Efficacy and safety of intensified platinum-based neoadjuvant chemotherapy in locally advanced triple-negative breast cancer: Preliminary results of non-randomized phase II study

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Background: patients with locally-advanced triple negative breast cancer (TNBC) have dismal prognosis with current standard of care therapy. Pathologic complete response (pCR) is the most important prognostic factor for long-term survival of these patients. Methods: this was non-randomized prospective single-center phase II study. Key inclusion criteria were histologically verified locally advanced TNBC, non-eligibility for primary surgical treatment (ie, TNM stage Т2-4N 2-3M0) and no evidence of metastatic disease. Patients were treated with 8 cycles of neoadjuvant doxorubicine, paclitaxel and cisplatin chemotherapy (ATP; doxorubicine 40 mg/m2 day 1, paclitaxel 160 mg/m2 day 1 and cisplatin 50 mg/m2 day 1 every two weeks) with G-CSF support (filgrastim 5 mcg/kg day 2-6). After 8 cycles of chemotherapy patients were referred for surgical treatment; adjuvant radiation therapy was prescribed to all patients. Primary end point was pCR assessed in modified intention-to-treat population (ie, in patients who underwent surgical treatment). Key secondary endpoints were disease-free survival (DFS) and pCR rate according to BRCA status. Results: we enrolled 80 patients, 79 (98.7%) of them underwent surgical treatment and were included in the analysis. Median age was 46 years (25-68), 22 (27.1%) patients had BRCA1 mutations, 5382insC was the most common mutation (17 [77.2%] of patients); 1 (1.2%) patient had CHEK2 mutation. pCR was achieved in 51 (64.5%) patients. In with BRCA1-mutation carriers pCR rate was 61.9%, in patients with 5382insC – 81.2%. 2-year DFS was 77.3%; 2-year overall survival was 91.0% . Most common grade 3-4 adverse events were anemia (29.3%), neutropenia (17.8%), neuropathy (4.9%), stomatitis (3.7%) and thrombocytopenia (1.8%). Conclusions: the ATP regimen was effective in treatment of locally-advanced TNBC, especially in patients with founder 5382insC BRCA1 mutation for Slavic population and deserves further investigation.

Olanzapine (OLN) versus aprepitant (APR) in patients receiving high-emetogenic chemotherapy: Final results of randomized phase II trial

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Background: Management of chemotherapy-induced nausea and vomiting (CINV) remains challenging. OLN might provide several benefits over APR which is current standard of care – particularly in terms of nausea control and cost effectiveness. However, sedation associated with recommended doses of olanzapine precludes its wide use in oncology practice. Methods: This was randomized phase II single center study aimed to compare OLN and APR in CINV prophylaxis. Key inclusion criteria were: chemo- and radio-therapy naïve patients, planned administration of high-emetogenic chemotherapy (cisplatin, carboplatin AUC≥4, doxorubicin etc). Patients were randomized 1:1 ratio in the following arms: olanzapine 5 QD day 0-4 or aprepitant 125 mg day 1, 80 mg day 2,3. All patients received ondansetron 16 mg day 1 and dexamethasone 8 mg day 1-3. Primary endpoint was complete nausea control (no nausea and no rescue medication) 0-120 hours after chemotherapy. Complete response (no emesis and no rescue medication) was a key secondary end point. Nausea was assessed using MASCC Antiemesis Tool. Sample size: 94 patients to increase nausea control rate from 40 to 70% (α = 0.05; β = 0.80; 10% of estimated data loss). Results: We included in the analysis 93 patients who could be evaluated. The groups were well balanced, median age was 49 years, vast majority of patients (95.6%) were females. The proportion of patients with complete nausea control in OLN and APR groups was 44.2% and 24.0% respectively (RR 2.5; 95% CI 1.04-6.08; p = 0.039). Complete response was achieved in 74.4% and 54.0% patients respectively (RR 2.48; 95% CI 1.026-5.99; p = 0.041). No differences in rates of undesired sedations were detected. Conclusions: Our data suggests superiority of OLN regimen in terms of nausea control. This regimen deserves further investigation. Clinical trial information: NCT03478605.

