATIONALE AND OBJECTIVES

Hepatocellular carcinoma (HCC) is the only tumor entity that allows non-invasive diagnosis based on imaging without further histological proof. Therefore, excellent image quality is of utmost importance for HCC diagnosis. Novel photon-counting detector (PCD) CT improves image quality via noise reduction and higher spatial resolution, inherently providing spectral information. The aim of this study was to investigate these improvements for HCC imaging with triple-phase liver PCD-CT in a phantom and patient population study focusing on identification of the optimal reconstruction kernel.

MATERIALS AND METHODS

Phantom experiments were performed to analyze objective quality characteristics of the regular body and quantitative reconstruction kernels, each with four sharpness levels (36-40-44-48). For 24 patients with viable HCC lesions on PCD-CT, virtual monoenergetic images at 50 keV were reconstructed using these kernels. Quantitative image analysis included contrast-to-noise ratio (CNR) and edge sharpness. Three raters performed qualitative analyses evaluating noise, contrast, lesion conspicuity, and overall image quality.

RESULTS

In all contrast phases, the CNR was highest using the kernels with a sharpness level of 36 (all p < 0.05), with no significant influence on lesion sharpness. Softer reconstruction kernels were also rated better regarding noise and image quality (all p < 0.05). No significant differences were found in image contrast and lesion conspicuity. Comparing body and quantitative kernels with equal sharpness levels, there was no difference in image quality criteria, neither regarding in vitro nor in vivo analysis.

CONCLUSION

Soft reconstruction kernels yield the best overall quality for the evaluation of HCC in PCD-CT. As the image quality of quantitative kernels with potential for spectral post-processing is not restricted compared to regular body kernels, they should be preferred.

Health-related quality of life in patients with RAS wild-type metastatic colorectal cancer treated with fluorouracil and folinic acid with or without panitumumab as maintenance therapy: a prespecified secondary analysis of the PanaMa (AIO KRK 0212) trial

BACKGROUND

The PanaMa trial demonstrated significant benefit in progression-free survival with the addition of panitumumab (Pmab) to fluorouracil and folinic acid (FU/FA) as maintenance therapy following first-line induction therapy with FOLFOX/Pmab in patients with RAS wild-type metastatic colorectal cancer. Here, we report health-related quality of life (HRQOL) analyses from the PanaMa trial.

METHODS

HRQOL outcomes were evaluated using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) at every cycle of therapy until disease progression/death. HRQOL outcomes were mean and individual changes in EORTC QLQ-C30 from baselines (before induction therapy and before maintenance therapy) to each cycle of treatment. Comparative analyses were performed by randomisation status and treatment arm for induction- and maintenance-therapy, respectively. The trial is registered with clinicaltrials.gov (NCT01991873).

RESULTS

At least one HRQOL questionnaire was completed by a total of 349/377 (93%) patients who received induction therapy, and by 237/248 (96%) patients who were randomised and received maintenance therapy. During induction therapy, most HRQOL dimensions remained stable or showed improvement, while appetite loss and diarrhoea significantly deteriorated. During maintenance therapy, HRQOL dimensions remained stable, while those that deteriorated during induction therapy showed significant improvement, without significant differences between the treatment arms.

CONCLUSION

Maintenance therapy improves HRQOL dimensions that initially deteriorated during induction therapy while stabilising HRQOL in other dimensions. The addition of Pmab to FU/FA as maintenance therapy in patients with RAS wild-type metastatic colorectal cancer prolongs progression-free survival without negative impact on HRQOL.

Consensus Molecular Subtypes as Biomarkers of Fluorouracil and Folinic Acid Maintenance Therapy With or Without Panitumumab in RAS Wild-Type Metastatic Colorectal Cancer (PanaMa, AIO KRK 0212)

PURPOSE

Consensus molecular subtypes (CMSs) were evaluated as prognostic and predictive biomarkers of patients with RAS wild-type metastatic colorectal cancer (mCRC) receiving fluorouracil and folinic acid (FU/FA) with or without panitumumab (Pmab) after Pmab + mFOLFOX6 induction within the randomized phase II PanaMa trial.

METHODS

CMSs were determined in the safety set (ie, patients that received induction) and full analysis set (FAS; ie, randomly assigned patients who received maintenance) and correlated with median progression-free survival (PFS) and overall survival (OS) since the start of induction or maintenance treatment and objective response rates (ORRs). Hazard ratios (HRs) and 95% CI were calculated by univariate/multivariate Cox regression analyses.

RESULTS

Of 377 patients of the safety set, 296 (78.5%) had available CMS data: CMS1/2/3/4: 29 (9.8%)/122 (41.2%)/33 (11.2%)/112 (37.8%) and unclassifiable: 17 (5.7%). The CMSs were prognostic biomarkers in terms of PFS (P < .0001), OS (P < .0001), and ORR (P = .02) since the start of induction treatment. In FAS patients (n = 196), with CMS2/4 tumors, the addition of Pmab to FU/FA maintenance therapy was associated with longer PFS (CMS2: HR, 0.58 [95% CI, 0.36 to 0.95], P = .03; CMS4: HR, 0.63 [95% CI, 0.38 to 1.03], P = .07) and OS (CMS2: HR, 0.88 [95% CI, 0.52 to 1.52], P = .66; CMS4: HR, 0.54 [95% CI, 0.30 to 0.96], P = .04). The CMS interacted significantly with treatment in terms of PFS (CMS2 v CMS1/3: P = .02; CMS4 v CMS1/3: P = .03) and OS (CMS2 v CMS1/3: P = .03; CMS4 v CMS1/3: P < .001).

CONCLUSION

The CMS had a prognostic impact on PFS, OS, and ORR in RAS wild-type mCRC. In PanaMa, Pmab + FU/FA maintenance was associated with beneficial outcomes in CMS2/4, whereas no benefit was observed in CMS1/3 tumors.

Abstract OT2-01-09: ABEMACARE: Abemaciclib in Combination with Endocrine Therapy as First Line Therapy in Metastatic Breast Cancer Patients with Symptomatic Visceral Metastases or High Tumor Burden – A prospective multicenter observational study

