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Tong X, Patel AS, Kim E, Li H, Chen Y, Li S, Liu S, Dilly J, Kapner KS, Zhang N, Xue Y, Hover L, Mukhopadhyay S, Sherman F, Myndzar K, Sahu P, Gao Y, Li F, Li F, Fang Z, Jin Y, Gao J, Shi M, Sinha S, Chen L, Chen Y, Kheoh T, Yang W, Yanai I, Moreira AL, Velcheti V, Neel BG, Hu L, Christensen JG, Olson P, Gao D, Zhang MQ, Aguirre AJ, Wong KK, Ji H. Adeno-to-squamous transition drives resistance to KRAS inhibition in LKB1 mutant lung cancer. Cancer Cell 2024; 42:413-428.e7. [PMID: 38402609 DOI: 10.1016/j.ccell.2024.01.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/07/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024]
Abstract
KRASG12C inhibitors (adagrasib and sotorasib) have shown clinical promise in targeting KRASG12C-mutated lung cancers; however, most patients eventually develop resistance. In lung patients with adenocarcinoma with KRASG12C and STK11/LKB1 co-mutations, we find an enrichment of the squamous cell carcinoma gene signature in pre-treatment biopsies correlates with a poor response to adagrasib. Studies of Lkb1-deficient KRASG12C and KrasG12D lung cancer mouse models and organoids treated with KRAS inhibitors reveal tumors invoke a lineage plasticity program, adeno-to-squamous transition (AST), that enables resistance to KRAS inhibition. Transcriptomic and epigenomic analyses reveal ΔNp63 drives AST and modulates response to KRAS inhibition. We identify an intermediate high-plastic cell state marked by expression of an AST plasticity signature and Krt6a. Notably, expression of the AST plasticity signature and KRT6A at baseline correlates with poor adagrasib responses. These data indicate the role of AST in KRAS inhibitor resistance and provide predictive biomarkers for KRAS-targeted therapies in lung cancer.
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Affiliation(s)
- Xinyuan Tong
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai 200031, China
| | - Ayushi S Patel
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Eejung Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Hongjun Li
- MOE Key Laboratory of Bioinformatics, Bioinformatics Division and Center for Synthetic and Systems Biology, BNRist, Department of Automation, Tsinghua University, Beijing 100084, China
| | - Yueqing Chen
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai 200031, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shuai Li
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Shengwu Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Julien Dilly
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Biological and biomedical sciences program, Harvard Medical School, Boston, MA 02115, USA
| | - Kevin S Kapner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Ningxia Zhang
- Department of Respiratory and Critical Care Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Yun Xue
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai 200031, China; School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou 310024, China
| | - Laura Hover
- Monoceros Biosystems, LLC, San Diego, CA 92129, USA
| | - Suman Mukhopadhyay
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Fiona Sherman
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Khrystyna Myndzar
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Priyanka Sahu
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Yijun Gao
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Fei Li
- Department of Pathology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Fuming Li
- Shanghai Key Laboratory of Metabolic Remodeling and Health, Institute of Metabolism and Integrative Biology, Fudan University, Shanghai 200438, China
| | - Zhaoyuan Fang
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining 314400, China; The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Yujuan Jin
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai 200031, China
| | - Juntao Gao
- Institute for TCM-X, MOE Key Laboratory of Bioinformatics, Bioinformatics Division and Center for Synthetic and Systems Biology, BNRist, Tsinghua University, Beijing 100084, China
| | - Minglei Shi
- Institute of Medical Innovation, Peking University Third Hospital, Beijing 100191, China
| | - Satrajit Sinha
- Department of Biochemistry, State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203, USA
| | - Luonan Chen
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai 200031, China; School of Life Science and Technology, Shanghai Tech University, Shanghai 200120, China; Key Laboratory of Systems Biology, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Hangzhou 310024, China; West China Biomedical Big Data Center, Med-X Center for Informatics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yang Chen
- State Key Laboratory of Common Mechanism Research for Major Diseases, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Thian Kheoh
- Mirati Therapeutics, San Diego, CA 92121, USA
| | | | - Itai Yanai
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA; Institute of Systems Genetics, New York University Langone Health, New York, NY 10016, USA
| | - Andre L Moreira
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Vamsidhar Velcheti
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Benjamin G Neel
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Liang Hu
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai 200031, China
| | | | - Peter Olson
- Mirati Therapeutics, San Diego, CA 92121, USA
| | - Dong Gao
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai 200031, China
| | - Michael Q Zhang
- Department of Biological Sciences, Center for Systems Biology, The University of Texas, Richardson, TX 75080, USA.
| | - Andrew J Aguirre
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
| | - Kwok-Kin Wong
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA.
| | - Hongbin Ji
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai 200031, China; University of Chinese Academy of Sciences, Beijing 100049, China; School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou 310024, China; School of Life Science and Technology, Shanghai Tech University, Shanghai 200120, China.
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Pant S, Wainberg ZA, Weekes CD, Furqan M, Kasi PM, Devoe CE, Leal AD, Chung V, Basturk O, VanWyk H, Tavares AM, Seenappa LM, Perry JR, Kheoh T, McNeil LK, Welkowsky E, DeMuth PC, Haqq CM, O'Reilly EM. Lymph-node-targeted, mKRAS-specific amphiphile vaccine in pancreatic and colorectal cancer: the phase 1 AMPLIFY-201 trial. Nat Med 2024; 30:531-542. [PMID: 38195752 PMCID: PMC10878978 DOI: 10.1038/s41591-023-02760-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
Pancreatic and colorectal cancers are often KRAS mutated and are incurable when tumor DNA or protein persists or recurs after curative intent therapy. Cancer vaccine ELI-002 2P enhances lymph node delivery and immune response using amphiphile (Amph) modification of G12D and G12R mutant KRAS (mKRAS) peptides (Amph-Peptides-2P) together with CpG oligonucleotide adjuvant (Amph-CpG-7909). We treated 25 patients (20 pancreatic and five colorectal) who were positive for minimal residual mKRAS disease (ctDNA and/or serum tumor antigen) after locoregional treatment in a phase 1 study of fixed-dose Amph-Peptides-2P and ascending-dose Amph-CpG-7909; study enrollment is complete with patient follow-up ongoing. Primary endpoints included safety and recommended phase 2 dose (RP2D). The secondary endpoint was tumor biomarker response (longitudinal ctDNA or tumor antigen), with exploratory endpoints including immunogenicity and relapse-free survival (RFS). No dose-limiting toxicities were observed, and the RP2D was 10.0 mg of Amph-CpG-7909. Direct ex vivo mKRAS-specific T cell responses were observed in 21 of 25 patients (84%; 59% both CD4+ and CD8+); tumor biomarker responses were observed in 21 of 25 patients (84%); biomarker clearance was observed in six of 25 patients (24%; three pancreatic and three colorectal); and the median RFS was 16.33 months. Efficacy correlated with T cell responses above or below the median fold increase over baseline (12.75-fold): median tumor biomarker reduction was -76.0% versus -10.2% (P < 0.0014), and the median RFS was not reached versus 4.01 months (hazard ratio = 0.14; P = 0.0167). ELI-002 2P was safe and induced considerable T cell responses in patients with immunotherapy-recalcitrant KRAS-mutated tumors. ClinicalTrials.gov identifier: NCT04853017 .
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Affiliation(s)
- Shubham Pant
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Zev A Wainberg
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | - Alexis D Leal
- University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Olca Basturk
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Paweletz CP, Heavey GA, Kuang Y, Durlacher E, Kheoh T, Chao RC, Spira AI, Leventakos K, Johnson ML, Ignatius Ou SH, Riely GJ, Anderes K, Yang W, Christensen JG, Jänne PA. Early Changes in Circulating Cell-Free KRAS G12C Predict Response to Adagrasib in KRAS Mutant Non-Small Cell Lung Cancer Patients. Clin Cancer Res 2023; 29:3074-3080. [PMID: 37279096 PMCID: PMC10527102 DOI: 10.1158/1078-0432.ccr-23-0795] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/25/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE Non-invasive monitoring of circulating tumor DNA (ctDNA) has the potential to be a readily available measure for early prediction of clinical response. Here, we report on early ctDNA changes of KRAS G12C in a Phase 2 trial of adagrasib in patients with advanced, KRAS G12C-mutant lung cancer. EXPERIMENTAL DESIGN We performed serial droplet digital PCR (ddPCR) and plasma NGS on 60 KRAS G12C-mutant patients with lung cancer that participated in cohort A of the KRYSTAL-1 clinical trial. We analyzed the change in ctDNA at 2 specific intervals: Between cycles 1 and 2 and at cycle 4. Changes in ctDNA were compared with clinical and radiographic response. RESULTS We found that, in general, a maximal response in KRAS G12C ctDNA levels could be observed during the initial approximately 3-week treatment period, well before the first scan at approximately 6 weeks. 35 patients (89.7%) exhibited a decrease in KRAS G12C cfDNA >90% and 33 patients (84.6%) achieved complete clearance by cycle 2. Patients with complete ctDNA clearance at cycle 2 showed an improved objective response rate (ORR) compared with patients with incomplete ctDNA clearance (60.6% vs. 33.3%). Furthermore, complete ctDNA clearance at cycle 4 was associated with an improved overall survival (14.7 vs. 5.4 months) and progression-free survival (HR, 0.3). CONCLUSIONS These results support using early plasma response of KRAS G12C assessed at approximately 3 weeks to anticipate the likelihood of a favorable objective clinical response.
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Affiliation(s)
- Cloud P. Paweletz
- Belfer Center of Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02115
| | - Grace A. Heavey
- Belfer Center of Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02115
| | - Yanan Kuang
- Belfer Center of Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02115
| | - Emily Durlacher
- Lowe Center for Thoracic Oncology, Dana–Farber Cancer Institute, Boston, MA 02115
| | | | | | | | | | | | - Sai-Hong Ignatius Ou
- Chao Family Comprehensive Cancer Center, University of California-Irvine, , Orange, CA 92868
| | - Gregory J. Riely
- Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065
| | | | | | | | - Pasi A. Jänne
- Belfer Center of Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02115
- Lowe Center for Thoracic Oncology, Dana–Farber Cancer Institute, Boston, MA 02115
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4
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Yaeger R, Weiss J, Pelster MS, Spira AI, Barve M, Ou SHI, Leal TA, Bekaii-Saab TS, Paweletz CP, Heavey GA, Christensen JG, Velastegui K, Kheoh T, Der-Torossian H, Klempner SJ. Adagrasib with or without Cetuximab in Colorectal Cancer with Mutated KRAS G12C. N Engl J Med 2023; 388:44-54. [PMID: 36546659 PMCID: PMC9908297 DOI: 10.1056/nejmoa2212419] [Citation(s) in RCA: 90] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adagrasib, an oral small-molecule inhibitor of mutant KRAS G12C protein, has shown clinical activity in pretreated patients with several tumor types, including colorectal cancer. Preclinical studies suggest that combining a KRAS G12C inhibitor with an epidermal growth factor receptor antibody could be an effective clinical strategy. METHODS In this phase 1-2, open-label, nonrandomized clinical trial, we assigned heavily pretreated patients with metastatic colorectal cancer with mutant KRAS G12C to receive adagrasib monotherapy (600 mg orally twice daily) or adagrasib (at the same dose) in combination with intravenous cetuximab once a week (with an initial loading dose of 400 mg per square meter of body-surface area, followed by a dose of 250 mg per square meter) or every 2 weeks (with a dose of 500 mg per square meter). The primary end points were objective response (complete or partial response) and safety. RESULTS As of June 16, 2022, a total of 44 patients had received adagrasib, and 32 had received combination therapy with adagrasib and cetuximab, with a median follow-up of 20.1 months and 17.5 months, respectively. In the monotherapy group (43 evaluable patients), a response was reported in 19% of the patients (95% confidence interval [CI], 8 to 33). The median response duration was 4.3 months (95% CI, 2.3 to 8.3), and the median progression-free survival was 5.6 months (95% CI, 4.1 to 8.3). In the combination-therapy group (28 evaluable patients), the response was 46% (95% CI, 28 to 66). The median response duration was 7.6 months (95% CI, 5.7 to not estimable), and the median progression-free survival was 6.9 months (95% CI, 5.4 to 8.1). The percentage of grade 3 or 4 treatment-related adverse events was 34% in the monotherapy group and 16% in the combination-therapy group. No grade 5 adverse events were observed. CONCLUSIONS Adagrasib had antitumor activity in heavily pretreated patients with metastatic colorectal cancer with mutant KRAS G12C, both as oral monotherapy and in combination with cetuximab. The median response duration was more than 6 months in the combination-therapy group. Reversible adverse events were common in the two groups. (Funded by Mirati Therapeutics; KRYSTAL-1 ClinicalTrials.gov number, NCT03785249.).
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Affiliation(s)
- Rona Yaeger
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Jared Weiss
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Meredith S Pelster
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Alexander I Spira
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Minal Barve
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Sai-Hong I Ou
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Ticiana A Leal
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Tanios S Bekaii-Saab
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Cloud P Paweletz
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Grace A Heavey
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - James G Christensen
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Karen Velastegui
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Thian Kheoh
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Hirak Der-Torossian
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
| | - Samuel J Klempner
- From the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.Y.); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (J.W.); Sarah Cannon Research Institute, Tennessee Oncology, Nashville (M.S.P.); Virginia Cancer Specialists, NEXT Oncology-Virginia, Fairfax (A.I.S.); US Oncology Research, the Woodlands (A.I.S.), and Mary Crowley Cancer Research, Dallas (M.B.) - both in Texas; the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), and Mirati Therapeutics, San Diego (J.G.C., K.V., T.K., H.D.-T.) - all in California; the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta (T.A.L.); Medical Oncology, Mayo Clinic, Phoenix, Arizona (T.S.B.-S.); Belfer Center for Applied Cancer Science and the Department of Medical Oncology, Dana-Farber Cancer Institute (C.P.P., G.A.H.), and the Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital (S.J.K.) - both in Boston
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Jänne PA, Riely GJ, Gadgeel SM, Heist RS, Ou SHI, Pacheco JM, Johnson ML, Sabari JK, Leventakos K, Yau E, Bazhenova L, Negrao MV, Pennell NA, Zhang J, Anderes K, Der-Torossian H, Kheoh T, Velastegui K, Yan X, Christensen JG, Chao RC, Spira AI. Adagrasib in Non-Small-Cell Lung Cancer Harboring a KRASG12C Mutation. N Engl J Med 2022; 387:120-131. [PMID: 35658005 DOI: 10.1056/nejmoa2204619] [Citation(s) in RCA: 222] [Impact Index Per Article: 111.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adagrasib, a KRASG12C inhibitor, irreversibly and selectively binds KRASG12C, locking it in its inactive state. Adagrasib showed clinical activity and had an acceptable adverse-event profile in the phase 1-1b part of the KRYSTAL-1 phase 1-2 study. METHODS In a registrational phase 2 cohort, we evaluated adagrasib (600 mg orally twice daily) in patients with KRASG12C -mutated non-small-cell lung cancer (NSCLC) previously treated with platinum-based chemotherapy and anti-programmed death 1 or programmed death ligand 1 therapy. The primary end point was objective response assessed by blinded independent central review. Secondary end points included the duration of response, progression-free survival, overall survival, and safety. RESULTS As of October 15, 2021, a total of 116 patients with KRASG12C -mutated NSCLC had been treated (median follow-up, 12.9 months); 98.3% had previously received both chemotherapy and immunotherapy. Of 112 patients with measurable disease at baseline, 48 (42.9%) had a confirmed objective response. The median duration of response was 8.5 months (95% confidence interval [CI], 6.2 to 13.8), and the median progression-free survival was 6.5 months (95% CI, 4.7 to 8.4). As of January 15, 2022 (median follow-up, 15.6 months), the median overall survival was 12.6 months (95% CI, 9.2 to 19.2). Among 33 patients with previously treated, stable central nervous system metastases, the intracranial confirmed objective response rate was 33.3% (95% CI, 18.0 to 51.8). Treatment-related adverse events occurred in 97.4% of the patients - grade 1 or 2 in 52.6% and grade 3 or higher in 44.8% (including two grade 5 events) - and resulted in drug discontinuation in 6.9% of patients. CONCLUSIONS In patients with previously treated KRASG12C -mutated NSCLC, adagrasib showed clinical efficacy without new safety signals. (Funded by Mirati Therapeutics; ClinicalTrials.gov number, NCT03785249.).
