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Cecchi F, Viglianti N, Rebelatto M, Shire NJ, Barry ST, Milenkova T, Croydon E, Carroll D, Barrett JC. The HORIZON III retrospective exploratory analysis: HER2 expression amplification in colorectal cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.194] [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: 01/26/2023] Open
Abstract
194 Background: Although regularly used in breast and gastric cancer, HER2 testing is not routinely performed in colorectal cancer (CRC). Immunohistochemistry (IHC) and in situ hybridization (ISH) scoring have not been optimized for assessment of HER2 overexpression and amplification in CRC. Varying rates of HER2 overexpression (2%-11%) have been reported in previously untreated CRC (Wang World J Gastrointest Oncol 2019) and patients with advanced/metastatic CRC with HER2 amplification or overexpression respond poorly to current standard of care therapies (Sartore-Bianchi Oncologist 2019). We characterized HER2 prevalence in a retrospective cohort analysis of clinical trial patients. Methods: The HORIZON III trial (NCT00384176) evaluated FOLFOX + bevacizumab or cediranib (AZD2171) as first-line (1L) treatment in patients with metastatic CRC (Schmoll J Clin Oncol 2012). The primary objective of this analysis of a subset of HORIZON III samples was to characterize HER2 prevalence in 1L metastatic CRC. Secondary and exploratory objectives included correlating HER2 status to other molecular findings (eg, RAS/RAF mutations), clinicopathologic characteristics, and patient outcomes. IHC was performed using a monoclonal anti-HER2 antibody PATHWAY HER2 [4B5] Ventana on primary CRC tumor sections and scored according to ASCO/CAP guidelines for gastric cancer (Bartley Arch Pathol Lab Med 2016). H&E staining was performed to determine the adequacy of tumor samples (ie, > 100 viable tumor cells per specimen). All tumors with an IHC score of 2+ were analyzed for amplification by ISH (HER2 IQFISH pharmDx dual probe kit, Agilent Technologies K573111-5). Targeted mutation panel testing was used to determine other molecular alterations. Descriptive statistics were used to summarize baseline and clinical outcome data by HER2 status. The current analysis was approved by the AstraZeneca bioethics review board. Results: Of the 1614 patients in HORIZON III, 396 met the inclusion criteria of appropriate consent, sufficient tumor sample for analysis, and a unique identifier. HER2-positive tumors (IHC3+ or IHC2+/ISH+) were identified in 2.1% of samples; 1.3% were IHC3+ and 0.8% were IHC2+/ISH+. Compared with IHC3+, IHC2+ tumors were more heterogeneous with mixed components of cells weakly expressing HER2 and lacking HER2 expression. Conclusions: This exploratory analysis of the HORIZON III study provides insights into HER2 prevalence in 1L, unselected, advanced/metastatic CRC, finding that 2.1% of tumors were HER2 positive. The demographic characteristics of patients with analyzable samples were representative of the entire HORIZON III study population; however, further assessment of KRAS status and other clinicopathological characteristics is needed. These data may inform future clinical development and support selection of patients with CRC who are likely to benefit from HER2 targeting therapies. Clinical trial information: NCT00384176 .
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Affiliation(s)
- Fabiola Cecchi
- AstraZeneca Translational Medicine, Early Oncology, Gaithersburg, MD
| | | | | | | | - Simon T Barry
- AstraZeneca Pharmaceuticals, Cambridge, United Kingdom
| | | | | | - Danielle Carroll
- AstraZeneca Translational Medicine, Early Oncology, Cambridge, United Kingdom
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Herzog TJ, Vergote I, Gomella LG, Milenkova T, French T, Tonikian R, Poehlein C, Hussain M. Testing for homologous recombination repair or homologous recombination deficiency for poly (ADP-ribose) polymerase inhibitors: A current perspective. Eur J Cancer 2023; 179:136-146. [PMID: 36563604 DOI: 10.1016/j.ejca.2022.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/20/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
Poly (ADP-ribose) polymerase inhibitors (PARPis) have demonstrated clinical activity in patients with BRCA1 and/or BRCA2 mutated breast, ovarian, prostate, and pancreatic cancers. Notably, BRCA mutations are associated with defects in the homologous recombination repair (HRR) pathway. This homologous recombination deficiency (HRD) phenotype can also be observed as genomic instability in tumour cells. Accordingly, PARPi sensitivity has been observed in various tumours with HRD, independent of BRCA mutations. Currently, four PARPis are approved by regulatory agencies for the treatment of cancer across multiple tumour types. Most indications are specific to tumours with a confirmed BRCA mutation, mutations in other HRR-related genes, HRD evidenced by genomic instability, or evidence of platinum sensitivity. Regulatory agencies have also approved companion and complementary diagnostics to facilitate patient selection for each PARPi indication. This review aims to summarise the biological basis, clinical validation, and clinical relevance of the available diagnostic methods and assays to assess HRD.
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Affiliation(s)
- Thomas J Herzog
- University of Cincinnati Cancer Center, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219, USA.
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium, European Union
| | - Leonard G Gomella
- Department of Urology, Sidney Kimmel Cancer Center-Jefferson University Health, 1025 Walnut St Suite 1100, Philadelphia, PA 19107, USA
| | | | - Tim French
- AstraZeneca, 316 Hills Rd, Cambridge CB2 8PA, UK
| | - Raffi Tonikian
- Merck & Co., Inc., 90 E Scott Ave, Rahway, NJ 07065, USA
| | | | - Maha Hussain
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, 420 E Superior St, Chicago, IL 60611, USA
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Lee JM, Moore RG, Ghamande S, Park MS, Diaz JP, Chapman J, Kendrick J, Slomovitz BM, Tewari KS, Lowe ES, Milenkova T, Kumar S, Dymond M, Brown J, Liu JF. Cediranib in Combination with Olaparib in Patients without a Germline BRCA1/2 Mutation and with Recurrent Platinum-Resistant Ovarian Cancer: Phase IIb CONCERTO Trial. Clin Cancer Res 2022; 28:4186-4193. [PMID: 35917514 PMCID: PMC9527502 DOI: 10.1158/1078-0432.ccr-21-1733] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/11/2022] [Accepted: 07/29/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The efficacy, safety, and tolerability of cediranib plus olaparib (cedi/ola) were investigated in patients with nongermline-BRCA-mutated (non-gBRCAm) platinum-resistant recurrent ovarian cancer. PATIENTS AND METHODS PARP inhibitor-naïve women aged ≥18 years with platinum-resistant non-gBRCAm ovarian cancer, ECOG performance status of 0-2, and ≥3 prior lines of therapy received cediranib 30 mg once daily plus olaparib 200 mg twice daily in this single-arm, multicenter, phase IIb trial. The primary endpoint was objective response rate (ORR) by independent central review (ICR) using RECIST 1.1. Progression-free survival (PFS), overall survival (OS), and safety and tolerability were also examined. RESULTS Sixty patients received cedi/ola, all of whom had confirmed non-gBRCAm status. Patients had received a median of four lines of chemotherapy; most (88.3%) had received prior bevacizumab. ORR by ICR was 15.3%, median PFS was 5.1 months, and median OS was 13.2 months. Forty-four (73.3%) patients reported a grade ≥3 adverse event (AE), with one patient experiencing a grade 5 AE (sepsis), considered unrelated to the study treatment. Dose interruptions, reductions, and discontinuations due to AEs occurred in 55.0%, 18.3%, and 18.3% of patients, respectively. Patients with high global loss of heterozygosity (gLOH) had ORR of 26.7% [4/15; 95% confidence interval (CI), 7.8-55.1], while ORR was 12.5% (4/32; 95% CI, 3.5-29.0) in the low gLOH group. CONCLUSIONS Clinical activity was shown for the cedi/ola combination in heavily pretreated, non-gBRCAm, platinum-resistant patients with ovarian cancer despite failing to meet the target ORR of 20%, highlighting a need for further biomarker studies.
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Affiliation(s)
- Jung-Min Lee
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland.,Corresponding Author: Jung-Min Lee, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Building 10, Room 4B54, Bethesda, MD 20892-1906. Phone: 240-760-6128; E-mail:
| | - Richard G. Moore
- Wilmot Cancer Institute, Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York
| | - Sharad Ghamande
- Cancer Center, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Min S. Park
- Swedish Cancer Institute, Swedish Medical Center, Seattle, Washington
| | - John P. Diaz
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Julia Chapman
- Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas
| | | | - Brian M. Slomovitz
- Broward Health, Fort Lauderdale, Florida, and Department of Obstetrics and Gynecology, Florida International University, Miami, Florida
| | | | | | | | | | | | | | - Joyce F. Liu
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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González-Martín A, Desauw C, Heitz F, Cropet C, Gargiulo P, Berger R, Ochi H, Vergote I, Colombo N, Mirza MR, Tazi Y, Canzler U, Zamagni C, Guerra-Alia EM, Levaché CB, Marmé F, Bazan F, de Gregorio N, Dohollou N, Fasching PA, Scambia G, Rubio-Pérez MJ, Milenkova T, Costan C, Pautier P, Ray-Coquard I. Maintenance olaparib plus bevacizumab in patients with newly diagnosed advanced high-grade ovarian cancer: Main analysis of second progression-free survival in the phase III PAOLA-1/ENGOT-ov25 trial. Eur J Cancer 2022; 174:221-231. [PMID: 36067615 DOI: 10.1016/j.ejca.2022.07.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND PAOLA-1/ENGOT-ov25 (NCT02477644) demonstrated a significant progression-free survival (PFS) benefit with maintenance olaparib plus bevacizumab versus placebo plus bevacizumab in newly diagnosed, advanced ovarian cancer. We report the prespecified main second progression-free survival (PFS2) analysis for PAOLA-1. METHODS This randomised, double-blind, phase III trial was conducted in 11 countries. Eligible patients had newly diagnosed, advanced, high-grade ovarian cancer and were in response after first-line platinum-based chemotherapy plus bevacizumab. Patients were randomised 2:1 to olaparib (300 mg twice daily) or placebo for up to 24 months; all patients received bevacizumab (15 mg/kg every 3 weeks) for up to 15 months. Primary PFS end-point was reported previously. Time from randomisation to second disease progression or death was a key secondary end-point included in the hierarchical-testing procedure. RESULTS After a median follow-up of 35.5 months and 36.5 months, respectively, median PFS2 was 36.5 months (olaparib plus bevacizumab) and 32.6 months (placebo plus bevacizumab), hazard ratio 0.78; 95% confidence interval (CI) 0.64-0.95; P = 0.0125. Median time to second subsequent therapy or death was 38.2 months (olaparib plus bevacizumab) and 31.5 months (placebo plus bevacizumab), hazard ratio 0.78; 95% CI 0.64-0.95; P = 0.0115. Seventy-two (27%) patients in the placebo plus bevacizumab group received a poly(ADP-ribose) polymerase inhibitor as first subsequent therapy. No new safety signals were observed for olaparib plus bevacizumab. CONCLUSION In newly diagnosed, advanced ovarian cancer, maintenance olaparib plus bevacizumab provided continued benefit beyond first progression, with a significant PFS2 improvement and a time to second subsequent therapy or death delay versus placebo plus bevacizumab.