Impact of BRCA mutation status and time to platinum resistance on patients with advanced ovarian cancer

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Background: The influence of germline BRCA1/2 mutations (gBRCAmt) on ovarian cancer patients (pts) long-term survival remains controversial. Methods: 228 pts with serous and endometrial ovarian cancer stage Ic-IV were enrolled in the retrospective study. Next-generation sequencing testing of BRCA1/2 in blood was employed. Progression-free survival (PFS), overall survival (OS) and time to platinum resistance (TPR) were analyzed. TPR was defined as time from first line chemotherapy to registration of platinum resistance relapse. Results: The rate of pathogenic gBRCAmt was defined in 29.4% (67/228) pts. There was no any significant difference between BRCA1/2 mutation carries and non-carries in both PFS (18.3 and 16.7 months, p = 0.27, HR 0.79, 95%CI 0.52-1.20) and OS (71.9 and 79.1 months, p = 0.69, HR 0.88, 95%CI 0.46-1.68). However, TPR was significantly longer in pts with gBRCAmt than in germline BRCA wild type (gBRCAwt) pts (51.4 and 34.4 months, p = 0.05, HR 0.60, 95% CI 0.36-0.98). Pts with gBRCAmt had poor prognosis after registration of platinum resistance. gBRCAwt pts had longer survival than gBRCAmt after platinum-resistance relapse: 33.7 and 16.9 months respectively (p = 0.05; HR 1.85, 95%CI 1.02-4.08). Conclusions: Our finding provided possible explanation of equal survival of pts with or without BRCA1/2 mutations. Long-term sensitivity to platinum-based chemotherapy allowed pts with gBRCA1/2mt to control the disease for a long period of time. However the non-platinum regimens had less efficacy in pts with gBRCAmt than gBRCAwt after platinum resistance.

Phase II trial (BCD-100-2/MIRACULUM) of the novel PD-1 inhibitor (BCD-100) in patients with advanced melanoma

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Background: MIRACULUM (NCT03269565) is a multicenter open-label parallel-arm phase II study investigating the antitumor activity of BCD-100, an IgG1 anti-PD-1 monoclonal antibody with Fc silencing “LALA” mutation, in patients with advanced melanoma. Interim analysis at 6-months is presented. Methods: Patients (pts) with unresectable or metastatic melanoma, without autoimmune disease, and no prior anti-PD-1 or anti-CTLA-4 therapy were eligible. Pts received BCD-100 1 mg/kg Q2W (arm 1) or BCD-100 3 mg/kg Q3W (arm 2) until disease progression or intolerable toxicity. Primary endpoint was ORR assessed per irRECIST by independent central radiology review. A statistical hypothesis that BCD-100 has significant anti-tumor effect (ORR more than 28% in per protocol population) was tested for each study arm with alpha 0.05 and 80% power. Results: 126 pts were treated and 114 were evaluable for the primary endpoint (9 pts dropped out before their first efficacy assessment and 3 pts had major protocol deviations). In arm 1 and arm 2, 17 (27%) and 16 (25%) pts received prior treatment for advanced disease, respectively. The study met its primary endpoint in both study arms. In arm 1, 34% ORR was achieved among 59 response-evaluable patients, including 4 CR and 16 PR, and the disease control rate (DCR) was 68%. In arm 2, 29% ORR was achieved among 55 response-evaluable pts, including 2 CR and 14 PR, and the DCR was 55%. All responses were durable; only one patient in arm 1 presented disease progression, and median PFS and OS were not reached in either study arms at 6 months follow-up. Treatment-related AEs (TRAEs) occurred in 48% of pts in each study arm, including 6% and 5% with grade 3/4 TRAEs in arm 1 and 2, respectively. Immune-related AEs (irAEs) occurred in 29% of pts in arm 1 and 30% of pts in arm 2, including 3% of pts with grade 3/4 irAEs in each arm. Conclusions: Both dosing regimens of BCD-100 (1 mg/kg Q2W and 3 mg/kg Q3W) have durable antitumor activity and a manageable safety profile in patients with advanced melanoma. Clinical trial information: NCT03269565.