ABEMACARE: Abemaciclib in Combination with Endocrine Therapy as First Line Therapy in Metastatic Breast Cancer Patients with Symptomatic Visceral Metastases or High Tumor Burden – A prospective Multicenter Observational Study Sophia Ramsperger, Franziska Kotzur, Lothar Müller, Stephan Seitz, Peter A. Fasching, Stefanie Jilg, Dorothea Fischer, Silvia Egert-Schwender, Victoria Kehl, Ute Reuning, Lukas Rief, Romina Rösch, Holger Bronger, Christof Winter, Marion Kiechle, Johannes Ettl Background: Combined endocrine therapy with Cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitors and aromatase inhibitor (AI) or Fulvestrant has become standard of care in first line therapy of estrogen receptor (ER) positive, HER2 negative metastatic breast cancer. Numeral trials have shown excellent results regarding disease control and survival while maintaining quality of life for patients. In the MONARCH 2 and MONARCH 3 trials, patients with liver metastases derived a particularly large benefit from the use of Abemaciclib. Nevertheless, in real world many patients with endocrine sensitive metastatic breast cancer are still being treated with chemotherapy in first line. Symptomatic visceral disease and/or high tumor burden are often seen as reasons for upfront chemotherapy even in the absence of visceral crisis. In this specific patient population Abemacare aims at determining the efficacy of Abemaciclib in combination with endocrine therapy as first line treatment. Further, the question is addressed, whether circulating tumor DNA might serve as a predictive biomarker for early tumor response. Study Design: Abemacare is a prospective multicenter noninterventional, observational study. 96 patients in 10 German cancer centers who receive first line Abemaciclib in combination with AI or Fulvestrant are planned to be enrolled. Recruitment started in December 2020. As of July 1st 2022, 51 patients have been included in six study sites. Patients with documented ER-positive, HER2-negative metastatic breast cancer and measurable visceral disease are eligible if they fulfill one of the following inclusion criteria: Presence of clinical signs or symptoms of visceral disease (e.g. pleural effusion, ascites, abdominal pain from liver or peritoneal metastases, dyspnea from pleural effusion or lymphangiosis of the lung, elevated liver enzymes or bilirubin level (&gt; 2x ULN)) or signs of high tumor burden (e.g. LDH &gt; 399 U/l with K+ in normal range, abnormal CEA or CA 15-3 level (&gt; 2x ULN), radiographic signs of lymphangiosis of the lung, cytologically proven bone marrow infiltration). Patients with prior therapy with a CDK 4/6 inhibitor in any setting or first line therapy for metastatic disease are excluded from the trial. Primary endpoint is best objective response rate (ORR) defined by the proportion of patients who are evaluated using RECIST V1.1 as having partial (PR) or complete response (CR) while being on study treatment. ORR will be analyzed using the one group χ2 test at the 5% significance level. The test hypotheses are as follows: H0: ORR = 0.43, HA: ORR ≠ 0.43. In addition, ORR will be reported with a 95% CI. Several additional endpoints regarding disease control and patient reported outcomes will also be evaluated. Plasma samples for ctDNA are being collected at d1 and d15 of cycle 1 and d1 of cycle 2 and 3. Contact information: For further information please contact the leading physician Dr. Johannes Ettl via johannes.ettl@tum.de This study is supported by Eli Lilly and Company. NCT04681768

a&gt;Disclosure(s):

Johannes Ettl, n/a: Amgen, Celgene, Eisai, Myriad, Teva.: Consulting Fees (e.g., advisory boards) (Ongoing); Novartis: Consulting Fees (e.g., advisory boards) (Ongoing); Pfizer, Pierre Fabre, Lilly, Roche, AstraZeneca, Daiichi, Gilead, Seagen: Consulting Fees (e.g., advisory boards) (Ongoing)

Ramsperger Sophia, n/a: No financial relationships to disclose

Franziska Kotzur, n/a: No financial relationships to disclose

Lothar Müller, n/a: No financial relationships to disclose

Stephan Seitz, n/a: AstraZeneca: Consulting Fees (e.g., advisory boards) (Ongoing), Fees for Non-CME Services Received Directly from Commercial Interest or their Agents (e.g., speakers’ bureaus) (Ongoing); GE; Gedeon-Richter; GSK; Lilly;: Consulting Fees (e.g., advisory boards) (Ongoing)

Peter A. Fasching, MD: Agendia: Consulting Fees (e.g., advisory boards) (Ongoing); AstraZeneca: Consulting Fees (e.g., advisory boards) (Ongoing); Biontech: Contracted Research (Ongoing); Cepheid: Contracted Research (Ongoing); Daiichi Sankyo: Consulting Fees (e.g., advisory boards) (Ongoing); Eisai: Consulting Fees (e.g., advisory boards) (Ongoing); Genentech: Consulting Fees (e.g., advisory boards) (Ongoing); Gilead: Consulting Fees (e.g., advisory boards) (Ongoing); Lilly: Consulting Fees (e.g., advisory boards) (Ongoing); Merck Sharp & Dohme: Consulting Fees (e.g., advisory boards) (Ongoing); Novartis: Consulting Fees (e.g., advisory boards) (Ongoing); Pfizer: Consulting Fees (e.g., advisory boards) (Ongoing); Pierre Fabre: Consulting Fees (e.g., advisory boards) (Ongoing); Roche: Consulting Fees (e.g., advisory boards) (Ongoing); Sanofi Aventis: Consulting Fees (e.g., advisory boards) (Ongoing); SeaGen: Consulting Fees (e.g., advisory boards) (Ongoing)

Stefanie Jilg, n/a: No financial relationships to disclose

Dorothea Fischer, n/a: No financial relationships to disclose

Silvia Egert-Schwender, n/a: No financial relationships to disclose

Kehl Victora, n/a: No financial relationships to disclose

Ute Reuning, n/a: No financial relationships to disclose

Romina Rösch, n/a: No financial relationships to disclose

Lukas Rief, n/a: No financial relationships to disclose

Holger Bronger, n/a: No financial relationships to disclose

Christof Winter, n/a: No financial relationships to disclose

Marion Kiechle, n/a: Myriad Genetics, Bavarian KVB, DKMS Life, BLAEK, TEVA, Exeltis. Equity owner: Therawis Diagnostic GmbH, AIM GmbH.: Consulting Fees (e.g., advisory boards) (Ongoing), Contracted Research (Ongoing), Fees for Non-CME Services Received Directly from Commercial Interest or their Agents (e.g., speakers’ bureaus) (Ongoing)

&lt;/a&gt;

Citation Format: Johannes Ettl, Ramsperger Sophia, Franziska Kotzur, Lothar Müller, Stephan Seitz, Peter A. Fasching, Stefanie Jilg, Dorothea Fischer, Silvia Egert-Schwender, Kehl Victora, Ute Reuning, Romina Rösch, Lukas Rief, Holger Bronger, Christof Winter, Marion Kiechle. ABEMACARE: Abemaciclib in Combination with Endocrine Therapy as First Line Therapy in Metastatic Breast Cancer Patients with Symptomatic Visceral Metastases or High Tumor Burden – A prospective multicenter observational study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT2-01-09.

Nivoswitch trial: Predictive value of PD-L1 in plasma and extracellular vesicles

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Background: Predictive markers for immune checkpoint inhibition (ICI) in renal cell carcinoma patients are still missing. Until now, mainly primary tumor tissues have been analyzed to identify reliable markers including PD-L1, although distant metastases represent the therapy targets. Taking into account putative heterogeneity between primary tumors and metastases as well as dynamic changes during tumor progression and treatment, markers from liquid biopsies seem to be more suitable. The aim of this study was to investigate the predictive value of PD-L1 in plasma and on extracellular vesicles (EV) from plasma in the Nivoswitch trial. Methods: Plasma samples at randomization were obtained from 39 patients who received 3 months of tyrosine kinase inhibitor (TKI) therapy followed by random allocation to Nivolumab (“switch arm”) or continued TKI therapy (control arm) and during treatment (day 30). PD-L1 concentration was quantified by ELISA. EVs were isolated by ultracentrifugation or by using a commercial kit. They were characterized by Western blotting using cell specific, EV-specific markers as well as PD-L1 antibody. The data was analyzed by Mann Whitney and Kruskal Wallis tests as well as Kaplan Meier estimates. Results: PD-L1 was detected in plasma and EVs in all patients. PD-L1 plasma concentration was similar between response categories both in the overall cohort and the control (TKI) arm. In contrast, PD-L1 concentration in the “switch arm” was significantly lower in patients with objective response compared to patients with stable (p=0.028) or progressive disease (p=0.008) at day 0, whereas no significant difference occurred at day 30. Plasma PD-L1 levels during treatment (day 30 compared to day 0) did not show an association with therapy response in both arms. A trend towards better OS was found in patients with lower PD-L1 irrespective of treatment arm, but not for PFS. PD-L1 was detected on plasma EVs both by Western blotting as well as by ELISA, although the concentrations were too low for statistical analysis. Conclusions: In this study, plasma PD-L1 concentration did not show strong associations with clinical outcomes which might be caused by the rather small sample size and inherent heterogeneity of treatment. However, PD-L1 concentrations may have prognostic value confirming published data on tumor tissues. PD-L1 is detectable on EVs from plasma. Further studies should investigate the potential of EVs as biomarkers as well as their functional role in therapy response, especially in ICI. Clinical trial information: NCT02959554 .