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Affiliation(s)
- Pasi A Jänne
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Gregory J Riely
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Shirish M Gadgeel
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Rebecca S Heist
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Sai-Hong I Ou
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Jose M Pacheco
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Melissa L Johnson
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Joshua K Sabari
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Konstantinos Leventakos
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Edwin Yau
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Lyudmila Bazhenova
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Marcelo V Negrao
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Nathan A Pennell
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Jun Zhang
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Kenna Anderes
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Hirak Der-Torossian
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Thian Kheoh
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Karen Velastegui
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Xiaohong Yan
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - James G Christensen
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Richard C Chao
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
| | - Alexander I Spira
- From the Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute (P.A.J.), and Massachusetts General Hospital (R.S.H.) - both in Boston; the Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College (G.J.R.), and Perlmutter Cancer Center, New York University Langone Health (J.K.S.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (E.Y.) - all in New York; the Henry Ford Cancer Institute, Detroit (S.M.G.); the University of California Irvine School of Medicine, Chao Family Comprehensive Cancer Center, Orange (S.-H.I.O.), the University of California San Diego Moores Cancer Center, La Jolla (L.B.), and Mirati Therapeutics, San Diego (K.A., H.D.-T., T.K., K.V., X.Y., J.G.C., R.C.C.) - all in California; the Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.M.P.); Sarah Cannon Research Institute at Tennessee Oncology, Nashville (M.L.J.); the Department of Oncology, Mayo Clinic, Rochester, MN (K.L.); the University of Texas M.D. Anderson Cancer Center, Houston (M.V.N.) and US Oncology Research, The Woodlands (A.I.S.) - both in Texas; Cleveland Clinic Taussig Cancer Institute, Cleveland (N.A.P.); the Division of Medical Oncology, Department of Internal Medicine, and the Department of Cancer Biology, University of Kansas Medical Center, Kansas City (J.Z.); and Virginia Cancer Specialists and NEXT Oncology Virginia - both in Fairfax (A.I.S.)
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Sabari JK, Spira AI, Heist RS, Janne PA, Pacheco JM, Weiss J, Gadgeel SM, Der-Torossian H, Velastegui K, Kheoh T, Christensen JG, Negrao MV. Activity of adagrasib (MRTX849) in patients with KRAS G12C-mutated NSCLC and active, untreated CNS metastases in the KRYSTAL-1 trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.17_suppl.lba9009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA9009 Background: CNS metastases (mets) occur in 27–42% of NSCLC harboring KRASG12C mutations and are associated with poor prognosis. Adagrasib (ada), an investigational agent, is a KRASG12C inhibitor that irreversibly and selectively binds KRASG12C, locking it in its inactive state, and is optimized for favorable PK properties, including a long half-life (̃24 h) and dose-dependent PK. Ada has demonstrated dose-dependent CNS penetration and intracranial (IC) tumor regression in preclinical models of CNS mets. Methods: KRYSTAL-1 (NCT03785249) is a multicohort Phase 1/2 study evaluating ada as monotherapy or in combination with selected agents in patients (pts) with advanced solid tumors harboring a KRASG12C mutation. In a Phase 1b cohort, pts with KRASG12C-mutant NSCLC and active, untreated CNS mets were treated with ada 600 mg BID. The objectives for this Phase 1b cohort were to evaluate safety and clinical activity, including systemic and IC objective response rate (ORR) by blinded independent central review (BICR), duration of response (DOR), progression-free survival (PFS), and overall survival (OS). Systemic responses were assessed by RECIST 1.1; IC responses were assessed by modified RANO criteria and IC RECIST. Cerebrospinal fluid (CSF) was collected when feasible and was used to measure ada concentrations for optional evaluation. Results: As of 31 December 2021, 25 pts with NSCLC were enrolled and treated. Median follow-up was 6.6 months at the cutoff date. Median age was 66 years, 52% were female, 28%/72% had ECOG PS 0/1, and median lines of prior systemic therapy was one (range 0–4+). IC ORR per modified RANO criteria by BICR was 31.6% (6/19; 3 CRs, 2 PRs, 1 unconfirmed PR); IC disease control rate (DCR) was 84.2% (16/19, including 10 SDs). Median IC DOR was not reached (95% CI 4.1–NE); median IC PFS was 4.2 months (95% CI 3.8–NE). CSF samples were obtained for two pts for whom regression of CNS mets was observed and ada CSF concentrations exceeded the CNS penetrance partition coefficients observed for other therapies with demonstrated CNS penetration and CNS antitumor activity (Kp,uu 0.47). Systemic ORR by BICR was 35.0% (7/20), DCR was 80.0% (16/20) and median DOR was 9.6 months (95% CI 2.7–9.6); median PFS was 5.6 months (95% CI 3.8–11.0). For all pts enrolled, OS was immature, and the median had not been reached at the time of analysis. Safety was consistent with that previously reported with ada; any grade TRAEs occurred in 96% of pts, grade 3 TRAEs in 36%, and there were no grade 4/5 TRAEs. Further data describing IC activity assessed by IC RECIST will be presented. Conclusions: Ada was well tolerated, and these preliminary data demonstrate CNS penetration and encouraging IC activity in pretreated pts with NSCLC harboring a KRASG12C mutation and active, untreated CNS mets. These are the first clinical data demonstrating CNS-specific activity of a KRASG12C inhibitor in this population. Clinical trial information: NCT03785249.
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Affiliation(s)
- Joshua K. Sabari
- Perlmutter Cancer Center, New York University Langone Health, New York, NY
| | | | | | - Pasi A. Janne
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jose M. Pacheco
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jared Weiss
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | | | | | | | | | | | - Marcelo Vailati Negrao
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX
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Bekaii-Saab TS, Spira AI, Yaeger R, Buchschacher GL, McRee AJ, Sabari JK, Johnson ML, Barve MA, Hafez N, Velastegui K, Christensen JG, Kheoh T, Der-Torossian H, Rybkin II. KRYSTAL-1: Updated activity and safety of adagrasib (MRTX849) in patients (Pts) with unresectable or metastatic pancreatic cancer (PDAC) and other gastrointestinal (GI) tumors harboring a KRASG12C mutation. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.519] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
519 Background: KRAS, the most frequently mutated oncogene in cancer, is a key mediator of the RAS/MAPK signaling cascade that promotes cellular growth and proliferation. KRAS mutations occur in approximately 90% of pancreatic cancer, and approximately 2% of these are KRASG12C mutations. Adagrasib, an investigational agent, is a KRASG12C inhibitor that irreversibly and selectively binds KRASG12C, locking it in its inactive state; adagrasib has been optimized for favorable pharmacokinetic (PK) properties, including long half-life (̃24 h), extensive tissue distribution, dose-dependent PK, as well as CNS penetration. Methods: KRYSTAL-1 (NCT03785249) is a multicohort Phase 1/2 study evaluating adagrasib as monotherapy or in combinations in pts with advanced solid tumors harboring a KRASG12C mutation. Here we report preliminary data from pts enrolled in a Phase 2 cohort evaluating single-agent adagrasib administered orally at 600 mg BID in previously treated pts with unresectable or metastatic solid tumors (excluding NSCLC and CRC), including pancreatic and other GI cancers. Study endpoints include clinical activity, safety, and PK. Results: The data cutoff was 10 September 2021. A total of 42 pts were enrolled in this cohort (median age 63.5 years, range 21–89; 52% female; 71% white; 29%/71% ECOG PS 0/1; median 2 prior lines of therapy, range 1–7; median follow-up 6.3 months), of whom 30 pts had KRASG12C-mutant GI tumors (12 PDAC, 8 biliary tract, 5 appendiceal, 2 gastro-esophageal junction, 2 small bowel, and 1 esophageal). In a preliminary analysis, 27 pts with GI tumors were evaluable for clinical activity; partial responses (PRs) were seen in 41% (11/27, including 3 unconfirmed PRs); the disease control rate (DCR) was 100% (27/27). Of the 12 pts with PDAC (median 3 prior lines of therapy; median follow-up 8.1 months), 10 were evaluable for clinical activity; PRs were seen in 50% (5/10, including 1 unconfirmed PR); the DCR was 100% (10/10). Median progression-free survival (PFS) was 6.6 months (95% CI 1.0–9.7), and treatment was ongoing in 50% of pts with PDAC. Among the 17 evaluable pts with other GI tumors, 6 achieved PR (35%; 2 unconfirmed) with a DCR of 100% (17/17); 11 pts were still receiving treatment. In the overall cohort, treatment-related adverse events of any grade occurred in 91% (38/42), the most frequent being nausea (48%), diarrhea (43%), vomiting (43%), and fatigue (29%); grade 3/4 events occurred in 21% of pts, with no grade 5 events. Conclusions: Adagrasib monotherapy is well tolerated and demonstrates encouraging clinical activity in pretreated pts with PDAC and other GI tumors harboring a KRASG12C mutation. Further exploration of adagrasib is ongoing in this pt population (NCT03785249). Clinical trial information: NCT03785249.
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Affiliation(s)
| | | | - Rona Yaeger
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Navid Hafez
- Yale University School of Medicine, New Haven, CT
| | | | | | - Thian Kheoh
- Janssen Research and Development, LLC, San Diego, CA
| | | | - Igor I. Rybkin
- Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI
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Weiss J, Yaeger R, Johnson M, Spira A, Klempner S, Barve M, Christensen J, Chi A, Der-Torossian H, Velastegui K, Kheoh T, Ou SH. LBA6 KRYSTAL-1: Adagrasib (MRTX849) as monotherapy or combined with cetuximab (Cetux) in patients (Pts) with colorectal cancer (CRC) harboring a KRASG12C mutation. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2093] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Tabernero J, Bendell J, Corcoran R, Kopetz S, Lee J, Davis M, Christensen J, Chi A, Kheoh T, Yaeger R. P-71 KRYSTAL-10: A randomized phase 3 study of adagrasib (MRTX849) in combination with cetuximab vs chemotherapy in patients with previously treated advanced colorectal cancer with KRASG12C mutation. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mok TSK, Lawler WE, Shum MK, Dakhil SR, Spira AI, Barlesi F, Reck M, Garassino MC, Spigel DR, Alvarez D, Kheoh T, Paxton W, Chao RC, Felip E. KRYSTAL-12: A randomized phase 3 study of adagrasib (MRTX849) versus docetaxel in patients (pts) with previously treated non-small-cell lung cancer (NSCLC) with KRASG12C mutation. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps9129] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9129 Background: Despite significant advances in chemotherapy and immunotherapy for advanced NSCLC, the majority of pts ultimately develop progressive disease associated with poor outcomes. KRAS is a key mediator of the RAS/MAPK signaling cascade that promotes cell growth and proliferation. KRASG12C mutations occur in 14% of NSCLC (adenocarcinoma), and mutations in KRAS are associated with a poor prognosis. Although KRAS has historically been undruggable, recent research into the development of agents that specifically bind mutant KRAS has led to the development of direct inhibitors of KRASG12C. Adagrasib, an investigational agent, is a potent, covalent inhibitor of KRASG12C that irreversibly and selectively binds to and locks KRASG12C in its inactive state. Adagrasib was optimized for favorable pharmacokinetic (PK) properties, including oral bioavailability, long half-life (̃24 h), and extensive tissue distribution. Initial results have demonstrated encouraging antitumor activity and tolerability of adagrasib monotherapy in pts with NSCLC harboring a KRASG12C mutation. Methods: KRYSTAL-12 is a multicenter, randomized Phase 3 study evaluating the efficacy of adagrasib (600 mg BID) vs docetaxel in pts with advanced NSCLC harboring a KRASG12C mutation who have progressed during or after treatment with a platinum-based regimen and an immune checkpoint inhibitor. The study is designed to demonstrate improvement in the dual primary endpoints of progression-free survival (PFS) and overall survival (OS). Secondary endpoints include safety, objective response rate (ORR) per RECIST 1.1, duration of response (DOR), plasma PK parameters of adagrasib, and patient-reported outcomes (PROs). The study will also explore correlations between gene alterations (at baseline and upon development of treatment resistance) and efficacy. Approximately 450 patients will be randomized in a 2:1 ratio to receive adagrasib or docetaxel and will be stratified by region (United States/Canada vs other countries) and sequential vs concurrent administration of prior platinum-based chemotherapy and anti–PD-1/PD-L1 antibody. The planned sample size is sufficiently powered for the hypothesized treatment effect of the endpoints. Pts will receive study treatment until disease progression, unacceptable adverse events, investigator decision to terminate treatment, or patient withdrawal. This study is currently enrolling and will be open at sites in the United States, Europe, and Asia. Clinical trial information: NCT04685135.
