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Lorusso D, Colombo N, Herraez AC, Santin AD, Colomba E, Miller DS, Fujiwara K, Pignata S, Baron-Hay SE, Ray-Coquard IL, Shapira-Frommer R, Kim YM, McCormack M, Massaad R, Nguyen AM, Zhao Q, McKenzie J, Prabhu VS, Makker V. Health-Related Quality of Life in Patients With Advanced Endometrial Cancer Treated With Lenvatinib Plus Pembrolizumab or Treatment of Physician's Choice. Eur J Cancer 2023; 186:172-184. [PMID: 37086595 PMCID: PMC11003310 DOI: 10.1016/j.ejca.2023.03.015] [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: 01/26/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Lenvatinib and pembrolizumab (LEN+PEMBRO) demonstrated clinically meaningful and statistically significant improvements in efficacy versus treatment of physician's choice (TPC) in patients with advanced endometrial cancer (aEC) in the phase 3 Study 309/KEYNOTE-775. Health-related quality-of-life (HRQoL) is reported. PATIENTS AND METHODS Patients were randomly assigned to receive LEN+PEMBRO (n = 411; LEN 20 mg/day; PEMBRO 200 mg Q3W) or TPC (n = 416; doxorubicin 60 mg/m2 Q3W or paclitaxel 80 mg/m2 [weekly, 3 weeks on/1 week off]). Impact of treatment on HRQoL assessed by the global health status/quality of life (GHS/QoL) score of the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30) was a secondary objective; other scales of the Quality-of-Life Questionnaire (QLQ-C30), EORTC QLQ-Endometrial, 24 questions (EORTC QLQ-EN24), and EuroQoL 5 dimensions, 5 levels (EQ-5D-5L) were exploratory objectives. HRQoL was assessed on day 1 of each cycle. Completion/compliance, change from baseline, time to first and definitive deterioration were assessed. No multiplicity adjustments were applied for HRQoL endpoints. RESULTS The latest timepoint at which the predefined rates of completion (≥60%) and compliance (≥80%) were met was week 12. HRQoL at week 12 between treatment groups was generally similar. Time to first deterioration symptom scales favoured LEN+PEMBRO for QLQ-C30 dyspnoea, and QLQ-EN24 for poor body image, tingling/numbness, and hair loss; and TPC was favoured for QLQ-C30 pain, appetite loss, and diarrhoea, and QLQ-EN24 muscular pain. While the QLQ-C30 physical functional scale favoured TPC, other functional scales were generally similar between arms. Time to definitive deterioration favoured LEN+PEMBRO on most scales. CONCLUSION HRQoL data from Study 309/KEYNOTE-775, with previously published efficacy and safety results, indicate that LEN+PEMBRO has an overall favourable benefit/risk profile versus TPC for the treatment of patients with aEC. CLINICALTRIALS GOV: NCT03517449.
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Affiliation(s)
- Domenica Lorusso
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, and Catholic University of Sacred Heart, Rome, Italy.
| | - Nicoletta Colombo
- University of Milan-Bicocca, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Emeline Colomba
- Gustave Roussy Cancerology Institute, Villejuif, GINECO Group, France
| | | | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS-Fondazione G. Pascale, Naples, Italy
| | | | | | | | - Yong Man Kim
- Asan Medical Center, University of Ulsan, Seoul, Korea, Republic of South Korea
| | - Mary McCormack
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | - Vicky Makker
- Weill Cornell Medical Center, New York, NY, USA; Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Au-Yeung G, Bressel M, Prall O, Surace D, Andrews J, Mongta S, Lee YC, Gao B, Meniawy T, Baron-Hay SE, Black AJ, Kichenadasse G, Ananda S, Fox P, Bowtell D, Mileshkin LR. IGNITE: A phase II signal-seeking trial of adavosertib targeting recurrent high-grade, serous ovarian cancer with cyclin E1 overexpression with and without gene amplification. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5515] [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
