Effect of KRAS codon 12 or 13 mutations on survival with trifluridine/tipiracil in pretreated metastatic colorectal cancer: a meta-analysis

Background

KRAS gene mutations can predict prognosis and treatment response in patients with metastatic colorectal cancer (mCRC).

Methods

We undertook a meta-analysis of three randomized, placebo-controlled trials (RECOURSE, TERRA and J003) to investigate the impact of KRAS mutations in codons 12 or 13 on overall survival (OS) and progression-free survival in patients receiving trifluridine/tipiracil (FTD/TPI) for refractory mCRC.

Results

A total of 1375 patients were included, of whom 478 had a KRAS codon 12 mutation and 130 had a KRAS codon 13 mutation. In univariate analyses, the absence of a KRAS codon 12 mutation was found to significantly increase the OS benefit of FTD/TPI relative to placebo compared with the presence of the mutation {hazard ratio (HR), 0.62 [95% confidence interval (CI): 0.53-0.72] versus 0.86 (0.70-1.05), respectively; interaction P = 0.0206}. Multivariate analyses showed that taking confounding factors into account reduced the difference in treatment effect between the presence and the absence of KRAS codon 12 mutations, confirming that treatment benefit was maintained in patients with [HR, 0.73 (95% CI: 0.59-0.89)] and without [HR, 0.63 (95% CI: 0.54-0.74)] codon 12 mutations (interaction P = 0.2939). KRAS mutations in codon 13 did not reduce the OS benefit of FTD/TPI relative to placebo, and, furthermore, KRAS mutations at either codon 12 or codon 13 did not affect the progression-free survival benefit.

Conclusions

Treatment with FTD/TPI produced a survival benefit, relative to placebo, regardless of KRAS codon 12 or 13 mutation status in patients with previously treated mCRC.

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KRAS mutations are associated with negative outcomes in patients with mCRC; codon 12 and 13 mutations are the most common.

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FTD/TPI was associated with longer median overall survival vs placebo both in patients with wild-type KRAS and mutant KRAS.

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FTD/TPI produced a survival benefit, relative to placebo, regardless of KRAS codon 12 or 13 mutation status in this patient group.

Age alters peripheral vascular endothelial function without affecting coronary flow reserve in healthy volunteers

Background

Age is a key risk factor contributing to vascular endothelial dysfunction. Whether the impact of ageing is uniform on various vascular beds is unknown. Endothelial function is classically evaluated by the brachial flow mediated dilatation (FMD) after a brief occlusion which mainly involves nitric oxide (NO) production. However, FMD measurement, requiring highly trained technicians, has been shown to be associated with a high degree of variability. Endothelial function could be also assessed by cutaneous iontophoresis combined with Laser Doppler. By contrast to FMD, this method is easily done by nurses and shows less variability. In parallel, myocardial imaging allows measurement of coronary flow reserve (CFR) coupled with an adenosine challenge leading to both a NO release and a modulation of potassium channels.

Purpose

The aim of this study was to determine the impact of ageing on vasodilation of peripheral (cutaneous) and coronary blood vessels in healthy volunteers.

Methods

This prospective single German center study enrolled 75 healthy non-smoking normotensive volunteers, taking no medication. They were divided into three age-subgroups (n=25/group): 18–30, 50–59, and 60–70 years (women: 54, 27 and 23%, respectively). All subjects underwent clinical and laboratory evaluation.

Peripheral endothelial function, expressed in cutaneous blood flow (delta CBF), was assessed through cutaneous microcirculation dilation by the non-invasive method using Laser Doppler Speckle Contrast Imaging (LSCI, Perimed) coupled with iontophoresis to locally deliver 125 nmoles of acetylcholine (Ach). The CFR was determined by cardiac magnetic resonance (CMR) coupling with an intravenous infusion of adenosine at 140 μg/kg/min for at least 3 minutes.

Results

Age was associated with a 23% reduction of peripheral endothelial function (delta CBF, p=0.005) in the elderly group (60–70y) vs. the younger one (18–30y) (median: 56.4 vs. 73.6). By contrast, calculated CFR was unchanged (median: 4.1 vs. 4.2, p=0.38). No relationship was observed between peripheral endothelial function (delta CBF) and CFR (r=0.01, p>0.97) in healthy volunteers.