Prognostic factors in nonsmall cell lung cancer: insights from the German CRISP registry

INTRODUCTION

Understanding prognosis, especially long-term outcome, in advanced nonsmall cell lung cancer (NSCLC) is crucial to inform patients, guide treatment and plan supportive and palliative care.

METHODS

Prognostic factors influencing overall survival (OS) and progression-free survival (PFS) in 2082 patients with wild-type (WT)-NSCLC (629 M1a, 249 M1b, 1204 M1c) are reported. Patients were included in the prospective German CRISP registry recruiting in >150 centres. Analysis for pre-therapeutic factors was based on results from Cox proportional hazard models.

RESULTS

Current M-descriptors of the Union for International Cancer Control-8 staging system were validated: M1a and M1b patients had significantly longer median time to events compared to M1c (OS/PFS 16.4/7.2 months, 17.8/6.7 months and 10.9/5.4 months, respectively). OS and PFS were influenced by number and location of metastatic organ systems. M1c and four or more metastatic organs involved had shorter OS and PFS than M1c with one to three organs (OS hazard ratio (HR) 1.69, p<0.001; PFS HR 1.81, p<0.001). M1b-liver metastases had shorter OS/PFS than M1b involving other organs (OS HR 2.70, p=0.006; PFS HR 2.48, p=0.007). Based on number of involved organs (orgsys) and liver metastases, two risk groups (low-risk: M1a, M1b-non-liver, M1c-1-3-orgsys-non-liver; high-risk: M1c-liver, M1b-liver, M1c-4+-orgsys) with significantly different prognoses could be amalgamated (median OS/PFS 14.3/6.5 months and 7.7/4.1 months, respectively). Other favourable factors were female gender and Eastern Cooperative Oncology Group stage 0, with age showing no impact. Those with T1- or N0-status were associated with longer OS than T2-4 or N2-3.

CONCLUSION

In this large observational dataset, we further defined factors for outcome in WT-NSCLC, including increased number of involved metastatic organ systems and liver metastases, as those with overall poorer prognosis and reduced survival chance.

Prognostic and predictive impact of metastatic organ involvement on maintenance therapy in advanced metastatic CRC: Analysis of patients treated within the PanaMa trial (AIO KRK 0212)

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Background: Despite molecular selection, patients with RAS wildtype mCRC represent a heterogeneous population, including different metastatic patterns and number of organs involved. We investigated metastatic patterns for their prognostic and predictive impact on maintenance therapy with (FU/FA plus Pmab or FU/FA alone) in patients treated within the PanaMa trial. Methods: The study population was stratified according to number of organs involved and also to different patterns including liver metastases alone or in combination with additional organs. Kaplan-Meier method and Cox regressions were used to correlate efficacy endpoints (i.e. progression-free survival (PFS) and overall survival (OS) of maintenance therapy) in the aforementioned populations. Results: Of 248 patients (pts) receiving maintenance therapy, 133 pts had a one-metastatic site disease (53.6%). Of those, 102 pts had liver-only metastases. Furthermore, liver metastases plus one additional involved organ was observed in 61/248 patients (24.6%), and liver metastases plus two or more organs in 40/248 patients (16.1%). In general, one organ disease was associated with favourable PFS of maintenance therapy compared to patients with ≥2 organs involved (HR 0.68, 95% CI 0.52–0.88; P = 0.004). A predictive impact of disease spread in terms of pmab-containing maintenance therapy was present for the PFS of maintenance therapy in patients with ≥ 2 organ disease (HR 0.58, 95% CI 0.39–0.86; P = 0.006) unlike in patients with only one-organ disease (HR 0.83, 95% CI, 0.57-1.21; P = 0.332) and also specifically in patients with a 2-organ disease including the liver (HR 0.57, 95% CI 0.33–0.99; P = 0.046). Conclusions: Consistent with previous reports, organ spread has prognostic impact in mCRC. The efficacy of more intensive maintenance therapy (including pmab and 5-FU/FA) is predominantly seen in patients with more than one organ involved in the metastatic spread, while less striking effects were seen in patients with only one organ disease. These data may support clinical decisions when EGFR-based maintenance therapy is considered. Clinical trial information: NCT01991873 .

A multicentre, randomised, double-blind, phase II study to evaluate the tolerability of an induction dose escalation of everolimus in patients with metastatic breast cancer (DESIREE)

BACKGROUND

Stomatitis is one of the main reasons to discontinue everolimus in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (mBC). To decrease stomatitis and subsequently early treatment discontinuations or dose reductions, the DESIREE trial investigated the use of a stepwise dose-escalation schedule of everolimus (EVE esc).

PATIENTS AND METHODS

DESIREE is a phase II, multicentre, randomised, double-blind, placebo-controlled trial in patients with HR+/HER2- mBC and progression/relapse after nonsteroidal aromatase inhibitor treatment. Patients were randomised to EVE esc (2.5 mg/day, week 1; 5 mg/day, week 2; 7.5 mg/day, week 3; 10 mg/day, weeks 4-24) or everolimus 10 mg/day (EVE 10mg) for 24 weeks plus exemestane. The primary endpoint was the incidence of stomatitis episodes grade ≥2 within 12 weeks of treatment. The secondary endpoints included toxicity, relative total dose intensity (RTDI) and quality of life (QoL).

RESULTS

A total of 160 patients were randomised and 156 started treatment (EVE esc: 80; EVE 10mg: 76). The median age of patients was 64 years (range 33-85), 56.3% patients in the EVE esc arm versus 42.1% in the EVE 10mg arm had liver metastasis (P = 0.081) and 62.5% versus 51.3% received over one metastatic therapy line (P = 0.196). Within 12 weeks, the incidence of stomatitis episodes grade ≥2 was significantly lower in the EVE esc arm compared with the EVE 10mg arm (28.8% versus 46.1%; odds ratio 0.47, 95% confidence interval 0.24-0.92; P = 0.026). Toxicity was in line with the known safety profile without new safety concerns. The median RTDI was 91.1% in the EVE esc arm versus 80.0% in the EVE 10mg arm (P = 0.329). Discontinuation rate in the first 3 weeks was 6.3% versus 15.8%, respectively (P = 0.073). QoL was comparable between the two treatment arms.

CONCLUSIONS

A dose-escalation schema of everolimus over 3 weeks can be successfully used to reduce the incidence of high-grade stomatitis in the first 12 weeks of treatment in patients with HR+/HER2- mBC.

TRIAL REGISTRATION

ClinicalTrials.govNCT02387099; https://clinicaltrials.gov/ct2/show/NCT02387099.

Photon-counting detector CT improves quality of arterial phase abdominal scans: A head-to-head comparison with energy-integrating CT

PURPOSE

Photon-counting detector (PCD)-CT is expected to have a substantial impact on oncologic abdominal imaging. We compared subjective and objective image quality between PCD-CT and conventional energy-integrating detector (EID-)CT arterial phase abdominal scans.