5515 Background: Cyclin E1 gene amplification and protein over-expression is a marker of platinum resistance in high grade serous ovarian, fallopian tube or primary peritoneal cancer (HGSC), and may predict response to WEE1 inhibition. Adavosertib, a WEE1 inhibitor, has demonstrated activity in unselected women with recurrent ovarian and serous endometrial cancer. We aimed to evaluate the efficacy of adavosertib in women with recurrent platinum resistant HGSC with cyclin E1 over-expression, with and without gene amplification. Methods: IGNITE is a multicentre, phase 2 trial with 2 cohorts of women with recurrent platinum resistant HGSC. Tumors were assessed for cyclin E1 protein expression by IHC and CCNE1 copy number by FISH. Patients were assigned to Cohort 1 if tumors were cyclin E1 over-expressed (H-score>50) and amplified (≥8 copies), and Cohort 2 if tumors were overexpressed and nonamplified. Patients with evaluable disease by RECIST v1.1 or GCIG CA-125 criteria were included. Adavosertib 300mg PO was given daily on days 1-5 and 8-12 of a 21-day cycle. The primary endpoint was investigator assessed clinical benefit (CB) defined as absence of progression for ≥ 18 weeks. Here we present the 18-week response data for the first 32 patients treated from Cohort 2, with a data cut-off of August 2021. Results: Between Jan-2020 and May-2021, 32 patients were accrued to Cohort 2. Median age was 62 years (range 42-77) and 84% had received ≥2 prior lines of chemotherapy. Median cyclin E1 IHC H-score was 120 and 28 patients (88%) had measurable disease by RECIST. Median number of cycles commenced was 8 (range 1-19). Overall response rate (ORR) was 53% and CB rate was 61% for all evaluable patients. Seventeen patients (53%) required a dose reduction, most commonly for neutropenia or fatigue. Seventeen patients experienced ≥Grade 3 treatment related adverse event, and 4 patients (15%) discontinued due to toxicity. Conclusions: The efficacy results in a biomarker-selected cohort of patients are promising with a higher response rate than reported in previous studies of adavosertib in unselected women with recurrent HGSC. Duration of response and progression free survival data will be presented as data matures. Clinical trial information: ACTRN12619001185156P. [Table: see text]
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Affiliation(s)
- George Au-Yeung
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mathias Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - Owen Prall
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Daniela Surace
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - John Andrews
- Australia New Zealand Gynaecological Oncology Group, Camperdown, NSW, Australia
| | - Sally Mongta
- Parkville Cancer Clinical Trials Unit, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Yeh Chen Lee
- Prince of Wales Hospital, Sydney, NSW, Australia
| | - Bo Gao
- Westmead Hospital, Westmead, Australia
| | - Tarek Meniawy
- Sir Charles Gairdner Hospital and Linear Research Institute, Nedlands, Australia
| | | | | | | | - Sumitra Ananda
- Dept of Oncology, Sunshine Hospital, St Albans, Australia
| | - Peter Fox
- Central West Cancer Services, Orange, Australia
| | - David Bowtell
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Linda R. Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Slomovitz BM, Cibula D, Simsek T, Mirza MR, Maćkowiak-Matejczk B, Hudson E, Romero I, Colombo N, Korach J, Yin R, Gilbert L, Hasegawa K, Tyulyandina A, Baron-Hay SE, Willmott L, Backes FJ, Orlowski RJ, Zhou X, Khemka V, Pignata S. KEYNOTE-C93/GOG-3064/ENGOT-en15: A phase 3, randomized, open-label study of first-line pembrolizumab versus platinum-doublet chemotherapy in mismatch repair deficient advanced or recurrent endometrial carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps5623] [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
TPS5623 Background: Carboplatin-paclitaxel chemotherapy (with trastuzumab for HER2+ uterine serous carcinoma) is the standard of care first-line systemic treatment for recurrent or metastatic endometrial carcinoma (EC), which has a 5-year relative survival rate of only 17%. Worse survival outcomes have been shown for the mismatch repair deficient (dMMR) subtype of EC. Pembrolizumab (pembro), an anti-PD-1 antibody, showed compelling antitumor activity in previously treated, advanced MSI-H/dMMR EC in the phase 2 KEYNOTE-158 study (ORR, 48%; median duration of response [DOR], not reached; O’Malley JCO 2022). KEYNOTE-C93/GOG-3064/ENGOT-en15 (NCT05173987) is a phase 3, randomized, open-label study evaluating first-line pembro versus carboplatin-paclitaxel chemotherapy in patients with dMMR advanced or recurrent EC. Methods: Patients aged ≥18 years with histologically confirmed stage III/IV recurrent EC including carcinosarcoma (mixed Mullerian tumor), radiographically evaluable disease (measurable or nonmeasurable per RECIST v1.1), no prior systemic therapy (prior radiation with or without radiosensitizing chemotherapy > 2 weeks before first dose or prior hormonal therapy ≥1 week before randomization is