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Affiliation(s)
- Tony S. K. Mok
- State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Hong Kong, China
| | | | | | - Shaker R. Dakhil
- NSABP/NRG Oncology, and Wichita NCORP via Christi Reg. Med. Ctr, Wichita, KS
| | | | - Fabrice Barlesi
- Aix-Marseille University, CEPCM CLIP, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Martin Reck
- LungenClinic, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Marina Chiara Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - David R. Spigel
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | | | - Thian Kheoh
- Janssen Research and Development, LLC, San Diego, CA
| | | | | | - Enriqueta Felip
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
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Riely G, Ou SH, Rybkin I, Spira A, Papadopoulos K, Sabari J, Johnson M, Heist R, Bazhenova L, Barve M, Pacheco J, Velastegui K, Cilliers C, Olson P, Christensen J, Kheoh T, Chao R, Jänne P. 99O_PR KRYSTAL-1: Activity and preliminary pharmacodynamic (PD) analysis of adagrasib (MRTX849) in patients (Pts) with advanced non–small cell lung cancer (NSCLC) harboring KRASG12C mutation. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01941-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Spira A, Riely G, Lawler W, Shum M, Socinski M, Yanagihara R, Roshan S, Kheoh T, Christensen J, Chao R, Janne P, Garassino M. P90.03 A Phase 2 Trial of MRTX849 in Combination with Pembrolizumab in Patients with Advanced Non-Small Cell Lung Cancer with KRAS G12C Mutation. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cloughesy TF, Petrecca K, Walbert T, Butowski N, Salacz M, Perry J, Damek D, Bota D, Bettegowda C, Zhu JJ, Iwamoto F, Placantonakis D, Kim L, Elder B, Kaptain G, Cachia D, Moshel Y, Brem S, Piccioni D, Landolfi J, Chen CC, Gruber H, Rao AR, Hogan D, Accomando W, Ostertag D, Montellano TT, Kheoh T, Kabbinavar F, Vogelbaum MA. Effect of Vocimagene Amiretrorepvec in Combination With Flucytosine vs Standard of Care on Survival Following Tumor Resection in Patients With Recurrent High-Grade Glioma: A Randomized Clinical Trial. JAMA Oncol 2021; 6:1939-1946. [PMID: 33119048 DOI: 10.1001/jamaoncol.2020.3161] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance New treatments are needed to improve the prognosis of patients with recurrent high-grade glioma. Objective To compare overall survival for patients receiving tumor resection followed by vocimagene amiretrorepvec (Toca 511) with flucytosine (Toca FC) vs standard of care (SOC). Design, Setting, and Participants A randomized, open-label phase 2/3 trial (TOCA 5) in 58 centers in the US, Canada, Israel, and South Korea, comparing posttumor resection treatment with Toca 511 followed by Toca FC vs a defined single choice of approved (SOC) therapies was conducted from November 30, 2015, to December 20, 2019. Patients received tumor resection for first or second recurrence of glioblastoma or anaplastic astrocytoma. Interventions Patients were randomized 1:1 to receive Toca 511/FC (n = 201) or SOC control (n = 202). For the Toca 511/FC group, patients received Toca 511 injected into the resection cavity wall at the time of surgery, followed by cycles of oral Toca FC 6 weeks after surgery. For the SOC control group, patients received investigators' choice of single therapy: lomustine, temozolomide, or bevacizumab. Main Outcomes and Measures The primary outcome was overall survival (OS) in time from randomization date to death due to any cause. Secondary outcomes reported in this study included safety, durable response rate (DRR), duration of DRR, durable clinical benefit rate, OS and DRR by IDH1 variant status, and 12-month OS. Results All 403 randomized patients (median [SD] age: 56 [11.46] years; 62.5% [252] men) were included in the efficacy analysis, and 400 patients were included in the safety analysis (3 patients on the SOC group did not receive resection). Final analysis included 271 deaths (141 deaths in the Toca 511/FC group and 130 deaths in the SOC control group). The median follow-up was 22.8 months. The median OS was 11.10 months for the Toca 511/FC group and 12.22 months for the control group (hazard ratio, 1.06; 95% CI 0.83, 1.35; P = .62). The secondary end points did not demonstrate statistically significant differences. The rates of adverse events were similar in the Toca 511/FC group and the SOC control group. Conclusions and Relevance Among patients who underwent tumor resection for first or second recurrence of glioblastoma or anaplastic astrocytoma, administration of Toca 511 and Toca FC, compared with SOC, did not improve overall survival or other efficacy end points. Trial Registration ClinicalTrials.gov Identifier: NCT02414165.
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Affiliation(s)
| | - Kevin Petrecca
- Montreal Neurological Institute, Montreal, Quebec, Canada
| | | | | | - Michael Salacz
- University of Kansas Medical Center, Kansas City, Kansas
| | - James Perry
- Sunnybrook Research Institute, Sunnybrook Hospital, Toronto, Canada
| | | | - Daniela Bota
- University of California, Irvine, Irvine, California
| | | | | | | | | | - Lyndon Kim
- Thomas Jefferson University, Philadelphia, Pennsylvania.,Mount Sinai Hospital, New York, New York
| | | | - George Kaptain
- John Theurer Cancer Center, Hackensack University, Hackensack, New Jersey
| | - David Cachia
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Steven Brem
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Piccioni
- University of California San Diego, San Diego, California
| | | | | | - Harry Gruber
- Formerly Tocagen Inc, San Diego, California.,AmpiSwitch, San Diego, California
| | - Aliz R Rao
- Formerly Tocagen Inc, San Diego, California.,Bionano Genomics, San Diego, California
| | - Daniel Hogan
- Formerly Tocagen Inc, San Diego, California.,Impossible Foods, San Francisco, California
| | - William Accomando
- Formerly Tocagen Inc, San Diego, California.,Fate Therapeutics, San Diego, California
| | - Derek Ostertag
- Formerly Tocagen Inc, San Diego, California.,Abintus Bio, San Diego, California
| | - Tiffany T Montellano
- Formerly Tocagen Inc, San Diego, California.,Kura Oncology, San Diego, California
| | - Thian Kheoh
- Formerly Tocagen Inc, San Diego, California.,Mirati Therapeutics, San Diego, California
| | - Fairooz Kabbinavar
- Formerly Tocagen Inc, San Diego, California.,Puma Biotechnology, Los Angeles, California
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Jänne P, Rybkin I, Spira A, Riely G, Papadopoulos K, Sabari J, Johnson M, Heist R, Bazhenova L, Barve M, Pacheco J, Leal T, Velastegui K, Cornelius C, Olson P, Christensen J, Kheoh T, Chao R, Ou S. KRYSTAL-1: Activity and Safety of Adagrasib (MRTX849) in Advanced/ Metastatic Non–Small-Cell Lung Cancer (NSCLC) Harboring KRAS G12C Mutation. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31076-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Johnson M, Ou S, Barve M, Rybkin I, Papadopoulos K, Leal T, Velastegui K, Christensen J, Kheoh T, Chao R, Weiss J. KRYSTAL-1: Activity and Safety of Adagrasib (MRTX849) in Patients with Colorectal Cancer (CRC) and Other Solid Tumors Harboring a KRAS G12C Mutation. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31077-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Falchook GS, Rodon Ahnert J, Venkat S, Donahue A, Horner P, Thomassen A, Accomando W, Rodriguez-Aguirre M, Bentley C, Hogan D, Ostertag D, Yavrom S, Kheoh T, Jolly DJ, Gruber HE, Shorr J, Merchan JR. Immune modulation after Toca 511 and Toca FC treatment of colorectal cancer patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
186 Background: Toca 511 (vocimagene amiretrorepvec) is a cancer-selective, retroviral replicating vector encoding yeast cytosine deaminase that converts 5-fluorocytosine (5-FC) into 5-fluorouracil in the tumor microenvironment (TME). In animal models, Toca 511 and 5-FC kill dividing cancer and nearby immunosuppressive cells, leading to antitumor immune activity. A Phase 1 study of Toca 511 & Toca FC (extended-release 5-FC) in patients with recurrent high grade glioma revealed results consistent with this proposed mechanism. A Phase 3 trial is ongoing. Methods: Toca 6 (NCT02576665) is a Phase 1b, single-arm, multicenter study designed to investigate immunological changes after Toca 511 & Toca FC treatment in patients with advanced solid tumors, including colorectal cancer (CRC). Patients received intravenous (IV) Toca 511 for 3 days, and underwent biopsy of metastatic tumor before and ~ 4 weeks after starting oral Toca FC. Toca FC was repeated every 4-6 weeks. Peripheral blood mononuclear cells and tumor biopsies were evaluated for treatment related immune responses. Results: 17 CRC patients with a median 5 lines of prior chemotherapy were enrolled. At last data cut-off, 9 patients were alive and the median overall survival was 9.4 months. A patient receiving concomitant panitumumab had a partial response. IV Toca 511 led to viral expression in tumor, which decreased post-Toca FC while maintaining a reservoir of virus in the remaining tumor. T cells shifted from naïve to effector phenotypes, CD4 memory T cells expanded, and/or B cells increased after Toca FC treatment in 36% of patients. Marked changes in tumor infiltrating cells (CD11b myeloid cells, Tregs, exhausted T cells and CD8 T cells) occurred after Toca FC treatment. Treatment has been generally well tolerated. We also plan to report insights gained from RNA analysis of TME and update on clinical finding. Conclusions: Clinical data suggest a signal of activity in these heavily pretreated CRC patients warranting further exploration. IV Toca 511 administration showed viral infection of CRC metastatic tumor. Toca 511 & Toca FC may be associated with T cell mediated immune activity in peripheral blood and metastatic tumor, consistent with pre-clinical data in multiple tumor types. Clinical trial information: NCT02576665.
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Affiliation(s)
| | | | - Shree Venkat
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Arthur Donahue
- Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Peder Horner
- Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Amber Thomassen
- University of Miami-Sylvester Comprehensive Cancer Center, Miami, FL
| | | | | | | | | | | | | | - Thian Kheoh
- Janssen Research and Development, LLC, San Diego, CA
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17
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Cloughesy TF, Landolfi J, Vogelbaum MA, Ostertag D, Elder JB, Bloomfield S, Carter B, Chen CC, Kalkanis SN, Kesari S, Lai A, Lee IY, Liau LM, Mikkelsen T, Nghiemphu P, Piccioni D, Accomando W, Diago OR, Hogan DJ, Gammon D, Kasahara N, Kheoh T, Jolly DJ, Gruber HE, Das A, Walbert T. Durable complete responses in some recurrent high-grade glioma patients treated with Toca 511 + Toca FC. Neuro Oncol 2019; 20:1383-1392. [PMID: 29762717 DOI: 10.1093/neuonc/noy075] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Vocimagene amiretrorepvec (Toca 511) is an investigational gamma-retroviral replicating vector encoding cytosine deaminase that, when used in combination with extended-release 5-fluorocytosine (Toca FC), results preclinically in local production of 5-fluorouracil, depletion of immune-suppressive myeloid cells, and subsequent induction of antitumor immunity. Recurrent high-grade glioma (rHGG) patients have a high unmet need for effective therapies that produce durable responses lasting more than 6 months. In this setting, relapse is nearly universal and most responses are transient. Methods In this Toca 511 ascending-dose phase I trial (NCT01470794), HGG patients who recurred after standard of care underwent surgical resection and received Toca 511 injected into the resection cavity wall, followed by orally administered cycles of Toca FC. Results Among 56 patients, durable complete responses were observed. A subgroup was identified based on Toca 511 dose and entry requirements for the follow-up phase III study. In this subgroup, which included both isocitrate dehydrogenase 1 (IDH1) mutant and wild-type tumors, the durable response rate is 21.7%. Median duration of follow-up for responders is 35.7+ months. As of August 25, 2017, all responders remain in response and are alive 33.9+ to 52.2+ months after Toca 511 administration, suggesting a positive association of durable response with overall survival. Conclusions Multiyear durable responses have been observed in rHGG patients treated with Toca 511 + Toca FC in a phase I trial, and the treatment will be further evaluated in a randomized phase III trial. Among IDH1 mutant patients treated at first recurrence, there may be an enrichment of complete responders.
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Affiliation(s)
- Timothy F Cloughesy
- Departments of Neuro-Oncology and Neurosurgery, University of California, Los Angeles, California
| | - Joseph Landolfi
- New Jersey Neuroscience Institute, JFK Brain Tumor Center, Edison, New Jersey
| | | | | | - James B Elder
- Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Stephen Bloomfield
- New Jersey Neuroscience Institute, JFK Brain Tumor Center, Edison, New Jersey
| | - Bob Carter
- Moores Cancer Center, Department of Neurosciences, University of California, San Diego, California
| | - Clark C Chen
- Moores Cancer Center, Department of Neurosciences, University of California, San Diego, California
| | | | - Santosh Kesari
- Moores Cancer Center, Department of Neurosciences, University of California, San Diego, California
| | - Albert Lai
- Departments of Neuro-Oncology and Neurosurgery, University of California, Los Angeles, California
| | - Ian Y Lee
- Henry Ford Hospital, Detroit, Michigan
| | - Linda M Liau
- Departments of Neuro-Oncology and Neurosurgery, University of California, Los Angeles, California
| | | | - Phioanh Nghiemphu
- Departments of Neuro-Oncology and Neurosurgery, University of California, Los Angeles, California
| | - David Piccioni
- Moores Cancer Center, Department of Neurosciences, University of California, San Diego, California
| | | | | | | | | | - Noriyuki Kasahara
- Tocagen Inc., San Diego, California.,Departments of Cell Biology and Pathology, University of Miami, UM
| | | | | | | | - Asha Das
- Tocagen Inc., San Diego, California
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Merchan J, Rodon J, Ostertag D, Venkat S, Donahue A, Horner P, Tijera D, Kheoh T, Jolly DJ, Gruber HE, Shorr JS, Falchook GS. Abstract A018: Effects of Toca 511 and Toca FC on tumor microenvironment and peripheral blood populations in patients with advanced malignancies. Cancer Immunol Res 2019. [DOI: 10.1158/2326-6074.cricimteatiaacr18-a018] [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
Toca 511 (vocimagene amiretrorepvec) is an investigational, conditionally lytic, retroviral replicating vector that selectively infects cancer cells due to cell division requirements for virus integration into the genome, and defects in innate and adaptive immune responses found in malignant tissues that support virus replication. Toca 511 spreads through cancer cells and stably delivers optimized yeast cytosine deaminase (CD) that, upon administration of the prodrug, Toca FC (an investigational, extended-release version of 5-fluorocytosine [5-FC]), converts 5-FC into 5-fluorouracil (5-FU). 5-FU kills infected dividing cancer cells and diffuses to and kills surrounding cells in the tumor microenvironment, including immunosuppressive myeloid cells. In animal models, this depletion of immunosuppressive myeloid cells leads to therapeutically active immunity against tumors. A similarly derived antitumor response may occur in cancer patients, as local injection of Toca 511 into the tumor bed after resection of recurrent high-grade glioma followed by treatment with Toca FC has been associated with prolonged survival and durable complete responses (median duration of follow-up: 37.4+ months); responses were delayed in onset, consistent with time to response for immuno-oncology agents. The current phase 1b, multicenter, open-label study (Toca 6; NCT02576665) is designed to investigate changes in immune activity after treatment with Toca 511 and Toca FC in patients with advanced malignancies. Toca 511 is administered intravenously (IV) daily for 3 days and then as a single injection into metastatic or recurrent tumor. Oral Toca FC is started ~4 weeks later and repeated every 4-6 weeks. Biopsies are obtained prior to and following exposure to Toca 511 and Toca FC treatment to evaluate changes in immune activity, and peripheral blood is obtained contemporaneously for evaluation. The study has enrolled 19 patients to date (colorectal cancer: 15; sarcoma: 2; non-small cell lung and pancreas cancer: 1 each). Treatment has been well tolerated. Viral RNA, DNA, and CD protein expression are observed in tumor after IV delivery of Toca 511. We plan to report on tumor microenvironment remodeling that follows treatment with Toca 511 and Toca FC. Infiltrating T-cell subpopulations, B cells, and monocytes quantified by immunofluorescence from stained formalin-fixed, paraffin-embedded samples will be presented. Additionally, changes in peripheral blood, including T-cell effector, helper/memory, and regulatory populations, and myeloid lineage cells following exposure to Toca 511 alone and following subsequent exposure to Toca FC will be reported. Data from this study will inform future development of Toca 511 and Toca FC alone or in combination with other therapies in patients with solid tumors.
Citation Format: Jaime Merchan, Jordi Rodon, Derek Ostertag, Shree Venkat, Arthur Donahue, Peder Horner, Dalissa Tijera, Thian Kheoh, Douglas J. Jolly, Harry E. Gruber, Jolene S. Shorr, Gerald S. Falchook. Effects of Toca 511 and Toca FC on tumor microenvironment and peripheral blood populations in patients with advanced malignancies [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr A018.
