CAIRE: A basket multicenter open-label phase 2 study evaluating the EZH2 inhibitor tazemetostat in combination with durvalumab in patients with advanced solid tumors

TPS2703

Background: Recent studies have shown shown that genetic depletion of EZH2 in Tregs (using FoxP3creEZH2fl/fl mice) and pharmacological inhibition of EZH2 elicits phenotypic and functional alterations of Tregs, leading to an effector-like T cell profile. Further, EZH2 inhibition enhances the cytotoxicity of human Teffs in vitro and the proportion of tumor-infiltrating cytotoxic T cells in vivo in murine models. It has been shown that immune checkpoint inhibition (ICI) increases EZH2 expression in human T cells across various tumor types and that increased EZH2 expression in T cells inversely correlate with clinical outcome. Upregulation of EZH2 mediated by immune checkpoint inhibition in T cells modulates T cell responses and diminishes the effectiveness of immunotherapy. Consistent with this mechanism, pharmacologic inhibition of EZH2 has been shown to increase effector-like T cell responses and enhances effectiveness of immune checkpoint therapy in tumor-bearing mice [16-17]. Our group also reported first clinical data from a participant with sarcoma showing strong T cell infiltration after treatment with tazemetostat (Italiano et al Lancet Oncol 2018). Altogether, these findings pave the way for clinical trials combining ICI with the specific EZH2 inhibitor, tazemetostat in solid tumors. Methods: CAIRE (NCT04705818) is a multi-cohort, four single-arm phase 2, multicenter, open-label study investigating tazemetostat combined with durvalumab in patients with advanced cancers: pancreatic adenocarcinoma (cohort A), microsatellite stable colorectal cancer (cohort B), solid tumors with presence of tertiary lymphoid structures (assessed centrally) (cohort C), soft-tissue sarcomas (cohort D). Cohort A will enroll ̃32 patients and cohorts B, C and D ̃47 patients respectively. Eligible patients must have no standard treatment options available or a contraindication to standard treatment options, and ECOG PS 0–1. Patients with prior exposure to EZH2 inhibitor and/or PD1/PDL1 monoclonal antibodies are excluded. Tazemetostat will be administered per-os, twice daily (800 mg x 2), continuously. Treatment by Tazemetostat will start on Day 1 (of cycle 1). Durvalumab will be administered by intravenous infusion (1120 mg) on day 1, every 3 weeks. Treatment by Durvalumab will start on Day 1 of cycle 2. The primary endpoints are disease control rate within 24 weeks of treatment as per RECIST 1.1 in cohort A and B; objective response rate within 24 weeks of treatment as per RECIST 1.1 in cohort C, and 6-months non progression rate for cohort D. Secondary endpoints include adverse events (AEs)/serious AEs, duration of response, and progression-free survival. Pharmacodynamic and other biomarkers will be explored. The first patient received study drug on July, 30, 2022 and 1 site across France are currently enrolling patients. Clinical trial information: NCT04705818.

Metzolimos metronomic cyclophosphamide (CP) and methotrexate (MTX) combined with zoledronic acid (ZA) and sirolimus (SIR) in patients with advanced solid tumor with bone metastasis and advanced pretreated osteosarcoma (OSS): A phase Ib study