permitted), and an ECOG PS ≤1 are eligible. Patients must have central confirmation of dMMR status. Approximately 350 patients will be randomized 1:1 to receive pembro 400 mg IV Q6W for 18 cycles (̃2 years) or carboplatin AUC 5 or 6 mg/mL/min IV Q3W and paclitaxel 175 mg/m2 IV Q3W for 6 cycles (with option for > 6 cycles). Trastuzumab is permitted for patients in the chemotherapy arm with HER2+ serous EC. Randomization is stratified by disease status (newly diagnosed advanced EC vs recurrent EC) and histology (endometrioid vs nonendometrioid). Treatment will continue for the specified number of cycles or until PD or unacceptable toxicity. Patients in the chemotherapy arm have the option to receive pembro following confirmed PD by blinded independent central review (BICR). Tumor imaging will be performed Q9W from randomization to week 54 and Q12W thereafter. AEs will be assessed from randomization to 30 days (90 days for serious AEs) after treatment discontinuation and graded per NCI CTCAE version 5.0. Dual primary endpoints are PFS per RECIST v1.1 by BICR and OS. Secondary endpoints are ORR, disease control rate, and DOR per RECIST v1.1 by BICR; PFS per RECIST v1.1 by investigator review; PFS2 (ie, time from randomization to PD per investigator assessment or death from any cause after start of subsequent anticancer therapy); safety; and patient-reported outcomes. PFS and OS will be estimated by the Kaplan-Meier method, with treatment differences assessed by the stratified log-rank test and HRs with 95% CIs determined using a Cox proportional hazard model. Enrollment is ongoing. Clinical trial information: NCT05173987.
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Affiliation(s)
- Brian M. Slomovitz
- Division of Gynecologic Oncology, Mount Sinai Medical Center, Miami Beach, FL
| | - David Cibula
- Department of Obstetrics and Gynecology, General Faculty Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tayup Simsek
- Department of Gynecology and Obstetrics, Akdeniz University, Antalya, Turkey
| | - Mansoor Raza Mirza
- NSGO-CTU & Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Emma Hudson
- Gynecologic Oncology, NRCI, Velindre Cancer Centre, Cardiff, United Kingdom
| | - Ignacio Romero
- Fundación Instituto Valenciano de Oncología, Calle del Profesor Beltrán Bàguena, Valencia, Spain
| | - Nicoletta Colombo
- University of Milan-Bicocca and European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Jacob Korach
- Gynecologic Oncology Department, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Rutie Yin
- Department of Gynecology and Obstetrics, and Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lucy Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Kosei Hasegawa
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Alexandra Tyulyandina
- N. N. Blokhin Russian Cancer Research Center and I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | | | | | - Floor Jenniskens Backes
- Division of Gynecologic Oncology, Ohio State University and James Cancer Hospital, Columbus, OH
| | | | | | | | - Sandro Pignata
- Department Uro-Ginecologico, Istituto Nazionale Tumori-Fondazione “G. Pascale”, Naples, Italy
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Lorusso D, Colombo N, Casado Herraez A, Santin A, Colomba E, Miller DS, Fujiwara K, Pignata S, Baron-Hay SE, Ray-Coquard IL, Shapira-Frommer R, Kim YM, McCormack M, Bird S, Prabhu VS, Martin Nguyen A, Zhao Q, Dutta L, Makker V. Health-related quality of life (HRQoL) in advanced endometrial cancer (aEC) patients (pts) treated with lenvatinib plus pembrolizumab or treatment of physician’s choice (TPC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5570] [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
5570 Background: In Study 309/KEYNOTE-775, lenvatinib + pembrolizumab (L+P) demonstrated significant and clinically meaningful improvement in OS, PFS, and ORR compared with TPC in aEC pts following prior platinum-based systemic therapy. Given the medical complexity/age of EC pts, QoL analyses are critical, but often under-reported. We present results of pt-reported HRQoL for Study 309/KEYNOTE-775. Methods: Pts were randomized 1:1 to receive lenvatinib 20 mg QD PO + pembrolizumab 200 mg IV Q3W (n=411) or TPC (n=416; doxorubicin 60 mg/m2 IV Q3W or paclitaxel 80 mg/m2 IV QW, 3 wks on/1 wk off). Pt-reported HRQoL was assessed at cycle 1 day 1, day 1 of each subsequent cycle and at time of discontinuation using EORTC QLQ-C30, its EC module QLQ-EN24, and EQ-5D-5L in treated pts