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Affiliation(s)
- Jaime Merchan
- University of Miami, Miami, FL; University of Texas MD Anderson Cancer Center, Houston, TX; Tocagen, Inc., San Diego, CA; Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Jordi Rodon
- University of Miami, Miami, FL; University of Texas MD Anderson Cancer Center, Houston, TX; Tocagen, Inc., San Diego, CA; Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Derek Ostertag
- University of Miami, Miami, FL; University of Texas MD Anderson Cancer Center, Houston, TX; Tocagen, Inc., San Diego, CA; Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Shree Venkat
- University of Miami, Miami, FL; University of Texas MD Anderson Cancer Center, Houston, TX; Tocagen, Inc., San Diego, CA; Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Arthur Donahue
- University of Miami, Miami, FL; University of Texas MD Anderson Cancer Center, Houston, TX; Tocagen, Inc., San Diego, CA; Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Peder Horner
- University of Miami, Miami, FL; University of Texas MD Anderson Cancer Center, Houston, TX; Tocagen, Inc., San Diego, CA; Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Dalissa Tijera
- University of Miami, Miami, FL; University of Texas MD Anderson Cancer Center, Houston, TX; Tocagen, Inc., San Diego, CA; Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Thian Kheoh
- University of Miami, Miami, FL; University of Texas MD Anderson Cancer Center, Houston, TX; Tocagen, Inc., San Diego, CA; Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Douglas J. Jolly
- University of Miami, Miami, FL; University of Texas MD Anderson Cancer Center, Houston, TX; Tocagen, Inc., San Diego, CA; Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Harry E. Gruber
- University of Miami, Miami, FL; University of Texas MD Anderson Cancer Center, Houston, TX; Tocagen, Inc., San Diego, CA; Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Jolene S. Shorr
- University of Miami, Miami, FL; University of Texas MD Anderson Cancer Center, Houston, TX; Tocagen, Inc., San Diego, CA; Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Gerald S. Falchook
- University of Miami, Miami, FL; University of Texas MD Anderson Cancer Center, Houston, TX; Tocagen, Inc., San Diego, CA; Sarah Cannon Research Institute at HealthONE, Denver, CO
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Accomando W, Cloughesy T, Kalkanis S, Mikkelsen T, Landolfi J, Carter B, Chen C, Vogelbaum M, Elder J, Piccioni D, Walbert T, Hogan D, Diago O, Gammon D, Haghighi A, Kheoh T, Gruber H, Jolly D, Ostertag D. ATIM-26. IMMUNOLOGIC TRENDS ASSOCIATED WITH PATIENT OUTCOMES IN A PHASE 1 CLINICAL TRIAL OF TOCA 511 AND TOCA FC IN RECURRENT HIGH GRADE GLIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Steven Kalkanis
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | | | | | - Bob Carter
- Massachusetts General Hospital, Boston, MA, USA
| | - Clark Chen
- University of Minnesota Department of Neurosurgery, Minneapolis, MN, USA
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Heller G, McCormack R, Kheoh T, Molina A, Smith MR, Dreicer R, Saad F, de Wit R, Aftab DT, Hirmand M, Limon-Carrera A, Fizazi K, Fleisher M, de Bono JS, Scher HI. Reply to C. Ren et al. J Clin Oncol 2018; 36:2354-2356. [PMID: 29894273 DOI: 10.1200/jco.2018.78.2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- Glenn Heller
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Robert McCormack
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Thian Kheoh
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Arturo Molina
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Matthew R Smith
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Robert Dreicer
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Fred Saad
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Ronald de Wit
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Dana T Aftab
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Mohammed Hirmand
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Ana Limon-Carrera
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Karim Fizazi
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Martin Fleisher
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Johann S de Bono
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
| | - Howard I Scher
- Glenn Heller, Memorial Sloan Kettering Cancer Center, New York, NY; Robert McCormack and Thian Kheoh, Janssen Research & Development, Raritan, NJ; Arturo Molina, Janssen Research & Development, Los Angeles, CA; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, Netherlands; Dana T. Aftab, Exelixis, South San Francisco, CA; Mohammed Hirmand, Medivation, San Francisco, CA; Ana Limon-Carrera, Takeda Oncology, Cambridge, MA; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; Martin Fleisher, Memorial Sloan Kettering Cancer Center, New York, NY; Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom; and Howard I. Scher, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY
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21
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Rathkopf DE, Smith MR, Ryan CJ, Berry WR, Shore ND, Liu G, Higano CS, Alumkal JJ, Hauke R, Tutrone RF, Saleh M, Chow Maneval E, Thomas S, Ricci DS, Yu MK, de Boer CJ, Trinh A, Kheoh T, Bandekar R, Scher HI, Antonarakis ES. Androgen receptor mutations in patients with castration-resistant prostate cancer treated with apalutamide. Ann Oncol 2018. [PMID: 28633425 DOI: 10.1093/annonc/mdx283] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Mutations in the androgen receptor (AR) ligand-binding domain (LBD), such as F877L and T878A, have been associated with resistance to next-generation AR-directed therapies. ARN-509-001 was a phase I/II study that evaluated apalutamide activity in castration-resistant prostate cancer (CRPC). Here, we evaluated the type and frequency of 11 relevant AR-LBD mutations in apalutamide-treated CRPC patients. Patients and methods Blood samples from men with nonmetastatic CRPC (nmCRPC) and metastatic CRPC (mCRPC) pre- or post-abiraterone acetate and prednisone (AAP) treatment (≥6 months' exposure) were evaluated at baseline and disease progression in trial ARN-509-001. Mutations were detected in circulating tumor DNA using a digital polymerase chain reaction-based method known as BEAMing (beads, emulsification, amplification and magnetics) (Sysmex Inostics' GmbH). Results Of the 97 total patients, 51 had nmCRPC, 25 had AAP-naïve mCRPC, and 21 had post-AAP mCRPC. Ninety-three were assessable for the mutation analysis at baseline and 82 of the 93 at progression. The overall frequency of detected AR mutations at baseline was 7/93 (7.5%) and at progression was 6/82 (7.3%). Three of the 82 (3.7%) mCRPC patients (2 AAP-naïve and 1 post-AAP) acquired AR F877L during apalutamide treatment. At baseline, 3 of the 93 (3.2%) post-AAP patients had detectable AR T878A, which was lost after apalutamide treatment in 1 patient who continued apalutamide treatment for 12 months. Conclusions The overall frequency of detected mutations at baseline (7.5%) and progression (7.3%) using the sensitive BEAMing assay was low, suggesting that, based on this assay, AR-LBD mutations such as F877L and T878A are not common contributors to de novo or acquired resistance to apalutamide. ClinicalTrials.gov identifier NCT01171898.
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Affiliation(s)
- D E Rathkopf
- Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York
| | - M R Smith
- Massachusetts General Hospital and Harvard Medical School, Boston
| | - C J Ryan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco
| | - W R Berry
- Cancer Centers of North Carolina, Raleigh
| | - N D Shore
- Carolina Urologic Research Center, Myrtle Beach
| | - G Liu
- University of Wisconsin Carbone Cancer Center, Madison
| | - C S Higano
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle
| | - J J Alumkal
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | - R Hauke
- Nebraska Cancer Specialists, Omaha
| | - R F Tutrone
- Chesapeake Urologic Research Associates, Baltimore
| | - M Saleh
- University of Alabama Comprehensive Cancer Center, Birmingham
| | | | - S Thomas
- Janssen Research & Development, Spring House
| | - D S Ricci
- Janssen Research & Development, Spring House
| | - M K Yu
- Janssen Research & Development, Los Angeles
| | - C J de Boer
- Janssen Biologics, B. V., Leiden, the Netherlands
| | - A Trinh
- Janssen Research & Development, Los Angeles
| | - T Kheoh
- Janssen Research & Development, San Diego
| | - R Bandekar
- Janssen Research & Development, Spring House
| | - H I Scher
- Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York
| | - E S Antonarakis
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, USA
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22
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Heller G, McCormack R, Kheoh T, Molina A, Smith MR, Dreicer R, Saad F, de Wit R, Aftab DT, Hirmand M, Limon A, Fizazi K, Fleisher M, de Bono JS, Scher HI. Circulating Tumor Cell Number as a Response Measure of Prolonged Survival for Metastatic Castration-Resistant Prostate Cancer: A Comparison With Prostate-Specific Antigen Across Five Randomized Phase III Clinical Trials. J Clin Oncol 2017; 36:572-580. [PMID: 29272162 DOI: 10.1200/jco.2017.75.2998] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose Measures of response that are clinically meaningful and occur early are an unmet need in metastatic castration-resistant prostate cancer clinical research and practice. We explored, using individual patient data, week 13 circulating tumor cell (CTC) and prostate-specific antigen (PSA) response end points in five prospective randomized phase III trials that enrolled a total of 6,081 patients-COU-AA-301, AFFIRM, ELM-PC-5, ELM-PC-4, and COMET-1- ClinicalTrials.Gov identifiers: NCT00638690, NCT00974311, NCT01193257, NCT01193244, and NCT01605227, respectively. Methods Eight response end points were explored. CTC nonzero at baseline and 0 at 13 weeks (CTC0); CTC conversion (≥ 5 CTCs at baseline, ≤ 4 at 13 weeks-the US Food and Drug Administration cleared response measure); a 30%, 50%, and 70% decrease in CTC count; and a 30%, 50%, and 70% decrease in PSA level. Patients missing week-13 values were considered nonresponders. The discriminatory strength of each end point with respect to overall survival in each trial was assessed using the weighted c-index. Results Of the eight response end points, CTC0 and CTC conversion had the highest weighted c-indices, with smaller standard deviations. For CTC0, the mean (standard deviation) was 0.81 (0.04); for CTC conversion, 0.79 (0.03); for 30% decrease in CTC count, 0.72 (0.06); for 50% decrease in CTC count, 0.72 (0.06); for 70% decrease in CTC count, 0.73 (0.05); for 30% decrease in PSA level, 0.71 (0.03); for 50% decrease in PSA level, 0.72 (0.06); and for 70% decrease in PSA level, 0.74 (0.05). Seventy-five percent of eligible patients could be evaluated with the CTC0 end point, compared with 51% with the CTC conversion end point. Conclusion The CTC0 and CTC conversion end points had the highest discriminatory power for overall survival. Both are robust and meaningful response end points for early-phase metastatic castration-resistant prostate cancer clinical trials. CTC0 is applicable to a significantly higher percentage of patients than CTC conversion.
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Affiliation(s)
- Glenn Heller
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Robert McCormack
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Thian Kheoh
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Arturo Molina
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Matthew R Smith
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Robert Dreicer
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Fred Saad
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Ronald de Wit
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Dana T Aftab
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Mohammad Hirmand
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Ana Limon
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Karim Fizazi
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Martin Fleisher
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Johann S de Bono
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Howard I Scher
- Glenn Heller, Martin Fleisher, and Howard I. Scher, Memorial Sloan Kettering Cancer Center; Howard I. Scher, Weill Cornell Medical College, New York, NY; Robert McCormack, Janssen Research & Development, Raritan, NJ; Thian Kheoh and Arturo Molina, Janssen Research & Development, Los Angeles; Dana T. Aftab, Exelixis, South San Francisco; Mohammad Hirmand, Medivation, San Francisco, CA; Matthew R. Smith, Massachusetts General Hospital, Boston; Ana Limon, Takeda Oncology, Cambridge, MA; Robert Dreicer, University of Virginia Medical School, Charlottesville, VA; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Ronald de Wit, Erasmus Medical Center, Rotterdam, the Netherlands; Karim Fizazi, Institut Gustave Roussy, Villejuif, and University of Paris Sud, Orsay, France; and Johann S. de Bono, The Institute of Cancer Research, and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
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Rydzewska LHM, Burdett S, Vale CL, Clarke NW, Fizazi K, Kheoh T, Mason MD, Miladinovic B, James ND, Parmar MKB, Spears MR, Sweeney CJ, Sydes MR, Tran N, Tierney JF. Adding abiraterone to androgen deprivation therapy in men with metastatic hormone-sensitive prostate cancer: A systematic review and meta-analysis. Eur J Cancer 2017; 84:88-101. [PMID: 28800492 PMCID: PMC5630199 DOI: 10.1016/j.ejca.2017.07.003] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is a need to synthesise the results of numerous randomised controlled trials evaluating the addition of therapies to androgen deprivation therapy (ADT) for men with metastatic hormone-sensitive prostate cancer (mHSPC). This systematic review aims to assess the effects of adding abiraterone acetate plus prednisone/prednisolone (AAP) to ADT. METHODS Using our framework for adaptive meta-analysis (FAME), we started the review process before trials had been reported and worked collaboratively with trial investigators to anticipate when eligible trial results would emerge. Thus, we could determine the earliest opportunity for reliable meta-analysis and take account of unavailable trials in interpreting results. We searched multiple sources for trials comparing AAP plus ADT versus ADT in men with mHSPC. We obtained results for the primary outcome of overall survival (OS), secondary outcomes of clinical/radiological progression-free survival (PFS) and grade III-IV and grade V toxicity direct from trial teams. Hazard ratios (HRs) for the effects of AAP plus ADT on OS and PFS, Peto Odds Ratios (Peto ORs) for the effects on acute toxicity and interaction HRs for the effects on OS by patient subgroups were combined across trials using fixed-effect meta-analysis. FINDINGS We identified three eligible trials, one of which was still recruiting (PEACE-1 (NCT01957436)). Results from the two remaining trials (LATITUDE (NCT01715285) and STAMPEDE (NCT00268476)), representing 82% of all men randomised to AAP plus ADT versus ADT (without docetaxel in either arm), showed a highly significant 38% reduction in the risk of death with AAP plus ADT (HR = 0.62, 95% confidence interval [CI] = 0.53-0.71, p = 0.55 × 10-10), that translates into a 14% absolute improvement in 3-year OS. Despite differences in PFS definitions across trials, we also observed a consistent and highly significant 55% reduction in the risk of clinical/radiological PFS (HR = 0.45, 95% CI = 0.40-0.51, p = 0.66 × 10-36) with the addition of AAP, that translates to a 28% absolute improvement at 3 years. There was no evidence of a difference in the OS benefit by Gleason sum score, performance status or nodal status, but the size of the benefit may vary by age. There were more grade III-IV acute cardiac, vascular and hepatic toxicities with AAP plus ADT but no excess of other toxicities or death. INTERPRETATION Adding AAP to ADT is a clinically effective treatment option for men with mHSPC, offering an alternative to docetaxel for men who are starting treatment for the first time. Future research will need to address which of these two agents or whether their combination is most effective, and for whom.