Incidence and prognostic factors in patents (pts) with mutant BRAF (mBRAF) metastatic colorectal cancer (mCRC) in Russia

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Background: m BRAF mCRC has the aggressive phenotype. The incidence of such mutation in Europe and the USA is around 8-14%, in Asian countries - 4-8%. The purpose of this population-based study was to determine the incidence and identifying prognostic factors in pts with mBRAF mCRC in Russia. Methods: A multicenter retrospective analysis of clinical data and treatment results of pts with mBRAF mCRC was performed. The main method for determining mutations was a PCR. The main efficacy endpoint was progression free survival (PFS) at the 1st line. Multivariate analysis was performed using Cox regression model. Results: 437 out of 8646 pts (5%) with a known mutational status had m BRAF (V600E). Clinical data were collected from 119/437 (27.2%): female - 65.5%, average age - 60 years (28-86), MSI-H -10%; the right-sided primary tumor – in 65%, left-sided – in 17%, rectum – in 18%; the primary tumor was removed in 76%; adjuvant chemotherapy was administered in 30%; lung metastases – in 15 %, liver - 45%, peritoneal metastases – in 38%; metastasectomy was performed in 13% pts. The first line was administered in 86 (72%) pts: FOLFIRI / XELIRI - 17 (20%), FOLFOX / XELOX - 50 (58%), FOLFOXIRI - 12 (14%), monotherapy of fluoropyrimidines – in 7 (8%). Bevacizumab was added to chemotherapy at 1st line in 25 (29%) patients, anti-EGFR – in 8 (9%) pts. PFS at the 1st line was 7 months: XELOX / FOLFOX - 7, FOLFOXIRI - 7, FOLFIRI / XELIRI - 6 and fluoropyrimidines - 2 months (HR 0.9, 95% CI 0.6-1.1, p = 0.3). None of the clinical or morphological factors except the presence of metastases in the retroperitoneal lymph nodes (HR 2.6, 95% CI 1.3-5.4, p = 0.006) did not have an independent negative prognostic value. Conclusions: In contrast to Western countries the incidence of mBRAF gene in the population of pts with mCRC in the Russia is low and we found a high incidence of localization of the primary tumor in the rectum. We didn’t reveal any prognostic factors except metastases in the retroperitoneal lymph nodes, and didn’t reveal any differences between the usual duplets and standard regimen for such mutation - FOLFOXIRI in term of 1st line PFS. This suggests we need a prospective randomized study to determine the optimal regimen of chemotherapy at 1st line for mBRAF mCRC pts.

Aflibercept (Afl) for patients (pts) with metastatic colorectal cancer (mCRC): Clinical predictors of nonhematologic (nonhem) toxicity

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Background: Afl is one of the antiagiogenic agents used for the treatment for mCRC. Cardiovascular toxicity of Afl is shown to be a main reason of the drug discontinuation but there are no studies on factors associated with nonhem adverse events(AEs). The aim of the study was to define clinical factors associated with the development of Gd.3-4 nonhem AEs. Methods: Pts with mCRC treated with FOLFIRI+Afl were included in a multicenter prospective base from 2016-18. Multivariative regression analysis was performed with Chicago, IL v.22.0. Factors studied included demographic, disease characteristics, data about concomitant diseases(CD) and concomitant medications. Results: 278 pts with mCRC from 18 centers were included. Mean age – 58.7, 48.6% were male, mean number of metastases– 2. ECOG 0-1–97.5%pts. RASm had 133 (47.8%) pts. Afl+FOLFIRI was used as the 2nd line therapy–in 67.6%. CD were in 194 (69.8%), cardiovascular–in 175 (62.9%). ORR(CR+PR)17.3%, SD-43.9%. MedPFS was 6.0 mos. Afl discontinuation due to AEs 11.9%. AE were reported in 201 (72.3%), Gd3-4 – in 69 (24.8%); nonhem AEs – in 178 (64%), Gd3-4–52 (18.8%)pts. Among Gd3-4 nonhem AEs were arterial hypertension Gd1-2–77 (27.7%), Gd3-4-in 36 (12.9%), vomiting Gd1-2–45 (16.2%), diarrhea Gd1-2–in 32 (11.5%), asthenia Gd1-2 –in 29 (10.4%), hepatotoxicity Gd1-2–in 2(5%), thrombosis–in 2 (5%) pts. Multivariate regression analysis showed that among the factors studied number of lines of treatment (OR1.4,95%CI1.1-2.1,p=0.03) and CD requiring medical support (OR 2.0,95%CI1.1-3.7,p=0.03) were found as independent factors of nonhem AE Gd3-4 development. ACE-inhibitors (OR2.2,95%CI1.2-4.3,p=0.02), calcium-channel blockers (CCB)(OR4.1,95%CI1.6-10.4,p=0.003 ) were the medical drugs considered to be significant. Conclusions: Number of lines and CD requiring medical support, especially with ACE-inhibitors or CCB, identifies a significant risk of developing cardiovascular non-hem AEs Gd3-4 with FOLFIRI + Afl.