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Affiliation(s)
- Antonio González-Martín
- Grupo Español de Investigación en Cáncer de Ovario (GEICO), Spain and MD Anderson Cancer Center Madrid, Spain.
| | - Christophe Desauw
- Centre Hospitalier Régional Universitaire de Lille, Lille, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), France
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen; European Competence Center of Ovarian Cancer, Charité Campus Virchow-Klinikum, Charité- Universitaetsmedizin Berlin, Berlin; corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin; Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), Germany
| | | | - Piera Gargiulo
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Napoli, and Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Italy
| | - Regina Berger
- Department for Gynaecology and Obstetrics, Medical University of Innsbruck, Innsbruck, and AGO-Austria, Austria
| | - Hiroyuki Ochi
- University of Tsukuba, Ibaraki, and Gynecologic Oncology Trial and Investigation Consortium (GOTIC), Japan
| | - Ignace Vergote
- University Hospital Leuven, Leuven Cancer Institute, Leuven, and Belgian and Luxembourg Gynaecological Oncology Group (BGOG), Belgium
| | - Nicoletta Colombo
- University of Milan-Bicocca and IEO European Institute of Oncology IRCCS, Milan, and Mario Negri Gynecologic Oncology Group (MANGO), Italy
| | - Mansoor R Mirza
- Rigshospitalet, Copenhagen University Hospital, and Nordic Society of Gynecologic Oncology (NSGO), Denmark
| | - Youssef Tazi
- Strasbourg Oncologie Libérale, Strasbourg, and GINECO, France
| | - Ulrich Canzler
- Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, and AGO, Germany
| | - Claudio Zamagni
- IRCCS Azienda Ospedaliero-universitaria di Bologna, Bologna, and MITO, Italy
| | - Eva M Guerra-Alia
- Hospital Universitario Ramón y Cajal, Madrid, and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Spain
| | | | - Frederik Marmé
- Medical Faculty Mannheim, Heidelberg University, Heidelberg, and AGO, Germany
| | - Fernando Bazan
- Centre Hospitalier Regional Universitaire de Besançon, Besançon, and GINECO, France
| | | | - Nadine Dohollou
- Polyclinique Bordeaux Nord Aquitaine, Bordeaux, and GINECO, France
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, and AGO, Germany
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica, Rome, and MITO, Italy
| | | | | | | | | | - Isabelle Ray-Coquard
- Centre Léon BERARD and University Claude Bernard Lyon 1, Lyon, and GINECO, France
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Lukashchuk N, Armenia J, Tobalina L, Carr TH, Milenkova T, Liu YL, Penson RT, Robson ME, Harrington E. BRCA reversion mutations mediated by microhomology-mediated end joining (MMEJ) as a mechanism of resistance to PARP inhibitors in ovarian and breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5559] [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
5559 Background: PARP inhibitors exploit synthetic lethality in tumor cells with deficiency in homologous recombination repair (HRR). In line with this, most reported mechanisms of PARP inhibitor resistance restore HRR. Of multiple resistance mechanisms reported preclinically, reversion mutations in BRCA genes are the only confirmed mechanism of resistance to both platinum and PARP inhibitors in patients (pts) to date (Lin K et al. Cancer Discov 2019), with most studies focusing on ovarian cancer. MMEJ is an alternative DNA damage repair pathway, in which DNA polymerase θ (POLθ) has a key role; MMEJ has been suggested to play a role in BRCA reversion mutations (Tobalina L et al. Ann Oncol 2021). Methods: Targeted circulating tumor DNA (ctDNA) sequencing analyzed over 500 plasma samples collected at baseline and at progression to therapy in pts with ovarian or breast cancer and a mutation in BRCA1 and/or BRCA2 (BRCAm) who were treated with olaparib or chemotherapy in one of three Phase II/III clinical studies (LIGHT NCT02983799, SOLO3 NCT02282020, OlympiAD NCT02000622). Only pts with an original pathogenic BRCAm detected in ctDNA were evaluable. BRCA reversion mutations were identified using internal computational framework; DNA sequences surrounding BRCA reversion sites were analyzed for MMEJ signatures. Results: At baseline, in pooled data across treatment arms and across all available samples, BRCA reversion mutations were detected in 4/114 (3.5%) and 6/133 (4.5%) of breast and ovarian cancer pts, respectively, which may have developed on prior platinum therapy. At progression, BRCA reversion mutations were detected in 34/79 (43%) breast cancer pts and in 26/101 (26%) ovarian cancer pts who received olaparib, with at least 2/79 and 4/101 reversions already present at baseline, respectively. At progression, in the chemotherapy arm, BRCA reversion mutations were detected in 3/34 (9%) breast cancer pts and 1/29 (3%) ovarian cancer pts, with 2/34 and 0/29 reversions present at baseline, respectively. Reversion mutations varied in allelic frequency and were either present as single or multiple reversions, suggesting multiple events within the tumor were driving resistance. The location and type of reversion mutations reflected the functional importance of BRCA protein domains. A large proportion of BRCA reversion mutations (47/69 [68%] that were evaluable) were mediated by the MMEJ pathway based on the presence of MMEJ signatures around BRCA reversion sites. Conclusions: We detected BRCA reversion mutations in at least ̃40% of breast and ̃20% of ovarian cancer pts following treatment with olaparib. A large proportion of these reversion mutations are likely to have been mediated by MMEJ repair, suggesting that POLθ inhibitors in combination with platinum or PARP inhibitors might prevent or delay emergence of PARP inhibitor resistance. Clinical trial information: NCT02983799, NCT02282020, NCT02000622.
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Affiliation(s)
| | | | | | | | | | - Ying L Liu
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Mark E. Robson
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Hodgson DR, Brown JS, Dearden SP, Lai Z, Elks CE, Milenkova T, Dougherty BA, Lanchbury JS, Perry M, Timms KM, Harrington EA, Barrett JC, Leary A, Pujade-Lauraine E. Concordance of BRCA mutation detection in tumor versus blood, and frequency of bi-allelic loss of BRCA in tumors from patients in the phase III SOLO2 trial. Gynecol Oncol 2021; 163:563-568. [PMID: 34742578 DOI: 10.1016/j.ygyno.2021.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Maintenance olaparib provided a progression-free survival benefit in the phase III SOLO2 trial (NCT01874353) in patients with platinum-sensitive relapsed ovarian cancer and a BRCA mutation (BRCAm). However, questions remain regarding tumor versus germline BRCA testing and the impact of heterozygous versus bi-allelic loss of BRCA1 or BRCA2 in the tumor. METHODS Blood and tumor samples were analyzed. A concordance analysis of germline BRCAm status (BRACAnalysis® CLIA test) and tumor BRCAm status (myChoice® CDx test) was conducted (Myriad Genetic Laboratories, Inc.). Bi-allelic loss of BRCA1 and BRCA2 and a genomic instability score (GIS) (myChoice® CDx test) were also determined. RESULTS 289 of 295 enrolled patients had a germline BRCAm confirmed centrally and tumor BRCAm status was evaluable in 241 patients. There was 98% and 100% concordance between tumor and germline testing for BRCA1m and BRCA2m, respectively, with discordance found in four cases. Of 210 tumor samples evaluable for BRCA zygosity, 100% of germline BRCA1-mutated tumors (n = 144) and 98% of germline BRCA2-mutated tumors (n = 66) had bi-allelic loss of BRCA. One patient with a heterozygous BRCA2m had a GIS of 53, was progression free for 911 days and remained on olaparib at data cut-off. CONCLUSIONS Very high concordance was demonstrated between tumor and germline BRCA testing, supporting wider implementation of tumor BRCA testing in ovarian cancer. Near 100% rates of bi-allelic loss of BRCA in platinum-sensitive relapsed ovarian tumors suggest routine testing for BRCA zygosity is not required in this population and reflects BRCA loss being a driver of tumorigenesis.