Conclusion

In healthy volunteers, ageing is associated with a progressive peripheral but not with a coronary vascular dysfunction. This suggests that the impact of age on endothelial dysfunction depends on different vascular beds. Peripheral endothelial function assessment does not predict coronary vascular function in healthy volunteers.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Servier

Abstract P1-09-11: A phase Ib study of oral administration of lucitanib in combination with fulvestrant in patients with HR+ metastatic breast cancer (mBC)

FGFR1 amplification could mediate resistance to endocrine therapy and FGFR1 inhibition reverses this resistance. This phase Ib seeks to evaluate whether the combination of lucitanib, a potent FGFR/VEGFR/PDFGR inhibitor, in combination with fulvestrant, an endocrine agent, reverses resistance to fulvestrant.

Eligible patients for this study were postmenopausal with ER+/HER2- mBC and have relapsed during or after treatment with fulvestrant. There were 2 parts in the study: a dose allocation to assess the tolerability of the combination in terms of DLTs and MTD using a modified Continual Reassessment Method (mCRM) [part I] and a dose expansion, with patients assigned to 2 different cohorts based on FGFR amplification, to further evaluate the tolerability of the combination and to identify the recommended phase II dose (RP2D) [part II]. Surrogate target hitting biomarkers were also dosed at baseline and on-treatment. The sponsor decided to halt the clinical development in mBC indication and the study was prematurely terminated after 18 patients (15 in part I and 3 in part II). The presentation will focus on these 18 patients.

Patients had ECOG PS 0 or 1 and median number of previous treatments in metastatic setting was 3. Two doses of lucitanib (10mg daily n=9 and 12.5mg daily n=6) in combination with 500 mg/month of fulvestrant were tested in part I. At the 10mg dose level, one patient experienced a DLT (grade 3 hypertension). Based on global lucitanib development program data, it was decided to start Part II with lucitanib 10mg daily. The most common related grade ≥3 toxicities occurring in more than 10% of patients were hypertension (78%) and asthenia (22%). All patients required at least one dose interruption mainly for toxicities, while 13 patients (72%) required at least a dose reduction for toxicities. Thirteen patients (72%) withdrew from the study for disease progression, 3 (17%) for adverse events (at 10mg) and 2 (11%) for non-medical reasons. Three patients achieved a confirmed partial response (as per RECIST v1.1), one at 10mg and two at 12.5mg. About 55% of the patients experienced clinical benefit with a median duration of the benefit of 39.6 weeks and a maximun duration of the benefit of 79.1 weeks for 1 patient (PR at Cycle 4). Biomarker modulations were consistent with lucitanib mode of action; targeting VEGFRs (significant increase of VEGFA, IL8, PlGF) and FGFR1 (significant increase of FGF23).

The combination is feasible but requires close patient monitoring and intensive management of adverse events. Those are in line with the anti-angiogenic activity of lucitanib.

  10mg (N=12)12.5mg (N=6)All (N=18)Objective Response Rate (ORR)n(%) 11 (8.3)2 (33.3)3 (16.7) 95% CI 3[1.5;35.4][9.7;70.0][5.8;39.2]Clinical Benefit Rate (CBR)n(%) 24 (33.3)6 (100.0)10 (55.6) 95% CI 3[13.8;61.0][61.0;100.0][33.7;75.4]Duration of Clinical Benefitmedian (weeks)28.171.339.6 95% CI 3[27.9; 32.7][29.1; 79.1][27.9; 79.1]1: CR or PR 2: CR or PR or stabilization (SD or NonCR/NonPD) >24 weeks or at end of cycle 6 3: 95% Wilson method of Confidence interval of the estimate

Citation Format: Campone M, Bachelot T, Penault-Llorca F, Pallis A, Agrapart V, Pierrat M-J, Poirot C, Paux G, Dubois F, Xuereb L, Robert R, Andre F. A phase Ib study of oral administration of lucitanib in combination with fulvestrant in patients with HR+ metastatic breast cancer (mBC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-09-11.