Efficacy and safety of RGB-02, a pegfilgrastim biosimilar to prevent chemotherapy-induced neutropenia: results of a randomized, double-blind phase III clinical study vs. reference pegfilgrastim in patients with breast cancer receiving chemotherapy

Background

Treatment with recombinant human granulocyte-colony stimulating factor (G-CSF) is accepted standard for prevention of chemotherapy-induced neutropenia. RGB-02 (Gedeon Richter) is a proposed biosimilar to pegylated G-CSF (Neulasta®, Amgen) with sustained release properties. This is a randomized, comparative, double-blind, multicenter study to evaluate efficacy and safety of RGB-02 in breast cancer patients receiving cytotoxic regimen.

Methods

Two hundred thirty-nine women presenting with breast cancer were randomized to RGB-02 (n = 121) and the reference product (n = 118). All patients received up to 6 cycles of docetaxel/doxorubicin chemotherapy combination and a once-per-cycle injection of a fixed 6 mg dose of pegfilgrastim. Primary endpoint was the duration of severe neutropenia (ANC < 0.5 × 10⁹/L) in Cycle 1 (2-sided CI 95%). Secondary endpoints included incidence and duration of severe neutropenia (in cycles 2–4), incidence of febrile neutropenia, time to ANC recovery, depth of ANC nadir, and safety outcomes.

Results

The mean duration of severe neutropenia in Cycle 1 was 1.7 (RGB-02) and 1.6 days (reference), with a difference (LS Mean) of 0.1 days (95% CI -0.2, 0.4). Equivalence could be established as the CI for the difference in LS Mean lay entirely within the pre-defined range of ±1 day. This positive result was supported by the analysis of secondary endpoints, which also revealed no clinical meaningful differences. Safety profiles were comparable between groups. No neutralizing antibodies against pegfilgrastim were identified.

Conclusions

Treatment equivalence in reducing the duration of chemotherapy induced neutropenia between RGB-02 and Neulasta® could be demonstrated. Similar efficacy and safety profiles of the once-per-cycle administration of RGB-02 and the pegfilgrastim reference were demonstrated.

Trial registration

The trial was registered prospectively, prior to study initiation. EudraCT number (2013–003166-14). The date of registration was 12 July, 2013.

Electronic supplementary material

The online version of this article (10.1186/s12885-019-5329-6) contains supplementary material, which is available to authorized users.

Dose-reduced first cycle of chemotherapy for prevention of life-threatening acute complications in nonseminomatous germ cell tumor patients with ultra high tumor markers and/or poor performance status

PURPOSE

Patients with metastatic nonseminomatous germ cell tumors (mNSGCT) and a high tumor burden or a poor performance status at initial diagnosis are at risk from potentially life-threatening early complications during or after the first chemotherapy cycle. The outcomes with dose-reduced first cycle of chemotherapy in this population of patients are not well established.

METHODS

We performed a retrospective analysis of patients with mNSGCT and International Germ Cell Cancer Collaborative Group (IGCCCG) poor risk features. All patients received cisplatin and etoposide-based combinations as first-line treatment. Ultra high tumor marker levels were defined as α-fetoprotein ≥ 100,000 ng/ml or human chorionic gonadotropin ≥ 200,000 mIU/ml. Before 2005, the first treatment cycle was administered at a full dose in our center. After 2005, we used an abbreviated course of cisplatin and etoposide (EP) for the first cycle, followed by subsequent full-dose administration.

