Randomized phase II BGOG/ENGOT-cx1 study of paclitaxel-carboplatin with or without nintedanib in first-line recurrent or advanced cervical cancer

OBJECTIVE

Nintedanib is an oral tyrosine kinase inhibitor targeting, among others, vascular endothelial growth factor receptor. The aim was to establish the role of nintedanib in addition to paclitaxel and carboplatin in first-line recurrent/metastatic cervical cancer.

METHODS

Double-blind phase II randomized study in patients with first-line recurrent or primary advanced (FIGO stage IVB) cervical cancer. Patients received carboplatin-paclitaxel with oral nintedanib 200 mg BID/placebo. The primary endpoint was progression-free survival (PFS) at 1.5 years and α = 0.15, β = 80%, one sided.

RESULTS

120 patients (62 N, 58C) were randomized. Median follow-up was 35 months. Baseline characteristics were similar in both groups (total population: squamous cell carcinoma 62%, prior radiotherapy 64%, primary advanced 25%, recurrent 75%). The primary endpoint was met with a PFS at 1.5 years of 15.1% versus 12.8% in favor of the nintedanib arm (p = 0.057). Median overall survival (OS) was 21.7 and 16.4 months for N and C, respectively. Confirmed RECIST response rate was 48% for N and 39% for C. No new adverse events were noted for N. However, N was associated with numerically more serious adverse events for anemia and febrile neutropenia. Global health status during and at the end of the study was similar in both arms.

CONCLUSION

The study met its primary endpoint with a prolonged PFS in the N arm. No new safety signals were observed.

Predictive value for thrombosis of pre-chemotherapy D-Dimer in ambulatory cancer patients

e20601

Background: Elevated D-Dimer (DD) is related with activated coagulation system. We pretended to assess if high DD is predictive of thrombosis in ambulatory cancer patients. Methods: We prospectively determined DD in plasma specimens from ambulatory cancer patients, without previous thromboembolic events (TE), before chemotherapy initiation. DD was determined with an immunological test in an automated coagulometer (IL D-Dimer test, Instrumentations laboratory). The selected cut-off point for DD was 1.5 x UNL, as it was the nearest point to the median DD. All thromboembolic events were recorded. Results: Between June 2007 and December 2008 eighty four patients were included, 66% with advanced and 34% with early disease. The most frequent tumours were colorectal 31%, breast 27% and genitourinary cancers 30% (12% HR prostate and 28% non prostate cancers). Antiangiogenic drugs were included in 24% of treatments (16% Bevacizumab and 8% Sunitinib). Median ECOG was 1. With a median follow-up of 6.5 months, 12 thromboembolic events were observed (5 PE, 3 DVT and 4 Arterial thrombosis). The following variables were included in the univariate analysis: high DD (>1.5 x UNL), low haemoglobin (Hb <10 mg/dL), high leukocyte, high platelet, high BMI and tumour location. High DD (HR = 6,25, 95% CI: 1,34–29,25; p= 0,02) and low Hb (HR= 6,17, 95% CI: 1,77- 21,53; p=0,004) were associated with increased TE. The high risk group in the Khorana index was also significant (p=0.02). In multivariate analysis both high DD (HR= 5,06, 95%CI: 1,05–24,48; p=0,044) and low Hb (HR=3,77, 95%CI: 1,02–13,97; p=0,047) remained significant. Conclusions: High pre-chemotherapy DD is associated with increased risk of thrombosis in ambulatory cancer patients.

No significant financial relationships to disclose.