1
|
Kim M, Lee JL, Shin SJ, Bae WK, Lee HJ, Byun JH, Choi YJ, Youk J, Ock CY, Kim S, Song H, Park KH, Keam B. Phase II study of a trastuzumab biosimilar in combination with paclitaxel for HER2-positive recurrent or metastatic urothelial carcinoma: KCSG GU18-18. ESMO Open 2023; 8:101588. [PMID: 37385153 PMCID: PMC10485395 DOI: 10.1016/j.esmoop.2023.101588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/11/2023] [Accepted: 05/21/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Human epidermal growth factor receptor 2 (HER2) is a widely explored therapeutic target in solid tumors. We evaluated the efficacy and safety of trastuzumab-pkrb, a biosimilar of trastuzumab, in combination with paclitaxel, in HER2-positive recurrent or metastatic urothelial carcinoma (UC). PATIENTS AND METHODS We enrolled 27 patients; they were administered a loading dose of 8 mg/kg trastuzumab-pkrb on day 1, followed by 6 mg/kg and 175 mg/m2 paclitaxel on day 1 every 3 weeks, intravenously. All patients received six cycles of the combination treatment and continued to receive trastuzumab-pkrb maintenance until disease progression, unacceptable toxicity, or for up to 2 years. HER2 positivity (based on immunohistochemistry analysis) was determined according to the 2013 American Society of Clinical Oncology /College of American Pathologists HER2 testing guidelines. The primary endpoint was objective response rate (ORR); the secondary endpoints were overall survival (OS), progression-free survival (PFS), and safety. RESULTS Twenty-six patients were evaluated via primary endpoint analysis. The ORR was 48.1% (1 complete and 12 partial responses) and the duration of response was 6.9 months [95% confidence interval (CI) 4.4-9.3 months]. With a median follow-up of 10.5 months, the median PFS and OS were 8.4 months (95% CI 6.2-8.8 months) and 13.5 months (95% CI 9.8 months-not reached), respectively. The most common treatment-related adverse event (TRAE) of any grade was peripheral neuropathy (88.9%). The most common grade 3/4 TRAEs were neutropenia (25.9%), thrombocytopenia (7.4%), and anemia (7.4%). CONCLUSIONS Trastuzumab-pkrb plus paclitaxel demonstrates promising efficacy with manageable toxicity profiles in patients with HER2-positive recurrent or metastatic UC.
Collapse
Affiliation(s)
- M Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; Cancer Research Institute, Seoul National University College of Medicine, Seoul
| | - J L Lee
- Department of Oncology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - S J Shin
- Division of Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul
| | - W K Bae
- Department of Hemato-Oncology, Chonnam National University Medical School & Hwasun Hospital, Hwasun
| | - H J Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon
| | - J H Byun
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon
| | - Y J Choi
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul
| | - J Youk
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; Cancer Research Institute, Seoul National University College of Medicine, Seoul
| | - C Y Ock
- Lunit, Seoul, Republic of Korea
| | - S Kim
- Lunit, Seoul, Republic of Korea
| | - H Song
- Lunit, Seoul, Republic of Korea
| | - K H Park
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul
| | - B Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; Cancer Research Institute, Seoul National University College of Medicine, Seoul.
| |
Collapse
|
2
|
An E, Ock CY, Kim TY, Lee KH, Han SW, Im SA, Kim TY, Liao WL, Cecchi F, Blackler A, Thyparambil S, Kim WH, Burrows J, Hembrough T, Catenacci DVT, Oh DY, Bang YJ. Quantitative proteomic analysis of HER2 expression in the selection of gastric cancer patients for trastuzumab treatment. Ann Oncol 2017; 28:110-115. [PMID: 27687309 PMCID: PMC5378223 DOI: 10.1093/annonc/mdw442] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background A wide range of response rates have been reported in HER2-positive gastric cancer (GC) patients treated with trastuzumab. Other HER2-targeted therapies for GC have yet to show efficacy in clinical trials. These findings raise question about the ability of standard HER2 diagnostics to accurately distinguish between GC patients who would and would not benefit from anti-HER2 therapies. Patients and methods GC patients (n = 237), including a subset from the Trastuzumab in GC (ToGA) trial were divided into three groups based on HER2 status and history of treatment with standard chemotherapy or chemotherapy plus trastuzumab. We applied mass spectrometry-based proteomic analysis to quantify HER2 protein expression in formalin-fixed tumor samples. Using HER2 expression as a continuous variable, we defined a predictive protein level cutoff to identify which patients would benefit from trastuzumab. We compared quantitated protein level with clinical outcome and HER2 status as determined by conventional HER2 diagnostics. Results Quantitative proteomics detected a 115-fold range of HER2 protein expression among patients diagnosed as HER2 positive by standard methods. A protein level of 1825 amol/µg was predicted to determine benefit from the addition of trastuzumab to chemotherapy. Trastuzumab treated patients with HER2 protein levels above this cutoff had twice the median overall survival (OS) of their counterparts below the cutoff (35.0 versus 17.5 months, P = 0.011). Conversely, trastuzumab-treated patients with HER2 levels below the cutoff had outcomes similar to HER2-positive patients treated with chemotherapy. (Progression-free survival = 7.0 versus 6.5 months: P = 0.504; OS = 17.5 versus 12.6 months: P = 0.520). HER2 levels were not prognostic for response to chemotherapy. Conclusions Proteomic analysis of HER2 expression demonstrated a quantitative cutoff that improves selection of GC patients for trastuzumab as compared with current diagnostic methods.
Collapse
Affiliation(s)
- E An
- NantOmics, Rockville, USA,Oncoplex Diagnostics, Rockville, USA
| | - C-Y Ock
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea
| | - T-Y Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea
| | - K-H Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Seoul, Korea
| | - S-W Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Seoul, Korea
| | - S-A Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Seoul, Korea
| | - T-Y Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Seoul, Korea
| | - W-L Liao
- NantOmics, Rockville, USA,Oncoplex Diagnostics, Rockville, USA
| | - F Cecchi
- NantOmics, Rockville, USA,Oncoplex Diagnostics, Rockville, USA
| | - A Blackler
- NantOmics, Rockville, USA,Oncoplex Diagnostics, Rockville, USA
| | - S Thyparambil
- NantOmics, Rockville, USA,Oncoplex Diagnostics, Rockville, USA
| | - W H Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - J Burrows
- Oncoplex Diagnostics, Rockville, USA
| | - T Hembrough
- NantOmics, Rockville, USA,Oncoplex Diagnostics, Rockville, USA
| | - D V T Catenacci
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, USA
| | - D-Y Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Seoul, Korea
| | - Y-J Bang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Seoul, Korea
| |
Collapse
|