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Affiliation(s)
- Darren R Hodgson
- Translational Medicine, Oncology R+D, Research and Early Development, AstraZeneca, Boston, MA, USA
| | - Jessica S Brown
- Translational Medicine, Oncology R+D, Research and Early Development, AstraZeneca, Cambridge, United Kingdom.
| | - Simon P Dearden
- Precision Medicine and Biosamples, R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Zhongwu Lai
- Translational Medicine, Oncology R+D, Research and Early Development, AstraZeneca, Boston, MA, USA
| | - Cathy E Elks
- Precision Medicine and Biosamples, R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | | | - Brian A Dougherty
- Translational Medicine, Oncology R+D, Research and Early Development, AstraZeneca, Boston, MA, USA
| | | | | | | | - Elizabeth A Harrington
- Translational Medicine, Oncology R+D, Research and Early Development, AstraZeneca, Cambridge, United Kingdom
| | - J Carl Barrett
- Translational Medicine, Oncology R+D, Research and Early Development, AstraZeneca, Boston, MA, USA
| | - Alexandra Leary
- Department of Medicine and INSERM U981, Université Paris Saclay and Institut Gustave-Roussy, Villejuif, France
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Tjokrowidjaja A, Friedlander M, Lord SJ, Asher R, Rodrigues M, Ledermann JA, Matulonis UA, Oza AM, Bruchim I, Huzarski T, Gourley C, Harter P, Vergote I, Scott CL, Meier W, Shapira-Frommer R, Milenkova T, Pujade-Lauraine E, Gebski V, Lee CK. Prognostic nomogram for progression-free survival in patients with BRCA mutations and platinum-sensitive recurrent ovarian cancer on maintenance olaparib therapy following response to chemotherapy. Eur J Cancer 2021; 154:190-200. [PMID: 34293664 DOI: 10.1016/j.ejca.2021.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The impact of maintenance therapy with PARP inhibitors (PARPi) on progression-free survival (PFS) in patients with BRCA mutations and platinum-sensitive recurrent ovarian cancer (PSROC) varies widely. Individual prognostic factors do not reliably distinguish patients who progress early from those who have durable benefit. We developed and validated a prognostic nomogram to predict PFS in these patients. METHODS The nomogram was developed using data from a training patient cohort with BRCA mutations and high-grade serous PSROC on the placebo arm of two maintenance therapy trials, Study 19 and SOLO2/ENGOT-ov21. We performed multivariable Cox regression analysis based on pre-treatment characteristics to develop a nomogram that predicts PFS. We assessed the discrimination and validation of the nomogram in independent validation patient cohorts treated with maintenance olaparib. RESULTS The nomogram includes four PFS predictors: CA-125 at randomisation, platinum-free interval, presence of measurable disease and number of prior lines of platinum therapy. In the training (placebo) cohort (internal validation C-index 0.64), median PFS in the model-predicted good, intermediate and poor-risk groups was: 7.7 (95% CI 5.3-11.3), 5.4 (4.8-5.8) and 2.9 (2.8-4.4) months, respectively. In the validation (olaparib) cohort (C-index 0.71), median PFS in the model-predicted good, intermediate and poor-risk groups was: not reached, 16.6 (13.1-22.4) and 8.3 (7.1-10.8) months, respectively. The nomogram showed good calibration in the validation cohort (calibration plot). CONCLUSIONS This nomogram can be used to predict PFS and counsel patients with BRCA mutations and PSROC prior to maintenance olaparib and for stratification of patients in trials of maintenance therapies.
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Affiliation(s)
- Angelina Tjokrowidjaja
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia; Department of Medical Oncology, St George Hospital, Kogarah, NSW 2217, Australia; Australia New Zealand Gynecological Oncology Group, Camperdown, New South Wales, Australia.
| | - Michael Friedlander
- Australia New Zealand Gynecological Oncology Group, Camperdown, New South Wales, Australia; Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Sarah J Lord
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia; School of Medicine, The University of Notre Dame, Sydney, NSW 2007, Australia
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia
| | - Manuel Rodrigues
- INSERM U830, DNA Repair and Uveal Melanoma (D.R.U.M.), Equipe Labellisée Par La Ligue Nationale Contre le Cancer, Paris, France; Department of Medical Oncology, Institut Curie, PSL Research University, Paris, France
| | - Jonathan A Ledermann
- UCL Cancer Institute, University College London, London WC1E 6DD, Great Britain, UK
| | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Amit M Oza
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada
| | - Ilan Bruchim
- Gynecologic Oncology Division, Hillel Yaffe Medical Center, Technion Institute of Technology, Haifa, Israel
| | - Tomasz Huzarski
- Department of Genetics and Pathology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Ignace Vergote
- Department of Oncology, KU Leuven - University of Leuven, B-3000 Leuven, Belgium; Division of Gynaecological Oncology, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Clare L Scott
- Walter and Eliza Hall Institute of Medical Research, Stem Cells, and Cancer, University of Melbourne, Melbourne, Victoria, Australia
| | - Werner Meier
- Department of Gynaecology and Obstetrics, Evangelisches Krankenhaus Düsseldorf, Germany; University Hospital Düsseldorf, Düsseldorf, Germany
| | | | | | | | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia
| | - Chee K Lee
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia; Department of Medical Oncology, St George Hospital, Kogarah, NSW 2217, Australia; Australia New Zealand Gynecological Oncology Group, Camperdown, New South Wales, Australia
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Poveda A, Floquet A, Ledermann JA, Asher R, Penson RT, Oza AM, Korach J, Huzarski T, Pignata S, Friedlander M, Baldoni A, Park-Simon TW, Tamura K, Sonke GS, Lisyanskaya A, Kim JH, Filho EA, Milenkova T, Lowe ES, Rowe P, Vergote I, Pujade-Lauraine E. Olaparib tablets as maintenance therapy in patients with platinum-sensitive relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT-Ov21): a final analysis of a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol 2021; 22:620-631. [PMID: 33743851 DOI: 10.1016/s1470-2045(21)00073-5] [Citation(s) in RCA: 182] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/26/2021] [Accepted: 02/03/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, has previously been shown to extend progression-free survival versus placebo when given to patients with relapsed high-grade serous or endometrioid ovarian cancer who were platinum sensitive and who had a BRCA1 or BRCA2 (BRCA1/2) mutation, as part of the SOLO2/ENGOT-Ov21 trial. The aim of this final analysis is to investigate the effect of olaparib on overall survival. METHODS This double-blind, randomised, placebo-controlled, phase 3 trial was done across 123 medical centres in 16 countries. Eligible patients were aged 18 years or older, had an Eastern Cooperative Oncology Group performance status at baseline of 0-1, had histologically confirmed, relapsed, high-grade serous or high-grade endometrioid ovarian cancer, including primary peritoneal or fallopian tube cancer, and had received two or more previous platinum regimens. Patients were randomly assigned (2:1) to receive olaparib tablets (300 mg in two 150 mg tablets twice daily) or matching placebo tablets using an interactive web or voice-response system. Stratification was by response to previous chemotherapy and length of platinum-free interval. Treatment assignment was masked to patients, treatment providers, and data assessors. The primary endpoint of progression-free survival has been reported previously. Overall survival was a key secondary endpoint and was analysed in all patients as randomly allocated. Safety was assessed in all patients who received at least one treatment dose. This trial is registered with ClinicalTrials.gov, NCT01874353, and is no longer recruiting patients. FINDINGS Between Sept 3, 2013 and Nov 21, 2014, 295 patients were enrolled. Patients were randomly assigned to receive either olaparib (n=196 [66%]) or placebo (n=99 [34%]). One patient, randomised in error, did not receive olaparib. Median follow-up was 65·7 months (IQR 63·6-69·3) with olaparib and 64·5 months (63·4-68·7) with placebo. Median overall survival was 51·7 months (95% CI 41·5-59·1) with olaparib and 38·8 months (31·4-48·6) with placebo (hazard ratio 0·74 [95% CI 0·54-1·00]; p=0·054), unadjusted for the 38% of patients in the placebo group who received subsequent PARP inhibitor therapy. The most common grade 3 or worse treatment-emergent adverse event was anaemia (which occurred in 41 [21%] of 195 patients in the olaparib group and two [2%] of 99 patients in the placebo group). Serious treatment-emergent adverse events were reported in 50 (26%) of 195 patients receiving olaparib and eight (8%) of 99 patients receiving placebo. Treatment-emergent adverse events with a fatal outcome occurred in eight (4%) of the 195 patients receiving olaparib, six of which were judged to be treatment-related (attributed to myelodysplastic syndrome [n=3] and acute myeloid leukaemia [n=3]). INTERPRETATION Olaparib provided a median overall survival benefit of 12·9 months compared with placebo in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation. Although statistical significance was not reached, these findings are arguably clinically meaningful and support the use of maintenance olaparib in these patients. FUNDING AstraZeneca and Merck.