METHODS

This study included 84 patients undergoing both types of abdominal CT. EID-CT scans were acquired with a tube voltage of 100 kVp. With PCD-CT, acquired with 120-kVp, we reconstructed polychromatic T3D images and virtual monoenergetic images (VMIs) in 10-keV intervals from 40 to 90 keV. Quantitative image analysis included noise and contrast-to-noise ratio (CNR) of hepatic vessels, kidney cortex, and hypervascular liver lesions to liver parenchyma. Three raters used a 5-point Likert scale for qualitative image analysis of image noise and contrast, lesion conspicuity, and overall image quality. Radiation dose exposure (CT dose index) was compared between the two CT types.

RESULTS

Mean CT dose index and effective dose were respectively 18 % and 26 % lower with PCD-CT versus EID-CT. Compared with EID-CT, CNRs of kidney cortex and vessel to liver parenchyma were significantly higher in PCD-CT VMIs at energies ≤ 60 keV and in polychromatic T3D images (p < 0.004). Overall image quality of PCD-CT VMIs at 50 and 60 keV was rated as significantly better (p < 0.01) than the EID-CT images (inter-reader agreement alpha = 0.80). Lesion conspicuity was significantly better in low-keV VMIs (p < 0.03) and worse in > 70-keV VMIs.

CONCLUSIONS

With low-keV VMI, PCD-CT yields significantly improved objective and subjective quality of arterial phase oncological imaging compared with EID-CT. This advantage may translate into higher diagnostic confidence and lower radiation dose protocols.

Influence of the skeletal muscle index on pharmacokinetics and toxicity of fluorouracil

BACKGROUND

The body composition of patients has been associated with tolerability and effectiveness of anticancer therapy. This study aimed to assess the influence of the skeletal muscle index (SMI) on the pharmacokinetics and toxicity of fluorouracil.

METHODS

Patients treated in an oncological practice with fluorouracil-based chemotherapy and undergoing therapeutic drug monitoring were retrospectively investigated. Computed tomography images were analyzed to measure abdominal skeletal muscle areas in Hounsfield units for the psoas major muscle, back and total skeletal muscle to determine the SMI. For the latter, an automated segmentation method was used additionally. SMI measures were tested as covariates on fluorouracil clearance in a population pharmacokinetic model. Furthermore, regression analyses were performed to analyze the influence of SMI measures on the probability of clinically relevant adverse events (CTCAE grades ≥ 2).

RESULTS

Fluorouracil plasma concentrations of 111 patients were available. Covariate analyses showed significant improvements of the model fit by all SMI measures. However, interindividual variability of fluorouracil clearance was only slightly reduced, whereas the SMI of the back muscle showed the largest reduction (-1.1 percentage points). Lower SMI values of the back muscle increased the probability for polyneuropathy and lower SMI of the psoas increased the probability for fatigue.

CONCLUSIONS

Our results suggest that pharmacokinetics and toxicity of fluorouracil may be associated with specific SMI measures which deserve further investigation.

Study protocol of the FIRE-8 (AIO-KRK/YMO-0519) trial: a prospective, randomized, open-label, multicenter phase II trial investigating the efficacy of trifluridine/tipiracil plus panitumumab versus trifluridine/tipiracil plus bevacizumab as first-line treatment in patients with metastatic colorectal cancer

Background

Initial systemic therapy for patients with metastatic colorectal cancer (mCRC) is usually based on two- or three-drug chemotherapy regimens with fluoropyrimidine (5-fluorouracil (5-FU) or capecitabine), oxaliplatin and/or irinotecan, combined with either anti-VEGF (bevacizumab) or, for RAS wild-type (WT) tumors, anti-EGFR antibodies (panitumumab or cetuximab). Recommendations for patients who are not eligible for intensive combination therapies are limited and include fluoropyrimidine plus bevacizumab or single agent anti-EGFR antibody treatment. The use of a monochemotherapy concept of trifluridine/ tipiracil in combination with monoclonal antibodies is not approved for first-line therapy, yet. Results from the phase II TASCO trial evaluating trifluridine/ tipiracil plus bevacicumab in first-line treatment of mCRC patients and from the phase I/II APOLLON trial investigating trifluridine/ tipiracil plus panitumumab in pre-treated mCRC patients suggest favourable activity and tolerability of these new therapeutic approaches.

Methods

FIRE-8 (NCT05007132) is a prospective, randomized, open-label, multicenter phase II study which aims to evaluate the efficacy of first-line treatment with trifluridine/tipiracil (35 mg/m² body surface area (BSA), orally twice daily on days 1–5 and 8–12, q28 days) plus either the anti-EGFR antibody panitumumab (6 mg/kg body weight, intravenously on day 1 and 15, q28 days) [arm A] or (as control arm) the anti-VEGF antibody bevacizumab (5 mg/kg body weight, intravenously on day 1 and 15, q28 days) [arm B] in RAS WT mCRC patients. The primary objective is to demonstrate an improved objective response rate (ORR) according to RECIST 1.1 from 30% (control arm) to 55% with panitumumab. With a power of 80% and a two-sided significance level of 0.05, 138 evaluable patients are needed. Given an estimated drop-out rate of 10%, 153 patients will be enrolled.

Discussion

To the best of our knowledge, this is the first phase II trial to evaluate the efficacy of trifluridine/tipiracil plus panitumumab in first-line treatment of RAS WT mCRC patients. The administration of anti-EGFR antibodies rather than anti-VEGF antibodies in combination with trifluridine/tipiracil may result in an increased initial efficacy.

Trial registration

EU Clinical Trials Register (EudraCT) 2019-004223-20. Registered October 22, 2019, ClinicalTrials.govNCT05007132. Registered on August 12, 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09892-8.

Impact of age and gender on the efficacy and safety of panitumumab plus fluorouracil and folinic acid versus fluorouracil and folinic acid alone as maintenance therapy in RAS WT metastatic colorectal cancer (mCRC): Subgroup analysis of the PANAMA-study (AIO-KRK-0212)

3567

Background: Clinical trials in mCRC are usually conducted irrespective of gender and mostly also irrespective of age. However, gender- and age-associated differences relating to safety and efficacy in the treatment of mCRC are of presently moving into the focus of interest. We investigated the effect of gender and age on efficacy and safety in the PANAMA trial. Methods: PANAMA investigated the efficacy of panitumumab (Pmab) plus fluorouracil and folinic acid (FU/FA) versus FU/FA alone after first-line induction therapy with six cycles of FU/FA and oxaliplatin plus Pmab in patients with RAS wild-type metastatic colorectal cancer. In this post-hoc analysis, the study population was stratified for age (≤ 65 years versus > 65 years) and gender (male versus female). Evaluated efficacy endpoints were progression-free survival (PFS), overall survival (OS) of maintenance therapy and objective response rate (ORR) during maintenance therapy. Safety endpoints were rates of any grade and grade 3/4 adverse events (AEs). Results: In total, 165 male and 83 female patients were randomized and treated. Male patients had a significant benefit from the addition of Pmab to maintenance treatment with regard to PFS (HR 0.63; 95% CI 0.45-0.88; p = 0.006) and demonstrated a strong trend towards better ORR during maintenance therapy (Odds ratio 1.92; 95%CI 1.02-3.70, p = 0.053). In female patients, no difference regarding PFS was seen between treatment arms (HR 0.85; 95% CI 0.53-1.35, p = 0.491), while a trend towards better ORR with Pmab (Odds ratio 2.50; 95% CI 0.99-6.25; p = 0.063) was observed. Gender had no significant impact on OS, nor did age categories affect survival endpoints. Adverse events grade ≥ 3 occurring during maintenance therapy were comparable between male and female patients (12.9% vs 13.5%; p = 0.791) and in different age categories (p = 0.393). Conclusions: In the Panama trial, addition of Pmab to maintenance treatment with FU/FA improved outcome in RAS wild-type mCRC. This effect is irrespective of age and is pronounced in male patients. Our results support the relevance of gender in mCRC. Clinical trial information: NCT01991873. [Table: see text]