who had ≥1 HRQoL assessment available. Higher scores indicate better functioning/QoL (EORTC QLQ-C30, EQ-5D-5L) or worse symptom severity (QLQ-EN24). Changes in EORTC QLQ-C30 global health status (GHS)/QoL was a secondary endpoint. This was analyzed from baseline to the latest timepoint at which overall completion was ≥60% and overall compliance was ≥80%, using constrained longitudinal data analysis; other HRQoL analyses were exploratory. Results: Completion and compliance rates of EORTC QLQ-C30 were >95% in both groups at baseline. Primary analysis was conducted at wk 12 as completion rate was 80% for L+P and 62% for TPC; compliance rate was 93% for L+P and 87% for TPC. Baseline GHS/QoL scores were similar between the L+P group and TPC group: mean (SD) of 65.74 (21.87) vs 65.69 (22.71), respectively. Over 12 wks of follow-up, pts in both groups had slight decreases in GHS/QoL. Similar decreases were observed for pts receiving L+P vs TPC: -5.97 (95% CI: -8.36, -3.58) vs -6.98 (95% CI: -9.63, -4.33). The between-group difference in least-squares (LS) mean score change from baseline to wk 12 for L+P vs TPC was 1.01 points (95% CI: -2.28, 4.31). Over time, QoL scores were generally similar across treatments. Results were similar for other HRQoL endpoints (Table). Conclusions: No significant differences were observed in HRQoL scores between treatment groups. With no standard treatment approach following failure of platinum-based therapy, these data along with previously reported efficacy and safety findings from Study 309/KEYNOTE-775 further support that L+P has an overall favorable benefit/risk profile compared to chemotherapy. Clinical trial information: NCT03517449. [Table: see text]
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Affiliation(s)
- Domenica Lorusso
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS and Scientific Directorate, Rome, Italy
| | - Nicoletta Colombo
- University of Milan-Bicocca and European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | | | - Alessandro Santin
- Smilow Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT
| | - Emeline Colomba
- Gustave Roussy Cancerology Institute, Villejuif, Gineco Group, France
| | | | - Keiichi Fujiwara
- GOTIC and Saitama Medical University International Medical Center, Hidaka, Japan
| | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS-Fondazione G. Pascale, Naples, Italy
| | | | | | | | - Yong Man Kim
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | - Mary McCormack
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Qi Zhao
- Eisai Inc., Woodcliff Lake, NJ
| | | | - Vicky Makker
- Memorial Sloan Kettering Cancer Center, New York, NY
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5
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Wong V, de Boer R, Baron-Hay SE, Blum RH, Forster BC, Chua SLL, Cuff K, Green M, Lim E, Mok K, Nott LM, Nottage MK, Tafreshi A, Tsoi DTF, Yeo B, Gibbs P, Lok SW. Australian real-world outcomes of ribociclib and aromatase inhibitor in hormone receptor (HR) positive, HER2 negative metastatic breast cancer (MBC): Results from Kisqali Access Registry for Metastatic breast cancer in Australia (KARMA) collected alongside a medicine access program. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e13018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
e13018 Background: International guidelines recommend a combination of CDK4/6 inhibitor and endocrine therapy (ET) as first line treatment for HR+, HER2- MBC. Results from MONALEESA-2 demonstrate improved progression free survival (PFS) with ribociclib (CDK4/6 inhibitor) and ET as compared to ET alone. Prior to Australia’s Pharmaceutical Benefits Scheme funding, ̃800 patients participated in the ribociclib Medicine Access Program (MAP) from May 2017 to June 2018. Methods: KARMA is a secondary data use, non-interventional study of Australian patients who received first line treatment with ribociclib and aromatase inhibitor (AI), obtained via a MAP, for HR+, HER2- MBC. The aim was to capture comprehensive patient and treatment data to reflect real world practice and outcomes. Direct comparisons were made with the ribociclib/letrozole cohort in MONALEESA-2 given that the eligibility criteria were similar for both studies. Results: Data from 160 patients at 17 sites was analysed with a median follow up of 36.5 months. Baseline characteristics are shown in the table. 63 of 160 (39%) patients remain on ribociclib/AI at time of analysis. 