RESULTS

From 1987 to 2012, 265 patients with poor risk features according to IGCCCG received first-line chemotherapy. Among them, 63 out of 265 (24%) patients had ultra high tumor marker levels and/or ECOG performance status of 3-4. Dose reduction of the first chemotherapy cycle was associated with a significant decrease of life-threatening complications from 76 to 44% (p = 0.01), but not with the overall survival (HR 0.99, 95% CI 0.44-2.26).

CONCLUSIONS

Dose reduction of the first EP cycle by 40-60% in the subgroup of poor risk patients with ultra high tumor marker levels and/or ECOG performance status 3-4 is associated with significantly lowered acute complication rates but not with overall survival.

Abstract 1241: Profile of BRCA1/BRCA2 mutations in Russian ovarian cancer population detected by NGS and MLPA analysis: Interim results of OVATAR study

Background: This study is a first attempt to determine frequency of gBRCAm and share of sBRCAm in Russian ovarian cancer (OC) cancer patients (pts) using next-generation sequencing (NGS) and multiplex ligation-dependent probe amplification (MLPA). Russian population is known to have a sizable proportion of “frequent” germline mutations in BRCA genes, with occurrence in &gt;2% of all BRCAm cases.

Methods: 498 pts with primary serous and endometrioid OC were enrolled in noninterventional study OVATAR (NCT02122588). NGS testing of BRCAm in genomic DNA (gDNA) from leukocytes and primary tumor tissue was performed. MLPA assay for large rearrangements (LGR) was used on gDNA from leukocytes.

Results: Interim analysis includes pairs of tumor and blood samples from 400 pts. The total rate of BRCA1/2 mutations was 35% (140/400 pts) including 29.8% (119/400) of germline mutations (gBRCAm) and 5.2% (21/400) of somatic mutations. Alterations reported hereby were either classified as deleterious/pathogenic in public databases, or identified as “likely pathogenic” (e.g., loss-of-function). VUS were not included. Frequent gBRCAm were detected in 49.3% of gBRCAm cases (69/140). BRCAm were counted as rare: in 30.7% (43/140) pts, including LGR in 3.6% (5/140) pts. sBRCAm: in 15% (21/140) pts. Although previously counted as frequent, 6174delT in BRCA2 was not detected. 4 pts carried pathogenic germline BRCA2 c.T5286G:p.Y1762* nonsense mutation, with prevalence 2.9% among BRCAm carriers, which makes it the new and only potential “hot-spot” in BRCA2 gene. Large deletions comprise 5% of all BRCAm and mostly occur in BRCA1 gene.

Conclusion: The overall rate of both somatic and germline BRCA variations in Russian OC population is in line with global data, with high percent of 8 frequent gBRCAm (49.3%). Use of MLPA is limited by blood samples with low rate of germline LGR. NGS is becoming a method of choice to hit both small variations and LGR in BRCA genes.

gene/mutation# of pts (n=140) and % of BRCAmgBRCAmFrequent mutations n=69 (49,3%)BRCA15382insC3726,4%4154delA75,0%2080delA64,3%C61G53,6%185delAG42,9%3819del532,1%3875del432,1%BRCA2T5286G (c.T5286G:p.Y1762*)42,9%Rare mutations n=43 (30,7%)BRCA12417,1%BRCA21913,6%Exons deletions n=7 (5%)BRCA164,3%BRCA210,7%sBRCAmn=21 (15%)BRCA1139,3%BRCA285,7%

Citation Format: Alexandra Tyulyandina, Vera Gorbunova, Svetlana Khokhlova, Larisa Kolomiets, Maksim Filipenko, Evgeny Imyanitov, Irina Demidova, Yuri Moliaka, Nadezhda Cherdyntseva, Dmitriy Vodolajskiy, Ludmila Lyubchenko, Sergei Tjulandin, Ilya Tsimafeyeu, Olga Vedrova, Vera Karaseva, Sergei Andreev, Tatiana Kekeeva. Profile of BRCA1/BRCA2 mutations in Russian ovarian cancer population detected by NGS and MLPA analysis: Interim results of OVATAR study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1241.