Impact of the COVID-19 pandemic on colorectal cancer (CRC) care: Data from 22 German cancer centers (CC) and the Institute of Pathology, Ruhr-University Bochum - the AIO (Working Group for Internal Oncology of the German Cancer Society) CancerCOVID Consortium - AIO-YMO/KRK 520/ass

3626

Background: CRC still is one of the leading causes of cancer related death though prognosis has improved through guideline based management. The COVID-19 pandemic lead to re-allocation of resources subordinating all sections of care for CRC patients. We present data on changes of CRC care during the pandemic from 22 German AIO CC and our high volume Institute of Pathology (pathology). Methods: Data was collected retrospectively comparing the months (mo) of the first wave (fw) (4-6/2020) and second wave (sw) (11-12/2020) of the pandemic with corresponding periods (cp) in 2019 focusing on the number of precancerous (ICD-O/0+2) and malignant (ICD-O/3+6) colorectal lesions (CRL) diagnosed by our pathology, the number/stage of primary diagnoses (PD) and the number of surgeries (surg) at AIO CC. There, quality criteria of CRC care were also assessed (number of PD discussed within a multidisciplinary tumor board (tb), received social service (soc)/ psychological (psy) counseling or recruited into a clinical trial). Statistical analysis was performed using students t-test for paired data. Results: Numbers of CRL detected upon histology (row 1-3), number of cases, surg and quality criteria from AIO CC (row 4-9) are displayed in the table. We saw a dip in diagnosed CRL and number of surg (p=0.007) only during fw, whereas PD dipped significantly in both waves. A significant reduction in diagnosis of stage III CRC was detected for 2019 vs. 2020 (p=0.001), not for other stages. Quality criteria showed a significant reduction in clinical trial inclusion, a small dip in soc/psy counseling and persistently high tb presentation. Conclusions: We detected a significant decrease of premalignant lesions and primary cancers during the first year of the pandemic which may impact cancer mortality in the future. Certified German CC provided CRC care with significant reduction in clinical trial inclusion only, suggesting high stability of established certified cancer care infrastructure.[Table: see text]

OP0079 SYNOVIAL FIBROBLASTS – T CELL INTERACTIONS ARE MAJOR DRIVERS OF INFLAMMATION: A CLOSER LOOK INTO THE JOINT

Background

Rheumatoid Arthritis (RA) is a chronic inflammatory disease, which is characterized by synovial inflammation resulting in bone and cartilage destruction. Crosstalk between activated fibroblast-like synoviocytes (FLS) and immune cells, such as CD4+ T cells, within the synovium might amplify synovial inflammation and joint destruction.

Objectives

To define the interaction profile of activated FLS and CD4+ T cells within an inflammatory setting and to elucidate its consequence on synovial inflammation.

Methods

To screen for factors that activate FLS in RA, isolated FLS were treated with different inflammatory cytokines and transcriptomic changes were measured with RNA-seq. Fluorescence activated cell sorting (FACS) purified naïve CD4+ T-cells from the same patients were co-cultured with the cytokine pre-treated FLS. Automated fluorescence microscopy and downstream bioinformatic image analysis allowed visualization and quantification of cell-cell interactions. After co-culture T-cells were isolated and T-cell activation, proliferation and differentiation was determined by flow cytometry.

Results

To model the in vivo situation, FLS were pre-stimulated with different pro- and anti-inflammatory cytokines. RNA-seq revealed cytokine specific activation patterns of FLS. Correspondingly, we observed distinct CD4+ T cells – FLS interaction profiles depending on the cytokine used for FLS activation. In line with distinct interaction profiles, specific patterns in CD4+ T cells activation, proliferation and differentiation of naïve T cells into CD62Lhigh CD45ROhigh memory T cells could be detected. Signatures of cytokine-stimulated FLS could be identified in transcriptomic data from synovial tissue samples.

Conclusion

Within this study, we describe how cytokine induced CD4+ T cells – FLS interactions impact on T-cell proliferation, activation and differentiation.

References

[1]Zhang F, Wei K, Slowikowski K, Fonseka CY, Rao DA, Kelly S, et al. Defining inflammatory cell states in rheumatoid arthritis joint synovial tissues by integrating single-cell transcriptomics and mass cytometry. Nat Immunol. 2019.

[2]Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, et al. Rheumatoid arthritis. Nat Rev Dis Primers. 2018;4:18001.

[3]Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. The Lancet. 2016;388(10055):2023-38.

[4]Bartok B, Firestein GS. Fibroblast-like synoviocytes: key effector cells in rheumatoid arthritis. Immunol Rev. 2010;233(1):233-55.

[5]Zhang F, Wei K, Slowikowski K, Fonseka CY, Rao DA, Kelly S, et al. Defining inflammatory cell states in rheumatoid arthritis joint synovial tissues by integrating single-cell transcriptomics and mass cytometry. Nat Immunol. 2019.

Disclosure of Interests

None declared.

Diagnostic accuracy of wrist MRI in comparison to wrist arthroscopy regarding TFCC lesions in clinical practice

INTRODUCTION

The purpose of this study was to arthroscopically verify MRI diagnostic accuracy for triangular fibrocartilage complex (TFCC) lesions in a regular clinical environment.

METHODS

A total of 859 patients' data with both preoperative MRI of the wrist and additional wrist arthroscopy were retrospectively reviewed. Two board-certified hand surgeons and one orthopaedic surgeon executed wrist arthroscopy, whereas more than 100 radiologists examined the MRI of the wrist. The accordance of TFCC lesion classification using MRI in comparison to wrist arthroscopy and diagnostic precision of the former depending on technical details were evaluated.

RESULTS

Diagnostic accuracy of MRI for TFCC lesions is poor in comparison to wrist arthroscopy as the reference standard. Technical specifications for MRI of the wrist are heterogeneous among the radiologists. These parameters have not improved accuracy of TFCC evaluation at large.

CONCLUSION

The accuracy of MRI in a regular clinical environment still remains inferior to wrist arthroscopy for detection of TFCC lesions. Development of a standard MRI protocol may be implemented on a regular basis and application of the Palmer classification for TFCC lesion should be sought.

Panitumumab Plus Fluorouracil and Folinic Acid Versus Fluorouracil and Folinic Acid Alone as Maintenance Therapy in RAS Wild-Type Metastatic Colorectal Cancer: The Randomized PANAMA Trial (AIO KRK 0212)

PURPOSE

The randomized PANAMA trial investigated the efficacy of panitumumab (Pmab) when added to maintenance therapy with fluorouracil and folinic acid (FU/FA) in patients with RAS wild-type metastatic colorectal cancer.

METHODS

Following first-line induction therapy with six cycles of FU/FA and oxaliplatin plus Pmab, responding patients (stable disease or partial or complete remission) were randomly assigned (1:1, open-label) to maintenance treatment with either FU/FA plus Pmab or FU/FA alone. The primary objective was to demonstrate superiority of progression-free survival (PFS, time from random assignment until progression or death) in favor of FU/FA plus Pmab with a hazard ratio (HR) of 0.75, a power of 80%, and a significance level of 10%. Secondary end points included overall survival, objective response rate of maintenance therapy, and toxicity. Survival end points were analyzed by the Kaplan-Meier method and compared by log-rank test and Cox regressions. Dichotomous variables were compared by Fisher's exact test; odds ratios were indicated when appropriate. The trial is registered with ClinicalTrials.gov (NCT01991873).