58% of patients had at least 1 dose reduction, with the majority (77%) requiring only a single dose reduction. The most common reasons for dose reductions were neutropenia (68%) and abnormal liver enzymes (17%). 16 of 160 (10%) discontinued treatment due to toxicity, including 1 patient with QTc prolongation > 600ms. There were no deaths due to toxicity. Median duration of treatment and PFS were 24.5 (95% CI 17.8-33.3) and 36.3 months (95% CI 29.9- NR) respectively, compared to 20.2 and 25.3 months in MONALEESA-2. Landmark PFS was 76% at 12 months, 67% at 18 months and 64% at 24 months. Conclusions: This is the first real world study of ribociclib and AI developed alongside a MAP. The combination treatment was well tolerated with similar rates of dose reductions (58% in both) and treatment discontinuation due to toxicity (10% vs 8%) when compared to MONALEESA-2. This real-world cohort achieved a superior PFS, potentially explained in part by a younger population with more favourable baseline disease characteristics, including fewer disease sites and higher rates of bone only metastases. It is encouraging to see drug tolerability and efficacy replicated in real world patients.[Table: see text]
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Affiliation(s)
- Vanessa Wong
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | | | | | | | | | | | | | | | - Elgene Lim
- The Kinghorn Cancer Centre, Department of Oncology, St Vincent’s Hospital, Sydney, Australia
| | - Kelly Mok
- Liverpool Hospital, Sydney, NSW, Australia
| | | | | | - Ali Tafreshi
- Wollongong Private Hospital, Wollongong, Australia
| | | | - Belinda Yeo
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | - Peter Gibbs
- Walter & Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Sheau Wen Lok
- The Peter MacCallum Cancer Centre, Melbourne, Australia
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Smith D, Robledo K, Yip S, Cummins M, Kok PS, Lee YC, Friedlander M, Baron-Hay SE, Shannon CM, Coward J, Beale PJ, Goss G, Meniawy T, Lombard JM, Spurdle AB, Andrews J, Stockler MR, Mileshkin LR, Antill YC. Tumor-associated immune cells and progression-free survival in advanced endometrial cancer (EC), results from the PHAEDRA trial (ANZGOG 1601). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5584] [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
5584 Background: Activity of durvalumab in patients with deficient mismatch repair (dMMR) advanced endometrial carcinoma (EC) was confirmed in the PHAEDRA trial (ANZGOG 1601). This study investigated the association between immune biomarkers and clinical outcomes in PHAEDRA. Methods: Formalin-fixed paraffin embedded sections immunohistochemically stained for PD-L1 using the Ventana platform, were with matched H&E slides scored independently by two pathologists according to the Ventana PD-L1 (SP263) algorithm for urothelial carcinoma (UC). Immune biomarkers assessed were PD-L1 staining of tumor cells (TCP) and immune cells (IC), and presence of tumor-associated immune cells (ICP). Results: Sixty-seven of the 71 patients had sufficient tumor for PD-L1 testing. AUC were 0.667, 0.726 and 0.644 for TCP, ICP and IC, respectively for predicting tumor response. Optimal cutpoints were TCP≥1%, ICP≥10% and IC≥35%. ICP≥10% achieved the highest sensitivity (53%) and specificity (82%) of the individual cutpoints. The optimal cutpoint algorithm was able to identify patients who would not respond, (sensitivity 88%, negative predictive value 92%), but had low specificity (48%) and positive predictive value (37%). Differences in PFS were found using ICP≥10% (logrank p = 0.01), compared to TCP (p = 0.25), IC (p = 0.48) and the UC algorithm (p = 0.08) (Figure 1). PFS was shorter in patients with pMMR than dMMR after adjusting for ICP (HR 2.99, 95%CI: 1.61-5.57, p < 0.001). Adjustment for MMR reduced the prognostic significance of ICP≥10% for PFS (HR 0.59, 95% CI: 0.28-1.23, p = 0.16). For OS, differences were seen for the UC algorithm (p = 0.02), but not ICP (p = 0.07), TCP (p = 0.18) or IC (p = 0.23). Similarly to PFS, adjustment for MMR reduced the prognostic significance of the UC algorithm for OS (HR: 0.53, 95% CI: 0.25-1.12, p = 0.10). Conclusions: In this exploratory analysis, ICP was more closely associated with tumor response and PFS than TCP or IC. ICP alone was better than the UC algorithm for predicting PFS. The optimum cutpoint algorithm was promising for identifying non-responders, but requires external validation. Clinical trial information: ACTRN12617000106336.