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Affiliation(s)
- Larysa H M Rydzewska
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK.
| | - Sarah Burdett
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | - Claire L Vale
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | | | - Karim Fizazi
- Gustave-Roussy, University of Paris Sud, 114 Rue Edouard Vaillant, Villejuif 94800, France
| | - Thian Kheoh
- Janssen Research & Development, San Diego, CA, USA
| | | | | | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Queen Elizabeth Hospital, Birmingham, UK
| | - Mahesh K B Parmar
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | - Melissa R Spears
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | | | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | | | - Jayne F Tierney
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
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24
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Fizazi K, Tran N, Fein L, Matsubara N, Rodriguez-Antolin A, Alekseev BY, Özgüroğlu M, Ye D, Feyerabend S, Protheroe A, De Porre P, Kheoh T, Park YC, Todd MB, Chi KN. Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med 2017; 377:352-360. [PMID: 28578607 DOI: 10.1056/nejmoa1704174] [Citation(s) in RCA: 1353] [Impact Index Per Article: 193.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Abiraterone acetate, a drug that blocks endogenous androgen synthesis, plus prednisone is indicated for metastatic castration-resistant prostate cancer. We evaluated the clinical benefit of abiraterone acetate plus prednisone with androgen-deprivation therapy in patients with newly diagnosed, metastatic, castration-sensitive prostate cancer. METHODS In this double-blind, placebo-controlled, phase 3 trial, we randomly assigned 1199 patients to receive either androgen-deprivation therapy plus abiraterone acetate (1000 mg daily, given once daily as four 250-mg tablets) plus prednisone (5 mg daily) (the abiraterone group) or androgen-deprivation therapy plus dual placebos (the placebo group). The two primary end points were overall survival and radiographic progression-free survival. RESULTS After a median follow-up of 30.4 months at a planned interim analysis (after 406 patients had died), the median overall survival was significantly longer in the abiraterone group than in the placebo group (not reached vs. 34.7 months) (hazard ratio for death, 0.62; 95% confidence interval [CI], 0.51 to 0.76; P<0.001). The median length of radiographic progression-free survival was 33.0 months in the abiraterone group and 14.8 months in the placebo group (hazard ratio for disease progression or death, 0.47; 95% CI, 0.39 to 0.55; P<0.001). Significantly better outcomes in all secondary end points were observed in the abiraterone group, including the time until pain progression, next subsequent therapy for prostate cancer, initiation of chemotherapy, and prostate-specific antigen progression (P<0.001 for all comparisons), along with next symptomatic skeletal events (P=0.009). These findings led to the unanimous recommendation by the independent data and safety monitoring committee that the trial be unblinded and crossover be allowed for patients in the placebo group to receive abiraterone. Rates of grade 3 hypertension and hypokalemia were higher in the abiraterone group. CONCLUSIONS The addition of abiraterone acetate and prednisone to androgen-deprivation therapy significantly increased overall survival and radiographic progression-free survival in men with newly diagnosed, metastatic, castration-sensitive prostate cancer. (Funded by Janssen Research and Development; LATITUDE ClinicalTrials.gov number, NCT01715285 .).
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Affiliation(s)
- Karim Fizazi
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - NamPhuong Tran
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Luis Fein
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Nobuaki Matsubara
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Alfredo Rodriguez-Antolin
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Boris Y Alekseev
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Mustafa Özgüroğlu
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Dingwei Ye
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Susan Feyerabend
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Andrew Protheroe
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Peter De Porre
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Thian Kheoh
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Youn C Park
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Mary B Todd
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
| | - Kim N Chi
- From Gustave Roussy, University of Paris Sud, Villejuif, France (K.F.); Janssen Research and Development, Los Angeles (N.T.), Beerse, Belgium (P.D.P.), San Diego, CA (T.K.), and Raritan, NJ (Y.C.P.); Instituto de Oncologia de Rosário, Rosário, Argentina (L.F.); National Cancer Center Hospital East, Chiba, Japan (N.M.); 12 de Octubre University Hospital, Madrid (A.R.-A.); P.A. Hertsen Moscow Cancer Research Institute, Moscow (B.Y.A.); Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey (M.Ö.); Fudan University Shanghai Cancer Center, Shanghai, China (D.Y.); Studienpraxis Urologie, Nürtingen, Germany (S.F.); Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom (A.P.); Janssen Global Services, Raritan, NJ (M.B.T.); and BC Cancer Agency, Vancouver, Canada (K.N.C.)
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25
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Ryan CJ, Kheoh T, Li J, Molina A, De Porre P, Carles J, Efstathiou E, Kantoff PW, Mulders PFA, Saad F, Chi KN. Prognostic Index Model for Progression-Free Survival in Chemotherapy-Naïve Metastatic Castration-Resistant Prostate Cancer Treated With Abiraterone Acetate Plus Prednisone. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30211-2. [PMID: 28844792 PMCID: PMC5785489 DOI: 10.1016/j.clgc.2017.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/21/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Radiographic progression-free survival (rPFS) is associated with overall survival (OS) in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) patients. Using readily assessable baseline clinical and laboratory parameters, we developed a prognostic index model for rPFS in chemotherapy-naïve mCRPC patients without visceral disease who were treated with abiraterone acetate plus prednisone. METHODS Data from the abiraterone acetate plus prednisone arm of COU-AA-302 were used. rPFS was defined based on modified Prostate Cancer Working Group 2 criteria. Baseline variables were assessed for association with rPFS through univariate Cox modeling. The lower (LLN) and upper (ULN) limits of laboratory normal were used to dichotomize most laboratory parameters; baseline median was used to dichotomize prostate-specific antigen (PSA). Prognostic factors for rPFS were identified by multivariate Cox modeling. Model accuracy was estimated by the C-index. RESULTS Presence of lymph node metastasis (hazard ratio [HR] = 1.76, P < .0001), lactate dehydrogenase > ULN (234 IU/L) (HR = 1.71, P = .0001), ≥ 10 bone metastases (HR = 1.71, P = .0015), hemoglobin ≤ LLN (12.7 g/dL) (HR = 1.47, P = .0030) and PSA > 39.5 ng/mL (HR = 1.42, P = .0078) were associated with poor outcome. Patients were categorized into 3 prognostic groups (good, n = 230; intermediate, n = 152; poor, n = 164) based on number of risk factors. Median rPFS was calculated (27.6, 16.6, and 8.3 months for good, intermediate, and poor, respectively). The C-index was 0.83 (95% confidence interval = 0.73-0.91). CONCLUSIONS The prognostic index model for rPFS reveals differential outcomes based on factors readily available in clinical practice. If validated, this model can be integrated into clinical practice and design of risk-stratified trials.
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Affiliation(s)
- Charles J Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA.
| | - Thian Kheoh
- Janssen Research & Development, San Diego, CA
| | - Jinhui Li
- Johnson & Johnson Medical China, Shanghai, China
| | | | | | - Joan Carles
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Fred Saad
- Centre Hospitalier de l'Université de Montréal/CRCHUM, Montréal, QC, Canada
| | - Kim N Chi
- BC Cancer Agency, Vancouver, BC, Canada
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Fizazi K, Tran N, Fein LE, Matsubara N, Rodríguez Antolín A, Alekseev BY, Ozguroglu M, Ye D, Feyerabend S, Protheroe A, De Porre P, Kheoh T, Park YC, Todd MB, Chi KN. LATITUDE: A phase III, double-blind, randomized trial of androgen deprivation therapy with abiraterone acetate plus prednisone or placebos in newly diagnosed high-risk metastatic hormone-naive prostate cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.18_suppl.lba3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA3 Background: Pts with newly diagnosed mHNPC, particularly with high-risk characteristics, have a poor prognosis. ADT+docetaxel showed improved outcomes in mHNPC, but many pts are not candidates for docetaxel and may benefit from alternative therapy. AA+P is indicated for metastatic castration-resistant prostate cancer pts. LATITUDE evaluates clinical benefit of early intervention with AA+P added to ADT in newly diagnosed, high-risk mHNPC pts. Methods: 1199 pts with newly diagnosed (≤ 3 mos prior to randomization) mHNPC (ECOG PS 0-2) with ≥ 2 of 3 risk factors (Gleason ≥ 8, ≥ 3 bone lesions, measurable visceral metastases) were randomized 1:1 to ADT+AA (1 g QD) + P (5 mg QD) or ADT+PBOs of AA and P. Co-primary end points were overall survival (OS) and radiographic progression-free survival (rPFS). One rPFS (~565 events), 2 interim, and 1 final OS analyses (~426, ~554, and ~852 events) were planned. Results: At this first interim analysis (median follow-up of 30.4 mos; 406 deaths [48%]; 593 rPFS events), OS, rPFS, and all secondary end points significantly favored ADT+AA+P (Table). The IDMC unanimously recommended unblinding the study and crossing pts to ADT+AA+P. Grade 3/4 adverse events (ADT+AA+P vs ADT+PBOs) (%): hypertension (20.3 vs 10.0); hypokalemia (10.4 vs 1.3); increased ALT (5.5 vs 1.3) or AST (4.4 vs 1.5). Conclusions: Early use of AA+P added to ADT in pts with high-risk mHNPC yielded significantly improved OS, rPFS, and all secondary end points vs ADT+PBOs alone. ADT+AA+P had a favorable risk/benefit ratio and supports early intervention with AA+P in newly diagnosed, high-risk mHNPC. Clinical trial information: NCT01715285. [Table: see text]
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Affiliation(s)
- Karim Fizazi
- Gustave Roussy Cancer Campus and University Paris-Sud, Villejuif, France
| | | | | | | | | | | | | | - Dingwei Ye
- Fudan University Shanghai Cancer Center, Shanghai, China
| | | | | | | | - Thian Kheoh
- Janssen Research and Development, LLC, San Diego, CA
| | - Youn C. Park
- Janssen Research and Development, LLC, Raritan, NJ
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Heller G, Mccormack RT, Kheoh T, Smith MR, Dreicer R, Saad F, De Wit R, Aftab DT, Hirmand M, MacLean DB, Fizazi K, De Bono JS, Scher HI. Circulating tumor cell (CTC) number as a response endpoint in metastatic castration resistant (mCRPC) compared with PSA across five randomized phase 3 trials. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5007 Background: Radiographic progression and overall survival (OS) are the traditional clinical benefit measures for mCRPC trials. Reliable indicators of response that occur early are a critical unmet need in practice and clinical research. We explored a week 13 CTC and prostate-specific antigen (PSA) endpoint relative to baseline in 5 prospective randomized phase 3 registration trials that enrolled 5912 pts. OS was the primary endpoint. Methods: CTC number (CellSearch) and PSA values in patients who survived at least 13 weeks were evaluated as response endpoints in COU-AA-301, AFFIRM, ELM-PC-5, ELM-PC-4 and COMET-1. Pts with missing values at week 13 were considered non-responders. The endpoints considered are shown in Table 1. Results: The discriminatory strength of the response endpoints with respect to OS was estimated using the weighted c-index. To summarize discrimination results for each measure, the mean and the standard deviation based on the weighted c-indices from the 5 studies were computed. Conclusions: CTC0 and CTC conversion endpoints had the highest discriminatory power for OS relative to the % decline in CTC or PSA endpoints. The percent of pts eligible and evaluable for the CTC0 endpoint was significantly higher than the conversion endpoint, 75% vs. 51%, respectively. These two absolute measures of CTC can be considered meaningful response indicators in mCRPC clinical trials. [Table: see text] [Table: see text]
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Affiliation(s)
- Glenn Heller
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Thian Kheoh
- Janssen Research and Development, LLC, San Diego, CA
| | | | | | - Fred Saad
- Montreal Cancer Institute/CRCHUM, Montreal, QC, Canada
| | | | | | | | | | - Karim Fizazi
- Gustave Roussy Cancer Campus and University Paris-Sud, Villejuif, France
| | - Johann S. De Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
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Fizazi K, Tran N, Fein LE, Matsubara N, Rodríguez Antolín A, Alekseev BY, Ozguroglu M, Ye D, Feyerabend S, Protheroe A, De Porre P, Kheoh T, Park YC, Todd MB, Chi KN. LATITUDE: A phase III, double-blind, randomized trial of androgen deprivation therapy with abiraterone acetate plus prednisone or placebos in newly diagnosed high-risk metastatic hormone-naive prostate cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.lba3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA3 The full, final text of this abstract will be available at abstracts.asco.org at 7:30 AM (EDT) on Saturday, June 3, 2017, and in the Annual Meeting Proceedings online supplement to the June 20, 2017, issue of the Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Sunday edition of ASCO Daily News.
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Affiliation(s)
- Karim Fizazi
- Gustave Roussy Cancer Campus and University Paris-Sud, Villejuif, France
| | | | | | | | | | | | | | - Dingwei Ye
- Fudan University Shanghai Cancer Center, Shanghai, China
| | | | | | | | - Thian Kheoh
- Janssen Research and Development, LLC, San Diego, CA
| | - Youn C. Park
- Janssen Research and Development, LLC, Raritan, NJ
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Scher HI, Heller G, Yu MK, Kheoh T, Peng W, De Bono JS. Clinical outcome of metastatic castration-resistant prostate cancer (mCRPC) patients (pts) with a post-treatment circulating tumor cell (CTC) of 0 vs CTC > 0: Post hoc analysis of COU-AA-301. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5015 Background: Assessment of radiographic response by RECIST in the majority of mCRPC pts is limited by the lack of measurable disease. Changes in CTC counts (CTCs) enumerated using Veridex CellSearch from unfavorable at baseline (BL [≥ 5 cells/7.5 mL]) to favorable (≤ 4) are prognostic for survival, and the test is FDA cleared as an aid in the monitoring of metastatic PC. The CTC cutpoint of ≥ 5 excludes many pts from response assessment. Examining CTCs alone and in combination with other biomarkers as a potential surrogate for clinical benefit was a secondary objective of COU-AA-301, a phase 3 trial of abiraterone acetate + prednisone vs prednisone alone in mCRPC. Methods: Pts from both treatment (tmt) groups with BL CTC > 0 were combined to assess CTC = 0 as a response criterion. Association between CTC response, defined as BL CTC > 0 and post-BL CTC = 0, and clinical outcomes was assessed. CTCs were determined at BL and 4, 8, and 12 wks. Pts with BL CTC > 0 and missing post-tmt CTCs were considered nonresponders. Radiographic response was first assessed at Wk 12. Overall survival (OS) was estimated using the Kaplan-Meier method. Results: Among739 pts with BL CTC > 0, 141 had measurable disease. At Wk 12, 19% (141/739) of pts were CTC responders and 81% (598/739) were CTC nonresponders. Among CTC responders, 74% (104/141) had stable disease or better by RECIST; 26% (37/141) were either not evaluable or had disease progression by RECIST. Median OS was 23.8 and 10.0 mos for CTC responders (n = 141) and nonresponders (n = 598), respectively. Among pts with liver and/or lung metastases, 86% (24/28) of CTC responders at Wk 12 had stable disease or better by RECIST; 14% (4/28) had disease progression by RECIST. Median OS was 19.9 and 7.1 mos for CTC responders (n = 28) and nonresponders (n = 127), respectively. Similar results were observed in Wk 8 CTC responders. Conclusions: For mCRPC pts with BL CTC > 0, CTC response on tmt (CTC = 0) is associated with longer survival and could be considered a response criterion. Additional analysis is required to fully characterize the relationship between CTC = 0 and objective response by RECIST in pts with measurable disease. Clinical trial information: NCT00638690.
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Affiliation(s)
| | - Glenn Heller
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Thian Kheoh
- Janssen Research and Development, LLC, San Diego, CA
| | - Weimin Peng
- Janssen Research and Development, LLC, Los Angeles, CA
| | - Johann S. De Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
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Smith MR, Saad F, Rathkopf DE, Mulders PFA, de Bono JS, Small EJ, Shore ND, Fizazi K, Kheoh T, Li J, De Porre P, Todd MB, Yu MK, Ryan CJ. Clinical Outcomes from Androgen Signaling-directed Therapy after Treatment with Abiraterone Acetate and Prednisone in Patients with Metastatic Castration-resistant Prostate Cancer: Post Hoc Analysis of COU-AA-302. Eur Urol 2017; 72:10-13. [PMID: 28314611 DOI: 10.1016/j.eururo.2017.03.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/02/2017] [Indexed: 11/26/2022]
Abstract
In the COU-AA-302 trial, abiraterone acetate plus prednisone significantly increased overall survival for patients with chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC). Limited information exists regarding response to subsequent androgen signaling-directed therapies following abiraterone acetate plus prednisone in patients with mCRPC. We investigated clinical outcomes associated with subsequent abiraterone acetate plus prednisone (55 patients) and enzalutamide (33 patients) in a post hoc analysis of COU-AA-302. Prostate-specific antigen (PSA) response was assessed. Median time to PSA progression was estimated using the Kaplan-Meier method. The PSA response rate (≥50% PSA decline, unconfirmed) was 44% and 67%, respectively. The median time to PSA progression was 3.9 mo (range 2.6-not estimable) for subsequent abiraterone acetate plus prednisone and 2.8 mo (range 1.8-not estimable) for subsequent enzalutamide. The majority of patients (68%) received intervening chemotherapy before subsequent abiraterone acetate plus prednisone or enzalutamide. While acknowledging the limitations of post hoc analyses and high censoring (>75%) in both treatment groups, these results suggest that subsequent therapy with abiraterone acetate plus prednisone or enzalutamide for patients who progressed on abiraterone acetate is associated with limited clinical benefit. PATIENT SUMMARY This analysis showed limited clinical benefit for subsequent abiraterone acetate plus prednisone or enzalutamide in patients with metastatic castration-resistant prostate cancer following initial treatment with abiraterone acetate plus prednisone. This analysis does not support prioritization of subsequent abiraterone acetate plus prednisone or enzalutamide following initial therapy with abiraterone acetate plus prednisone.