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Affiliation(s)
- Andrés Poveda
- Initia Oncology, Hospital Quirónsalud, Valencia, Spain; Grupo Español de Investigación en Cáncer de Ovario, Madrid, Spain.
| | - Anne Floquet
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France; Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Paris, France
| | - Jonathan A Ledermann
- UCL Cancer Institute, University College London, London, UK; National Cancer Research Institute, London, UK
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Richard T Penson
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Amit M Oza
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jacob Korach
- Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel; Israeli Society of Gynecologic Oncology, Ramat Gan, Israel
| | - Tomasz Huzarski
- International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; Read-Gene SA, Grzepnica, Szczecin, Poland
| | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy; Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies, Naples, Italy
| | - Michael Friedlander
- University of New South Wales Clinical School, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Alessandra Baldoni
- Istituto Oncologico Veneto, Padova, Italy; Mario Negri Gynecologic Oncology Group, Milan, Italy
| | - Tjoung-Won Park-Simon
- Hannover Medical School, Hannover, Germany; German Society of Gynecological Oncology, Essen, Germany
| | | | - Gabe S Sonke
- The Netherlands Cancer Institute, Amsterdam, Netherlands; Dutch Gynecological Oncology Group, Amsterdam, Netherlands
| | - Alla Lisyanskaya
- St Petersburg City Clinical Oncology Dispensary, St Petersburg, Russia
| | - Jae-Hoon Kim
- Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea; Korean Gynecologic Oncology Group, Seoul, South Korea
| | - Elias Abdo Filho
- Instituto do Câncer do Estado São Paulo-Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Ignace Vergote
- University Hospital Leuven, Leuven Cancer Institute, Belgium; Belgium and Luxembourg Gynaecological Oncology Group, Leuven, Belgium
| | - Eric Pujade-Lauraine
- Association de Recherche Contre les Cancers dont Gynécologiques-ARCAGY, Paris, France
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Zhou D, Li J, Bui K, Learoyd M, Berges A, Milenkova T, Al-Huniti N, Tomkinson H, Xu H. Bridging Olaparib Capsule and Tablet Formulations Using Population Pharmacokinetic Meta-analysis in Oncology Patients. Clin Pharmacokinet 2020; 58:615-625. [PMID: 30357650 DOI: 10.1007/s40262-018-0714-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Olaparib is a first-in-class potent oral poly(ADP-ribose) polymerase inhibitor. OBJECTIVES The aims of this analysis were to establish an integrated population pharmacokinetic (PK) model of olaparib in patients with solid tumors and to bridge the PK of olaparib between capsule and tablet formulations. METHODS The population PK model was developed using plasma concentration data from 659 patients in 11 phase I, II, and III studies of olaparib tablets/capsules monotherapy. Relative bioavailability between the tablet and capsule formulations was estimated and the relative exposure between olaparib tablet and capsule therapeutic doses was further assessed. RESULTS The concentration-time profile was described using a two-compartment model with sequential zero- and first-order absorption and first-order elimination for both capsules and tablets with different absorption parameters. Multiple-dose clearance compared with single-dose clearance was reduced by approximately 15% (auto-inhibition). Disease severity had an impact on olaparib clearance, and tablet strength had an impact on Ka. The olaparib geometric mean area under the curve (AUC) and maximal concentration (Cmax) following a single 300 mg tablet were 42.1 μg h/mL and 5.8 μg/mL, respectively, and the steady-state geometric mean AUC and Cmax following a 300 mg tablet twice daily were 49.0 μg h/mL and 7.7 μg/mL, respectively. The relative exposure (AUC) of the 300 mg tablet formulation is 13% higher than the 400 mg capsule formulation. CONCLUSION This analysis bridged the olaparib capsule and tablet formulation PK and provided key assessment to support the approval of the olaparib tablet formulation in patients with ovarian cancer, regardless of their BRCA mutation status.
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Affiliation(s)
- Diansong Zhou
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, AstraZeneca, 35 Gatehouse Drive, Boston, MA, 02451, USA
| | - Jianguo Li
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, AstraZeneca, 35 Gatehouse Drive, Boston, MA, 02451, USA
| | - Khanh Bui
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, AstraZeneca, 35 Gatehouse Drive, Boston, MA, 02451, USA
| | - Maria Learoyd
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | - Alienor Berges
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | | | - Nidal Al-Huniti
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, AstraZeneca, 35 Gatehouse Drive, Boston, MA, 02451, USA
| | - Helen Tomkinson
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, UK
| | - Hongmei Xu
- Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, AstraZeneca, 35 Gatehouse Drive, Boston, MA, 02451, USA.
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Lee JM, Moore RG, Ghamande SA, Park MS, Diaz JP, Chapman JA, Kendrick JE, Slomovitz BM, Tewari KS, Lowe ES, Milenkova T, Kumar S, Dymond M, Kozarewa I, Liu JF. Cediranib in combination with olaparib in patients without a germline BRCA1/2 mutation with recurrent platinum-resistant ovarian cancer: Phase IIb CONCERTO trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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
6056 Background: A Phase I trial (NCT01116648) of cediranib (cedi) in combination with olaparib (ola) (cedi + ola) demonstrated an overall response rate of 44% in patients (pts) with recurrent ovarian cancer (OC), including pts without a deleterious or suspected deleterious gBRCAm (non-gBRCAm; Liu et al. Eur J Cancer 2013). The subsequent Phase II trial (NCT01116648) showed significant improvement in progression-free survival (PFS) with cedi + ola versus ola monotherapy in recurrent platinum-sensitive OC pts, notably in non-gBRCAm pts (Liu et al. Lancet Oncol 2014). We report data from the Phase IIb, single-arm, open-label CONCERTO study investigating cedi + ola in non-gBRCAm pts with recurrent platinum-resistant OC who had received ≥3 previous lines of therapy for advanced OC (NCT02889900). Methods: Pts with disease progression <6 months from the last receipt of platinum-based chemotherapy received cedi tablets (30 mg once daily) plus ola tablets (200 mg twice daily) until progression or unacceptable toxicity. gBRCAm pts were ineligible. Primary endpoint: objective response rate (ORR) by independent central review (ICR; RECIST 1.1). Key secondary endpoints: PFS and safety. Results: 60 pts from the USA were included (median age: 64.5 years; median number of previous systemic treatment regimens: 4 [range: 2–9]; previous bevacizumab: 53). All pts had high-grade OC (90% serous; 3.3% clear cell; 3.3% endometrioid; 3.3% other). 7% of pts had tumor BRCA2 (confirmed somatic) mutations, 80% of pts had no tumor BRCA mutation (non-tBRCAm) and 13% of pts were not evaluable for tBRCAm. Five (8%) pts who were non-tBRCAm carried somatic homologous recombination repair gene mutations (FoundationOne Clinical Trial Assay, Foundation Medicine, Inc). The Table shows results of key endpoints. Most common grade ≥3 adverse events (AEs) that occurred in pts were hypertension (30%), fatigue (22%) and diarrhea (13%). 37% of pts reported serious AEs, of which nausea (7%) was most common. Dose interruptions, reductions and discontinuations were caused by AEs in 55%, 18% and 18% of pts, respectively, who received cedi + ola. Conclusions: Cedi + ola showed evidence of antitumor activity in heavily pretreated non-gBRCAm pts with recurrent platinum-resistant OC. Toxicity was manageable with dose modifications. Clinical trial information: NCT02889900. [Table: see text]
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Penson RT, Valencia RV, Cibula D, Colombo N, Leath CA, Bidziński M, Kim JW, Nam JH, Madry R, Hernández C, Mora PAR, Ryu SY, Milenkova T, Lowe ES, Barker L, Scambia G. Olaparib Versus Nonplatinum Chemotherapy in Patients With Platinum-Sensitive Relapsed Ovarian Cancer and a Germline BRCA1/2 Mutation (SOLO3): A Randomized Phase III Trial. J Clin Oncol 2020; 38:1164-1174. [PMID: 32073956 PMCID: PMC7145583 DOI: 10.1200/jco.19.02745] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE A phase II study (ClinicalTrials.gov identifier: NCT00628251) showed activity of olaparib capsules versus pegylated liposomal doxorubicin in patients with germline BRCA-mutated platinum-resistant or partially platinum-sensitive relapsed ovarian cancer. We conducted a phase III trial (SOLO3) of olaparib tablets versus nonplatinum chemotherapy in patients with germline BRCA-mutated platinum-sensitive relapsed ovarian cancer who had received at least 2 prior lines of platinum-based chemotherapy. PATIENTS AND METHODS In this randomized, open-label trial, patients were randomly assigned 2:1 to olaparib 300 mg twice a day or physician's choice single-agent nonplatinum chemotherapy (pegylated liposomal doxorubicin, paclitaxel, gemcitabine, or topotecan). The primary end point was objective response rate (ORR) in the measurable disease analysis set assessed by blinded independent central review (BICR). The key secondary end point was progression-free survival (PFS) assessed by BICR in the intent-to-treat population. RESULTS Of 266 randomly assigned patients, 178 were assigned to olaparib and 88 to chemotherapy. In patients with measurable disease (olaparib, n = 151; chemotherapy, n = 72), the BICR-assessed ORR was significantly higher with olaparib than with chemotherapy (72.2% v 51.4%; odds ratio [OR], 2.53 [95% CI, 1.40 to 4.58]; P = .002). In the subgroup who had received 2 prior lines of treatment, the ORR was 84.6% with olaparib and 61.5% with chemotherapy (OR, 3.44 [95% CI, 1.42 to 8.54]). BICR-assessed PFS also significantly favored olaparib versus chemotherapy (hazard ratio, 0.62 [95% CI, 0.43 to 0.91]; P = .013; median, 13.4 v 9.2 months). Adverse events were consistent with the established safety profiles of olaparib and chemotherapy. CONCLUSION Olaparib resulted in statistically significant and clinically relevant improvements in ORR and PFS compared with nonplatinum chemotherapy in patients with germline BRCA-mutated platinum-sensitive relapsed ovarian cancer who had received at least 2 prior lines of platinum-based chemotherapy.