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Affiliation(s)
- Deborah Smith
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Kristy Robledo
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | | | - Peey-Sei Kok
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, Australia
| | - Yeh Chen Lee
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | | | | | - Tarek Meniawy
- Sir Charles Gairdner Hospital and Linear Research Institute, Nedlands, WA, Australia
| | | | | | - John Andrews
- NHMRC Clinical Trials Centre, Camperdown, NSW, Australia
| | - Martin R. Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Linda R. Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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7
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Antill YC, Kok PS, Robledo K, Barnes E, Friedlander M, Baron-Hay SE, Shannon CM, Coward J, Beale PJ, Goss G, Meniawy T, Yip S, Smith D, Spurdle AB, Parry M, Andrews J, Kelly M, Stockler MR, Mileshkin LR. Activity of durvalumab in advanced endometrial cancer (AEC) according to mismatch repair (MMR) status: The phase II PHAEDRA trial (ANZGOG1601). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5501] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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
5501 Background: Deficient DNA mismatch repair (dMMR) occurs in approximately 15% of AEC and is associated with a high tumour mutation burden. Expression of PD-1 and PD-L1 has been reported in up to 90% of ECs, including those with proficient DNA mismatch repair (pMMR). We report here preliminary results of PHAEDRA, a single-arm phase 2 trial designed to determine the activity of single-agent durvalumab, an antibody to PD-L1, in 2 cohorts of women with AEC. Methods: Participants (pts) had pMMR AEC progressing after 1-3 lines of chemotherapy, or dMMR AEC progressing after 0-3 lines of chemotherapy, and were treated with durvalumab 1500mg IV Q4W. The primary endpoint was objective tumour response (OTR = complete response [CR] or partial response [PR] by iRECIST). Secondary endpoints included disease control at 16 weeks (DC16w = CR, PR, or stable disease at 16 weeks [SD16w]), immune-related adverse events (irAEs), PD-L1, germline mutations and MLH1 methylation. Other secondary endpoints include: OTR and DC by RECIST1.1, other AE, PFS, OS & quality of life will be reported later. Results: 71 pts with AEC were recruited from Feb 2017 to Sep 2018: 35 dMMR and 36 pMMR. Median follow-up were 8.3 vs 14.8 months in dMMR vs pMMR pts. Median age: 67 (range 36-81); ECOG PS: 0-1 in 68, and 2 in 3. Pathology: endometrioid in 94% and 58%; serous in 0% and 31%; grade: high in 42% and 83% (dMMR and pMMR respectively). Durvalumab was the 1st, 2nd and subsequent line of non-hormonal therapy in 15, 14, and 6 pts with dMMR and 0, 21, and 15 pts with pMMR. Among dMMR pts, the OTR rate was 40% (14/35, 95% CI 26-56), with 4 CR and 10 PR; 7 others had SD 16w for a DC16w rate of 60% (21/35, 95% CI 44-74). OTR rate was 40% as 1st line, 43% as 2nd line, and 33% as subsequent line treatment. Among pMMR pts, the OTR rate was 1/36 (3%, 95% CI 1-14) with 1 PR; 6 others had SD16w for a DC16w rate of 19% (7/36; 95% CI 10-35). IrAEs occurred in 14 pts: hyperthyroidism in 6, hypothyroidism in 6, pneumonitis in 1 and hepatitis in 1. Conclusions: Durvalumab monotherapy showed promising activity and safety in AEC with dMMR regardless of prior lines of chemotherapy, but there was limited evidence of activity in AEC with pMMR. Clinical trial information: ACTRN12617000106336.
