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Tao Y, Sun XS, Pointreau Y, Tourneau CL, Sire C, Gollmer K, Crompton P, Bourhis J. Long-term results from a clinical study of xevinapant plus chemoradiotherapy in people with high-risk locally advanced squamous cell carcinoma of the head and neck: a plain language summary. Future Oncol 2023; 19:1769-1776. [PMID: 37439181 DOI: 10.2217/fon-2023-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? Squamous cell carcinoma of the head and neck (SCCHN) is the most common type of head and neck cancer. About half of the people with locally advanced (LA) SCCHN will have surgery to remove their cancer. For people who do not have surgery, chemoradiotherapy is the standard treatment, with the aim of fully removing the cancer. However, in many people, this treatment does not completely kill the cancer. This summary presents the main results of a phase 2 study of a medicine called xevinapant, which is under investigation as a potential future medicine for people with this type of cancer. WHAT DID THE RESEARCHERS WANT TO FIND OUT? In this study, researchers wanted to find out whether xevinapant plus chemoradiotherapy could stop the cancer from growing back or getting worse in the years after treatment completion in people with LA SCCHN. They also looked at whether people with this type of cancer had side effects from taking this medicine. Short-term results were collected 18 months after treatment with chemoradiotherapy ended. These results showed that people who received xevinapant plus chemoradiotherapy were less likely to have their cancer grow back, or get worse in the part of the body where it was first found, than people who received liquid placebo-which looked and tasted the same as the active medicine (in this case, xevinapant), but did not contain any medicine-plus chemoradiotherapy. Researchers then continued to collect information for a longer amount of time (at least 3 years). They wanted to see if treatment with xevinapant plus chemoradiotherapy was stopping the cancer from growing back or getting worse and helping people live longer. After this, people were monitored for a further 2 years to see if they were alive 5 years after treatment. WHAT WERE THE MAIN FINDINGS OF THE STUDY? The results showed that people with this type of cancer who were treated with xevinapant plus chemoradiotherapy were less likely to die, lived longer on average, and were less likely to have their cancer get worse. A phase 3 study, named TrilynX, in a larger group of people, is currently taking place to confirm the results of this study. Clinical Trial Registration: NCT02022098 (Debio 1143-201 Dose-finding and Efficacy Phase I/II Trial) (ClinicalTrials.gov).
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Affiliation(s)
- Yungan Tao
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Xu-Shan Sun
- Department of Radiation Oncology, Nord Franche-Comté de Montbéliard & CHRU de Besançon, Besançon, France
| | - Yoann Pointreau
- Oncologie-Radiothérapie, Institut Inter-Régional de Cancérologie, Centre Jean Bernard, Le Mans, France
| | - Christophe Le Tourneau
- Department of Drug Development & Innovation (D3i), Institut Curie, Paris-Saclay University, Paris, France
| | - Christian Sire
- South Brittany Hospital Center, Hôpital du Scorff Radiothérapie, Lorient, France
| | | | | | - Jean Bourhis
- CHUV, Radiation Oncology Department, Bâtiment Hospitalier, Lausanne, Switzerland
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Tao Y, Sun XS, Pointreau Y, Le Tourneau C, Sire C, Kaminsky MC, Coutte A, Alfonsi M, Calderon B, Boisselier P, Martin L, Miroir J, Ramee JF, Delord JP, Clatot F, Rolland F, Villa J, Magne N, Elicin O, Gherga E, Nguyen F, Lafond C, Bera G, Calugaru V, Geoffrois L, Chauffert B, Damstrup L, Crompton P, Ennaji A, Gollmer K, Nauwelaerts H, Bourhis J. Extended follow-up of a phase 2 trial of xevinapant plus chemoradiotherapy in high-risk locally advanced squamous cell carcinoma of the head and neck: a randomised clinical trial. Eur J Cancer 2023; 183:24-37. [PMID: 36796234 DOI: 10.1016/j.ejca.2022.