RESULTS

Overall, 248 patients were randomly assigned and received maintenance therapy with either FU/FA plus Pmab (125 patients) or FU/FA alone (123 patients). At data cutoff, with 218 events (of 218 needed), PFS of maintenance therapy was significantly improved with FU/FA plus Pmab (8.8 months v 5.7 months; HR, 0.72; 80% CI, 0.60 to 0.85; P = .014). Overall survival (event rate 54%) numerically favored the FU/FA plus Pmab arm (28.7 months v 25.7 months; HR, 0.84; 95% CI, 0.60 to 1.18; P = .32). Objective response rates were 40.8% in patients receiving FU/FA plus Pmab versus 26.0% in patients receiving FU/FA alone (odds ratio, 1.96; 95% CI, 1.14 to 3.36; P = .02). The most frequent Common Terminology Criteria for Adverse Event grade ≥ 3 event during maintenance therapy was skin rash (7.2%).

CONCLUSION

In RAS wild-type metastatic colorectal cancer, maintenance therapy with FU/FA plus Pmab induced a significantly superior PFS compared with FU/FA alone. If active maintenance therapy is aspired following induction therapy with FU/FA and oxaliplatin plus Pmab, FU/FA plus Pmab appears to be the most favorable option.

Climate change as the driving force behind the intensification of agricultural land use

Climate change in Europe will lead to new precipitation patterns over the coming years and the annual temperature will increase significantly. These changes in climate variables and the resulting effects on agricultural productivity must be differentiated regionally. Plant production depends on sufficient rainfall in summer and, in some regions, on the amount of rainfall in winter. In Central Europe, the amount of precipitation in summer will decrease in the coming decades due to climate change, while in some regions, the amount of winter precipitation will increase significantly. Agricultural production is likely to suffer severely as a result of rising summer temperatures and low water retention capacities in the soil. The effects of reduced summer precipitation and increased air temperatures are partially offset by the expected increased CO2 concentration. Therefore, the effects that changed climatic conditions have on crop production are sometimes less drastic in terms of crop yields. The greatest impact of climate change on land use is expected from increasing evapotranspiration and lower amounts of precipitation in the production of leachate. In addition to the expected mean changes, the occurrence of extreme weather conditions is key. Periods of drought in the growing season and heavy flooding as a result of extreme rainfall are to be expected. However, these events are very difficult or even impossible to predict. In addition to the effects that climate change will have on regional crop production, global changes will have a strong impact on world markets for agricultural products. Another consequence of climate change and population growth is a higher demand for agricultural products on world markets. This will lead to dramatic local land use changes and an intensification of agriculture that will transform existing crop production systems. The intensification caused by rising land and lease prices will primarily affect the maximization of the use of fertilizers and pesticides.

Prognostic relevance of the HER2 status of circulating tumor cells in metastatic breast cancer patients screened for participation in the DETECT study program

BACKGROUND

Circulating tumor cells (CTCs) have been reported to predict clinical outcome in metastatic breast cancer (MBC). Biology of CTCs may differ from that of the primary tumor and HER2-positive CTCs are found in some patients with HER2-negative tumors.

PATIENTS AND METHODS

Patients with HER2-negative MBC were screened for participation in DETECT III and IV trials before the initiation of a new line of therapy. Blood samples were analyzed using CELLSEARCH. CTCs were labeled with an anti-HER2 antibody and classified according to staining intensity (negative, weak, moderate, or strong staining).

RESULTS

Screening blood samples were analyzed in 1933 patients with HER2-negative MBC. As many as 1217 out of the 1933 screened patients (63.0%) had ≥1 CTC per 7.5 ml blood; ≥5 CTCs were detected in 735 patients (38.0%; range 1-35 078 CTCs, median 8 CTCs). HER2 status of CTCs was assessed in 1159 CTC-positive patients; ≥1 CTC with strong HER2 staining was found in 174 (15.0%) patients. The proportion of CTCs with strong HER2 staining among all CTCs of an individual patient ranged between 0.06% and 100% (mean 15.8%). Patients with estrogen receptor (ER)- and progesterone receptor (PR)-positive tumors were more likely to harbor ≥1 CTC with strong HER2 staining. CTC status was significantly associated with overall survival (OS). Detection of ≥1 CTC with strong HER2 staining was associated with shorter OS [9.7 (7.1-12.3) versus 16.5 (14.9-18.1) months in patients with CTCs with negative-to-moderate HER2 staining only, P = 0.013]. In multivariate analysis, age, ER status, PR status, Eastern Cooperative Oncology Group performance status, therapy line, and CTC status independently predicted OS.

CONCLUSION

CTC detection in patients with HER2-negative disease is a strong prognostic factor. Presence of ≥1 CTC with strong HER2 staining was associated with shorter OS, supporting a biological role of HER2 expression on CTCs.

Multicenter, Observational Study of Lanreotide Autogel for the Treatment of Patients with Neuroendocrine Tumors in Routine Clinical Practice in Germany and Austria

Background The long-acting somatostatin analog lanreotide autogel is effective in the treatment of patients with neuroendocrine tumors.

Objective To evaluate the long-term treatment response in patients with neuroendocrine tumors receiving lanreotide autogel in routine clinical practice.

Methods Non-interventional, 24-month study in patients with neuroendocrine tumors treated with lanreotide autogel (NCT01840449).

Results Patients (n=80) from 26 centers in Germany and Austria were enrolled. Neuroendocrine tumors were mainly grade 1/2, metastasized, intestinal, and associated with carcinoid syndrome; 88.9% had received previous neuroendocrine tumor treatment. Of those, 84.4% had previous surgery, 18.7% had received octreotide. The primary endpoint, defined by a <50% chromogranin A increase at month 12 compared with the lowest value between baseline and month 3 was achieved by 89.5% patients. Stable disease according to Response Evaluation Criteria in Solid Tumors 1.1 was observed in 76.9 and 75.0% patients at months 12 and 24 of lanreotide treatment, respectively. Mean change of chromogranin A levels from baseline to month 24 was −0.12 × upper limit of normal (95% CI, −0.22; −0.45). In a post hoc analysis, 38.5% of the subgroup of patients with carcinoid syndrome had daily diarrhea at baseline vs. 21.4% at month 24. At baseline, 27.8% of patients received lanreotide 120 mg every 4 weeks vs. 56.7% at month 24. Quality of life data were heterogeneous. No new safety issues arose and/or required further investigation.

Conclusions Our study reflects routine lanreotide autogel use in patients with advanced/metastatic neuroendocrine tumors. This analysis shows effectiveness with stabilization of disease-related symptoms and good tolerability of lanreotide autogel in clinical practice.