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Affiliation(s)
- Richard T Penson
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | | | - David Cibula
- First Faculty of Medicine, Charles University and General University, Prague, Czech Republic
| | - Nicoletta Colombo
- University of Milan-Bicocca and IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | - Mariusz Bidziński
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Jae-Weon Kim
- Seoul National University Hospital, Seoul, South Korea
| | | | - Radoslaw Madry
- Medical University K. Marcinkowski and Clinical Hospital of the Transfiguration, Poznań, Poland
| | | | - Paulo A R Mora
- Instituto COI de Educação e Pesquisa, Rio de Janeiro, Brazil
| | - Sang Young Ryu
- Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | | | | | | | - Giovanni Scambia
- Università Cattolica del Sacro Cuore-Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
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Gourley C, Brown J, Lai Z, Lao-Sirieix P, Elks C, McGarvey H, French T, Milenkova T, Bloomfield R, Rowe P, Hodgson D, Barrett J, Moore K, DiSilvestro P, Harrington E. Analysis of tumour samples from SOLO1: Frequency of BRCA specific loss of heterozygosity (LOH) and progression-free survival (PFS) according to homologous recombination repair deficiency (HRD)-LOH score. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Penson RT, Villalobos Valencia R, Cibula D, Colombo N, Leath CA, Bidziński M, Kim JW, Nam JH, Madry R, Hernández CH, Mora PAR, Ryu SY, Milenkova T, Lowe ES, Barker L, Scambia G. Olaparib monotherapy versus (vs) chemotherapy for germline BRCA-mutated (gBRCAm) platinum-sensitive relapsed ovarian cancer (PSR OC) patients (pts): Phase III SOLO3 trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5506] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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
5506 Background: Data from a randomized Phase II trial (NCT00628251) of olaparib (capsules, 200 or 400 mg bid, n=32 per arm) vs pegylated liposomal doxorubicin (PLD, n=33) in gBRCAm OC pts with recurrence ≤12 months after prior platinum therapy indicated efficacy for olaparib (Kaye et al. JCO 2012). However, the efficacy of PLD was higher than previously reported in this setting. We led a confirmatory Phase III, open-label study of olaparib vs non-platinum chemotherapy in gBRCAm PSR OC pts (NCT02282020). Methods: Pts were randomized (2:1) to olaparib tablets (300 mg bid) or chemotherapy treatment of physician’s choice (TPC) (paclitaxel [P; 80 mg/m2 on day 1 (D1), D8, D15, D22 every 4 weeks (q4w)], topotecan [T; 4 mg/m2 D1, D8, D15 q4w], gemcitabine [G; 1000 mg/m2 D1, D8, D15 q4w] or PLD [50 mg/m2 D1 q4w]) until progression, stratified by: TPC, prior lines of chemotherapy (2–3 vs ≥4) and platinum-free interval (6–12 vs >12 months). Primary endpoint: ORR (blinded independent central review [BICR]). Secondary endpoints included PFS and safety. Results: 266 gBRCAm PSR OC pts were randomized (olaparib, n=178; TPC, n=88 [ PLD, n=47; P, n=20; G, n=13; T, n=8]); 12 in the TPC arm withdrew before receiving study treatment. 223 pts (84%) had baseline BICR measurable disease (olaparib, n=151; TPC, n=72). ORR was 72% with olaparib vs 51% with TPC (OR 2.53, 95% CI 1.40–4.58; P=0.002). HR for PFS by BICR was 0.62 (95% CI 0.43–0.91; P=0.013; median 13.4 vs 9.2 months [olaparib vs TPC]) and by investigator assessment was 0.49 (95% CI 0.35–0.70; P<0.001; median 13.2 vs 8.5 months, respectively). Most common adverse events (AEs) with olaparib were nausea (65% vs 34% [TPC]) and anemia (50% vs 25%) and with TPC were palmar-plantar erythrodysesthesia (PPE; 36% vs 1% [olaparib]) and nausea. Most common grade ≥3 AEs in either arm were anemia (21% [olaparib] vs 0 [TPC]), PPE (0 vs 12%) and neutropenia (6% vs 11%). For olaparib vs TPC, serious AEs were reported by 24% vs 18% and AEs led to treatment discontinuation in 7% vs 20%. Conclusions: Pts with gBRCAm PSR OC receiving olaparib monotherapy had a significant, clinically relevant improvement in ORR and PFS vs TPC, with no new safety signals. Clinical trial information: NCT02282020.
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Affiliation(s)
| | | | - David Cibula
- First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | | | - Mariusz Bidziński
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Jae-Weon Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Joo-Hyun Nam
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Radoslaw Madry
- Uniwersytet Medyczny im K Marcinkowskiego w Poznaniu and Szpital Kliniczny Przemienienia Pańskiego, Poznań, Poland
| | | | | | - Sang Young Ryu
- Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | | | | | | | - Giovanni Scambia
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy
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Zhou D, Li J, Learoyd M, Bui K, Berges A, Milenkova T, Al‐Huniti N, Tomkinson H, Xu H. Efficacy and Safety Exposure‐Response Analyses of Olaparib Capsule and Tablet Formulations in Oncology Patients. Clin Pharmacol Ther 2019; 105:1492-1500. [DOI: 10.1002/cpt.1338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/07/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Diansong Zhou
- Quantitative Clinical Pharmacology, Early Clinical DevelopmentIMED Biotech UnitAstraZeneca Boston Massachusetts USA
| | - Jianguo Li
- Quantitative Clinical Pharmacology, Early Clinical DevelopmentIMED Biotech UnitAstraZeneca Boston Massachusetts USA
| | - Maria Learoyd
- Quantitative Clinical Pharmacology, Early Clinical DevelopmentIMED Biotech UnitAstraZeneca Cambridge UK
| | - Khanh Bui
- Quantitative Clinical Pharmacology, Early Clinical DevelopmentIMED Biotech UnitAstraZeneca Boston Massachusetts USA
| | - Alienor Berges
- Quantitative Clinical Pharmacology, Early Clinical DevelopmentIMED Biotech UnitAstraZeneca Cambridge UK
| | | | - Nidal Al‐Huniti
- Quantitative Clinical Pharmacology, Early Clinical DevelopmentIMED Biotech UnitAstraZeneca Boston Massachusetts USA
| | - Helen Tomkinson
- Quantitative Clinical Pharmacology, Early Clinical DevelopmentIMED Biotech UnitAstraZeneca Cambridge UK
| | - Hongmei Xu
- Quantitative Clinical Pharmacology, Early Clinical DevelopmentIMED Biotech UnitAstraZeneca Boston Massachusetts USA
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15
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Liu JF, Lee JM, Strock E, Phillips R, Mari K, Killiam B, Bonam M, Milenkova T, Kohn EC, Ivy SP. Technology Applications: Use of Digital Health Technology to Enable Drug Development. JCO Clin Cancer Inform 2018; 2:1-12. [PMID: 30652584 PMCID: PMC6874035 DOI: 10.1200/cci.17.00153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This pilot study developed and evaluated the feasibility, usability, and perceived satisfaction with an end-user mobile medical application and provider web portal. The two interfaces allowed for remote monitoring, provided daily guidance in the management of hypertension and diarrhea, and allowed for rapid management of adverse events during a clinical trial of olaparib and cediranib. PATIENTS AND METHODS eCO (eCediranib/Olaparib) was designed for patient self-reported, real-time management of hypertension and diarrhea using remote monitoring. eCO links to a Bluetooth-enabled blood pressure (BP) monitor and transmits data to a secure provider web portal. eCO use was assessed for suitability, usability, and satisfaction after 4 weeks using a 17-item questionnaire. Metrics regarding patient-reported BP and diarrhea events were analyzed. RESULTS Sixteen patients enrolled in the pilot. A total of 98.2% of expected BP values were reported: 94.2% via Bluetooth and 5.8% entered manually. Twelve patients experienced 21 BP events (systolic BP > 140 and/or diastolic BP > 90 mmHg on two consecutive readings); data from cycle 1 were comparable to the study database. Thirteen patients reported diarrhea (more than one stool per 24 hours over baseline) categorized as grade 1 or 2, which was comparable to the study database. Survey analysis showed that patients had statistically significant, positive responses to the use of the eCO application. Patients indicated eCO use made them feel more involved in their care and better connected to their health care team. The only aspect of the application that did not show a statistically significant positive response was the process of reporting diarrhea. CONCLUSION The eCO application was designed to assist in managing acute treatment-related events most often associated with treatment discontinuation, need for drug holidays, or dose interruption. Hypertension and diarrhea events reported via eCO allowed rapid provider response and a positive overall patient experience.