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Affiliation(s)
| | - Peey Sei Kok
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Kristy Robledo
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Barnes
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sally E. Baron-Hay
- Medical Oncology Department, Royal North Shore Hospital, St Leonards, Australia
| | | | | | | | | | | | - Sonia Yip
- Sydney Catalyst Translational Cancer Research Centre, Sydney, Australia
| | - Deborah Smith
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | | | - Michelle Parry
- NHMRC Clinical Trials Centre, Camperdown, NSW, Australia
| | - John Andrews
- NHMRC Clinical Trials Centre, Camperdown, NSW, Australia
| | - Marzena Kelly
- NHMRC Clinical Trials Centre, Camperdown, NSW, Australia
| | - Martin R. Stockler
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
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8
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Khasraw M, Mukaro VR, West L, White K, Rippy E, Brandt C, Tobler R, Murphy CC, Collins IM, Baron-Hay SE, Ashley DM, Patil S. Tailored neoadjuvant epirubicin and cyclophosphamide (EC) and nanoparticle albumin-bound paclitaxel ( nab-P) in breast cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e12515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mustafa Khasraw
- NHMRC CTC, The University of Sydney, Camperdown NSW, Australia
| | | | - Linda West
- Lake Imaging Geelong, Geelong, Australia
| | | | | | | | | | | | - Ian M. Collins
- Wentworth Street Consulting Suites, Warrnambool, Australia
| | - Sally E. Baron-Hay
- Medical Oncology Department, Royal North Shore Hospital, St Leonards, Australia
| | | | - Sujata Patil
- Memorial Sloan Kettering Cancer Center, New York, NY
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9
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Pearson A, Justine P, Diakos CI, Dewar R, Chan D, Guminski AD, Gill AJ, Menzies AM, Baron-Hay SE. Prognostic utility of tumour infiltrating lymphocytes (TILs) and neutrophil-to-lymphocyte ratio (NLR) in early-stage triple negative breast cancer (TNBC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.1075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Antonia Pearson
- Medical Oncology Department, Royal North Shore Hospital, St Leonards, Australia
| | - Pickett Justine
- Anatomical Pathology, Royal North Shore Hospital and Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, St Leonards, Australia
| | - Connie Irene Diakos
- Medical Oncology Department, Royal North Shore Hospital, St Leonards, Australia
| | - Robert Dewar
- Sydney Medical School, University of Sydney, St Leonards, Australia
| | - David Chan
- Medical Oncology Department, Royal North Shore Hospital, St. Leonards, Australia
| | | | - Anthony J. Gill
- Anatomical Pathology, Royal North Shore Hospital and Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, Sydney, Australia
| | | | - Sally E. Baron-Hay
- Medical Oncology Department, Royal North Shore Hospital, St Leonards, Australia
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10
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Khasraw M, Mukaro VR, West L, Brandt C, Woollett AM, Edwards M, Spokes R, Mitchell G, Prince K, Hayes TM, Collins IM, Guminski AD, Baron-Hay SE, Olesen IH, Bryan J, Bowles S, Wong SF, Ashley DM, Patil S. Tailored neoadjuvant epirubicin and cyclophosphamide (EC) and nanoparticle albumin bound ( nab)-paclitaxel for newly diagnosed breast cancer (BC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e12025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mustafa Khasraw
- Andrew Love Cancer Center and Daekin University, Geelong, Australia
| | | | - Linda West
- Barwon Health and Lake Imaging, Geelong, Australia
| | | | | | | | | | | | | | | | - Ian M. Collins
- Wentworth Street Consulting Suites, Warrnambool, Australia
| | | | | | | | | | | | | | | | - Sujata Patil
- Memorial Sloan Kettering Cancer Center, New York, NY
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11
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Khasraw M, West L, Duan W, Mukaro V, Harvey S, Spokes R, Brandt C, Mitchell G, Prince K, Hayes TM, Baron-Hay SE, Woollett AM, Olesen IH, White K, Bowles S, Wong SF, Ashley DM, Patil S. Tailored neoadjuvant epirubicin and cyclophosphamide and nanoparticle albumin bound ( nab)-paclitaxel for newly diagnosed breast cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps1135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Linda West
- Barwon Health and Lake Imaging, Geelong, Australia
| | - Wei Duan
- Deakin University, Geelong, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sujata Patil
- Memorial Sloan Kettering Cancer Center, New York, NY
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