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION We report long-term efficacy and overall survival (OS) results from a randomised, double-blind, phase 2 study (NCT02022098) investigating xevinapant plus standard-of-care chemoradiotherapy (CRT) vs. placebo plus CRT in 96 patients with unresected locally advanced squamous cell carcinoma of the head and neck (LA SCCHN). METHODS Patients were randomised 1:1 to xevinapant 200 mg/day (days 1-14 of a 21-day cycle for 3 cycles), or matched placebo, plus CRT (cisplatin 100 mg/m2 every 3 weeks for 3 cycles plus conventional fractionated high-dose intensity-modulated radiotherapy [70 Gy/35 F, 2 Gy/F, 5 days/week for 7 weeks]). Locoregional control, progression-free survival, and duration of response after 3 years, long-term safety, and 5-year OS were assessed. RESULTS The risk of locoregional failure was reduced by 54% for xevinapant plus CRT vs. placebo plus CRT but did not reach statistical significance (adjusted hazard ratio [HR] 0.46; 95% CI, 0.19-1.13; P = .0893). The risk of death or disease progression was reduced by 67% for xevinapant plus CRT (adjusted HR 0.33; 95% CI, 0.17-0.67; P = .0019). The risk of death was approximately halved in the xevinapant arm compared with placebo (adjusted HR 0.47; 95% CI, 0.27-0.84; P = .0101). OS was prolonged with xevinapant plus CRT vs. placebo plus CRT; median OS not reached (95% CI, 40.3-not evaluable) vs. 36.1 months (95% CI, 21.8-46.7). Incidence of late-onset grade ≥3 toxicities was similar across arms. CONCLUSIONS In this randomised phase 2 study of 96 patients, xevinapant plus CRT demonstrated superior efficacy benefits, including markedly improved 5-year survival in patients with unresected LA SCCHN.
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Affiliation(s)
- Yungan Tao
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Xu-Shan Sun
- Department of Radiation Oncology, Nord Franche-Comté de Montbéliard and CHRU de Besançon, Besançon, France
| | - Yoann Pointreau
- Oncologie-Radiothérapie, Institut Inter-Régional de Cancérologie, Centre Jean Bernard, Le Mans, France
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris-Saclay University, Paris, France
| | - Christian Sire
- South Brittany Hospital Center, Hôpital du Scorff Radiothérapie, Lorient, France
| | - Marie-Christine Kaminsky
- Institut Cancérologie de Lorraine - Alexis Vautrin, Oncologie Médicale, Vandoeuvre-lès-Nancy, France
| | | | - Marc Alfonsi
- Institut Sainte Catherine, Radiothérapie, Avignon, France
| | | | - Pierre Boisselier
- Institut du Cancer de Montpellier, Val d'Aurelle, Oncologie-Radiothérapie, Montpellier, France
| | - Laurent Martin
- Centre de Radiothérapie Guillaume le Conquérant, Le Havre, France
| | - Jessica Miroir
- Jean Perrin Center, Radiothérapie, Clermont-Ferrand, France
| | | | - Jean-Pierre Delord
- Medical Oncology Dept, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Florian Clatot
- Henri Becquerel Centre, Service Oncologie Médicale rue d'Amiens, Rouen, France
| | - Frederic Rolland
- Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
| | - Julie Villa
- CHU Grenoble, Radiothérapie, Pôle de Cancérologie, Grenoble, France
| | - Nicolas Magne
- Institut de Cancérologie Lucien Neuwirth, Radiothérapie, Saint-Priest-en-Jarez, France
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elisabeta Gherga
- Department of Radiation Oncology, Nord Franche-Comté de Montbéliard and CHRU de Besançon, Besançon, France
| | - France Nguyen
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Cédrik Lafond
- Oncologie-Radiothérapie, Institut Inter-Régional de Cancérologie, Centre Jean Bernard, Le Mans, France
| | - Guillaume Bera
- South Brittany Hospital Center, Hôpital du Scorff Radiothérapie, Lorient, France
| | - Valentin Calugaru
- Radiotherapy Oncology Department, Institut Curie, Paris-Saclay University, Paris, France
| | - Lionnel Geoffrois
- Institut Cancérologie de Lorraine - Alexis Vautrin, Oncologie Médicale, Vandoeuvre-lès-Nancy, France
| | - Bruno Chauffert
- CHU Amiens Picardie, Oncologie-Radiothérapie, Amiens, France
| | | | | | | | | | | | - Jean Bourhis
- CHUV, Radiation Oncology Department, Bâtiment Hospitalier, Lausanne, Switzerland.