The PLATON pilot-study “Platform for analyzing targetable tumor mutations”: A PLATON network study

TPS6598

Background: PLATON Network is designed as a platform to improve personalized therapy based on genomic profiles in gastrointestinal cancer patients. PLATON’s study-design focuses on patient’s molecular profiling and will provide a network web application for interlinking PLATON investigators which integrates information of the participating centers, their patients, the molecular profiles and available clinical trials at PLATON`s study-sites. Methods: The PLATON Network is designed as a permanent open, multicenter, prospective, cohort study with biobanking, with a shared platform infrastructure for associated sub-studies. In a first approach the PLATON Network enrolls within its pilot-study 200 patients in Germany of both sexes and ages over 18 at 40 study sites (NCT04484636) with signed informed consent. All patients of the pilot-study are diagnosed with hepatocellular cancer (HCC), intra- and extrahepatic cholangiocellular carcinoma (CCA), gallbladder carcinoma (GBCA), pancreatic cancer (PDCA) or esophagogastric cancer (EC/GC). At the time of enrolment, patients are within their first-line therapy and no local curative therapy is available. Molecular profiling will be performed with the Foundation Medicine Assays FoundationOne CDx and FoundationOne Liquid CDx. Investigators may use the platform for searching clinical trials matching the individual molecular profile of their patients or may identify a patient, who may be eligible for a study or other treatment options available at the corresponding centers of the PLATON network. The interactive network web application will comprise a dashboard and a moderated chat room to interact for example in a virtual Molecular Tumor Board. The first patient was included on the 25th of November 2020. Up to 12th of February 2021, a total of 36 patients HCC (N = 1), CCA (N = 6), PDCA (N = 12), GBCA (N = 0) and EC/GC (N = 16) were enrolled at 11 study-sites and the results of 29 genetic analyses were completed. All cohorts of the pilot-study are open for recruitments up to a maximum of 40 individuals per diagnostic group. Clinical trial information: NCT04484636.

Maintenance therapy with 5-fluoruracil/leucovorin (5FU/LV) plus panitumumab (pmab) or 5FU/LV alone in RAS wildtype (WT) metastatic colorectal cancer (mCRC) - the PANAMA trial (AIO KRK 0212)

3503

Background: Planned discontinuation or stop-and-go use of oxaliplatin are established strategies in the systemic therapy of mCRC. Consequently, and irrespective of antibody use, 5FU/LV represents the standard backbone of most maintenance strategies. Unlike VEGF-targeted substances, there is limited evidence that EGFR-antibodies add efficacy to 5FU/LV maintenance in RAS wildtype ( RAS WT) mCRC patients. Methods: Following induction therapy with six cycles of 5FU/LV, oxaliplatin (FOLFOX) and pmab, the trial randomized maintenance therapy with 5FU/LV plus pmab vs. 5FU/LV alone in a 1:1 fashion in patients (pts) with RAS WT mCRC. The primary endpoint was PFS (progression-free survival: time from randomization until progression or death). With 218 events needed for PFS, the trial was designed to demonstrate superiority of the 5FU/LV+ pmab arm vs. 5FU/LV alone with a hazard ratio (HR) of 0.75, power of 80% and a significance level of 10%. Secondary endpoints included overall survival (OS), objective response to induction- and maintenance therapy as well as quality of life. The trial is registered with ClinicalTrials.gov, NCT01991873. Results: The full analysis set consists of 248 pts (125 pts 5FU/LV + pmab and 123 pts 5FU/LV) who were randomized and received maintenance therapy. Median age was 66 vs. 65 years, male patients were 69.6% vs. 63.4%, ECOG 0 was 56.8% vs. 60.2% in the respective trial arms (5FU/LV+ pmab vs. 5FU/LV). At data cut-off, with 218 events, PFS of maintenance therapy was improved with 5FU/LV+ pmab vs. 5FU/LV alone (8.8 (80% CI 7.6-10.2) months vs. 5.7 (80% CI 5.6-6.0) months, HR 0.72 (80%CI 0.60-0.85), p = 0.014). OS (event rate 54.4%) numerically favoured the 5FU/LV+ pmab arm (28.7 (95% CI 25.4-39.1) months) as compared to 5FU/LV alone (25.7 (95% CI 22.2-28.2) months), HR 0.84 (95% CI 0.60-1.18). Conclusion: In RAS WT mCRC, maintenance therapy with 5FU/LV+ pmab appears to be superior to 5FU/LV alone and should be regarded as standard of care maintenance regimen following induction therapy with FOLFOX plus pmab. Clinical trial information: NCT01991873.

Abstract OT-26-01: ABEMACARE: Abemaciclib in combination with endocrine therapy as first line therapy in metastatic breast cancer patients with symptomatic visceral metastases or high tumor burden

Background:

Cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitors in combination with endocrine therapy are well established in the therapy of estrogen receptor (ER) positive, HER2 negative metastatic breast cancer. They have shown excellent results regarding disease control and survival in numerous trials while maintaining good quality of life for patients. In the subgroup analysis of the MONARCH 2 and MONARCH 3 trials, patients with liver metastases derived a particularly large benefit from the combined endocrine treatment with Abemaciclib. Despite this evidence, in real world many patients with endocrine sensitive metastatic breast cancer are still being treated with first line chemotherapy. Especially in patients with symptomatic visceral disease and/or high tumor burden, use of upfront chemotherapy remains common even in the absence of visceral crisis. With this study we aim to determine the efficacy of Abemaciclib in combination with endocrine therapy as first line treatment in this specific patient population.

Study design:

In this prospective multicenter observational study, we intend to enroll 120 patients in 10 German cancer treatment centers who will receive first line therapy with Abemaciclib in combination with endocrine therapy within clinical routine. Recruitment is planned to start in August 2020. Patients with documented ER positive, HER2 negative metastatic breast cancer with measurable visceral disease are eligible if they fulfill one of the following inclusion criteria: Presence of clinical signs or symptoms of visceral disease (e.g. pleural effusion, ascites, abdominal pain from liver or peritoneal metastases, dyspnea from pleural effusion or lymphangiosis of the lung, elevated liver enzymes or bilirubin level (&gt; 2x ULN)) or signs of high tumor burden (e.g. LDH &gt; 399 U/l with K in normal range, abnormal CEA or CA 15-3 level (&gt; 2x ULN), radiographic signs of lymphangiosis of the lung, cytologically proven bone marrow infiltration). Patients may have received chemotherapy or endocrine therapy in the adjuvant setting, but no prior therapy with CDK 4/6 inhibitors and no first line therapy for metastatic disease. Primary endpoint is best objective response rate (ORR) defined by the proportion of patients who are evaluated as having partial (PR) or complete response (CR) while being on study treatment using RECIST V1.1. ORR will be analyzed using the one group χ2 test at the 5% significance level. The test hypotheses are as follows: H0: ORR = 0.43, HA: ORR ≠ 0.43. In addition, ORR will be reported with a 95% CI.Several additional endpoints regarding disease control and patient reported outcomes will also be evaluated. At the same time translational research to identify possible early predictive biomarkers for tumor response (e.g. circulating tumor DNA) will be conducted.

Contact information:

For further information please contact the leading physician Dr. Johannes Ettl via johannes.ettl@tum.de

This study is supported by Eli Lilly and Company.

Citation Format: Franziska Kotzur, Helen Bidner, Holger Bronger, Silvia Egert, Peter A Fasching, Dorothea Fischer, Victoria Kehl, Hans-Joachim Lück, Lothar Müller, Ute Reuning, Lukas Rief, Romina Rösch, Stephan Seitz, Christof Winter, Marion Kiechle, Johannes Ettl. ABEMACARE: Abemaciclib in combination with endocrine therapy as first line therapy in metastatic breast cancer patients with symptomatic visceral metastases or high tumor burden [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-26-01.

