Abstract P6-11-03: A phase 2 open-label study of lucitanib in patients (pts) with FGF aberrant metastatic breast cancer (MBC)

BACKGROUND: Lucitanib is a potent, oral antiangiogenic tyrosine kinase inhibitor of Vascular Endothelial Growth Factor Receptors 1-3 (VEGFR1-3), Platelet-Derived Growth Factor Receptors alpha and beta (PDGFRα/β), and Fibroblast Growth Factor Receptors 1-3 (FGFR1-3). FGF aberrancies (amplification of FGFR1,or 11q[amplicon containing FGF ligands 3, 4, and 19]), are genomic alterations observed in over 20% of breast cancer pts and promote cancer proliferation and survival.

METHODS: MBC pts who had received at least 1 metastatic line of therapy were randomized 1:1 to 10 or 15 mg QD of lucitanib. Stratification was based on local assessment of FGF aberrancy; pts with both FGFR1 and 11q-amplified tumors were stratified as FGFR1 amplified. Central confirmation of FGFR1 or 11q amplification was done using Abbott FISH probes (FGFR1 or 11q copy number ≥ 6 and a ratio of FGFR1 or 11q to centromere ≥ 2). Investigator-assessed progression-free survival (PFS) was the primary endpoint. Secondary endpoints included objective response rate (ORR) per RECIST 1.1, disease control rate (DCR), duration of response (DR), and incidence of treatment-emergent adverse events (TEAE).

RESULTS: Enrollment completed in 3/2016; 178 pts that received at least 1 dose of lucitanib are included in this analysis (baseline characteristics in Table 1). Due to grade 3 hypertension in the 15 mg group (46% vs 37% in 10 mg group), enrollment to the 15 mg group was halted. Overall, most pts (97%) experienced at least 1 TEAE, with the most frequently (≥ 30%) occurring events being hypertension (73%), fatigue (48%), nausea (43%), hypothyroidism (40%), and headache (33%). Grade ≥ 3 TEAEs occurred in 66% of pts, with hypertension as the most frequent event (40%) followed by proteinuria and hyponatremia (both 6%). AEs were manageable with dose interruption or reduction, with approximately 8% of pts ending treatment due to an AE. Current median PFS is 3.5 mos (95% CI 2.8-4.6; range 0.62-12.95) and 2.6 mos (95% CI 1.8-2.9; range 0.82-18.87) respectively for the 10 mg and 15 mg treatment groups. No differences in clinical activity were observed by treatment group, FGF aberrancy, hormone receptor or HER2 status. Of the 168 evaluable pts, confirmed ORR was 3%; overall DCR was 27% (32% for pts in the 10 mg group compared to 20% for the 15 mg group); overall mean (standard deviation) DR of 3.3 (1.8) mos.

Baseline Characteristics 10 mg QD15 mg QD N=109N=69Age (years)Median5653Range27-8227-80SexFemale109 (100%)67 (97%)Male02 (3%)ECOG PSmissing5 (5%)2 (3%)051 (47%)30 (43%)153 (49%)37 (54%)Number of prior anticancer therapies in the metastatic setting> 332 (29%)21 (30%)3-648 (44%)32 (46%)> 629 (27%)16 (23%)Endocrine/HER2 statusmissing7 (6%)1 (1%)ER+ or PR+74 (68%)50 (73%)HER2+12 (11%)7 (10%)TNBC16 (15%)11 (16%)FGFR aberrancyFGFR1 amplified54 (49%)29 (42%)11q amplified31 (28%)24 (35%)FGFR1 and 11q amplified13 (12%)9 (13%)FGFR1 and 11q non-amplified11 (10%)7 (10%)

CONCLUSION: At 10 mg QD, lucitanib has modest activity with manageable toxicity in this heavily pretreated pt population. Future clinical development for lucitanib may focus on alternative biomarkers to identify sensitive tumors and rational combinations with other anti-cancer drugs.