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Affiliation(s)
- Matthew R Smith
- Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA.
| | - Fred Saad
- University of Montréal, Montréal, Québec, Canada
| | - Dana E Rathkopf
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College New York, NY, USA
| | | | - Johann S de Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, Sutton, UK
| | - Eric J Small
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Neal D Shore
- Carolina Urologic Research Center, Atlantic Urology Clinics, Myrtle Beach, SC, USA
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Thian Kheoh
- Janssen Research & Development, San Diego, CA, USA
| | - Jinhui Li
- Johnson & Johnson Medical China, Shanghai, China
| | | | | | - Margaret K Yu
- Janssen Research & Development, Los Angeles, CA, USA
| | - Charles J Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
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Ryan CJ, Kheoh T, Scher HI, De Porre P, Yu MK, Morris MJ. Clinical versus radiographic progression and overall survival for patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) from COU-AA-302. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
193 Background: COU-AA-302 evaluated abiraterone acetate plus prednisone (AA) vs prednisone (P) in chemotherapy-naïve mCRPC pts, with overall survival (OS) and radiographic progression-free survival (rPFS) as co-primary end points. Per study criteria, pts with radiographic progression (RAD) only were allowed to continue treatment, while those with unequivocal clinical progression (UCP) only were not, and were censored for rPFS. We evaluated the clinical significance of survival outcomes for pts with UCP only vs RAD only from the prospective COU-AA-302 trial. Methods: UCP was defined per protocol as ≥ 1 of the following: initiation of chronic opiates, ECOG performance status (PS) decline to ≥ 3, or initiation of chemotherapy, palliative radiation therapy, or surgery. OS was evaluated for each type of progression using Cox proportional hazard models. Results: 500 (92%) pts in the AA arm and 540 (100%) in the P arm discontinued study treatment. Of the 736 pts who discontinued treatment for a protocol-defined reason, 280 (38%) discontinued for UCP only, 332 (45%) for RAD only, and 124 (17%) for both UCP and RAD. Clinical events cited as the reason for discontinuation for UCP (AA vs P arm) included pain requiring opiates (22% vs 25%), ECOG PS ≥ 3 (4% vs 5%), and initiation of chemotherapy (50% vs 53%), radiation therapy (36% vs 27%) and surgery (3% vs 5%). UCP only pts had shorter median OS compared with RAD only pts (Table). Conclusions: UCP is a criterion used as an indicator for a censored event, yet appears to confer inferior survival relative to RAD. The high frequency of UCP implies that it may be an important determinant of clinical outcome. The events that drive UCP should be defined as part of the development of more informative interim trial end points, in line with the PCWG3-proposed “no longer clinically benefitting” outcome measure, which captures pts with UCP. Clinical trial information: NCT00887198. [Table: see text]
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Affiliation(s)
- Charles J. Ryan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Thian Kheoh
- Janssen Research & Development, San Diego, CA
| | - Howard I. Scher
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | | | - Michael J. Morris
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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Bossi A, Dearnaley D, McKenzie M, Baskin-Bey E, Tyler R, Tombal B, Freedland S, Roach M, Widmark A, Dicker A, Wiegel T, Shore N, Smith M, Yu M, Kheoh T, Thomas S, Sandler H. ATLAS: A phase 3 trial evaluating the efficacy of apalutamide (ARN-509) in patients with high-risk localized or locally advanced prostate cancer receiving primary radiation therapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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de Bono JS, Smith MR, Saad F, Rathkopf DE, Mulders PFA, Small EJ, Shore ND, Fizazi K, De Porre P, Kheoh T, Li J, Todd MB, Ryan CJ, Flaig TW. Subsequent Chemotherapy and Treatment Patterns After Abiraterone Acetate in Patients with Metastatic Castration-resistant Prostate Cancer: Post Hoc Analysis of COU-AA-302. Eur Urol 2016; 71:656-664. [PMID: 27402060 PMCID: PMC5609503 DOI: 10.1016/j.eururo.2016.06.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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] [Received: 04/01/2016] [Accepted: 06/21/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Treatment patterns for metastatic castration-resistant prostate cancer (mCRPC) have changed substantially in the last few years. In trial COU-AA-302 (chemotherapy-naïve men with mCRPC), abiraterone acetate plus prednisone (AA) significantly improved radiographic progression-free survival and overall survival (OS) when compared to placebo plus prednisone (P). OBJECTIVE This post hoc analysis investigated clinical responses to docetaxel as first subsequent therapy (FST) among patients who progressed following protocol-specified treatment with AA, and characterized subsequent treatment patterns among older (≥75 yr) and younger (<75 yr) patient subgroups. DESIGN, SETTING, AND PARTICIPANTS Data were collected at the final OS analysis (96% of expected death events). Subsequent therapy data were prospectively collected, while response and discontinuation data were collected retrospectively following discontinuation of the study drug. INTERVENTION At the discretion of the investigator, 67% (365/546) of patients from the AA arm received subsequent treatment with one or more agents approved for mCRPC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Efficacy analysis was performed for patients for whom baseline and at least one post-baseline prostate-specific antigen (PSA) values were available. RESULTS AND LIMITATIONS Baseline and at least one post-baseline PSA values were available for 100 AA patients who received docetaxel as FST. While acknowledging the limitations of post hoc analyses, 40% (40/100) of these patients had an unconfirmed ≥50% PSA decline with first subsequent docetaxel therapy, and 27% (27/100) had a confirmed ≥50% PSA decline. The median docetaxel treatment duration among these 100 patients was 4.2 mo. Docetaxel was the most common FST among older and younger patients from each treatment arm. However, 43% (79/185) of older patients who progressed on AA received no subsequent therapy for mCRPC, compared with 17% (60/361) of younger patients. CONCLUSIONS Patients with mCRPC who progress with AA treatment may still derive benefit from subsequent docetaxel therapy. These data support further assessment of treatment patterns following AA treatment for mCRPC, particularly among older patients. TRIAL REGISTRATION ClinicalTrials.gov NCT00887198. PATIENT SUMMARY Treatment patterns for advanced prostate cancer have changed substantially in the last few years. This additional analysis provides evidence of clinical benefit for subsequent chemotherapy in men with advanced prostate cancer whose disease progressed after treatment with abiraterone acetate. Older patients were less likely to be treated with subsequent therapy.
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Affiliation(s)
- Johann S de Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, Sutton, UK.
| | - Matthew R Smith
- Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Fred Saad
- Centre Hospitalier University of Montréal, Montréal, Québec, Canada
| | - Dana E Rathkopf
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | | | - Eric J Small
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Neal D Shore
- Carolina Urologic Research Center, Atlantic Urology Clinics, Myrtle Beach, SC, USA
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | | | - Thian Kheoh
- Janssen Research & Development, San Diego, CA, USA
| | - Jinhui Li
- Johnson & Johnson Medical China, Shanghai, China
| | | | - Charles J Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
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Lorente D, Olmos D, Mateo J, Bianchini D, Seed G, Fleisher M, Danila DC, Flohr P, Crespo M, Figueiredo I, Miranda S, Baeten K, Molina A, Kheoh T, McCormack R, Terstappen LWMM, Scher HI, de Bono JS. Decline in Circulating Tumor Cell Count and Treatment Outcome in Advanced Prostate Cancer. Eur Urol 2016; 70:985-992. [PMID: 27289566 PMCID: PMC5568108 DOI: 10.1016/j.eururo.2016.05.023] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 05/16/2016] [Indexed: 01/08/2023]
Abstract
Background Treatment response biomarkers are urgently needed for castration-resistant prostate cancer (CRPC). Baseline and post-treatment circulating tumor cell (CTC) counts of ≥5 cells/7.5 ml are associated with poor CRPC outcome. Objective To determine the value of a ≥30% CTC decline as a treatment response indicator. Design, setting, and participants We identified patients with a baseline CTC count ≥5 cells/7.5 ml and evaluable post-treatment CTC counts in two prospective trials. Intervention Patients were treated in the COU-AA-301 (abiraterone after chemotherapy) and IMMC-38 (chemotherapy) trials. Outcome measures and statistical analysis The association between a ≥30% CTC decline after treatment and survival was evaluated using univariable and multivariable Cox regression models at three landmark time points (4, 8, and 12 wk). Model performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC) and c-indices. Results Overall 486 patients (122 in IMMC-38 and 364 in COU-AA-301) had a CTC count ≥5 cells/7.5 ml at baseline, with 440, 380, and 351 patients evaluable at 4, 8, and 12 wk, respectively. A 30% CTC decline was associated with increased survival at 4 wk (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.36–0.56; p < 0.001), 8 wk (HR 0.41, 95% CI 0.33–0.53; p < 0.001), and 12 wk (HR 0.39, 95% CI 0.3–0.5; p < 0.001) in univariable and multivariable analyses. Stable CTC count (<30% fall or <30% increase) was not associated with a survival benefit when compared with increased CTC count. The association between a 30% CTC decline after treatment and survival was independent of baseline CTC count. CTC declines significantly improved the AUC at all time-points. Finally, in the COU-AA-301 trial, patients with CTC ≥5 cells/7.5 ml and a 30% CTC decline had similar overall survival in both arms. Conclusions A 30% CTC decline after treatment from an initial count ≥5 cells/7.5 ml is independently associated with CRPC overall survival following abiraterone and chemotherapy, improving the performance of a multivariable model as early as 4 wk after treatment. This potential surrogate must now be prospectively evaluated. Patient summary Circulating tumor cells (CTCs) are cancer cells that can be detected in the blood of prostate cancer patients. We analyzed changes in CTCs after treatment with abiraterone and chemotherapy in two large clinical trials, and found that patients who have a decline in CTC count have a better survival outcome.
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Affiliation(s)
- David Lorente
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK; Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain
| | - David Olmos
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain; CNIO-IBIMA Genitourinary Cancer Unit, Department of Medical Oncology, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain
| | - Joaquin Mateo
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Diletta Bianchini
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - George Seed
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | | | | | - Penny Flohr
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Mateus Crespo
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Ines Figueiredo
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Susana Miranda
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK
| | - Kurt Baeten
- Medical Affairs, Janssen Diagnostics, Beerse, Belgium
| | | | - Thian Kheoh
- Janssen Research & Development, La Jolla, CA, USA
| | | | - Leon W M M Terstappen
- MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, Twente, The Netherlands
| | - Howard I Scher
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Johann S de Bono
- Prostate Cancer Targeted Therapy Group, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, UK.
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Li W, O'Shaughnessy J, Hayes D, Campone M, Bondarenko I, Zbarskaya I, Brain E, Stenina M, Ivanova O, Graas MP, Neven P, Ricci D, Griffin T, Kheoh T, Yu M, Gormley M, Martin J, Schaffer M, Zelinsky K, De Porre P, Johnston SRD. Biomarker Associations with Efficacy of Abiraterone Acetate and Exemestane in Postmenopausal Patients with Estrogen Receptor-Positive Metastatic Breast Cancer. Clin Cancer Res 2016; 22:6002-6009. [PMID: 27267854 DOI: 10.1158/1078-0432.ccr-15-2452] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/30/2016] [Accepted: 04/16/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Abiraterone may suppress androgens that stimulate breast cancer growth. We conducted a biomarker analysis of circulating tumor cells (CTCs), formalin-fixed paraffin-embedded tissues (FFPETs), and serum samples from postmenopausal estrogen receptor (ER)+ breast cancer patients to identify subgroups with differential abiraterone sensitivity. METHODS Patients (randomized 1:1:1) were treated with 1,000 mg/d abiraterone acetate + 5 mg/d prednisone (AA), AA + 25 mg/d exemestane (AAE), or exemestane. The biomarker population included treated patients (n = 293). The CTC population included patients with ≥3 baseline CTCs (n = 104). Biomarker [e.g., androgen receptor (AR), ER, Ki-67, CYP17] expression was evaluated. Cox regression stratified by prior therapies in the metastatic setting (0/1 vs. 2) and setting of letrozole/anastrozole (adjuvant vs. metastatic) was used to assess biomarker associations with progression-free survival (PFS). RESULTS Serum testosterone and estrogen levels were lowered and progesterone increased with AA. Baseline AR or ER expression was not associated with PFS in CTCs or FFPETs for AAE versus exemestane, but dual positivity of AR and ER expression was associated with improved PFS [HR, 0.41; 95% confidence interval (CI), 0.16-1.07; P = 0.070]. For AR expression in FFPETs obtained <1 year prior to first dose (n = 67), a trend for improved PFS was noted for AAE versus exemestane (HR, 0.56; 95% CI, 0.24-1.33; P = 0.19). CONCLUSIONS An AA pharmacodynamic effect was shown by decreased serum androgen and estrogen levels and increased progesterone. AR and ER dual expression in CTCs and newly obtained FFPETs may predict AA sensitivity. Clin Cancer Res; 22(24); 6002-9. ©2016 AACR.