11526

Background: Advanced pretreated OSS has a very poor prognosis. Metronomic CP and MTX have shown little activity in pediatric cancers, including OSS. Preclinical data suggest that ZA could have a synergic effect when combined with mTOR inhibition in OSS. Methods: This is a prospective phase Ib study investigating the combination of SIR with CP, MTX and ZA trough a dose-escalation phase (3 + 3 design) in patients ≥ 18 years with bone metastatic solid tumors (part I) and an expansion cohort dedicated to patients ≥ 13 years with advanced pretreated OSS (part II). SIR was given at two dose levels (4 mg and 6 mg) continuously, in combination with CP 50 mg x 2 per day, 1 week on / 1 week off, MTX at 2.5 mg x 2 per day, on day 1 and day 4 every week, and ZA 4mg IV every 4 weeks. Primary endpoints were dose limiting toxicities (DLT), maximum tolerated dose and recommended phase II dose (RP2D) of SIR combined with CP, MTX and ZA for Part I, and 6-month non-progression rate (NPR) according to RECIST v1.1 for part II. Secondary endpoints included safety, 6-month objective response rate (ORR), one-year progression-free (PFS) and overall survivals (OS), and pharmacodynamics biomarker analyses. At least one non-progression at 6 months after centralized review of imaging was needed among 14 patients to consider activity of the combination. Results: From February 2015 to March 2021, 23 patients were included in the three participating centers. In part I, nine patients with breast (56%), prostate (33%) or biliary duct carcinoma (11%) were included. Median number of cycles was 2 (1-6). Two DLT were reported at dose level 2: one grade 3 neutropenia and one grade 3 anemia, therefore dose level 1 was the RP2D for part II. In part II, 14 OSS patients were included. Median age was 27 years (14 - 80). Median number of previous lines in the advanced disease was 1 (1-3). At the time of analysis, 11 patients had died. Reason for study discontinuation was progressive disease for 10 patients (72%), toxicity for two (14%) (one grade 2 platelet count decrease and one grade 5 unrelated lung infection), and investigator decision for two (14%) , including one for cryotherapy of a residual lesion after an excellent partial response. Overall, 64 adverse events related to study drugs were reported, of which 14 (22%) grade 3, and 2 grade 4 (3%). They were mainly asthenia, nausea, mucositis oral, anemia, lymphocyte and platelet count decrease. Median follow up was 27.5 months [95% CI : 12.8-27.5]. Two non-progressions at 6 months (14%) were observed, including a partial response (7%). One-year PFS was 21.4% [95%CI 5.2-44.8] and median OS was 12.8 months [95% CI : 2.8-20.4]. Conclusions: The combination of SIR at 4 mg daily with CP, MTX and ZA has an acceptable toxicity profile and reached the initial targeted efficacy rate in advanced pretreated OSS patients. Clinical trial information: NCT02517918.

Feasibility of high-throughput sequencing in clinical routine cancer care: lessons from the cancer pilot project of the France Genomic Medicine 2025 plan

Background

Whole exome sequencing and RNA sequencing (WES/RNASeq) should now be implemented in the clinical practice in order to increase access to optimal care for cancer patients. Providing results to Tumour Boards in a relevant time frame—that is, compatible with the clinical pathway—is crucial. Assessing the feasibility of this implementation in the French care system is the primary objective of the Multipli study, as one of the four pilot projects of the national France Genomic Medicine 2025 (FGM 2025) plan. The Multipli study encompasses two innovative trials which will be driven in around 2400 patients suffering from a soft-tissue sarcoma (Multisarc) or a metastatic colorectal carcinoma (Acompli).

Methods

Prior to launching the FGM 2025 cancer pilot study itself, the performance of the Multipli genomic workflow has been evaluated through each step, from the samples collection to the Molecular Tumour Board (MTB) report. Two Multipli-assigned INCa-labelled molecular genetics centres, the CEA-CNRGH sequencing platform and the Institut Bergonié’s Bioinformatics Platform were involved in a multicentric study. The duration of each step of the genomic workflow was monitored and bottlenecks were identified.

Results

Thirty barriers which could affect the quality of the samples, sequencing results and the duration of each step of the genomic pathway were identified and mastered. The global turnaround time from the sample reception to the MTB report was of 44 calendar days.

Conclusion

Our results demonstrate the feasibility of tumour genomic analysis by WES/RNASeq within a time frame compatible with the current cancer patient care. Lessons learnt from the Multipli WES/RNASeq Platforms Workflow Study will constitute guidelines for the forthcoming Multipli study and more broadly for the future clinical routine practice in the first two France Genomic Medicine 2025 platforms.