RUSSCO-RSP study of immunohistochemistry (IHC) diagnostic assays for PD-L1 expression in urothelial cancer (UC)

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Background: This collaborative Russian Society of Clinical Oncology (RUSSCO) and Russian Society of Pathology (RSP) study assess the extent of concordance between three validated, commercially available PD-L1 IHC assays for UC patients. Methods: Tumors from 100 UC patients were stained with SP142 (Ventana), 22C3 (Dako) and SP263 (Ventana) clones as used in the clinical trials of second-line therapy of atezolizumab, pembrolizumab and durvalumab. Four trained pathologists independently evaluated the percentages of tumor (TC) and tumor infiltrating immune cells (IC) staining positive at any intensity. One test-specific cutoff rule for each assay in this analysis was pre-specified as: IC ≥5% for SP142, TC+IC ≥10% or TC ≥10% for 22C3, and TC ≥25% or IC ≥25% for SP263. Results: 300 IHC slides were scored. Patients were predominantly male (89%) with T1 (45%) and T2 (45%) stages, respectively. The percent of IC staining across 3 assays is shown to be higher than for TC staining (45% vs. 8% for SP142; 55% vs. 24% for 22C3; 72% vs. 27% for SP263). Pearson Correlation Coefficients for IC were: 0.5, 0.69 and 0.85 between SP142/22C3, SP263/22C3 and SP142/SP263, respectively. Pearson Correlation Coefficients for TC were: 0.93, 0.99 and 0.91 for the same pairs. Table indicates the agreement analysis using recommended individual cutoffs for each test. Conclusions: If a patient with UC is classified as negative by one of the three single tests using the corresponding recommended cutoff rule, the patient will be classified as negative by any other test with a high likelihood (91%-100%), and, therefore, repeated testing can be avoided.[Table: see text]

Abstract B073: PD-L1 expression in urothelial cancer: first results from RUSSCO-RSP assay comparision study

Background: To compare similarities and differences between PD-L1 IHC assays in patients with urothelial cancer (UC), collaborative Russian Society of Clinical Oncology (RUSSCO) and Russian Society of Pathology (RSP) study was conducted. The first results, presented here, describe a rate of PD-L1 IHC expression assessed by each test and evaluate concordance between 3 assays. Methods: 100 UC tumors were stained with PD-L1 IHC assays (clones SP142, 22C3 and SP263) as used in the clinical trials of second-line therapy of atezolizumab (Ventana SP142), pembrolizumab (Dako 22C3), and durvalumab (Ventana SP263). Four trained pathologists certified by Ventana/Roche and Dako/Agilent in interpreting respective assays independently evaluated the percentages of tumor (TC) and tumor-infiltrating immune cells (IC) staining positive at any intensity. Single clinical cut-off for inclusion in this comparative analysis was used: IC ≥5% for SP142, TC+IC/TC ≥10% for 22C3, and TC or IC ≥25% for SP263. Results: Patients were predominantly male (89%), 47/100 (47%) had grade 3 tumors, 45/100 (45%) and 45/100 (45%) had T1 and T2 stages, respectively. 300 IHC slides were scored. The percent of immune cell staining across 3 assays appears to be higher than for tumor cell staining (45% vs. 8% for SP142; 55% vs. 24% for 22C3; 72% vs. 27% for SP263). There were variabilities in immune cell staining for all assays and in tumor cell staining across SP142 and other assays. The percentage of PD-L1-positive patients was comparable with SP142 (9%), 22C3 (11%) and SP263 (7%). Table indicates the number of cases that were concordant with the index assay scoring algorithm, when an alternative cut-off was used to determine the allocation of cases to clinical groups above and below the cut point.

Table Assay clone used for slide stainingScoring AlgorithmSP142IC ≥5%22C3TC+IC / TC ≥10%SP263TC or IC ≥25%SP142100/100 (100%)92/100 (92%)95/100 (95%)22C395/100 (95%)100/100 (100%)95/100 (95%)SP26396/100 (96%)95/100 (95%)100/100 (100%)

Conclusions: First comparison showed that concordance was more than 90% between SP142, 22C3, and SP263 assays used for evaluation of PD-L1 expression in patients with urothelial carcinoma. Further analysis is required to draw a final conclusion.