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Affiliation(s)
- Joyce F. Liu
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Jung-min Lee
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Ellie Strock
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Ruth Phillips
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Karine Mari
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Bill Killiam
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Matthew Bonam
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Tsveta Milenkova
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - Elise C. Kohn
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
| | - S. Percy Ivy
- Joyce F. Liu, Dana Farber Cancer Institute, Boston; Ellie Strock, Ruth Phillips, and Karine Mari, Voluntis, Cambridge, MA; Jung-min Lee, Elise C. Kohn, and S. Percy Ivy, National Cancer Institute, Bethesda, MD; Bill Killiam, User-Centered Design, Ashburn, VA; and Matthew Bonam and Tsveta Milenkova, AstraZeneca, Cambridge, United Kingdom
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Hodgson DR, Dearden SP, Brown JS, Milenkova T, Lanchbury JS, Perry M, Gutin A, Abkevich V, Timms K, Harrington E, Barrett JC, Lai Z, Dougherty BA, Pujade-Lauraine E. Analysis of tumor samples from SOLO2: Concordance of BRCA mutation ( BRCAm) detection in tumor vs. blood and frequency of BRCA-specific loss of heterozygosity (LOH) and loss of function somatic mutations. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.12017] [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)
| | | | - Jessica S Brown
- Translational Sciences, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | | | | | | | | | | | | | - Elizabeth Harrington
- Translational Science, Oncology, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - J Carl Barrett
- Translational Science, Oncology, IMED Biotech Unit, AstraZeneca, Waltham, MA
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Korach J, Turner S, Milenkova T, Alecu I, McMurtry E, Bloomfield R, Pujade-Lauraine E. Incidence of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) in patients (pts) with a germline (g) BRCA mutation (m) and platinum-sensitive relapsed ovarian cancer (PSR OC) receiving maintenance olaparib in SOLO2: Impact of prior lines of platinum therapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5548] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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)
- Jacob Korach
- Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
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Timms K, Brown JS, Hodgson DR, Barrett JC, Milenkova T, Ledermann JA, Gourley C, Pujade-Lauraine E, Perry M, Gutin A, Abkevich V, Lanchbury JS. Locus-specific loss of heterozygosity (LOH) in BRCA1/2 mutated (mBRCA) ovarian tumors from the SOLO2 (NCT01874353) and Study 19 (NCT00753545) clinical trials. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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)
| | - Jessica S Brown
- Translational Sciences, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | | | - J Carl Barrett
- Translational Science, Oncology, IMED Biotech Unit, AstraZeneca, Waltham, MA
| | | | | | - Charlie Gourley
- University of Edinburgh Cancer Research UK Centre, MRC IGMM, Edinburgh, United Kingdom
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Alecu I, Milenkova T, Turner SR. Risk of severe hematologic toxicities in cancer patients treated with PARP inhibitors: results of monotherapy and combination therapy trials. Drug Des Devel Ther 2018; 12:347-348. [PMID: 29505040 PMCID: PMC5826089 DOI: 10.2147/dddt.s156746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Iulian Alecu
- Research and Development, AstraZeneca UK Limited, Cambridge, UK
| | | | - Simon R Turner
- Research and Development, AstraZeneca UK Limited, Cambridge, UK
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Douillard JY, Ostoros G, Cobo M, Ciuleanu T, Cole R, McWalter G, Walker J, Dearden S, Webster A, Milenkova T, McCormack R. Gefitinib treatment in EGFR mutated caucasian NSCLC: circulating-free tumor DNA as a surrogate for determination of EGFR status. J Thorac Oncol 2014; 9:1345-53. [PMID: 25122430 PMCID: PMC4224589 DOI: 10.1097/jto.0000000000000263] [Citation(s) in RCA: 359] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION In the phase IV, open-label, single-arm study NCT01203917, first-line gefitinib 250 mg/d was effective and well tolerated in Caucasian patients with epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (previously published). Here, we report EGFR mutation analyses of plasma-derived, circulating-free tumor DNA. METHODS Mandatory tumor and duplicate plasma (1 and 2) baseline samples were collected (all screened patients; n = 1060). Preplanned, exploratory analyses included EGFR mutation (and subtype) status of tumor versus plasma and between plasma samples. Post hoc, exploratory analyses included efficacy by tumor and plasma EGFR mutation (and subtype) status. RESULTS Available baseline tumor samples were 1033 of 1060 (118 positive of 859 mutation status known; mutation frequency, 13.7%). Available plasma 1 samples were 803 of 1060 (82 positive of 784 mutation status known; mutation frequency, 10.5%). Mutation status concordance between 652 matched tumor and plasma 1 samples was 94.3% (95% confidence interval [CI], 92.3-96.0) (comparable for mutation subtypes); test sensitivity was 65.7% (95% CI, 55.8-74.7); and test specificity was 99.8% (95% CI, 99.0-100.0). Twelve patients of unknown tumor mutation status were subsequently identified as plasma mutation-positive. Available plasma 2 samples were 803 of 1060 (65 positive of 224 mutation status-evaluable and -known). Mutation status concordance between 224 matched duplicate plasma 1 and 2 samples was 96.9% (95% CI, 93.7-98.7). Objective response rates are as follows: mutation-positive tumor, 70% (95% CI, 60.5-77.7); mutation-positive tumor and plasma 1, 76.9% (95% CI, 65.4-85.5); and mutation-positive tumor and mutation-negative plasma 1, 59.5% (95% CI, 43.5-73.7). Median progression-free survival (months) was 9.7 (95% CI, 8.5-11.0; 61 events) for mutation-positive tumor and 10.2 (95% CI, 8.5-12.5; 36 events) for mutation-positive tumor and plasma 1. CONCLUSION The high concordance, specificity, and sensitivity demonstrate that EGFR mutation status can be accurately assessed using circulating-free tumor DNA. Although encouraging and suggesting that plasma is a suitable substitute for mutation analysis, tumor tissue should remain the preferred sample type when available.
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Affiliation(s)
- Jean-Yves Douillard
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Gyula Ostoros
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Manuel Cobo
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Tudor Ciuleanu
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Rebecca Cole
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Gael McWalter
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Jill Walker
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Simon Dearden
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Alan Webster
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Tsveta Milenkova
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
| | - Rose McCormack
- Institut de Cancerologie, Centre René Gauducheau, Nantes, France; National Koranyi Institute of Pulmonology, Budapest, Hungary; Hospital Regional Universitario, Malaga, Spain; Institutul Oncologic Prof. Dr. Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania; and AstraZeneca, Macclesfield, United Kingdom
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Douillard JY, Ostoros G, Cobo M, Ciuleanu T, McCormack R, Webster A, Milenkova T. First-line gefitinib in Caucasian EGFR mutation-positive NSCLC patients: a phase-IV, open-label, single-arm study. Br J Cancer 2013; 110:55-62. [PMID: 24263064 PMCID: PMC3887309 DOI: 10.1038/bjc.2013.721] [Citation(s) in RCA: 300] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 10/17/2013] [Accepted: 10/21/2013] [Indexed: 01/14/2023] Open
Abstract
Background: Phase-IV, open-label, single-arm study (NCT01203917) to assess efficacy and safety/tolerability of first-line gefitinib in Caucasian patients with stage IIIA/B/IV, epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC). Methods: Treatment: gefitinib 250 mg day−1 until progression. Primary endpoint: objective response rate (ORR). Secondary endpoints: disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and safety/tolerability. Pre-planned exploratory objective: EGFR mutation analysis in matched tumour and plasma samples. Results: Of 1060 screened patients with NSCLC (859 known mutation status; 118 positive, mutation frequency 14%), 106 with EGFR sensitising mutations were enrolled (female 70.8% adenocarcinoma 97.2% never-smoker 64.2%). At data cutoff: ORR 69.8% (95% confidence interval (CI) 60.5–77.7), DCR 90.6% (95% CI 83.5–94.8), median PFS 9.7 months (95% CI 8.5–11.0), median OS 19.2 months (95% CI 17.0–NC; 27% maturity). Most common adverse events (AEs; any grade): rash (44.9%), diarrhoea (30.8%); CTC (Common Toxicity Criteria) grade 3/4 AEs: 15% SAEs: 19%. Baseline plasma 1 samples were available in 803 patients (784 known mutation status; 82 positive; mutation frequency 10%). Plasma 1 EGFR mutation test sensitivity: 65.7% (95% CI 55.8–74.7). Conclusion: First-line gefitinib was effective and well tolerated in Caucasian patients with EGFR mutation-positive NSCLC. Plasma samples could be considered for mutation analysis if tumour tissue is unavailable.
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Affiliation(s)
- J-Y Douillard
- Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Bd J. Monod, 44805 St-Herblain, Nantes, France
| | - G Ostoros
- National Koranyi Institute of Pulmonology, Piheno ut 1, Budapest H-1121, Hungary
| | - M Cobo
- Hospital Regional Universitario Carlos Haya, Málaga, Andalucia 29010, Spain
| | - T Ciuleanu
- Institutul Oncologic Ion Chiricuta and UMF Iuliu Hatieganu, Cluj-Napoca 400015, Romania
| | - R McCormack
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - A Webster
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - T Milenkova
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
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Douillard J, Ostoros G, Cobo M, Ciuleanu T, McCormack R, Webster A, Milenkova T. 68O EFFICACY, SAFETY AND TOLERABILITY RESULTS FROM A PHASE IV, OPEN-LABEL, SINGLE ARM STUDY OF 1ST-LINE GEFITINIB IN CAUCASIAN PATIENTS (PTS) WITH EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) MUTATION-POSITIVE NON-SMALL-CELL LUNG CANCER (NSCLC). Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70288-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sun Y, Wu YL, Li LY, Liao ML, Jiang GL, Kim ES, Douillard JY, Milenkova T. [Efficacy and safety of gefitinib or docetaxel in Chinese patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) who had failed previous platinum-based first-line chemotherapy]. Zhonghua Zhong Liu Za Zhi 2011; 33:377-380. [PMID: 21875470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To compare the efficacy and safety of gefitinib or docetaxel in Chinese patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) who had failed previous platinum-based first-line chemotherapy. METHODS We retrospectively reviewed 222 Chinese NSCLC patients in the subgroup of INTEREST (gefitinib versus docetaxel in previously treated non-small cell lung cancer) study. Survival analysis was evaluated by Kaplan-Meier method, and Functional Assessment of Cancer Therapy-Lung (FACT-L) was used to compare the quality of life between gefitinib group and docetaxel group. RESULTS A total of 222 patients were analyzed in this subgroup study. 107 patients were treated with gefitinib, and 115 patients treated with docetaxel. There were all balanced between the two groups in terms of sex, age, staging and pathology in patient characteristics. The median overall survival in the two groups was similar (11 months in the gefitinib group vs. 14.0 months in the docetaxel group, P = 0.783). The progression-free survival (PFS) was also similar between the two groups (median PFS: 3.4 months in gefitinib group vs. 3.8 months in docetaxel group, P = 0.214). The response rate in gefitinib group was significantly higher than that in the docetaxel group (21.9% vs. 9.1%, P = 0.016). CONCLUSION The efficacy of gefitinib is similar with that of docetaxel in pretreated patients with locally advanced or metastatic NSCLC, however, gefitinib is more favorable in the tolerance and quality of life improvement.
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Affiliation(s)
- Yan Sun
- Chinese Academy of Medical Sciences, Beijing 100021, China.