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Bourhis J, Le Tourneau C, Calderon B, Martin L, Sire C, Pointreau Y, Ramee JF, Coutte A, Boisselier P, Kaminsky-Forrett MC, Delord JP, Clatot F, Sun X, Villa J, Magne N, Elicin O, Damstrup L, Gollmer K, Crompton P, Tao Y. LBA33 5-year overall survival (OS) in patients (pts) with locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) treated with xevinapant + chemoradiotherapy (CRT) vs placebo + CRT in a randomized, phase II study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Piggott L, Gavillet B, Brichory F, Gollmer K, Bouisset F, Vuagniaux G. Abstract 3443: The IAP antagonist xevinapant, in combination with high-dose cisplatin chemoradiotherapy, induces NF-kB and apoptotic pathway biomarkers in patients with high-risk locally advanced squamous cell carcinoma of the head and neck. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Inhibitor of Apoptosis Proteins (IAPs) regulate apoptosis and modulate NF-kB signaling, which in turn drives the expression of genes involved in immune and inflammatory responses. Xevinapant (XVT) (a.k.a Debio 1143) is an orally available IAP antagonist shown to enhance tumor response to radiation through the proapoptotic cytokine TNFα and caspase activation. Results from a double-blind, multicenter, randomized, phase II trial in patients with high-risk locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) revealed significant improvement in overall survival (OS), progression free survival (PFS) and duration of response with XVT in combination with high-dose cisplatin chemoradiotherapy (CRT) vs CRT alone (NCT02022098). We analyzed XVT pharmacodynamic (PD) biomarker time-concentration profiles and explored the association of PD changes over time with clinical efficacy and safety parameters.
Methods: Three serum PD biomarkers were measured during cycle 1: caspase-cleaved cytokeratin 18 fragment (CKM30), a biomarker of epithelial apoptosis, MCP1 and TNFα, both NF-kB target genes. Time course changes in PD biomarker exposure, measured by their Area Under the Curve (AUC), were tested for association with clinical efficacy and safety endpoints, by linear, logistic, and Cox Proportional Hazard models. Clinical response parameters included locoregional control (LRC) at 18 months from end of treatment (EOT), PFS, duration of LRC, time to distant relapse (TTDR), OS and complete response (CR) 6 months after EOT.
Results: The biomarker analysis set was composed of all patients with baseline PD assessments and at least one post-baseline measurement and included 35 and 40 patients in the XVT and placebo (PBO) arms, respectively. All three serum PD biomarkers increased upon administration of CRT + XVT during cycle 1. The increase in CKM30 and MCP1 levels was significantly higher in the CRT + XVT arm vs the CRT + PBO arm, as tested by linear mixed effect models (CKM30: p = 0.0167; MCP1: p = 0.0135). Interestingly, CKM30 AUC appeared to be correlated with response in CRT + XVT but not CRT + PBO (based on LRC at month 18 or CR at month 6). No associations between any of the three biomarkers were observed with the safety endpoints explored.
Conclusions: Xevinapant has demonstrated promising activity in combination with CRT in LA-SCCHN. The outcome of the exploratory PD analyses indicates that XVT modulates NF-kB signaling, leading to serum increases in MCP1 and TNFα while further augmenting CRT-induced apoptotic marker CKM30. Our findings further characterize the mechanism of action of XVT and how it may ultimately result in enhanced clinical responses to CRT.
Citation Format: Luke Piggott, Bruno Gavillet, Franck Brichory, Kathrin Gollmer, Florilene Bouisset, Gregoire Vuagniaux. The IAP antagonist xevinapant, in combination with high-dose cisplatin chemoradiotherapy, induces NF-kB and apoptotic pathway biomarkers in patients with high-risk locally advanced squamous cell carcinoma of the head and neck [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3443.