Citation Format: Larisa Zavalishina, Patritsiya Povilaitite, Yulia Andreeva, A. Petrov, Inna Pugach, Ekaterina Kharitonova, Alexey Rumyantsev, Grigory Raskin, Georgy Frank, Sergei Tjulandin, Ilya Tsimafeyeu. PD-L1 expression in urothelial cancer: first results from RUSSCO-RSP assay comparision study [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr B073.

Abstract B084: Preclinical pharmacokinetic evaluation of alofanib for cancer treatment

Alofanib (RPT835) is a novel allosteric FGFR2 inhibitor with activity in FGFR2-expressing cancers. Here we explore the pharmacokinetic (PK) profile of compound. Five preclinical PK studies were conducted. In Study 1, alofanib was administered to 49 male BALB/C mice via two routes (oral and iv). Mice in group 1 received a single iv injection of the alofanib (30 mg/kg), while mice in group 2 received a single dose (30 mg/kg) via oral gavage. The aim of Study 2 was to evaluate the PK in 24 male Sprague Dawley rats after a single iv dose of 22 mg/kg and oral dosing in capsules at three dose levels (22, 110, and 220 mg/kg). In Study 3, PK of pharmaceutical form of alofanib in male Sprague Dawley rats after a single iv dose of 55.3, 113.8 and 218.7 mg/kg was evaluated. Studies 4 and 5 compared PK profile for alofanib in male Sprague Dawley rats after a single intraduodenal (i.d.) and subcutaneous (s.c.) dosing at 29 and 145 mg/kg. Six animals per dose group were dosed, with plasma samples collected from the tail vein up to 24 hours. Plasma concentrations were quantified by LC-MS/MS using a research qualified method. The PK data are summarized in Table. StudyGroup(dose, mg/kg)C0/Cmax,ng/mlTmax,ht1/2AUC,h*ng/mLCL,mL/min/kgVss,L/kgF,%1iv, 3057739-0.93580386.76.9NCoral/gavage, 3043.61-2NCNANCNCNC2iv, 2279323-0.441423427.10.47-oral/caps, 2222.02.0NC68.0--0.36oral/caps, 11082.32.5NC1.0--0.18oral/caps, 220110.01.0NC1.0--0.183iv, 55.3246499-0.863710523.80.3-iv, 113.8432342-0.7313078814.80.29-iv, 218.7730496-0.6836314510.10.26-4i.d, 29360.5NC116---i.d, 145980.5NC188---5s.c, 2975130.50.9817218---s.c, 145373000.51.7855020---

NC - Parameter cannot be calculated

Following oral administration, alofanib appeared rapidly in plasma but could not be detected after 2 hours. Bioavailability for oral administration is estimated to be low (&lt;1%). Following single iv bolus dosing, animals showed a moderate intra-individual variability in plasma levels. Alofanib plasma levels were quantifiable up to 8 hours post dose in all animals in Study 3. The compound resulted in a moderate and low clearance (32-12% of liver blood flow), small volume of distribution (0.26-0.5 L/kg), and short half-life (0.4-0.9 h). After a single i.d. dose of alofanib, animals showed moderate inter-individual variability in plasma levels, with mean CV of 47 (29 mg/kg) and 69% (145 mg/kg). Alofanib plasma levels were quantifiable up to 8 hours. At a dose of 145 mg/kg, plasma levels were quantifiable up to 24 hours. Following i.d. administration, Cmax and exposure increased lower than dose proportionally between 29 and 145 mg/kg. After a single s.c. dose of alofanib, animals showed moderate inter-individual variability, with mean CV of 47 (29 mg/kg) and 40% (145 mg/kg). Plasma levels were quantifiable up to 8 hours post 29 mg/kg dose in all animals. At a dose of 145 mg/kg, plasma levels were quantifiable up to 24 hours. Parenteral route (iv and s.c.) of alofanib administration is more preferable in clinical trials.

Citation Format: Ilya Tsimafeyeu, Mikhail Byakhov, Vlatka Bencetić Mihaljević, Jasna Padovan, Genoveva Murillo, Nadezhda Dragun, Evgenia Gavrilova, Sergei Tjulandin. Preclinical pharmacokinetic evaluation of alofanib for cancer treatment [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr B084.