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Affiliation(s)
- Weimin Li
- Janssen Research & Development, Spring House, Pennsylvania.
| | | | - Daniel Hayes
- The University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | | | - Igor Bondarenko
- Dnepropetrovsk Medical Academy, Municipal Clinical Hospital #4, Dnepropetrovsk, Ukraine
| | - Irina Zbarskaya
- Leningrad Regional Oncology Dispensary, Saint Petersburg, Russia
| | | | | | - Olga Ivanova
- Research Institute of Oncology, Saint Petersburg, Russia
| | | | | | | | | | - Thian Kheoh
- Janssen Research & Development, San Diego, California
| | - Margaret Yu
- Janssen Research & Development, Los Angeles, California
| | | | - Jason Martin
- Janssen Research & Development, High Wycombe, United Kingdom
| | | | - Kathy Zelinsky
- Janssen Research & Development, Spring House, Pennsylvania
| | | | - Stephen R D Johnston
- The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
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Sandler HM, McKenzie MR, Tombal BF, Baskin-Bey E, Freedland SJ, Roach M, Widmark A, Bossi A, Dicker A, Wiegel T, Shore ND, Smith MR, Yu MK, Kheoh T, Thomas S, Dearnaley DP. ATLAS: A randomized, double-blind, placebo-controlled, phase 3 trial of apalutamide (ARN-509) in patients with high-risk localized or locally advanced prostate cancer receiving primary radiation therapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.tps5087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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)
| | | | | | | | | | - Mack Roach
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | | | | | - Adam Dicker
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | - Thian Kheoh
- Janssen Research & Development, San Diego, CA
| | | | - David P. Dearnaley
- The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
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Lorente D, Olmos D, Mateo J, Zafeiriou Z, Rescigno P, Bianchini D, Mehra N, Molina A, Kheoh T, Baeten K, Mccormack RT, Terstappen LWMM, Scher HI, De Bono JS. Circulating tumor cell (CTC) rise and outcome in patients with metastatic castration-resistant prostate cancer (mCRPC) with low baseline CTC counts. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.5042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- David Lorente
- Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom
| | - David Olmos
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Joaquin Mateo
- Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom
| | - Zafeiris Zafeiriou
- Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom
| | - Pasquale Rescigno
- Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom
| | - Diletta Bianchini
- Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom
| | - Niven Mehra
- Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom
| | | | - Thian Kheoh
- Janssen Research & Development, San Diego, CA
| | - Kurt Baeten
- Medical Affairs, Janssen Diagnostics, Beerse, Belgium
| | | | | | - Howard I. Scher
- Sidney Kimmel Center for Prostate and and Urologic Cancers and Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Johann S. De Bono
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
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Cella D, Li S, Li T, Kheoh T, Todd M, Basch E. Repeated measures analysis of patient-reported outcomes in prostate cancer after abiraterone acetate. J Community Support Oncol 2016; 14:148-54. [DOI: 10.12788/jcso.0246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 11/20/2022]
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Tagawa ST, Posadas EM, Bruce J, Lim EA, Petrylak DP, Peng W, Kheoh T, Maul S, Smit JW, Gonzalez MD, De Porre P, Tran N, Nanus DM. Phase 1b Study of Abiraterone Acetate Plus Prednisone and Docetaxel in Patients with Metastatic Castration-resistant Prostate Cancer. Eur Urol 2016; 70:718-721. [PMID: 26852075 DOI: 10.1016/j.eururo.2016.01.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/15/2016] [Indexed: 11/24/2022]
Abstract
Coadministration of docetaxel and abiraterone acetate plus prednisone (AA + P) may benefit patients with metastatic castration-resistant prostate cancer (mCRPC) because of complementary mechanisms of action. COU-AA-206 was a phase 1b study to determine the safe dose combination of docetaxel and AA + P in three cohorts of chemotherapy-naïve mCRPC patients. Twenty-two patients received escalating doses of docetaxel plus AA + P. The primary endpoint was the proportion of patients with a dose-limiting toxicity (DLT) between weeks 2 and 7. The recommended phase 2 dose (RP2D) was the highest safe combination of docetaxel plus AA + P. Prostate-specific antigen (PSA) changes and intensive pharmacokinetic parameters for each drug were evaluated. Docetaxel 75mg/m2 + AA 1000mg + P 10mg was deemed the RP2D, with DLT in one of six patients. PSA declines from baseline of ≥50% and ≥90% were observed for 85.7% and 66.7% of patients, respectively. During median follow-up of 14.5 mo, eight patients had PSA progression and six had radiographic progression or died. Systemic exposure was comparable for docetaxel and abiraterone when given alone or in combination. Studies are ongoing to confirm the efficacy of potent androgen receptor-targeted therapy plus taxane in early mCRPC. PATIENT SUMMARY The combination of hormonal therapy and chemotherapy may improve outcomes in men with metastatic prostate cancer. This study demonstrates the ability to combine the hormonal therapy agent abiraterone acetate, plus prednisone, and the chemotherapy drug docetaxel with an acceptable side effect profile. A high rate of prostate-specific antigen decline was seen, but the study was small and additional research is needed before this becomes a standard approach.
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Affiliation(s)
- Scott T Tagawa
- Weill Cornell Medical College and Meyer Cancer Center, New York, NY, USA.
| | | | - Justine Bruce
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Emerson A Lim
- Columbia University Medical Center, New York, NY, USA
| | | | - Weimin Peng
- Janssen Research & Development, Los Angeles, CA, USA
| | - Thian Kheoh
- Janssen Research & Development, San Diego, CA, USA
| | - Scott Maul
- Janssen Research & Development, Los Angeles, CA, USA
| | | | | | | | | | - David M Nanus
- Weill Cornell Medical College and Meyer Cancer Center, New York, NY, USA
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Scher HI, Heller G, Molina A, Kheoh T, de Bono JS. Reply to A. Addeo and A. Bahl. J Clin Oncol 2016; 34:387-8. [PMID: 26598756 DOI: 10.1200/jco.2015.64.6562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- Howard I Scher
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Glenn Heller
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Thian Kheoh
- Janssen Research & Development, San Diego, CA
| | - Johann S de Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom
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Flaig TW, Smith MR, Saad F, Rathkopf DE, Mulders PF, Small EJ, Shore ND, Fizazi K, De Porre P, Kheoh T, Li J, Todd MB, Griffin TW, Ryan CJ, De Bono JS. Treatment patterns after abiraterone acetate in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC): Post hoc analysis of COU-AA-302. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.168] [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: 11/20/2022] Open
Abstract
168 Background: Treatment patterns of mCRPC have changed substantially in the last few years. In COU-AA-302 (chemotherapy-naïve men with mCRPC), abiraterone acetate plus prednisone (AA) significantly improved radiographic progression-free survival and overall survival vs placebo plus prednisone (P). There is limited information about treatment patterns after AA. In this post hoc analysis of pts in the AA treatment arm who progressed, we characterized subsequent therapy after pts discontinued study drug. Methods: In COU-AA-302, 546 pts were randomized and received AA. Treatment patterns of pts receiving ≥ 1 subsequent therapy for mCRPC after progressing on AA were collected retrospectively and source verified. Results: As of March 2014, 8% (44/546) of pts continued on AA; 67% (365/546) received ≥ 1 subsequent therapy for mCRPC. 36% (194/546) and 15% (83/546) of pts had ≥ 2 and ≥ 3 subsequent therapies, respectively. 80% (435/543) of pts in the P arm had ≥ 1 subsequent therapy. Most frequent subsequent therapy in AA pts was taxane chemotherapy (docetaxel [DOC], cabazitaxel [CBZ]), androgen signaling–directed therapy (AA, enzalutamide [ENZ], ketoconazole [KETO]), and immunotherapy (sipuleucel-T [SIP-T]) (Table). Among AA pts who received DOC as first subsequent therapy, median age was 69 years; median duration of DOC post-AA (n = 261) was 3 months (IQR: 0.95-5.7); and PSA progression was the most common reason for discontinuation. Among AA pts with baseline PSA and ≥ 1 post-baseline PSA value, 40% (40/100) had ≥ 50% PSA decline (27/100 confirmed responses) with first subsequent DOC chemotherapy. Conclusions: This post hoc analysis indicates that treatment with subsequent therapy was common (67% and 80%) in pts with chemotherapy-naïve mCRPC who progressed with AA or P, respectively. PSA decline suggests antitumor activity in pts who progressed with AA and received subsequent DOC. Despite limitations of a retrospective analysis, these data support further assessment of subsequent therapy following AA treatment for mCRPC. Clinical trial information: NCT00887198. [Table: see text]
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Affiliation(s)
| | - Matthew R. Smith
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Fred Saad
- University of Montréal, Montréal, QC, Canada
| | - Dana E. Rathkopf
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | - Eric Jay Small
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | | | - Thian Kheoh
- Janssen Research & Development, San Diego, CA
| | - Jinhui Li
- Johnson & Johnson Medical China, Shanghai, China
| | | | | | - Charles J. Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | - Johann S. De Bono
- The Institute of Cancer Research, The Royal Marsden Hospital, Sutton, United Kingdom
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Chi KN, Kheoh T, Ryan CJ, Molina A, Bellmunt J, Vogelzang NJ, Rathkopf DE, Fizazi K, Kantoff PW, Li J, Azad AA, Eigl BJ, Heng DYC, Joshua AM, de Bono JS, Scher HI. A prognostic index model for predicting overall survival in patients with metastatic castration-resistant prostate cancer treated with abiraterone acetate after docetaxel. Ann Oncol 2015; 27:454-60. [PMID: 26685010 PMCID: PMC4769990 DOI: 10.1093/annonc/mdv594] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/27/2015] [Indexed: 12/17/2022] Open
Abstract
A prognostic index model was developed, composed of six readily available and assessable factors and categorizing patients with metastatic castration-resistant prostate cancer treated with abiraterone–prednisone into distinct prognostic risk groups. This model could be useful for determining patient prognosis for follow-up, monitoring and patient stratification for clinical trials. Background Few prognostic models for overall survival (OS) are available for patients with metastatic castration-resistant prostate cancer (mCRPC) treated with recently approved agents. We developed a prognostic index model using readily available clinical and laboratory factors from a phase III trial of abiraterone acetate (hereafter abiraterone) in combination with prednisone in post-docetaxel mCRPC. Patients and methods Baseline data were available from 762 patients treated with abiraterone–prednisone. Factors were assessed for association with OS through a univariate Cox model and used in a multivariate Cox model with a stepwise procedure to identify those of significance. Data were validated using an independent, external, population-based cohort. Results Six risk factors individually associated with poor prognosis were included in the final model: lactate dehydrogenase > upper limit of normal (ULN) [hazard ratio (HR) = 2.31], Eastern Cooperative Oncology Group performance status of 2 (HR = 2.19), presence of liver metastases (HR = 2.00), albumin ≤4 g/dl (HR = 1.54), alkaline phosphatase > ULN (HR = 1.38) and time from start of initial androgen-deprivation therapy to start of treatment ≤36 months (HR = 1.30). Patients were categorized into good (n = 369, 46%), intermediate (n = 321, 40%) and poor (n = 107, 13%) prognosis groups based on the number of risk factors and relative HRs. The C-index was 0.70 ± 0.014. The model was validated by the external dataset (n = 286). Conclusion This analysis identified six factors used to model survival in mCRPC and categorized patients into three distinct risk groups. Prognostic stratification with this model could assist clinical practice decisions for follow-up and monitoring, and may aid in clinical trial design. Trial registration numbers NCT00638690.
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Affiliation(s)
- K N Chi
- Department of Medical Oncology, BC Cancer Agency, Vancouver, Canada
| | - T Kheoh
- Janssen Research & Development, San Diego
| | - C J Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco
| | - A Molina
- Janssen Research & Development, Menlo Park
| | - J Bellmunt
- Department of Solid Tumor Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | | | - D E Rathkopf
- Department of Oncology and Internal Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - K Fizazi
- Groupe Uro-Genitologie, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - P W Kantoff
- Department of Solid Tumor Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - J Li
- Johnson & Johnson Medical China, Shanghai, China
| | - A A Azad
- Department of Medical Oncology, BC Cancer Agency, Vancouver, Canada
| | - B J Eigl
- Department of Medical Oncology, BC Cancer Agency, Vancouver, Canada
| | - D Y C Heng
- Tom Baker Cancer Center and University of Calgary, Calgary
| | - A M Joshua
- Department of Medical Oncology, Princess Margaret Hospital and University of Toronto, Toronto, Canada
| | - J S de Bono
- Drug Development Unit, Division of Cancer Therapeutics/Clinical Studies, The Institute for Cancer Research and Royal Marsden Hospital, Sutton, UK
| | - H I Scher
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
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Fizazi K, Flaig TW, Stöckle M, Scher HI, de Bono JS, Rathkopf DE, Ryan CJ, Kheoh T, Li J, Todd MB, Griffin TW, Molina A, Ohlmann CH. Does Gleason score at initial diagnosis predict efficacy of abiraterone acetate therapy in patients with metastatic castration-resistant prostate cancer? An analysis of abiraterone acetate phase III trials. Ann Oncol 2015; 27:699-705. [PMID: 26609008 DOI: 10.1093/annonc/mdv545] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/27/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The usefulness of Gleason score (<8 or ≥8) at initial diagnosis as a predictive marker of response to abiraterone acetate (AA) plus prednisone in patients with metastatic castration-resistant prostate cancer (mCRPC) was explored retrospectively. PATIENTS AND METHODS Initial diagnosis Gleason score was obtained in 1048 of 1195 (COU-AA-301, post-docetaxel) and 996 of 1088 (COU-AA-302, chemotherapy-naïve) patients treated with AA 1 g plus prednisone 5 mg twice daily by mouth or placebo plus prednisone. Efficacy end points included radiographic progression-free survival (rPFS) and overall survival (OS). Distributions and medians were estimated by Kaplan-Meier method and hazard ratio (HR) and 95% confidence interval (CI) by Cox model. RESULTS Baseline characteristics were similar across studies and treatment groups. Regardless of Gleason score, AA treatment significantly improved rPFS in post-docetaxel [Gleason score <8: median, 6.4 versus 5.5 months (HR = 0.70; 95% CI 0.56-0.86), P = 0.0009 and Gleason score ≥8: median, 5.6 versus 2.9 months (HR = 0.58; 95% CI 0.48-0.72), P < 0.0001] and chemotherapy-naïve patients [Gleason score <8: median, 16.5 versus 8.2 months (HR = 0.50; 95% CI 0.40-0.62), P < 0.0001 and Gleason score ≥8: median, 13.8 versus 8.2 months (HR = 0.61; 95% CI 0.49-0.76), P < 0.0001]. Clinical benefit of AA treatment was also observed for OS, prostate-specific antigen (PSA) response, objective response and time to PSA progression across studies and Gleason score subgroups. CONCLUSION OS and rPFS trends demonstrate AA treatment benefit in patients with pre- or post-chemotherapy mCRPC regardless of Gleason score at initial diagnosis. The initial diagnostic Gleason score in patients with mCRPC should not be considered in the decision to treat with AA, as tumour metastases may no longer reflect the histology at the time of diagnosis. CLINICAL TRIALS NUMBER COU-AA-301 (NCT00638690); COU-AA-302 (NCT00887198).
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Affiliation(s)
- K Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - T W Flaig
- University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, USA
| | - M Stöckle
- Saarland University, Homburg/Saar, Germany
| | - H I Scher
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - J S de Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, Sutton, UK
| | - D E Rathkopf
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - C J Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco
| | - T Kheoh
- Janssen Research & Development, San Diego
| | - J Li
- Janssen Research & Development, Raritan
| | - M B Todd
- Janssen Global Services, Raritan
| | | | - A Molina
- Janssen Research & Development, Menlo Park, USA
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O'Shaughnessy J, Campone M, Brain E, Neven P, Hayes D, Bondarenko I, Griffin TW, Martin J, De Porre P, Kheoh T, Yu MK, Peng W, Johnston S. Abiraterone acetate, exemestane or the combination in postmenopausal patients with estrogen receptor-positive metastatic breast cancer. Ann Oncol 2015; 27:106-13. [PMID: 26504153 PMCID: PMC4684153 DOI: 10.1093/annonc/mdv487] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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] [Received: 05/04/2015] [Accepted: 09/30/2015] [Indexed: 11/28/2022] Open
Abstract
Resistance to nonsteroidal aromatase inhibitors is a major obstacle in the management of estrogen receptor-positive postmenopausal metastatic breast cancer. The addition of abiraterone acetate to exemestane did not improve clinical outcomes compared with exemestane alone in an androgen receptor-enriched population, potentially due to induced serum progesterone as a resistance mechanism. Background Androgen receptor (AR) signaling and incomplete inhibition of estrogen signaling may contribute to metastatic breast cancer (MBC) resistance to a nonsteroidal aromatase inhibitor (NSAI; letrozole or anastrozole). We assessed whether combined inhibition of androgen biosynthesis with abiraterone acetate plus prednisone and estradiol synthesis with exemestane (E) may be of clinical benefit to postmenopausal patients with NSAI-pretreated estrogen receptor-positive (ER+) MBC. Patients and methods Patients (N = 297) were stratified by the number of prior therapies for metastatic disease (0–1 versus 2) and by prior NSAI use (adjuvant versus metastatic), and randomized (1 : 1 : 1) to receive oral once daily 1000 mg abiraterone acetate plus 5 mg prednisone (AA) versus AA with 25 mg E (AAE) versus 25 mg E alone (E). Each treatment arm was well balanced with regard to the proportion of patients with AR-positive breast cancer. The primary end point was progression-free survival (PFS). Secondary end points included overall survival, clinical benefit rate, duration of response, and overall response rate. Results There was no significant difference in PFS with AA versus E (3.7 versus 3.7 months; hazard ratio [HR] = 1.1; 95% confidence interval [CI] 0.82–1.60; P = 0.437) or AAE versus E (4.5 versus 3.7 months; HR = 0.96; 95% CI 0.70–1.32; P = 0.794). Increased serum progesterone concentrations were observed in both arms receiving AA, but not with E. Grade 3 or 4 treatment-emergent adverse events associated with AA, including hypokalemia and hypertension, were less common in patients in the E (2.0% and 2.9%, respectively) and AA arms (3.4% and 1.1%, respectively) than in the AAE arm (5.8% for both). Conclusions Adding AA to E in NSAI-pretreated ER+ MBC patients did not improve PFS compared with treatment with E. An AA-induced progesterone increase may have contributed to this lack of clinical activity. ClinicalTrials.gov NCT01381874.
