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Chiang NJ, Tan KT, Bai LY, Hsiao CF, Huang CY, Hung YP, Huang CJ, Chen SC, Shan YS, Chao Y, Huang YH, Lee IC, Lee PC, Su YY, Chen SJ, Yeh CN, Chen LT, Chen MH. Impaired Chromatin Remodeling Predicts Better Survival to Modified Gemcitabine and S-1 plus Nivolumab in Advanced Biliary Tract Cancer: A Phase II T1219 Study. Clin Cancer Res 2022; 28:4248-4257. [PMID: 35849151 PMCID: PMC9527499 DOI: 10.1158/1078-0432.ccr-22-1152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/12/2022] [Accepted: 07/14/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Modified gemcitabine and S-1 (GS) is an active regimen for patients with advanced biliary tract cancer (ABTC) in our previous study. Herein, we report the results of a single-arm phase II of nivolumab plus modified GS (NGS) as first-line treatment in ABTC. PATIENTS AND METHODS Patients received nivolumab 240 mg and 800 mg/m2 gemcitabine on day 1 plus daily 80/100/120 mg of S-1 (based on body surface area) on days 1 to 10, in a 2-week cycle. The primary endpoint was the objective response rate (ORR). The correlation between therapeutic efficacy and genetic alterations with signatures identified by targeted next-generation sequencing panels was explored. RESULTS Between December 2019 and December 2020, 48 eligible patients were enrolled. After a median of 17.6 months of follow-up, the ORR was 45.9% [95% confidence interval (CI), 31.4%-60.8%]. The median progression-free survival (PFS) and overall survival (OS) was 9.1 (95% CI, 5.8-9.6) and 19.2 (95% CI, 11.6-not reached) months, respectively. All grade 3/4 treatment-related adverse events (AE) were less than 10%, except fatigue (14.6%) and skin rash (10.4%). Eighteen patients (35.4%) experienced immune-related AEs without treatment-related death. High tumor mutational burden (TMB-H; top 20%; ≥7.1 mut/Mb) only predicted prolonged median PFS but not OS. Up to 28.9% of patients who harbored loss-of-function mutations in chromatin remodeling genes demonstrated significantly longer median PFS and OS than those without alterations. CONCLUSIONS NGS is a safe and promising regimen in ABTC. Impaired functions of chromatin remodeling genes may be a potential surrogate biomarker with predictive value in this study.
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Affiliation(s)
- Nai-Jung Chiang
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Kien Thiam Tan
- ACT Genomics Co., Ltd., Taipei, Taiwan.,Corresponding Authors: Ming-Huang Chen, Department of Oncology, Taipei Veterans General Hospital, No. 201, Sector 2, Shipai Road, Beitou District, Taipei 11217, Taiwan, ROC. E-mail: ; Li-Tzong Chen, National Institute of Cancer Research, National Health Research Institutes, 2F, No. 367, Sheng-Li Road, Tainan 704, Taiwan, ROC. E-mail: ; and Kien Thiam Tan, ACT Genomics Co., Ltd., Taipei, Taiwan, 1F, 280 Xinhu 2nd Road, Neihu District, Taipei 11494, Taiwan, ROC. E-mail:
| | - Li-Yuan Bai
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Fu Hsiao
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | | | - Yi-Ping Hung
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Jui Huang
- Division of Gastroenterology, Department of Internal Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - San-Chi Chen
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yan-Shen Shan
- Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yee Chao
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hsiang Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-Cheng Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Chang Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Yeh Su
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.,Department of Oncology, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | | | - Chun-Nan Yeh
- Department of Surgery, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan.,Liver Research Center and Cancer Genome Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.,Department of Oncology, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan.,Corresponding Authors: Ming-Huang Chen, Department of Oncology, Taipei Veterans General Hospital, No. 201, Sector 2, Shipai Road, Beitou District, Taipei 11217, Taiwan, ROC. E-mail: ; Li-Tzong Chen, National Institute of Cancer Research, National Health Research Institutes, 2F, No. 367, Sheng-Li Road, Tainan 704, Taiwan, ROC. E-mail: ; and Kien Thiam Tan, ACT Genomics Co., Ltd., Taipei, Taiwan, 1F, 280 Xinhu 2nd Road, Neihu District, Taipei 11494, Taiwan, ROC. E-mail:
| | - Ming-Huang Chen
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Corresponding Authors: Ming-Huang Chen, Department of Oncology, Taipei Veterans General Hospital, No. 201, Sector 2, Shipai Road, Beitou District, Taipei 11217, Taiwan, ROC. E-mail: ; Li-Tzong Chen, National Institute of Cancer Research, National Health Research Institutes, 2F, No. 367, Sheng-Li Road, Tainan 704, Taiwan, ROC. E-mail: ; and Kien Thiam Tan, ACT Genomics Co., Ltd., Taipei, Taiwan, 1F, 280 Xinhu 2nd Road, Neihu District, Taipei 11494, Taiwan, ROC. E-mail:
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