Citation Format: Mayer IA, Arteaga CL, Nanda R, Miller KD, Jhaveri K, Brufsky AM, Rugo H, Yardley DA, Vahdat LT, Sadeghi S, Audeh MW, Rolfe L, Litten J, Knox A, Raponi M, Tankersley C, Isaacson J, Wride K, Morganstern DE, Vogel C, Connolly RM, Gradishar WJ, Patel R, Pusztai L, Abu-Khalaf M. A phase 2 open-label study of lucitanib in patients (pts) with FGF aberrant metastatic breast cancer (MBC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-11-03.

Abstract P4-04-01: PDL-1 expression in primary breast cancers with germline mutations in BRCA 1 and 2

Background: The PD-1/PDL-1 pathway is a major inhibitory regulator of the immune response to tumors. Tumors responding to anti-PD-1 therapy appear to be characterized by a high "load" of somatic mutations, e.g.carcinogen-induced cancers (melanoma, lung) and tumors with a high intrinsic mutation rate (colorectal cancers with defects in DNA mismatch repair).High mutational load in these tumors may cause the expression of neoantigens which may induce an immune response unless the inhibitory PD-1/PDL-1 pathway is upregulated.Tumors in carriers of germline mutations in BRCA1/2 lack effective DNA repair and are genomically unstable, with a high mutational load and the possible expression of neoantigens. Breast cancers arising in carriers of germline mutations in BRCA1 and BRCA2 may rely on the PD-1/PDL-1 pathway to avoid immune destruction. Methods: Samples from thirty (30) treatment-naïve, primary breast cancers from 30 women with known germline mutations in BRCA 1 or BRCA2 were identified by records review in the Cedars-Sinai Department of Pathology, and selected for analysis of PD-1 and PDL-1 expression. Samples were analyzed for PD1 and PDL-1 expression utilizing immunohistochemical staining. Sections from FFPE tissue blocks were analysed with anti-PD-L1 clone 22C3(Merck); anti-PD-L1 clone SP142; or anti-PD-1 clone NAT105. IHC Scoring analyzed both tumor cell and non-tumor cell (inflammatory) infiltrate. A 0-5 scoring system (0= neg, 1 = rare, 2 = low, 3 = mod, 4 = high, 5 = very high) was applied. Tumors with IHC scores of 2 or greater were considered "positive" for expression of PD1 or PDL-1. Clinical Data: Age range 39-90 years, median age 61. Twenty(20) tumors were from BRCA 1 mutations carriers, and 10 were BRCA2. Sixteen (16) were basal type breast cancer (13 BRCA1, 3 BRCA2), 14 were estrogen receptor positive(ER+)(7 BRCA1, 7BRCA2), with 7 Luminal A and 7 Luminal B. There were no HER2 -amplified tumors in the cohort.Results: PD1 expression was observed in 11/30 (37%) of the cohort, and PDL-1 expression was detected in 21/30 (70%) of the cohort. PDL-1 expression was primarily seen in non-tumor, infiltrating immune cells. PDL-1 expression was seen in 15/20 (75%) of tumors from BRCA1 mutation carriers, and 6/10 (60%) of tumors from BRCA2 carriers. PDL-1 expression was present in 13/16 (81%) basal tumors and 8/14 (57%) ER+ tumors. Within the cohort of PDL-1 expressing cancers, 7/21 (33%) were scored as "high" or "very high", 5 basal breast cancers and 2 ER+ cancers. Conclusion: The current study has identified a high rate of PDL-1 expression in untreated primary breast cancers with germline BRCA1 and BRCA2 mutations, regardless of intrinsic subtype. Although the highest rate of expression was seen in basal breast cancers (81%), the majority of ER+ breast cancers, both Luminal A and Luminal B, also expressed PDL-1. Anti-PD-1 therapy has yielded a response rate of 19% in metastatic triple negative breast cancer, unselected for BRCA mutation.The current study suggests that tumors in carriers of germline mutations in BRCA1 or BRCA2 , regardless of intrinsic subtype, may rely on immune checkpoint inhibition for their growth and survival, and that therapy directed against the PD-1/PDL-1 pathway may be of benefit in this cohort of patients.