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Affiliation(s)
- J O'Shaughnessy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center/US Oncology, Dallas, USA
| | - M Campone
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes
| | - E Brain
- Departments of Clinical Research and Medical Oncology, Hôpital René Huguenin, Saint-Cloud, France
| | - P Neven
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - D Hayes
- Breast Oncology Program, The University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
| | - I Bondarenko
- Oncology Department, Municipal Clinical Hospital #4, State Medical Academy, Dnepropetrovsk, Ukraine
| | - T W Griffin
- Janssen Research & Development, Los Angeles, USA
| | - J Martin
- Janssen Research & Development, High Wycombe, UK
| | - P De Porre
- Janssen Research & Development, Beerse, Belgium
| | - T Kheoh
- Janssen Research & Development, Los Angeles, USA
| | - M K Yu
- Janssen Research & Development, Los Angeles, USA
| | - W Peng
- Janssen Research & Development, Los Angeles, USA
| | - S Johnston
- Department of Medicine, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
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Bellmunt J, Kheoh T, Yu MK, Smith MR, Small EJ, Mulders PFA, Fizazi K, Rathkopf DE, Saad F, Scher HI, Taplin ME, Davis ID, Schrijvers D, Protheroe A, Molina A, De Porre P, Griffin TW, de Bono JS, Ryan CJ, Oudard S. Prior Endocrine Therapy Impact on Abiraterone Acetate Clinical Efficacy in Metastatic Castration-resistant Prostate Cancer: Post-hoc Analysis of Randomised Phase 3 Studies. Eur Urol 2015; 69:924-32. [PMID: 26508309 DOI: 10.1016/j.eururo.2015.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 05/15/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The duration of prior hormonal treatment can predict responses to subsequent therapy in patients with metastatic castration-resistant prostate cancer (mCRPC). OBJECTIVE To determine if prior endocrine therapy duration is an indicator of abiraterone acetate (AA) sensitivity. DESIGN, SETTING, AND PARTICIPANTS Post-hoc exploratory analysis of randomised phase 3 studies examining post-docetaxel (COU-AA-301) or chemotherapy-naïve mCRPC (COU-AA-302) patients receiving AA. The treatment effect on overall survival (OS), radiographic progression-free survival (rPFS), and prostate-specific antigen (PSA) response analysed by quartile duration of prior gonadotropin-releasing hormone agonists (GnRHa) or androgen receptor (AR) antagonist. INTERVENTION Patients were randomised to AA (1000mg, orally once daily) plus prednisone (5mg, orally twice daily) or placebo plus prednisone. Prior endocrine therapy was GnRHa (COU-AA-301, n=1127 [94%]; COU-AA-302, n=1057 [97%], 45.1 mo or 36.7 mo median duration, respectively) and/or orchiectomy (COU-AA-301, n=78 [7%] COU-AA-302, n=44 [4%]); castrated patients received prior AR antagonists (COU-AA-301, n=1015 [85%]; COU-AA-302, n=1078 [99%], 15.7 mo or 16.1 mo median duration, respectively). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cox model was used to obtain hazard ratio and associated 95% confidence interval with statistical inference by log rank statistic. RESULTS AND LIMITATIONS Clinical benefit with AA was observed for OS, rPFS, and PSA response for nearly all quartiles with GnRHa or AR antagonists in both COU-AA-301 and COU-AA-302. In COU-AA-301, patients with a longer duration of prior endocrine therapy tended to have greater AA OS, rPFS, and PSA response benefit, with lead-time chemotherapy bias potentially impacting COU-AA-301 results. Time to castration resistance was not captured. This analysis is limited as a post-hoc exploratory analysis. CONCLUSIONS In the COU-AA-301 and COU-AA-302 studies, AA produced clinical benefits regardless of prior endocrine therapy duration in patients with mCRPC. PATIENT SUMMARY Metastatic castration-resistant prostate cancer patients derived clinical benefits with abiraterone acetate regardless of prior endocrine therapy duration.
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Affiliation(s)
- Joaquim Bellmunt
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Thian Kheoh
- Janssen Research & Development, San Diego, CA, USA
| | - Margaret K Yu
- Janssen Research & Development, Los Angeles, CA, USA
| | - Matthew R Smith
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric J Small
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | | | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Dana E Rathkopf
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Fred Saad
- University of Montréal, Montréal, Québec, Canada
| | - Howard I Scher
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Mary-Ellen Taplin
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ian D Davis
- Monash University and Eastern Health, Victoria, Australia
| | - Dirk Schrijvers
- ZNA Middelheim Oncology Clinic, Medical Oncology, Antwerp, Belgium
| | | | | | | | | | - Johann S de Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, Sutton, UK
| | - Charles J Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Stéphane Oudard
- Georges Pompidou Hospital, University René Descartes, Paris, France
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Rathkopf DE, Smith MR, Antonarakis ES, Ryan CJ, Berry WR, Shore ND, Liu G, Higano C, Alumkal JJ, Hauke R, Tutrone R, Saleh M, Chow Maneval E, Thomas S, Ricci D, Yu MK, de Boer CJ, Trinh A, Kheoh T, Bandekar R, Scher HI. Abstract CT134: Androgen receptor (AR) mutations in patients (pts) with castration-resistant prostate cancer (CRPC) with and without prior abiraterone acetate (AA) treatment. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-ct134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
Background: ARN-509 is a second-generation antiandrogen with antitumor activity in CRPC. Activating mutations in the AR ligand-binding domain (LBD) have been associated with resistance to first- (T877A) and second- (F876L) generation antiandrogens. We evaluated the type and frequency of relevant AR LBD mutations in ARN-509-treated CRPC pts at baseline (BL) and disease progression (PD).
Methods: ARN-509-001 was a phase I/II study that evaluated ARN-509 activity in nonmetastatic (M0), chemotherapy-naïve, and post-AA CRPC. Of the 97 pts enrolled in phase II at a dose of 240 mg/d, 92 were evaluable for the mutation analysis at BL and 82 at PD. Relevant mutations in circulating tumor DNA were detected using a digital PCR method called BEAMing (Beads, Emulsification, Amplification, and Magnetics) (Richardson AL. Clin Cancer Res. 2012).
Results: Median duration of therapy was ∼16 months. One pt in the M0 cohort and one in the chemotherapy-naïve cohort had the F876L mutation at BL. Two pts in the chemotherapy-naïve cohort and one in the post-AA cohort acquired the AR F876L mutation during treatment. Pts with M0 CRPC did not acquire a mutation (Table 1). Three pts in the post-AA cohort had the T877A mutation at BL; the T877A mutation was not detected in any other cohort at BL. In the post-AA cohort, one pt acquired the T877A mutation during treatment while another lost the mutation (Table). The two pts with detectable F876L at BL developed prostate-specific antigen (PSA) progression at 4 and 6 months, respectively, compared with a median time to PSA progression of 16.4 months in the remainder of pts.
Conclusions: Pts with metastatic CRPC who were treated with ARN-509 had a low rate of acquisition of the AR F876L (3/82 = 4%) and AR T877A (1/82 = 1%) mutations. These results suggest that ARN-509 may be continued in the setting of a rising PSA. Larger studies are needed to confirm the prevalence of F876L, T877A, and the conversion rate.
AR F876LAR T877AEvaluableBLPDAcquiredBLPDAcquiredpatientsn/Nn/Nn/Nn/NTotal922/925/823/823/923/821/82M0491/491/470/470/500/470/47Chemotherapy-naïve241/243/202/200/200/200/20Post-AA190/191/151/153/193/151/15
Citation Format: Dana E. Rathkopf, Matthew R. Smith, Emmanuel S. Antonarakis, Charles J. Ryan, William R. Berry, Neal D. Shore, Glenn Liu, Celestia Higano, Joshi J. Alumkal, Ralph Hauke, Ronald Tutrone, Mansoor Saleh, Edna Chow Maneval, Shibu Thomas, Deborah Ricci, Margaret K. Yu, Carla J. de Boer, Angela Trinh, Thian Kheoh, Rajesh Bandekar, Howard I. Scher. Androgen receptor (AR) mutations in patients (pts) with castration-resistant prostate cancer (CRPC) with and without prior abiraterone acetate (AA) treatment. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr CT134. doi:10.1158/1538-7445.AM2015-CT134
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Affiliation(s)
- Dana E. Rathkopf
- 1Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Matthew R. Smith
- 2Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Charles J. Ryan
- 4UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | - Neal D. Shore
- 6Carolina Urologic Research Center, Myrtle Beach, SC
| | - Glenn Liu
- 7University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Celestia Higano
- 8University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Joshi J. Alumkal
- 9Oregon Health and Science University, Knight Cancer Institute, Portland, OR
| | | | - Ronald Tutrone
- 11Chesapeake Urologic Research Associates, Baltimore, MD
| | | | | | | | | | | | | | - Angela Trinh
- 15Janssen Research & Development, Los Angeles, CA
| | - Thian Kheoh
- 17Janssen Research & Development, San Diego, CA
| | | | - Howard I. Scher
- 1Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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Chi KN, Spratlin J, Kollmannsberger C, North S, Pankras C, Gonzalez M, Bernard A, Stieltjes H, Peng L, Jiao J, Acharya M, Kheoh T, Griffin TW, Yu MK, Chien C, Tran NP. Food effects on abiraterone pharmacokinetics in healthy subjects and patients with metastatic castration-resistant prostate cancer. J Clin Pharmacol 2015; 55:1406-14. [DOI: 10.1002/jcph.564] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/03/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Lixian Peng
- Janssen Research & Development; Raritan NJ USA
| | - James Jiao
- Janssen Research & Development; Raritan NJ USA
| | | | - Thian Kheoh
- Janssen Research & Development; San Diego CA USA
| | | | | | - Caly Chien
- Janssen Research & Development; Titusville NJ USA
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Smith MR, Rathkopf DE, Mulders PFA, Carles J, Van Poppel H, Li J, Kheoh T, Griffin TW, Molina A, Ryan CJ. Efficacy and Safety of Abiraterone Acetate in Elderly (75 Years or Older) Chemotherapy Naïve Patients with Metastatic Castration Resistant Prostate Cancer. J Urol 2015; 194:1277-84. [PMID: 26151676 DOI: 10.1016/j.juro.2015.07.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [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] [Accepted: 06/09/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Metastatic castration resistant prostate cancer primarily affects elderly men. In this post hoc analysis we investigated the safety and efficacy of abiraterone acetate in elderly (age 75 years or greater) and younger (less than 75 years) patient subgroups at the prespecified interim analysis (55% of total overall survival events) for the COU-AA-302 (Abiraterone Acetate in Asymptomatic or Mildly Symptomatic Patients with Metastatic Castration-Resistant Prostate Cancer) trial. MATERIALS AND METHODS Patients were stratified and randomized 1:1 to abiraterone acetate 1,000 mg plus prednisone/prednisolone 5 mg twice daily (abiraterone-prednisone) vs placebo plus prednisone/prednisolone 5 mg twice daily (prednisone alone). Co-primary end points were radiographic progression-free and overall survival. Median time to event and HR were estimated using the Kaplan-Meier method and a Cox model, respectively. RESULTS A total of 350 elderly patients treated with abiraterone-prednisone had significant improvements in overall and radiographic progression-free survival vs those with prednisone alone (HR 0.71, 95% CI 0.53-0.96 vs HR 0.63, 95% CI 0.48-0.83), similar to 738 younger patients (HR 0.81, 95% CI 0.63-1.03 vs HR 0.49, 95% CI 0.40-0.59). All secondary end points favored the abiraterone-prednisone arm for both age subgroups. Specific adverse events with abiraterone-prednisone were similar between the age subgroups. Elderly patients in both treatment arms had higher rates of fluid retention and cardiac disorders than younger patients, although rates of dose reduction or treatment interruptions due to adverse events were low in both age subgroups. CONCLUSIONS Abiraterone acetate demonstrated clinical benefit and was well tolerated in elderly and younger men with chemotherapy naïve, metastatic castration resistant prostate cancer. Thus, findings support it as a treatment option for elderly patients who may not tolerate other therapies with greater toxicity.
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Affiliation(s)
- Matthew R Smith
- Department of Genitourinary Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
| | - Dana E Rathkopf
- Department of Oncology and Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter F A Mulders
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joan Carles
- Department of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Hendrik Van Poppel
- Department of Urology, University Hospitals of KU Leuven, Leuven, Belgium
| | - Jinhui Li
- Department of Biostatistics Oncology, Janssen Research & Development, Raritan, New Jersey
| | - Thian Kheoh
- Department of Biostatistics and Programming, Janssen Research & Development, San Diego, California
| | - Thomas W Griffin
- Department of WC Clinical Oncology, Janssen Research & Development, Los Angeles, California
| | - Arturo Molina
- Department of Oncology, Janssen Research & Development, Los Angeles, California
| | - Charles J Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California
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Ryan CJ, Kheoh T, Li J, Molina A, De Porre P, Carles J, Efstathiou E, Kantoff PW, Mulders PF, Saad F, Griffin TW, Chi KN. Prognostic index model (PIM) for overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC) patients (pts) without prior chemotherapy treated with abiraterone acetate (AA). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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)
- Charles J. Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | - Thian Kheoh
- Janssen Research & Development, San Diego, CA
| | - Jinhui Li
- Johnson & Johnson Medical China, Shanghai, China
| | | | | | - Joan Carles
- Vall d' Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | | | - Fred Saad
- University of Montreal, Montreal, QC, Canada
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Efstathiou E, Li W, Gormley M, McMullin R, Ricci DS, Davis JW, Li Ning Tapia EM, Troncoso P, Titus MA, Hoang A, Wen S, Zurita AJ, Tran N, Peng W, Kheoh T, Molina A, Logothetis C. Biological heterogeneity in localized high-risk prostate cancer (LHRPC) from a study of neoadjuvant abiraterone acetate plus leuprolide acetate (LHRHa) versus LHRHa. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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)
| | - Weimin Li
- Janssen Research & Development, Spring House, PA
| | | | | | | | - John W. Davis
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Anh Hoang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sijin Wen
- West Virginia University School of Public Health, Morgantown, WV
| | - Amado J. Zurita
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Weimin Peng
- Janssen Research & Development, Los Angeles, CA
| | - Thian Kheoh
- Janssen Research & Development, San Diego, CA
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