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Affiliation(s)
- Luke Piggott
- 1Debiopharm International SA, Lausanne, Switzerland
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Le Tourneau C, Tao Y, Gomez-Roca C, Cristina V, Borcoman E, Deutsch E, Bahleda R, Calugaru V, Modesto A, Rouits E, Gollmer K, Vuagniaux G, Crompton P, Zanna C, Szyldergemajn S, Delord JP, Bourhis J. Phase I Trial of Debio 1143, an Antagonist of Inhibitor of Apoptosis Proteins, Combined with Cisplatin Chemoradiotherapy in Patients with Locally Advanced Squamous Cell Carcinoma of the Head and Neck. Clin Cancer Res 2020; 26:6429-6436. [PMID: 32994295 DOI: 10.1158/1078-0432.ccr-20-0425] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/25/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Debio 1143 is an oral antagonist of inhibitor of apoptosis proteins, which enhances tumor response with concomitant chemoradiotherapy. Addition of Debio 1143 to cisplatin-based chemoradiotherapy in locally advanced squamous cell carcinomas of the head and neck (LA-SCCHN) was evaluated in a phase I/II study to determine the MTD and recommended phase II dose (RP2D). Here, phase I results are reported. PATIENTS AND METHODS Treatment-naïve patients with LA-SCCHN (stages III/IVA/IVB) received Debio 1143 (100, 200, 300 mg/day), for 14 days every 3 weeks, with cisplatin (100 mg/m², every 3 weeks), for three cycles, and concomitant conventional fractionation radiotherapy (70 Gy/7 weeks). Dose-limiting toxicity (DLT) was evaluated over 9 weeks using continual reassessment. RESULTS Fourteen patients were treated/evaluable for DLT. Median age was 64.5 years, and all patients were current/former smokers. Primary tumors were hypopharynx, oropharynx (all human papillomavirus/p16 negative), larynx, and oral cavity. Two of six patients at 200 mg/day had DLT (grade 3 tubular necrosis, grade 3 aspartate aminotransferase/alanine aminotransferase increase, grade 4 febrile neutropenia, and grade 3 lipase increase), which was considered the MTD and RP2D. Common grade 3-4 adverse events were dysphagia (36%) and mucositis (29%). Laboratory abnormalities were frequent and generally mild, including anemia, white blood cell decrease, and increased creatinine. Addition of Debio 1143 did not compromise chemotherapy administration. Overall locoregional control rate at 18 months was 85%. Overall response rate was 85%, including 69% complete responses. Progression-free survival rate at 24 months was 74%. CONCLUSIONS The RP2D of Debio 1143 is 200 mg/day for 14 days, every 3 weeks, when combined with concomitant high-dose cisplatin chemoradiotherapy in LA-SCCHN. Debio 1143 addition to chemoradiotherapy was safe and manageable. Preliminary efficacy is encouraging and supports further development.
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Affiliation(s)
- Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud.,INSERM U900 Research Unit, Institut Curie, Saint-Cloud, France.,Paris-Saclay University, Saint-Aubin, Paris, France
| | - Yungan Tao
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France.
| | - Carlos Gomez-Roca
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Valerie Cristina
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Edith Borcoman
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Rastislav Bahleda
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif, France
| | - Valentin Calugaru
- Department of Radiation Oncology, Institut Curie, Saint-Cloud and Paris, France
| | - Anouchka Modesto
- Department of Radiotherapy, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | | | | | | | | | | | - Jean-Pierre Delord
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Jean Bourhis
- Department of Radio-Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
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Janku F, Iyer G, Spreafico A, Yamamoto N, Bang YJ, Elez E, De Jonge MJ, Groen HJ, Marmé F, Gollmer K, St-Pierre A, Melendez M, Mais A, Nauwelaerts H, Stammberger UM, Dummer R. A phase I study of LXH254 in patients (pts) with advanced solid tumors harboring MAPK pathway alterations. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Filip Janku
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gopa Iyer
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Noboru Yamamoto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yung-Jue Bang
- Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea, Republic of (South)
| | - Elena Elez
- Medical Oncology Department, Vall d’Hebron University Hospital; Vall d’Hebron Institute of Oncology (VHIO)., Barcelona, Spain
| | | | - Harry J.M. Groen
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Frederik Marmé
- Allgemeine Frauenheilkunde und Geburtshilfe, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | | | | | - Anna Mais
- Novartis Pharma AG, Basel, Switzerland
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Ackerknecht M, Gollmer K, Germann P, Ficht X, Abe J, Fukui Y, Swoger J, Ripoll J, Sharpe J, Stein JV. Antigen Availability and DOCK2-Driven Motility Govern CD4+ T Cell Interactions with Dendritic Cells In Vivo. J I 2017; 199:520-530. [DOI: 10.4049/jimmunol.1601148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 05/09/2017] [Indexed: 01/07/2023]
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Gollmer K, Ringsdorf H. Untersuchung und Anwendung von Poly-S-vinylmercaptalen als Strahlenschutzstoffe. Angew Chem Int Ed Engl 1966. [DOI: 10.1002/ange.19660781145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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