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de Boer RH, Arrieta Ó, Yang CH, Gottfried M, Chan V, Raats J, de Marinis F, Abratt RP, Wolf J, Blackhall FH, Langmuir P, Milenkova T, Read J, Vansteenkiste JF. Vandetanib plus pemetrexed for the second-line treatment of advanced non-small-cell lung cancer: a randomized, double-blind phase III trial. J Clin Oncol 2011; 29:1067-74. [PMID: 21282537 DOI: 10.1200/jco.2010.29.5717] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Vandetanib is a once-daily oral inhibitor of vascular endothelial growth factor receptor and epidermal growth factor receptor signaling. This randomized, placebo-controlled phase III study assessed the efficacy of vandetanib plus pemetrexed as second-line therapy in advanced non-small-cell lung cancer. PATIENTS AND METHODS Patients (N = 534) were randomly assigned to receive vandetanib 100 mg/d plus pemetrexed 500 mg/m(2) every 21 days (n = 256) or placebo plus pemetrexed (n = 278). Progression-free survival (PFS) was the primary end point; overall survival, objective response rate, disease control rate, time to deterioration of symptoms, and safety were secondary assessments. RESULTS There was no significant difference in PFS between treatment arms (hazard ratio [HR], 0.86; 97.58% CI, 0.69 to 1.06; P = .108). Overall survival was also not significantly different (HR, 0.86; 97.54% CI, 0.65 to 1.13; P = .219). Statistically significant improvements in objective response rate (19% v 8%; P < .001) and time to deterioration of symptoms (HR, 0.71; P = .0052; median, 18.1 weeks for vandetanib and 12.1 weeks for placebo) were observed in patients receiving vandetanib. Adding vandetanib to pemetrexed increased the incidence of some adverse events, including rash, diarrhea, and hypertension, while showing a reduced incidence of nausea, vomiting, anemia, fatigue, and asthenia with no reduction in the dose intensity of pemetrexed. CONCLUSION This study did not meet the primary end point of statistically significant PFS prolongation with vandetanib plus pemetrexed versus placebo plus pemetrexed. The vandetanib combination showed a significantly higher objective response rate and a significant delay in the time to worsening of lung cancer symptoms versus the placebo arm as well as an acceptable safety profile in this patient population.
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De Boer R, Arrieta Ó, Gottfried M, Blackhall FH, Raats J, Yang CH, Langmuir P, Milenkova T, Read J, Vansteenkiste J. Vandetanib plus pemetrexed versus pemetrexed as second-line therapy in patients with advanced non-small cell lung cancer (NSCLC): A randomized, double-blind phase III trial (ZEAL). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [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
8010 Background: Vandetanib is a once-daily oral inhibitor of VEGFR, EGFR and RET signaling. A phase I trial of vandetanib + pemetrexed (pem) supported further investigation of this combination (de Boer et al, Ann Oncol 2008). Methods: The primary objective was to determine whether vandetanib 100 mg/day + pem 500 mg/m2 every 21 days (max 6 cycles) prolonged progression-free survival (PFS) vs placebo + pem. Overall survival (OS), objective response rate (ORR), time to deterioration of symptoms (TDS, by Lung Cancer Symptom Scale) and safety were secondary endpoints. Efficacy and safety were assessed in females as a co-primary analysis population. Eligibility criteria included stage IIIB/IV NSCLC, PS 0–2, and previous 1st-line therapy. Results: Between Jan 07-Mar 08, 534 patients (mean age 59 yrs; 38% female; 21% squamous histology; 8% brain metastases; stage IV 84%; PS 0/1/2: 41%/53%/6%) were randomized 1:1 to receive vandetanib + pem (n=256) or placebo + pem (n=278). Baseline characteristics were similar in both arms. Median duration of follow-up was 9.0 months, with 83% patients progressed and 50% deceased. There were positive trends seen for vandetanib + pem for both PFS (hazard ratio [HR] 0.86, 97.58% CI 0.69–1.06; P=0.108) and OS (HR 0.86, 97.54% CI 0.65–1.13; P=0.219); similar advantages were observed for females. There were statistically significant advantages for ORR (19.1% vs 7.9%, P<0.001) and TDS (HR 0.61, P=0.004). The adverse event profile was consistent with previous studies of vandetanib: rash (38% vs 26%), diarrhea (26% vs 18%) and hypertension (12% vs 3%) being more frequent in the vandetanib arm. There was evidence of reduced pem toxicity with the addition of vandetanib: anemia 8% vs 22%, nausea 29% vs 37%, vomiting 15% vs 22%, fatigue 37% vs 45%, and asthenia 11% vs 17%. The incidence of protocol-defined QTc prolongation was <1%. There was no increase in bleeding or thrombotic events in the vandetanib arm. Conclusions: The combination of vandetanib + pem demonstrated evidence of clinical benefit in patients with pretreated advanced NSCLC, although the study did not meet the primary endpoint of statistically significant PFS prolongation vs pem alone. Vandetanib + pem was generally well tolerated. [Table: see text]
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Affiliation(s)
- R. De Boer
- Western Hospital, Melbourne, Australia; Instituto Nacional de Cancerología (INCan), Mexico City, Mexico; Meir Medical Center, Kfar Saba, Israel; Christie Hospital NHS Trust, Manchester, United Kingdom; Panorama Medical Center, Capetown, South Africa; National Taiwan University Hospital, Taipei, Taiwan; AstraZeneca, Wilmington, DE; AstraZeneca, Macclesfield, United Kingdom; University Hospital Leuven, Leuven, Belgium
| | - Ó. Arrieta
- Western Hospital, Melbourne, Australia; Instituto Nacional de Cancerología (INCan), Mexico City, Mexico; Meir Medical Center, Kfar Saba, Israel; Christie Hospital NHS Trust, Manchester, United Kingdom; Panorama Medical Center, Capetown, South Africa; National Taiwan University Hospital, Taipei, Taiwan; AstraZeneca, Wilmington, DE; AstraZeneca, Macclesfield, United Kingdom; University Hospital Leuven, Leuven, Belgium
| | - M. Gottfried
- Western Hospital, Melbourne, Australia; Instituto Nacional de Cancerología (INCan), Mexico City, Mexico; Meir Medical Center, Kfar Saba, Israel; Christie Hospital NHS Trust, Manchester, United Kingdom; Panorama Medical Center, Capetown, South Africa; National Taiwan University Hospital, Taipei, Taiwan; AstraZeneca, Wilmington, DE; AstraZeneca, Macclesfield, United Kingdom; University Hospital Leuven, Leuven, Belgium
| | - F. H. Blackhall
- Western Hospital, Melbourne, Australia; Instituto Nacional de Cancerología (INCan), Mexico City, Mexico; Meir Medical Center, Kfar Saba, Israel; Christie Hospital NHS Trust, Manchester, United Kingdom; Panorama Medical Center, Capetown, South Africa; National Taiwan University Hospital, Taipei, Taiwan; AstraZeneca, Wilmington, DE; AstraZeneca, Macclesfield, United Kingdom; University Hospital Leuven, Leuven, Belgium
| | - J. Raats
- Western Hospital, Melbourne, Australia; Instituto Nacional de Cancerología (INCan), Mexico City, Mexico; Meir Medical Center, Kfar Saba, Israel; Christie Hospital NHS Trust, Manchester, United Kingdom; Panorama Medical Center, Capetown, South Africa; National Taiwan University Hospital, Taipei, Taiwan; AstraZeneca, Wilmington, DE; AstraZeneca, Macclesfield, United Kingdom; University Hospital Leuven, Leuven, Belgium
| | - C. H. Yang
- Western Hospital, Melbourne, Australia; Instituto Nacional de Cancerología (INCan), Mexico City, Mexico; Meir Medical Center, Kfar Saba, Israel; Christie Hospital NHS Trust, Manchester, United Kingdom; Panorama Medical Center, Capetown, South Africa; National Taiwan University Hospital, Taipei, Taiwan; AstraZeneca, Wilmington, DE; AstraZeneca, Macclesfield, United Kingdom; University Hospital Leuven, Leuven, Belgium
| | - P. Langmuir
- Western Hospital, Melbourne, Australia; Instituto Nacional de Cancerología (INCan), Mexico City, Mexico; Meir Medical Center, Kfar Saba, Israel; Christie Hospital NHS Trust, Manchester, United Kingdom; Panorama Medical Center, Capetown, South Africa; National Taiwan University Hospital, Taipei, Taiwan; AstraZeneca, Wilmington, DE; AstraZeneca, Macclesfield, United Kingdom; University Hospital Leuven, Leuven, Belgium
| | - T. Milenkova
- Western Hospital, Melbourne, Australia; Instituto Nacional de Cancerología (INCan), Mexico City, Mexico; Meir Medical Center, Kfar Saba, Israel; Christie Hospital NHS Trust, Manchester, United Kingdom; Panorama Medical Center, Capetown, South Africa; National Taiwan University Hospital, Taipei, Taiwan; AstraZeneca, Wilmington, DE; AstraZeneca, Macclesfield, United Kingdom; University Hospital Leuven, Leuven, Belgium
| | - J. Read
- Western Hospital, Melbourne, Australia; Instituto Nacional de Cancerología (INCan), Mexico City, Mexico; Meir Medical Center, Kfar Saba, Israel; Christie Hospital NHS Trust, Manchester, United Kingdom; Panorama Medical Center, Capetown, South Africa; National Taiwan University Hospital, Taipei, Taiwan; AstraZeneca, Wilmington, DE; AstraZeneca, Macclesfield, United Kingdom; University Hospital Leuven, Leuven, Belgium
| | - J. Vansteenkiste
- Western Hospital, Melbourne, Australia; Instituto Nacional de Cancerología (INCan), Mexico City, Mexico; Meir Medical Center, Kfar Saba, Israel; Christie Hospital NHS Trust, Manchester, United Kingdom; Panorama Medical Center, Capetown, South Africa; National Taiwan University Hospital, Taipei, Taiwan; AstraZeneca, Wilmington, DE; AstraZeneca, Macclesfield, United Kingdom; University Hospital Leuven, Leuven, Belgium
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de Boer R, Humblet Y, Wolf J, Nogová L, Ruffert K, Milenkova T, Smith R, Godwood A, Vansteenkiste J. An open-label study of vandetanib with pemetrexed in patients with previously treated non-small-cell lung cancer. Ann Oncol 2009; 20:486-91. [PMID: 19088171 DOI: 10.1093/annonc/mdn674] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- R de Boer
- Department of Medical Oncology, Western Hospital, Melbourne, Australia.