Abstract PD3-12: Efficacy of the tyrosine kinase inhibitor lapatinib in the treatment of patients with HER2-negative metastatic breast cancer and HER2-positive circulating tumor cells - results from the randomized phase III DETECT III trial

Background: It is well-known that tumor biology may change during the course of the disease due to clonal evolution, and such changes might have important implications for response to targeted treatments. Circulating tumor cells (CTCs) could serve as a real-time liquid biopsy to detect changes in tumor biology. It has been demonstrated that patients with HER2-negative metastatic breast cancer (MBC) may have discordant, HER2-positive CTCs in the peripheral blood. However, up to now there is no randomized clinical trial investigating whether treatment decisions based on CTC phenotype provide benefits in terms of improved outcome. The aim of the DETECT III study is to investigate whether patients with initially HER2-negative MBC and HER2-positive CTCs benefit from HER2-targeted therapy with the tyrosine kinase inhibitor lapatinib. In addition, the significance of CTCs as an early predictive marker for response to therapy will be analyzed. Methods: The randomized phase III DETECT III trial (NCT01619111) compares lapatinib in combination with standard therapy versus standard therapy alone in patients with initially HER2-negative MBC and HER2-positive CTCs. Efficacy of lapatinib treatment is evaluated by CTC clearance rate, progression-free survival (PFS) and overall survival (OS). In addition, we investigate the association between CTC results and both PFS and OS to assess the utility of CTCs as an early predictive marker for treatment response. CTC enumeration and phenotyping was performed using the CellSearch® technology (Menarini Silicon Biosystems; Bologna, Italy). Survival data are analyzed using log rank tests, univariable and adjusted multivariable cox regressions. Results: First results on CTC clearance rates, PFS and OS of 105 prospectively randomized patients will be presented. Conclusion: This first randomized clinical trial in breast cancer patients with treatment decisions being based on the phenotype of CTCs will show whether patients with HER2 negative MBC and HER2 positive CTCs benefit from additional HER2-targeted therapy with lapatinib. This finding might be increasingly important as novel HER2-targeted drugs become available.

Citation Format: Tanja Fehm, Volkmar Mueller, Maggie Banys-Paluchowski, Peter A Fasching, Thomas WP Friedl, Andreas Hartkopf, Jens Huober, Christian Loehberg, Brigitte Rack, Sabine Riethdorf, Andreas Schneeweiss, Diethelm Wallwiener, Franziska Meier-Stiegen, Oliver Hoffmann, Lothar Müller, Pauline Wimberger, Eugen Ruckhaeberle, Jens Blohmer, Wolfgang Janni. Efficacy of the tyrosine kinase inhibitor lapatinib in the treatment of patients with HER2-negative metastatic breast cancer and HER2-positive circulating tumor cells - results from the randomized phase III DETECT III trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD3-12.

Predicting resistance to first-line FOLFOX plus bevacizumab in metastatic colorectal cancer: Final results of the multicenter, international PERMAD trial

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Background: Antiangiogenic agents, in particular monoclonal antibodies (mAbs) against VEGF, a major driver of tumor angiogenesis, are widely used in cancer therapy including metastatic colorectal cancer (mCRC). However, some patients do not profit from antiangiogenic treatments (AT), other patients benefit initially, but subsequently develop resistance not only to chemotherapy but also to AT. So far, no biomarkers are available to predict resistance to AT. Having an accurate assessment of imminent resistance to an AT may e.g. enable to respond by treating the patient with a more broadly acting antiangiogenic agent and thereby further delay resistance to the treatment and at the same time avoid employing a not anymore efficacious treatment. We hypothesized that repeated analysis of multiple cytokines related to angiogenesis together with machine learning approaches may enable an accurate prediction of anti-VEGF resistance during first-line treatment of mCRC patients with FOLFOX plus bevacizumab. The PERMAD trial aimed at establishing a CAF marker combination that enables the prediction of treatment resistance of patients with mCRC receiving Bevacizumab plus mFOLFOX6 in a palliative first-line setting about three months prior to radiological progress using an omics approach and bioinformatics. Methods: A phase I/II biomarker trial was conducted, including 15 centers in Germany and Austria. All mCRC patients included were treatment naïve and received FOLFOX plus Bevacizumab treatment. 102 different, preselected CAFs were prospectively collected and centrally analyzed in plasma samples (n = 647) obtained prior to treatment and biweekly until radiological progress determined by CT scan every 2 months. The values of CAFs affected in a similar fashion by both chemotherapy and disease progress were excluded. Using the remaining CAFs we employed a random forest predictor to define a combination of 5 CAF (CAF marker combination) whose change in values/pattern correlated with subsequent progress 3 months prior to radiological progress according to RECIST 1.1. Results: Using the samples described above and a random forest predictor we established a CAF marker combination comprising 5 CAF whose specific change in value/pattern over time indicated treatment resistance 3 months prior to radiological progress. The model allowed to differentiate timepoints without progress from timepoints predicting progress 100 days before radiological progress with an accuracy of 83%, a sensitivity of 76% and specificity of 88%. Conclusions: Using advanced bioinformatics, we identified a CAF marker combination that points out treatment resistance to FOLFOX plus Bevacizumab in patients with mCRC 3 months prior to radiological progress. Clinical trial information: NCT02331927.

Efficacy and Safety of CAP7.1 as Second-Line Treatment for Advanced Biliary Tract Cancers: Data from a Randomised Phase II Study

Simple Summary

Advanced biliary tract cancer is difficult to treat, and 5-year survival is less than 5% for tumours that cannot be removed by surgery. CAP7.1 is a drug being investigated for biliary tract cancer. This study assessed treatment with CAP7.1 in patients with advanced biliary tract cancer whose disease had progressed despite receiving other treatments. One group of patients received CAP7.1 together with best supportive care (BSC) and another group received BSC from their physician. The patients receiving BSC were subsequently given CAP7.1 if their disease was seen to progress. Disease control in those receiving CAP7.1 was better than that observed in patients who received BSC, with an associated greater time to disease progression. Side effects were as expected for this type of anti-cancer drug, related to dose of CAP7.1, and manageable. CAP7.1 may offer a new treatment option for biliary tract cancer and should undergo further clinical investigation.

Abstract

CAP7.1 is a novel topoisomerase II inhibitor, converted to active etoposide via carboxylesterase 2 (CES2), with signals of efficacy in treatment-refractory solid tumours. In a Phase II trial, 27 patients with advanced biliary tract cancers (BTC) were randomised 1:1 to CAP7.1 plus best supportive care (BSC), or BSC alone, with crossover to CAP7.1 upon disease progression. The primary objective was disease control rate (DCR) following 28-day cycles of CAP7.1 (200/150 mg/m²; iv), or BSC until progression. Secondary objectives included progression-free survival (PFS), time-to-treatment failure (TTF), overall survival (OS) and safety. Fourteen patients received CAP7.1 and 13 BSC. DCR favoured CAP7.1 vs. BSC (50% vs. 20%; treatment difference: 30%, 95%CI −18.44, 69.22, full analysis set [FAS]), with disease progression in 40% vs. 70%, respectively. Significantly longer median PFS was achieved for CAP7.1 vs. BSC: 66 vs. 39 days, respectively (hazard ratio [HR] 0.31; 95%CI 0.11, 0.86; p = 0.009; FAS). Similar trends were observed for TTF and OS. CES2-positive patients had longer median PFS (158 vs. 56 days) and OS (228 vs. 82 days) vs. CES2-negative patients. Adverse events were predictable, dose-dependent and consistent with those previously observed with etoposide. These efficacy and safety findings in second-line BTC warrant further clinical investigation of CAP7.1.