Long-term efficacy update of crizotinib in patients with advanced, inoperable inflammatory myofibroblastic tumour from EORTC trial 90101 CREATE

PURPOSE

European Organisation for Research and Treatment of Cancer (EORTC) 90101 (CREATE) was a prospective, multicentric, non-randomised, open-label phase II basket trial to assess the efficacy and safety of crizotinib in patients with different types of cancers, including advanced inflammatory myofibroblastic tumour (IMT) with or without anaplastic lymphoma kinase (ALK) rearrangements. Here, we report updated results with long-term follow-up.

PATIENTS/METHODS

After central reference pathology, eligible ALK-positive and ALK-negative patients with advanced/metastatic IMT deemed incurable with surgery, radiotherapy or systemic therapy received oral crizotinib 250 mg twice daily. The ALK status was assessed centrally using immunohistochemistry and fluorescence in situ hybridisation. The primary end-point was the proportion of patients who achieved an objective response (i.e. complete or partial response). If ≥6 ALK-positive patients achieved a confirmed response, the trial would be deemed successful.

RESULTS

At data cut-off on 28th January 2021, we performed the final analysis of this trial. Of the 20 eligible and treated patients (19 of whom were evaluable for efficacy), with a median follow-up of 50 months, five were still on crizotinib treatment (4/12 ALK-positive and 1/8 ALK-negative patients). The updated objective response rate (ORR) was 66.7% (95% confidence interval [CI] 34.9-90.1%) in ALK-positive patients and 14.3% (95% CI 0.0-57.9%) in ALK-negative patients. In the ALK-positive and ALK-negative patients, the median progression-free survival was 18.0 months (95% CI 4.0-NE) and 14.3 months (95% CI 1.2-31.1), respectively; 3-year overall survival rates were 83.3% (95% CI 48.2-95.6) and 34.3% (95% CI 4.8-68.5). Safety results were consistent with previously reported data.

CONCLUSION

These updated results confirm previous findings that crizotinib is effective, with durable responses, in patients with locally advanced or metastatic ALK-positive IMT. With further follow-up after the original primary analysis, the ORR increased, as patients derived long-term benefit and some responses converted from stable disease to partial responses.

CLINICAL TRIAL NUMBER

EORTC 90101, NCT01524926.

The role of liver transplantation in the management of paediatric liver tumours

In recent years, considerable progress has been made in the treatment of children with hepatoblastoma largely due to effective pre-operative chemotherapy. Total hepatectomy and liver transplantation has emerged as an effective treatment for the small proportion of children with unresectable hepatoblastoma limited to the liver. A 5-year survival of 70% can be achieved in such cases. In contrast, the results of liver transplantation in children with hepatocellular cancer remain poor because these tumours are usually advanced with evidence of major vascular invasion and/or extrahepatic spread at the time of presentation. An exception is those children in whom the hepatocellular carcinoma is detected during surveillance of chronic liver disease - they typically have smaller tumours and frequently have a good prognosis after liver transplantation. The role of liver transplantation in children with other primary hepatic malignancies remains uncertain because experience is very limited. Liver transplantation is rarely needed in the management of children with benign liver tumours but, if other treatments have failed, it can be a life-saving intervention.

Histopathological features and clinical course of the gastrointestinal stromal tumors

BACKGROUND/AIMS

C-kit expression is a sensitive marker for a specific group of mesenchymal tumors of the gastrointestinal tract, gastrointestinal stromal tumors, the histogenesis and prognosis of which are uncertain.

METHODOLOGY

We have investigated the expression of c-kit by immunohistochemical analysis (APAAP method) in 12 out of 13 cases of mesenchymal gastrointestinal neoplasms operated from January 1991 to December 1998, in which the follow-up data were fully available. Furthermore, the c-kit expression was correlated both with the expression of vimentin, CD34 and the mitotic rate, and with the expression of muscle (muscle-specific actin-HHF35 and desmin) or neural (neuron-specific enolase) differentiation markers.

RESULTS

C-kit was expressed in all 12 cases (100%). Two different patterns of expression were observed: cytoplasmic in 7 (58.3%) cases and nuclear in 3 (25%) cases; in 2 (16.7%) cases both cytoplasmic and nuclear immunostaining was detected. Three (60%) out of the five cases showing a nuclear c-kit expression were also neuron-specific enolase positive, whereas none of the cases showing an exclusively cytoplasmic c-kit expression was neuron-specific enolase positive. The correlation between the two patterns of c-kit expression and the follow-up data have shown a trend towards a better prognosis in gastrointestinal stromal tumors with a nuclear c-kit immunostaining and neuron-specific enolase positivity, but the relatively low number of cases does not allow us to draw conclusions. In gastrointestinal stromal tumors the mitotic rate (> 2 x 10 HPF vs. < 2 x 10 HPF) is related with statistically significant differences (P < 0.05) to the 5-year survival (0% vs. 80%, respectively).

CONCLUSIONS

These findings, together with the already known c-kit nuclear immunostaining in normal adrenal medullary cells, suggest that a nuclear c-kit expression in gastrointestinal stromal tumors is consistent with a neural differentiation. In this study the mitotic rate has demonstrated a significant influence on the prognosis of gastrointestinal stromal tumors.

[DNA flow cytometry in smooth muscle tumors of the gastrointestinal tract]

DNA ploidy of 45 smooth muscle tumors of the G.I. tract was determined by flow cytometry and correlated with clinical features and prognosis. The sites of the tumors were: esophagus (1), stomach (24), small intestine (12), large intestine (6), liver (1) and pancreas (1). The histologic type was leiomyoma in 14, leiomyosarcoma in 29, and leiomyoblastoma in 2. DNA aneuploidy was more frequent in leiomyosarcoma (17/29) than leiomyoma (5/14), but the difference was not statistically significant. One leiomyoblastoma was diploid and the other was aneuploid. No patients with leiomyoma died. In patients with leiomyosarcomas, 5-year survival was significantly poorer in those with aneuploid tumors (38%) than in those with diploid tumors (83%). There was no correlation between DNA ploidy and clinico-pathological features of tumors. The present study disclosed that DNA ploidy is a prognostic variable, independent of other variables.