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Lee CH, Shah AY, Rasco D, Rao A, Taylor MH, Di Simone C, Hsieh JJ, Pinto A, Shaffer DR, Girones Sarrio R, Cohn AL, Vogelzang NJ, Bilen MA, Gunnestad Ribe S, Goksel M, Tennøe ØK, Richards D, Sweis RF, Courtright J, Heinrich D, Jain S, Wu J, Schmidt EV, Perini RF, Kubiak P, Okpara CE, Smith AD, Motzer RJ. Lenvatinib plus pembrolizumab in patients with either treatment-naive or previously treated metastatic renal cell carcinoma (Study 111/KEYNOTE-146): a phase 1b/2 study. Lancet Oncol 2021; 22:946-958. [PMID: 34143969 DOI: 10.1016/s1470-2045(21)00241-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite advances in the first-line treatment of metastatic renal cell carcinoma (RCC), there is an unmet need for options to address disease progression during or after treatment with immune checkpoint inhibitors (ICIs). Pembrolizumab and lenvatinib are active as monotherapies in RCC; thus, we aimed to evaluate the combination of lenvatinib plus pembrolizumab in these patients. METHODS We report results of the metastatic RCC cohort from an open-label phase 1b/2 study of lenvatinib plus pembrolizumab in patients aged at least 18 years with selected solid tumours and an Eastern Cooperative Oncology Group performance status of 0-1. Oral lenvatinib at 20 mg was given once daily along with intravenous pembrolizumab at 200 mg once every 3 weeks. Patients remained on study drug treatment until disease progression, development of unacceptable toxicity, or withdrawal of consent. Efficacy was analysed in patients with clear cell metastatic RCC receiving study drug by previous therapy grouping: treatment naive, previously treated ICI naive (previously treated with at least one line of therapy but not with an anti-PD-1 or anti-PD-L1 ICI), and ICI pretreated (ie, anti-PD-1 or anti-PD-L1) patients. Safety was analysed in all enrolled and treated patients. The primary endpoint was the objective response rate at week 24 per immune-related Response Evaluation Criteria In Solid Tumors (irRECIST) by investigator assessment. This trial is registered with ClinicalTrials.gov (NCT02501096) and with the EU Clinical Trials Register (EudraCT2017-000300-26), and is closed to new participants. FINDINGS Between July 21, 2015, and Oct 16, 2019, 145 patients were enrolled in the study. Two patients had non-clear cell RCC and were excluded from the efficacy analysis (one in the treatment-naive group and one in the ICI-pretreated group); thus, the population evaluated for efficacy comprised 143 patients (n=22 in the treatment-naive group, n=17 in the previously treated ICI-naive group, and n=104 in the ICI-pretreated group). All 145 enrolled patients were included in the safety analysis. The median follow-up was 19·8 months (IQR 14·3-28·4). The number of patients with an objective response at week 24 by irRECIST was 16 (72·7%, 95% CI 49·8-89·3) of 22 treatment-naive patients, seven (41·2%, 18·4-67·1) of 17 previously treated ICI-naive patients, and 58 (55·8%, 45·7-65·5) of 104 ICI-pretreated patients. Of 145 patients, 82 (57%) had grade 3 treatment-related adverse events and ten (7%) had grade 4 treatment-related adverse events. The most common grade 3 treatment-related adverse event was hypertension (30 [21%] of 145 patients). Treatment-related serious adverse events occurred in 36 (25%) patients, and there were three treatment-related deaths (upper gastrointestinal haemorrhage, sudden death, and pneumonia). INTERPRETATION Lenvatinib plus pembrolizumab showed encouraging antitumour activity and a manageable safety profile and might be an option for post-ICI treatment of metastatic RCC. FUNDING Eisai and Merck Sharp & Dohme.