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De Boer R, Vansteenkiste J, Humblet Y, Wolf J, Nogova L, Ruffert K, Smith R, Godwood A, Milenkova T. Vandetanib with pemetrexed in patients with previously treated non-small cell lung cancer (NSCLC): An open-label, multicenter phase I study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
7654 Background: Vandetanib (ZD6474) is a once-daily oral anticancer drug that selectively inhibits VEGF-dependent tumor angiogenesis and EGFR- and RET-dependent tumor cell proliferation and survival. Methods: Eligible patients had locally advanced or metastatic NSCLC (stage IIIB/IV) after failure of 1st-line chemotherapy. An initial cohort of 10 patients received once- daily oral vandetanib (100 mg) with pemetrexed (500 mg/m2 i.v. infusion every 21 days). If <2 patients experienced a vandetanib- related dose-limiting toxicity (DLT), an additional cohort received vandetanib 300 mg + pemetrexed. The planned duration of treatment was =6 weeks. The primary objective of the study was to establish the safety and tolerability of vandetanib + pemetrexed. Secondary objectives included an assessment of pharmacokinetic (PK) interaction and preliminary assessment of efficacy (RECIST). Results: Twenty- one patients (14 male, 7 female; mean age 60 years, range 44–77) received vandetanib 100 mg + pemetrexed (n=10) or vandetanib 300 mg + pemetrexed (n=11). One DLT was reported in each cohort: QTc prolongation (>100 ms from baseline, but absolute QTc <500 ms) in a male patient who had electrolyte imbalance and short baseline QTc interval of 318 ms (100 mg cohort); and interstitial lung disease, which resolved after steroid therapy, in a Caucasian female patient with bronchoalveolar carcinoma and a long smoking history (300 mg cohort). The most common adverse events (AEs) were rash, anorexia, fatigue and diarrhea (all n=10; 48%). The most frequent CTC grade 3/4 AEs were increased gamma-glutamyltransferase (n=4), anorexia (n=3) and dyspnea (n=3), which are generally consistent with previous experience with vandetanib and pemetrexed as monotherapies. There was no apparent PK interaction between vandetanib and pemetrexed. In 18 patients evaluable for efficacy, there was one confirmed partial response (female; 100 mg cohort) and 13 stable disease =6 weeks. Conclusions: In patients with advanced NSCLC, vandetanib + pemetrexed was generally well tolerated, with no apparent PK interaction. A Phase III trial of vandetanib 100 mg + pemetrexed in 2nd-line NSCLC has begun. No significant financial relationships to disclose.
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Affiliation(s)
- R. De Boer
- Western Hospital, Melbourne, Australia; University Hospital Leuven, Leuven, Belgium; Université Catholique de Louvain Hospital, Brussels, Belgium; University Hospital Cologne, Cologne, Germany; Clinic and General Practice of Internal Medicine, Jena, Germany; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Loughborough, United Kingdom
| | - J. Vansteenkiste
- Western Hospital, Melbourne, Australia; University Hospital Leuven, Leuven, Belgium; Université Catholique de Louvain Hospital, Brussels, Belgium; University Hospital Cologne, Cologne, Germany; Clinic and General Practice of Internal Medicine, Jena, Germany; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Loughborough, United Kingdom
| | - Y. Humblet
- Western Hospital, Melbourne, Australia; University Hospital Leuven, Leuven, Belgium; Université Catholique de Louvain Hospital, Brussels, Belgium; University Hospital Cologne, Cologne, Germany; Clinic and General Practice of Internal Medicine, Jena, Germany; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Loughborough, United Kingdom
| | - J. Wolf
- Western Hospital, Melbourne, Australia; University Hospital Leuven, Leuven, Belgium; Université Catholique de Louvain Hospital, Brussels, Belgium; University Hospital Cologne, Cologne, Germany; Clinic and General Practice of Internal Medicine, Jena, Germany; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Loughborough, United Kingdom
| | - L. Nogova
- Western Hospital, Melbourne, Australia; University Hospital Leuven, Leuven, Belgium; Université Catholique de Louvain Hospital, Brussels, Belgium; University Hospital Cologne, Cologne, Germany; Clinic and General Practice of Internal Medicine, Jena, Germany; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Loughborough, United Kingdom
| | - K. Ruffert
- Western Hospital, Melbourne, Australia; University Hospital Leuven, Leuven, Belgium; Université Catholique de Louvain Hospital, Brussels, Belgium; University Hospital Cologne, Cologne, Germany; Clinic and General Practice of Internal Medicine, Jena, Germany; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Loughborough, United Kingdom
| | - R. Smith
- Western Hospital, Melbourne, Australia; University Hospital Leuven, Leuven, Belgium; Université Catholique de Louvain Hospital, Brussels, Belgium; University Hospital Cologne, Cologne, Germany; Clinic and General Practice of Internal Medicine, Jena, Germany; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Loughborough, United Kingdom
| | - A. Godwood
- Western Hospital, Melbourne, Australia; University Hospital Leuven, Leuven, Belgium; Université Catholique de Louvain Hospital, Brussels, Belgium; University Hospital Cologne, Cologne, Germany; Clinic and General Practice of Internal Medicine, Jena, Germany; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Loughborough, United Kingdom
| | - T. Milenkova
- Western Hospital, Melbourne, Australia; University Hospital Leuven, Leuven, Belgium; Université Catholique de Louvain Hospital, Brussels, Belgium; University Hospital Cologne, Cologne, Germany; Clinic and General Practice of Internal Medicine, Jena, Germany; AstraZeneca, Macclesfield, United Kingdom; AstraZeneca, Loughborough, United Kingdom
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Van Cruijsen H, Voest EE, Van Herpen CM, Hoekman K, Witteveen PO, Tjin-A-ton ML, Punt CJ, Puchalski T, Milenkova T, Giaccone G. Phase I evaluation of AZD2171, a highly potent, selective VEGFR signaling inhibitor, in combination with gefitinib, in patients with advanced tumors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3017] [Citation(s) in RCA: 9] [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
3017 Background: AZD2171 is an oral, highly potent, vascular endothelial growth factor (VEGF) signaling inhibitor. This Phase I trial is evaluating the safety, tolerability, pharmacokinetics (PK) and efficacy of AZD2171, in combination with gefitinib (IRESSA), an inhibitor of EGF receptor tyrosine kinase. Methods: Patients with advanced solid tumors refractory to standard therapies received once-daily, oral AZD2171 (20, 25, 30 or 45 mg) and gefitinib 250 (Part A1) or 500 mg (Part B1) until dose-limiting toxicity was observed. The potential PK interaction of AZD2171 30 mg with gefitinib 250 mg was studied in an expanded cohort (Part A2). Part B2 follows the design of Part A2, with a gefitinib dose of 500 mg. Results: As of September 1, 2005, 70 patients (22–78 years) have received treatment ( Table ). Overall, the most frequently reported adverse events (AEs) were diarrhea, anorexia, fatigue and hypertension (91%, 64%, 51% and 51% of patients; respectively), with evidence of an AZD2171-related dose response for hypertension (reported in 36%, 75%, 47% and 75% of patients at AZD2171 20, 25, 30 and 45 mg; respectively). These were also the most commonly reported CTC grade ≥3 AEs, occurring in <13% of patients, in addition to increases in alanine aminotransferase (7%) and aspartate aminotransferase (4%). The steady-state PK parameters for AZD2171 (30 mg) and gefitinib (250 mg) are comparable with those seen previously with either agent alone. In total, 28 patients had a best RECIST response of stable disease (22 patients were non-evaluable). A patient with mesothelioma (45 mg AZD2171, Part A1) and a patient with renal cancer (20 mg AZD2171, Part B1) had confirmed partial responses. The second patient underwent surgery and is currently disease-free. Conclusions: No unexpected toxicities are associated with AZD2171 (20–45 mg) in combination with gefitinib (250 or 500 mg) and the preliminary response data are encouraging. [Table: see text] [Table: see text]
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Affiliation(s)
- H. Van Cruijsen
- VU Medical Center, Amsterdam, The Netherlands; University Medical Center, Utrecht, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; AstraZeneca, Wilmington, DE
| | - E. E. Voest
- VU Medical Center, Amsterdam, The Netherlands; University Medical Center, Utrecht, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; AstraZeneca, Wilmington, DE
| | - C. M. Van Herpen
- VU Medical Center, Amsterdam, The Netherlands; University Medical Center, Utrecht, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; AstraZeneca, Wilmington, DE
| | - K. Hoekman
- VU Medical Center, Amsterdam, The Netherlands; University Medical Center, Utrecht, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; AstraZeneca, Wilmington, DE
| | - P. O. Witteveen
- VU Medical Center, Amsterdam, The Netherlands; University Medical Center, Utrecht, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; AstraZeneca, Wilmington, DE
| | - M. L. Tjin-A-ton
- VU Medical Center, Amsterdam, The Netherlands; University Medical Center, Utrecht, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; AstraZeneca, Wilmington, DE
| | - C. J. Punt
- VU Medical Center, Amsterdam, The Netherlands; University Medical Center, Utrecht, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; AstraZeneca, Wilmington, DE
| | - T. Puchalski
- VU Medical Center, Amsterdam, The Netherlands; University Medical Center, Utrecht, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; AstraZeneca, Wilmington, DE
| | - T. Milenkova
- VU Medical Center, Amsterdam, The Netherlands; University Medical Center, Utrecht, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; AstraZeneca, Wilmington, DE
| | - G. Giaccone
- VU Medical Center, Amsterdam, The Netherlands; University Medical Center, Utrecht, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; AstraZeneca, Wilmington, DE
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