Citation Format: Audeh MW, Dadmanesh F, Yearley J. PDL-1 expression in primary breast cancers with germline mutations in BRCA 1 and 2. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-04-01.

Immobilization of acrylamide-modified oligonucleotides by co-polymerization

A flexible chemistry for solid phase attachment of oligonucleotides is described. Oligonucleotides bearing 5'-terminal acrylamide modifications efficiently co-polymerize with acrylamide monomers to form thermally stable DNA-containing polyacrylamide co-polymers. Co-polymerization attachment is specific for the terminal acrylamide group. Stable probe-containing layers are easily fabricated on supports bearing exposed acrylic groups, including plastic microtiter plates and silanized glass. Attachment can be accomplished using standard polyacrylamide gel recipes and polymerization techniques. Supports having a high surface density of hybridizable oligonucleotide (approximately 200 fmol/mm2) can be produced.

A phase II trial of carbetimer for the treatment of colorectal cancer. A trial of the Northern California Oncology Group

Carbetimer (carboxyimamidate) was administered at a dose of 6,500 mg/m2/day intravenously for 5 consecutive days to 14 patients with measurable metastatic or recurrent colorectal cancer in a single institution phase II study of the Northern California Oncology Group. A total of 38 cycles of therapy were administered; nine patients completed at least three cycles of treatment. No partial or complete responses were observed. One patient did have a greater than 50% response in the liver while developing new retroperitoneal lymphadenopathy and is considered a nonresponder. Carbetimer was well tolerated with elevations of calcium from 10.2 to 12.5 mg/dl in nine patients, prolongation of prothrombin time and partial thromboplastin time in 14 patients, proteinuria in 10 patients, dizziness in six patients, nausea in two patients, and venous pain during infusion in three patients. Myelosuppression was not observed. Carbetimer at this dose and schedule is inactive in the treatment of colorectal cancer.

Immunophenotypic differences between plasmacytoma/multiple myeloma and immunoblastic lymphoma

Four cases of plasmacytoma (PC), six cases of multiple myeloma (MM), and nine cases of immunoblastic lymphoma (IL) of B-cell phenotype were studied with a large panel of monoclonal antibodies applied to frozen tissue sections. There were no significant differences in the immunophenotypes of plasmacytomas and multiple myelomas. However, significant immunophenotypic differences were noticed between the plasmacytoma/multiple myeloma cases (PC/MM) and the immunoblastic lymphoma specimens. The PC/MM cases characteristically stained with alpha (or gamma) and T10 and did not usually stain with mu, leukocyte common antibodies, certain B-lineage antibodies (B1, T015, 4G7, 6A4), or Ia. In contrast, IL sections usually did not stain with alpha or T10 and generally did stain with mu (or gamma), leukocyte common antibodies, B-lineage antibodies, and Ia. Ki-67, an antibody to proliferating cells, stained significantly fewer cells in PC/MM than in IL and stained significantly fewer cells that had a good clinical outcome. We conclude that although no one antibody is useful in distinguishing PC/MM from IL, the application of a panel of antibodies may be helpful in making this distinction. The prognosis may correlate with the numbers of proliferating cells as measured by reactivity with Ki-67.

Small cell lung carcinoma in the elderly

Twenty-four patients over the age of 70 with small cell cancer of the lung were studied retrospectively. Ninety-two per cent of these patients had other concurrent medical disorders; 58 per cent had cardiac disease and 25 per cent had a second malignancy. The median survival of 20 treated patients was ten months, and the one-year survival was 30 per cent. Such elderly patients with multiple medical problems can benefit from combination chemotherapy.