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Affiliation(s)
- Chung-Han Lee
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Amishi Yogesh Shah
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Drew Rasco
- Department of Clinical Research, South Texas Accelerated Research Therapeutics, San Antonio, TX, USA
| | - Arpit Rao
- Division of Hematology, Oncology, and Transplantation, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Matthew H Taylor
- Earle A Chiles Research Institute, Providence Portland Medical Center, Portland, OR, USA
| | | | - James J Hsieh
- Department of Medicine, Oncology Division, Washington University School of Medicine, St Louis, MO, USA
| | - Alvaro Pinto
- Servicio de Oncología, Hospital Universitario La Paz, Madrid, Spain
| | - David R Shaffer
- Medical Oncology, US Oncology Research, New York Oncology Hematology, Albany, NY, USA
| | | | - Allen Lee Cohn
- Medical Oncology, US Oncology Research, Rocky Mountain Cancer Center, Denver, CO, USA
| | - Nicholas J Vogelzang
- Department of Medical Oncology, US Oncology Research, US Oncology Comprehensive Cancer Centers of Nevada, Las Vegas, NV, USA
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | - Musaberk Goksel
- Medical Oncology, Alaska Clinical Research Center, Anchorage, AK, USA
| | | | - Donald Richards
- Department of Oncology, US Oncology Research, Texas Oncology-Tyler, Tyler, TX, USA
| | - Randy F Sweis
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Jay Courtright
- Department of Oncology, US Oncology Research, Texas Oncology, Dallas, TX, USA
| | - Daniel Heinrich
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - Sharad Jain
- Department of Oncology, US Oncology Research, Texas Oncology-Denton, Denton, TX, USA
| | - Jane Wu
- Biostatistics, Eisai, Woodcliff Lake, NJ, USA
| | | | | | - Peter Kubiak
- Clinical Research, Eisai, Woodcliff Lake, NJ, USA
| | | | | | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Capozzi M, De Divitiis C, Ottaiano A, von Arx C, Scala S, Tatangelo F, Delrio P, Tafuto S. Lenvatinib, a molecule with versatile application: from preclinical evidence to future development in anti-cancer treatment. Cancer Manag Res 2019; 11:3847-3860. [PMID: 31118801 PMCID: PMC6502442 DOI: 10.2147/cmar.s188316] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/28/2019] [Indexed: 12/13/2022] Open
Abstract
Lenvatinib is an emerging multi-kinase inhibitor with a preferential anti-angiogenic activity, which has shown efficacy in the treatment of renal cell carcinoma, differentiated thyroid cancer and hepatocellular carcinoma. It inhibits vascular endothelial growth factor receptor family (VEGFR1–3), fibroblast growth factor receptor family (FGFR1–4), platelet-derived growth factor receptor–alpha (PDGFRα), tyrosine-kinase receptor (KIT) and rearranged during transfection receptor (RET). In this review we have evaluated the development from bench to bedside of lenvatinib. PubMed, MEDLINE and clinicaltrials.gov are the sources of data. Furthermore, the preclinical in vitro and in vivo data, as well as efficacy and toxicity results of lenvatinib in the clinic, are presented and discussed. Treatment with lenvatinib causes side effects (hypertension, proteinuria, fatigue and diarrhea), which are predominantly related to the inhibition of angiogenesis. For these reasons, the identification of biomarkers of efficacy and resistance to lenvatinib is a key challenge in order to select responsive patients. This review provides an overview on lenvatinib's clinical use, perspectives and indications for future development.
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Affiliation(s)
- Monica Capozzi
- Department of Abdominal Oncology, Istituto Nazionale Tumori, IRCCS - Fondazione "G. Pascale", Napoli, Italia
| | - Chiara De Divitiis
- UOSD Oncology- AOU "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italia
| | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases - Department of Abdominal Oncology, Istituto Nazionale Tumori, IRCCS - Fondazione "G. Pascale", Napoli, Italia
| | - Claudia von Arx
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stefania Scala
- Molecular Immunology and Immunoregulation, Istituto Nazionale Tumori, IRCCS - Fondazione "G. Pascale", Napoli, Italia
| | - Fabiana Tatangelo
- Department of Pathology, Istituto Nazionale Tumori, IRCCS - Fondazione "G. Pascale", Napoli, Italia
| | - Paolo Delrio
- Department of Abdominal Oncology, Istituto Nazionale Tumori, IRCCS - Fondazione "G. Pascale", Napoli, Italia
| | - Salvatore Tafuto
- Department of Abdominal Oncology, Istituto Nazionale Tumori, IRCCS - Fondazione "G. Pascale", Napoli, Italia
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